The Power of Choice: JSI’s Approach to Universal Contraception Access
For women and young people worldwide, the choice to use contraception is complicated. It involves navigating social norms, access, availability, knowledge, environmental influences, and more. Despite increases in contraceptive use over the past 30 years, significant disparities remain.
To achieve universal access to contraception and other modern family planning methods, system strengthening is a must to meet demand, as is putting people at the center of all programming and establishing tools and networks to capture and share data to inform evidence-based interventions. At JSI, we are doing just that.
Strengthening systems to foster change and respond to demand
To ensure options are available, the health care system must offer a range of high-quality, affordable contraceptive methods when and where people need them. At JSI, we are advancing contraceptive security through data-driven supply chain management. With our affiliate inSupply Health, we have introduced Information Mobilized for Performance Analysis and Continuous Transformation (IMPACT) teams in multiple countries. These teams bring data, people, processes, and technology together under the leadership of governments to improve data quality and use for decision making, ultimately strengthening supply chain performance. System sustainability hinges on active country leaders who own and directly engage as partners in the IMPACT team’s process.
We also strengthen the health system and promote contraceptive security by partnering with the private sector. In Kenya, through InSupply, we are working to increase access to contraception and deliver high-quality family planning services through private sector pharmacies. This guarantees women and young people have access to diverse contraceptive options in convenient and discrete ways that support their dignity, agency, choice, and health. It also provides a viable business model for pharmacies, which supports local economies and frees up public sector resources to be redirected to people with limited access to services.
Task sharing in health care services is another effective strategy we use to strengthen women and young people’s access to family planning and contraceptive methods. Our Strengthening Egypt’s Family Planning Program expanded family planning services in eight Egyptian governorates by introducing task sharing at health facilities to reach more women. Previously, only physicians at primary health care family clinics could provide counseling and services. Now, nurses can also provide those services. By expanding the pool of health care providers, more individuals have access to care.
Taking a person-centered approach
Lasting change requires a deep understanding of women and young people’s motivations and preferences for using contraception and other family planning services and the system and service delivery changes needed for them to have the power of choice. That is why, at JSI, we put person-centered care at the core of our family planning programs.
Self-care interventions are an increasingly common approach to allow people to manage their health based on their needs and preferences. In Nigeria, the Federal Ministry of Health has established a new national self-care guideline. As part of the effort to implement the guideline, Access Collaborative, led by JSI and PATH, is working with the government to roll out DMPA-SC, an easy-to-use self-injectable contraceptive. Since 2017, Access Collaborative has supported more than 20 countries to introduce and scale up DMPA-SC to expand women’s choice of and access to contraception.
The USAID-funded RHITES-North, Lango project in Uganda also illustrates our person-centered approach. By listening to the preferences of young women and girls about where and how they access services, the project trained 123 youth peers to provide family planning services where young people commonly gather. This helped more than double the number of adolescent girls and young women reached with contraceptive services in Lango in just over a year: from 22,326 at the end of April–June 2020 to 50,886 at the end of July–September 2021 (1).
Combining family planning services with the care women are already receiving is another way to consider people’s needs and expand access to contraceptive options. Postpartum family planning is vital to averting short intervals between births and protecting the health of women and children (2). Integrating family planning with postpartum care, particularly during early childhood immunization visits, reduces transportation costs, appointment times, and the overall burden on the health care system, reaching women who might otherwise be missed.
Engaging men is essential in providing person-centered family planning and contraceptive services as they can have an influence on women’s sexual and reproductive health decisions. Through the Engaging Young Men in Preventing Premature Fatherhood project, we designed and piloted a training and toolkit to equip health care professionals and other trusted adults to advance gender equity in pregnancy prevention in the U.S. These tools introduce participants to concepts associated with young men’s beliefs about relationships, fatherhood, and contraception to improve their ability to refer male clients to a range of sexual and reproductive healthcare services.
Using evidence to do better
Data is critical to diminish the gap in contraceptive needs. JSI leverages data and creates tools to generate evidence for improved decision-making from the national to the community level.
Supply chains: JSI helped curate 20 essential resources for Reproductive Health Commodity Security (RHCS) and supply chain management. These tools and resources support governments, program managers, and implementers to design, improve, and measure RHCS and supply chains to make strategic decisions, plan, and create targeted interventions to increase access to contraceptive commodities.
Health facilities: Through the USAID MOMENTUM Knowledge Accelerator project, we developed a new modular health facility assessment tool and user guide to help reproductive health and family planning programs in different contexts collect the information they need to strengthen their programs and improve quality of care.
Youth: JSI’s HCDExchange is the first global learning platform exploring how human-centered design can address the sexual and reproductive health needs of youth and adolescents. By incorporating youth perspectives and participation, it shares valuable insights and resources to shape this emerging area of public health.
Rural communities: Through JSI’s Last Ten Kilometers (L10K) project, we applied behavioral economics to design and test behavioral approaches to address the discontinuation of injectable contraceptive use in rural Ethiopia. This approach allowed us to understand factors contributing to discontinuation and design an intervention that resulted in nearly universal adherence to contraceptives.
Person-centered care: JSI created a person-centered care framework to ensure our approaches are culturally responsive, human rights-based, and data-driven across different sociological levels, from system to individual.
The way forward
World Contraception Day serves as a reminder that women and young people need regular access to and the power to choose from contraceptive options that meet their needs. This allows them to make informed choices, fosters autonomy, and contributes to gender equity, ultimately moving us closer to universal health coverage.
By Lauren Bader and Suzanne Slattery
- DHIS2 data, condoms excluded.
- Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012;380(9837):149–156. doi:10.1016/S0140–6736(12)60609–6.
