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Facilitate a Human Rights-Based Approach in Family Planning

This document is intended to guide program managers, planners, and decision-makers through a strategic process to facilitate a human rights-based approach (HRBA) to family planning programming. It was developed through consultation and discussion with organizations, including key populations, service providers, and technical experts in inclusion, family planning, and sexual and reproductive health and rights (SRHR).

Si Jeunesse Savait works with young women and girls in the Democratic Republic of the Congo to promote access to sexual and reproductive health, bodily autonomy, and being able to take charge of one's own life. Photo: Getty Images/Images of Empowerment.

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Scope of this SPG

This strategic planning guide provides an overview of the key steps for applying a HRBA to family planning with a focus on a human rights-based assessment of family planning programs. By following these steps, which are based on the United Nations Population Fund (UNFPA) and What Works Association Holistic Framework for Human Rights-Based Family Planning1 and its accompanying Support Tool2, program managers, planners, and decision-makers can evaluate their current family planning programs, policies, and practices and can develop an action plan to ensure greater access to and quality of family planning services that respect the human rights of all individuals.

While this strategic planning guide is the first on a HRBA to family planning, other SPGs and High Impact Practices (HIP) documents address some of the key points made below. Links to these and other documents are provided, where relevant.

It is a systemic process to ensure that human rights principles related to family planning are embedded in all programmatic phases, (i.e., including country needs assessment, program design, work plan development, implementation, monitoring and evaluation) at all levels of the program (community, legal and policy, service delivery, and individual). It ensures family planning programs support individuals and couples in exercising their rights to choose the timing and spacing of their pregnancies, to have the information and services to act on that right, and to be treated respectfully, equally, and without discrimination. Programs should address the specific needs, desires, and rights of the diversity of people seeking and receiving family planning services, including for those from populations at risk of exclusion, such as low-income individuals; individuals with disabilities; people of diverse gender identities and sexual orientation; adolescents; Indigenous, ethnic, and racial minorities; people living with HIV/AIDS; sex workers; individuals in humanitarian settings; and survivors of gender-based violence.

Human Rights Principles

The following key principles underlie a HRBA to family planning and are derived from international and regional human rights commitments.
 

  • Availability: Health care facilities, trained providers, and a wide range of modern contraceptive methods are available, allowing individuals to choose their preferred method, follow-up, and removal services.
  • Accessibility: Facilities and services are accessible, without financial, geographical, physical, sociocultural, or information barriers.
  • Acceptability: Services are provided in a culturally acceptable manner for different religious and ethnic groups and for Indigenous peoples, and they are youth friendly and are sensitive to gender and life-cycle requirements.
  • Quality: Individuals have access to high-quality contraceptive services and information that are scientifically and medically appropriate and up to date; user-provider interactions that respect informed choice, users’ preferences and needs, and privacy and confidentiality.
  • Nondiscrimination and Equality: Services are free from discrimination, on grounds such as age, geographic location, language, ethnicity, disability, religion, HIV status, gender, sex, sexual orientation, wealth, or marital status. Different population groups may require differing resources or special measures to overcome barriers.
  • Informed Decision-making: Individuals are informed about family planning options in a clear, accurate, and comprehensible format and can exercise full, free, and informed choice about these contraceptive methods without coercion.
  • Privacy and Confidentiality: Privacy of individuals is respected throughout the provision of contraceptive information and services; confidentiality of medical and other personal records and information is respected.
  • Participation and Accountability: Individuals have the ability to meaningfully participate in the design, provision, implementation, and evaluation of contraceptive services, programs, laws, and policies. When wrongdoing occurs, users have access to effective legal and social accountability mechanisms.

The following steps are intended to help program planners, managers, and decision-makers develop and integrate a HRBA to family planning programming. Steps 1-3 help prepare for an assessment, and Steps 5-8 put the results of the assessment in practice. This assessment can be done during a convening of stakeholders (Step 2). Step 4, the assessment, is discussed in detail below.

Step 1 | Compile key documents

Assemble a list of ratified treaties; recent concluding observations and recommendations made by rights bodies such as the Universal Periodic Review (UPR) or the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW); laws, policies, strategies, standards, results frameworks, and essential data related to human rights and family planning programs.

Step 2 | Convene representative stakeholders

Include service users, community leaders, women (including from marginalized populations), youth, policymakers, human rights experts (e.g., National Human Rights Institutions), program managers, service providers, and clients to engage in participatory program assessment and planning.

Step 3 | Establish a shared understanding

Agree on the parameters of a human rights-based approach to family planning.

Step 4 | Compare the existing program to the desired state

Use a vision of the desired state as a reference, and refer to the key documents as needed. Go systematically, point by point, to identify program strengths, weaknesses, and gaps from a human rights perspective.

