“Let us work hard to eliminate all barriers to access of information and services for AGYW in our communities”-Proscovia Katrina Oroma
This call to leaders to reduce and eliminate inequities in family planning (FP) programs was delivered by 19-year-old Proscovio Katrina Oroma from Gulu district in Uganda during the ICFP side event “Advancing Equity to Support UHC: Tools and Approaches for #NextGenFP” coordinated by FHI 360 and R4S. This side event, held on February 3, 2021 (recording available here), launched a dialogue about how to define, measure, plan for, and monitor equity within FP programs and research. We hope that you will continue this dialogue with us.
Erika Houghtaling from R4S’ management team at USAID defined equity in FP: “Equity implies that all groups have the same access to information and quality FP services including access to all available methods of contraception, their removal, and high-quality care that includes equal treatment by providers.” This definition draws from the importance of understanding inequities to reduce the critical unmet need for modern family planning for women and girls worldwide.
How do we identify inequities in FP programs though? Kaja Jurczynska from the Health Policy Plus project presented a few accessible, easy-to-use tabulation tools (PMA Datalab; Demographic and Health Survey STATcompiler) that produce visuals for key FP indicators, and statistical tools, including the Health Equity Assessment Toolkit (HEAT) Plus and the Health Policy Plus Family Planning Equity Tool, that assess inequities across multiple health indicators and dimensions by national and subnational levels. These tools can answer the “who, what, and where” of inequities and visually show where we need to focus our efforts and funding for future FP commitments.
Planning for Equity
Dr. Charles Olaro, Director of Clinical Services at the Ministry of Health (MOH) in Uganda spoke about the development of Uganda’s Costed Implementation Plan (CIP) for FP that focused on inequities throughout the process. The MOH used techniques like hotspot mapping for targeted programming, stakeholder assemblies with youth and people with disabilities, and Performance Management and Accountability (PMA). The 2021-2025 FP CIP will meet its equity goals through a multi-sectoral approach, specifically centered on young people, with a minimum FP package for young people through universal coverage and sustainability within subregions currently facing inequities.
Reality of Equity
Proscovio Katrina Oroma voiced the reality of women and girls who may lack adequate services and care from their communities. As a participant of the Anyaka Makwiri mentoring program for adolescent girls and young women (AGYW), she realized the need to call on leaders for better access to reproductive health, supportive self-employment, better child protection, and the sensitization of men and parents for AGYW like herself to thrive.
Dr. Rhoda Wanyenze from Makerere University highlighted the use of both monitoring approaches and implementation science to know if we are truly addressing equity in FP and to prevent perpetuating inequities across groups. Strengths in monitoring include well-established indicators, various data sources, and increased demand, while some emerging needs for monitoring include timely data, quality data challenges, and limited capacity to analyze and interpret the data. We must pay attention to what data is available to us and strive for seeing faster rates of progress for the groups who are most in need.
Future of Equity
R4S will continue its commitment to support the generation and use of evidence to support discussions on equity at country and at a global level. Stay tuned for the forthcoming Strategic Planning Guide on equity, led by R4S, USAID, and multiple stakeholders, and the soon-to-be-established Global Task Force on Equity. R4S calls on our FP community to explicitly engage in conversations about and explorations of inequities in FP programs in our countries, leveraging existing resources and ensuring participatory processes to identify, plan, and monitor equity.