We’re embarking on a new decade of partnership for family planning—transitioning from FP2020 to FP2030 this fall—building on the progress we’ve made as a community from the landmark 2012 London Summit on Family Planning. There, world leaders pledged to enable 120 million additional women and girls to use modern contraception by 2020, with many country commitments operationalized through Costed Implementation Plans for Family Planning. Since then we’ve made substantial progress. Although there are more than 60 million additional users of modern contraception in the FP2020 focus countries as compared to 2012, our agenda remains unfinished, with quality family planning information and services not yet reaching many of those with the greatest need. To reach women, girls, and their partners equitably, we need to know who faces the greatest disadvantage.
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:
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 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:
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.
The application of the tool showed that, at the national level, some unexpected groups of women are slipping through the cracks. Equity-sensitive family planning strategies most often direct services toward the poorest, youngest, and rural women—as in Uganda’s Family Planning Costed Implementation Plan, 2015–2020. However, this analysis shows that least-educated and unmarried women (in addition to the youngest) are some of the most disadvantaged. While there is a degree of overlap among these subgroups, failing to channel services to a diversity of women will leave many in need behind. Moreover, this analysis shows that inequity extends beyond use alone to the components that often impact our decision to use services—such as access to information and the quality of care. In traditional equity analyses focused on use and wealth quintile, this type of gap would go undetected.
We’ve made amazing progress as a community in expanding the reach of voluntary, rights-based family planning information and services in the last eight years. It’s our hope that instruments like the FP Equity Tool can help make what work remains easier, helping decision-makers and program staff choose which components to prioritize and where, thereby helping prevent women and girls from being left behind.