Step 5 | Identify the challenges

Pinpoint the challenges for each desired program element that is weak or lacking; conduct a root cause analysis; and identify actionable areas and any impediments and tensions that could block necessary action.

Step 6 | Set parameters of a plan

Prioritize what program strengths to expand and what areas to improve. Determine at what level(s) action is required and what actors have authority to act and identify desired strategic partners.

Step 7 | Formulate an action plan

Detail actions, responsible parties, time frame, and monitoring indicators.

Step 8 | Link the plan

Connect the plan to existing monitoring, evaluation, and accountability processes and mechanisms.

The Assessment: An Elaboration of Step 4

The four key assessment areas presented below, along with the bullet points that follow each area, can help assess the extent to which human rights inform the planning, development, implementation, and evaluation of family planning programs in a given country. They represent an ideal human rights-based framework by offering aspirational goals to guide improvements over time.

The assessment areas represent the various levels of the health care system: community, social, and gender norms (assessment area A), law and policy (assessment area B), service delivery (assessment area C), and the individual (assessment area D). When carrying out a HRBA assessment, consider splitting the assessment areas among groups that can discuss areas with which they are most familiar, such as service providers focusing on assessment area C.

The UNFPA Support Tool offers additional practical guidance for assessing family planning programs through a human rights perspective.

Participation and Inclusion

Participation and inclusion of a wide array of stakeholders should be facilitated at all stages of planning and preparation, from assessment through implementation, as well as in monitoring of programs. This includes participation from individuals representing populations at risk of exclusion,3 relevant government offices, professional associations, national human rights institutions, health care providers, women’s and feminist civil society, community leaders, and faith actors.4

Taking an inclusive approach from the beginning of the assessment rather than as an afterthought ensures that the critical barriers and priorities can be identified and addressed from the onset.

Key assessment area A: Supportive Community and Social and Gender Norms

Supportive community and social and gender norms5 are key to successfully implementing a HRBA to family planning. To gauge whether your country meets this area, assess your country situation against these HRBA criteria:

  • There is community support6 for safe and voluntary family planning services, for all population groups, including unmarried adolescents and youth, and gender-diverse individuals.
  • Community health workers7 and programs exist and support the acceptability of services, destigmatize contraceptive use, and ensure facts and not myths about contraceptives prevail in the community.
  • Gender norms support women, adolescents, youth, and individuals with diverse gender identities and sexual orientation to make informed decisions about their own sexual and reproductive health and rights.
  • Men and boys are engaged and supportive of family planning; healthy couples’ communication8 is promoted.
  • Affordable transportation links to service delivery points are available; community-based distribution of contraceptives is in place.
Key assessment area B: Law and Policy

All laws and policies should be assessed9, periodically reviewed and monitored for their alignment with human rights treaties and agreements, including SDG indicator 5.6.1.10 To determine whether your country meets this area, assess if your country’s laws and policies meet these HRBA criteria:

  • Promote and protect access to contraceptive information and services in an equitable manner11 and without discrimination, coercion, or violence (Principles Underpinning High Impact Practices [HIPs] for Family Planning12), including on the grounds of age, HIV status, disability status, gender identity and sexual orientation, or marital status.
  • Protect autonomy and agency of individuals to make choices concerning their own bodies, including on sexual and reproductive issues, and guarantee the right to access services, information, and resources to exercise that right.
  • Eliminate and prevent coercive or involuntary contraception13, including eliminating incentive programs and policies for health care workers or clients.
  • Guarantee confidentiality and privacy, such as by not allowing for third-party authorization for access to information and services, including from spouses or health care workers; minors should presumptively be allowed access without parental authorization, or at a minimum, on the basis of their evolving capacity.
  • Integrate self-care interventions14 for family planning.
  • Ensure availability of quality contraceptive products that are, at a minimum, in line with the World Health Organization’s Model List of Essential Medicines15; health facilities are stocked through a well-coordinated supply chain16 and through an integrated Family Planning Logistics Management Information System.
  • Establish an integrated system for confidential referrals, including for postabortion care and follow-up.
  • Provide nondiscriminatory, age-appropriate comprehensive sexuality education17 in and out of schools.
  • Include gender-based violence under universal health coverage initiatives.
  • Institute effective and accessible administrative and judicial safeguards and mechanisms to protect rights, ensuring remedies and redress.
  • Adopt professional ethical codes related to family planning are consistent with a HRBA.
  • Develop a national strategy and action plan on SRHR, with adequate budget allocations18, alongside effective laws that place gender equality at the center.
Key assessment area C: Service Delivery

Quality service delivery is the front line of ensuring a HRBA to family planning. To determine whether your country meets this area, assess if your country’s service delivery meets these HRBA criteria:

