For over decade I have been undertaking research to better understand and place women’s needs and behaviours at the centre of family planning programming. From my doctorate research on contraceptive -use through to testing new advocacy methodologies linking the local and global, both of which continue today. More recently I am doing implementation science to ensure research findings have real-world application, particularly how we can use community led monitoring to address issues in contraceptive delivery and clients’ full, free and informed choice. I am also testing an innovative facility based tools that measures individual facilities’ readiness to implement rights-based family planning, including identifying areas where there are potential rights vulnerabilities that can be addressed.
In 2001 I was living in El Salvador. Hearing friends regularly describe the utter lack of bodily integrity they experienced, and the steps they would take in the absence of contraception, profoundly moved me. Shortly after this I started my research on contraceptive use that took me to clinics in Indonesia, the Philippines and the United Kingdom. Though cultures, contexts and quality of care varied greatly, the anxieties and vulnerabilities posed by an unplanned pregnancy did not.
Respecting, protecting and fulfilling human rights remains a challenge, particularly with the push for numeric goals that may jeopardize women and men’s rights, but we have found a way to start to tackle this. Under the Evidence project, I am leading a study to develop a tool that translates declarations and conventions into practical action on the ground. In Uganda, we are testing a facility audit to measure adherence to rights-based family planning in service delivery.
In the UK, despite efforts to increase and incentivise long acting methods and emergency contraception, the rate of unplanned pregnancies remains static. Research increasingly points to the fact that women know about family planning and how to access and use it, but they do not see themselves at risk of pregnancy. Our challenge is to better understand contraceptive use from the users’ point of view and develop programs that respond to their needs.
It is an exciting time with growing momentum for client centred and rights-based approaches. Over the next 5 years I will continue to carry out research that places users at the centre of our programming. This includes further developing practical tools to ensure that users’ rights are respected, protected and fulfilled. This includes the urgent need to better understand the needs and behaviours of users and non-users, and converting the ‘last mile’ into the first when we design programs.