Expanding how we conceptualize and measure inequity in family planning
Until recently, our investigations of inequity in family planning were too focused on contraceptive uptake alone, rather than the range of programmatic components that affect use, such as access to information and services, good quality of care, etc. Much of our inquiry was focused on inequities experienced by the poor, overlooking other key dimensions by which people vary and where unjust differences may hide. Some sophisticated analytical approaches were not easily replicable outside of the research space, holding limited benefits for local decision making and those implementing programs.
In recognition of these and other challenges, the USAID-funded Health Policy Plus (HP+) project has developed a tool for identifying inequity in family planning programs that can be applied in any country with a Demographic and Health Survey. Specifically, our FP Equity Tool identifies inequities in family planning:
- For a range of commonly disadvantaged subgroups
- For various components of family planning programming
- At the national level and across and within each subnational area, essential as decision making becomes increasingly devolved
This work builds on the concepts and recommendations from the recent Discussion Paper on Equity for the High Impact Practices Partnership and is an important initial step on the road to eliminating unjust conditions. A Strategic Planning Guide on equity and family planning, detailing the full set of steps from inequity identification to resolution, is forthcoming.
The case for dynamic tools
The FP Equity Tool works by running a series of statistical computations for the user, examining the experience of seven commonly disadvantaged groups in five dimensions of family planning programming at national and subnational levels. In this way, the tool goes deeper than quick tabulations, which—while still insightful—don’t tell us whether the relationship among variables is significant. Findings are automatically generated in Microsoft Excel with signposts to help the user interpret the results, with accompanying maps and charts to easily visualize inequities. The tool thus answers the “who, what, and where” of inequities in family planning. This level of specificity is key to guiding national and subnational decision making on family planning beyond 2020, including decisions regarding:
- Policy and programmatic commitments, such as those that will be part of the FP2030 partnership, as well as goals within costed implementation plans
- Prioritizing limited funds across program activities and geographies
- Better tailoring and directing family planning program activities, particularly at subnational level.
Unexpected groups of women are slipping through the cracks
In finalizing the tool, we applied it to Uganda, where we found pervasive family planning inequities that (1) affect a broad range of underserved groups, (2) extend beyond traditional measures of uptake, and (3) penetrate all regions.