  • Builds the knowledge, skills, and competencies of health care providers19 for provision of human rights-based services. This includes the duty of care and other ethics of care and ensuring a client-centered approach by creating a safe, nonjudgmental environment that respects clients’ reproductive intentions, lifestyles, and preferences throughout their lives.
  • Ensures that the quality, accessibility, and availability of contraceptive information and services remain consistent and are not influenced by nonmedically indicated characteristics, such as age, geographic location, language, ethnicity, disability20, HIV status, gender identity and sexual orientation, wealth, or marital status, and that they offer services responsive to the needs of various populations, including adolescents21 and men and boys22.
  • Provides accurate, complete, and accessible counseling23 and information for diverse populations, guaranteeing confidentiality, and does so in relevant languages and in a manner understandable to adolescents and youth, less literate people, and people with physical or psychosocial disabilities; and guarantees informed decision-making for all.
  • Makes the broadest range of contraceptive methods, including emergency contraception, available, accessible, and affordable24.
  • Builds and sustains systems to support continuity of care for clients through an uninterrupted supply of contraceptives and related commodities, preventing stock-outs and ensuring integrated services along the reproductive life course, with referral systems and follow-up care.
  • Integrates postpartum25 and postabortion family planning, and health care for gender-based violence and sexual and reproductive needs26; as well as family planning self-care interventions, mobile outreach services27, and digital health.28
  • Ensures that client feedback mechanisms at the facility level are available, accessible, and confidential and that facility employees who breach their duty of care are held accountable.
  • Prioritizes a holistic approach to data collection, incorporating both quantitative indicators such as community perceptions and individual experiences; data collection should be disaggregated by age, sex, socioeconomic status, ethnicity, geographic location, marital status, and other relevant factors to enable targeted interventions and address diverse needs.
Key assessment area D: Individual at the center: empowered and satisfied client

All of the key action points above serve to promote an empowered and satisfied client. In addition to them, assess if your country meets these HRBA criteria:

  • Individuals can make and act on their own family planning decisions29, without pressure or obstacles from the health care system, provider, their partner or family, or anyone else; women and girls have economic opportunities30 to enable autonomy.
  • People are treated the same without discrimination based on who they are, their age, ethnicity, or their circumstances, their gender identity or sexual orientation, or other characteristics.
  • Individuals can choose from a wide range of available methods that suit the individual’s needs and preferences and are provided with information in an understandable manner for them.
  • Individuals’ privacy and confidentiality are respected in receiving and discussing information and services in a setting where no one can hear or observe client-provider interactions; records and information are not shared with third parties without the consent of the client.
  • Individuals are supported as part of social accountability31, to know and claim their rights and feel supported in speaking up if they face problems in the health facility, and have access to redress32.

Once this assessment is completed, continued work with the population groups and other stakeholders should be done to prioritize areas that are in immediate need of addressing, and an action plan should be developed to realize these changes. The UNFPA Support Tool provides details on how to go about doing this.

(see links throughout for further resources)

This document was written by Christina Zampas, Emilie Filmer-Wilson, Uluk Batyrgaliev, Pester Siraha, Elizabeth Arlotti-Parish, and Maryce Ramsey.

In addition, the following individuals provided critical review and helpful comments: Jennie Greaney, Heidi Quinn, Christine Galavotti, Rachel Templeton, Kimberley Ocheltree, Åsa Nihlén, and Dakshitha Wickremarathne. The authors acknowledge the work of Karen Hardee, Jan Kumar, Lynn Bakamjian, and Melanie Croce-Galis of What Works Association included in this SPG.

High-Impact Practices in Family Planning (HIPs). Facilitating a Human Rights-Based Approach in Family Planning: A Strategic Planning Guide. Washington, DC: HIP Partnership; 2025, February. Available from: https://www.fphighimpactpractices.org/guides/human-rights-based-approaches

To engage with the HIPs please go to: https://www.fphighimpactpractices.org/engage-with-the-hips/

The HIP Partnership is a diverse and results-oriented partnership encompassing a wide range of stakeholders and experts. As such, the information in HIP materials does not necessarily reflect the views of each co-sponsor or partner organization.

1 UNFPA, What Works Association. The Holistic Framework for Human Rights-Based Family Planning: UNFPA Technical Brief. New York: UNFPA; 2023. Accessed January 9, 2025. Available from: https://www.unfpa.org/sites/default/files/resource-pdf/UNFPAHRBAtoFP-TechBrief-v231207%20%281%29_0.pdf.

2 UNFPA, What Works Association. Human Rights-Based Approach to Family Planning: UNFPA Support Tool. New York: UNFPA; 2023 December. Accessed January 9, 2025. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA-HRBAtoFPSupportTool-v231207.pdf.

3 UNFPA. State of the World Population Report 2024: Interwoven Lives, Threads of Hope: Ending Inequalities in Sexual and Reproductive Health and Rights. New York: UNFPA; 2024. Accessed January 9, 2025. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/swp2024-english-240327-web.pdf.

4 High Impact Practices in Family Planning (HIP). Strengthening Partnership with Faith Actors in Family Planning: A Strategic Planning Guide. Washington, DC: HIP Partnership; 2023 August. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/guides/faith-actors-in-family-planning/.

5 High Impact Practices in Family Planning (HIP). Social Norms: Promoting Community Support for Family Planning. Washington, DC: USAID; 2022 May. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/briefs/social-norms/.

6 High Impact Practices in Family Planning (HIP). Community Engagement: Changing Norms to Improve Sexual and Reproductive Health. Washington, DC: USAID; 2016 October. Accessed January 9, 2025. Available from: http://www.fphighimpactpractices.org/briefs/community-group-engagement.

7 High Impact Practices in Family Planning (HIP). Community Health Workers: Bringing Family Planning Services to Where People Live and Work. Washington, DC: USAID; 2015. Accessed January 9, 2025. Available from: http://www.fphighimpactpractices.org/briefs/community-health-workers.

8 High Impact Practices in Family Planning (HIP). Promoting Healthy Couples’ Communication to Improve Reproductive Health Outcomes. Washington, DC: USAID; 2022 April. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/briefs/couplecommunication/.

9 High Impact Practices in Family Planning (HIP). Comprehensive Policy Processes: The Agreements That Outline Health Goals and the Actions to Realize Them. Washington, DC: HIP Partnership; 2022 May. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/briefs/policy/.

10 UNFPA. Women’s Ability to Decide: Issue Brief on Indicator 5.6.1 of the Sustainable Development Goals. New York: UNFPA; 2020 February. Accessed January 9, 2025. Available from: https://www.unfpa.org/sites/default/files/resource-pdf/20-033_SDG561-IssueBrief-v4.1.pdf.

11 High Impact Practices in Family Planning (HIP). Discussion Paper on Equity for the HIP Partnership. Washington, DC: HIPs Partnership; 2019 June. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/discussion-paper-on-equity-for-the-hip-partnership/.

12 High Impact Practices in Family Planning (HIP). Principles Underpinning High Impact Practices (HIPs) for Family Planning. Washington, DC: HIP Partnership; no date listed. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/principles-underpinning-high-impact-practices-hips-for-family-planning/.

13 OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF, World Health Organization. Eliminating Forced, Coercive, and Otherwise Involuntary Sterilization. Geneva: World Health Organization; 2014 May. Accessed January 9, 2025. Available from: https://www.who.int/publications/i/item/9789241507325.

14 World Health Organization. Self-care Interventions for Sexual and Reproductive Health and Rights to Advance Universal Health Coverage: 2023 Joint Statement by HRP, WHO, UNDP, UNFPA and the World Bank. Geneva: World Health Organization; 2023 October. Accessed January 9, 2025. Available from: https://www.who.int/publications/i/item/9789240081727.

15 World Health Organization. Model List of Essential Medicines. Geneva: World Health Organization; no date listed. Accessed January 9, 2025. Available from: https://list.essentialmeds.org/.

16 High Impact Practices in Family Planning (HIP). Supply Chain Management: Investing in the Supply Chain is Critical to Achieving Family Planning Goals. Washington, DC: HIPs Partnership; 2020 April. Accessed January 9, 2025. Available from: http://www.fphighimpactpractices.org/briefs/supply-chain-management/.

17 UNESCO, UNAIDS, UNFPA, UNICEF, UN Women, World Health Organization. International Technical Guidance on Sexuality Education: An Evidence-Informed Approach. UNESCO; 2018. Accessed January 9, 2025. Available from: https://doi.org/10.54675/UQRM6395.

18 High Impact Practices in Family Planning (HIP). Domestic Public Financing: Building a Sustainable Future for Family Planning Programs. Washington, DC: USAID; 2018 April. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/briefs/domestic-public-financing/.

19 World Health Organization. Quality of Care in Contraceptive Information and Services, Based on Human Rights Standards: A Checklist for Health Care Providers. Geneva: World Health Organization; 2017. Accessed January 9, 2025. Available from: https://iris.who.int/bitstream/handle/10665/254826/9789241512091-eng.pdf.

20 High Impact Practices in Family Planning (HIP). Facilitate the Inclusion of Persons with Disabilities in Family Planning Programming: A Strategic Planning Guide. Washington, DC: HIP Partnership; 2023 March. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/guides/facilitate-the-inclusion-of-persons-with-disabilities-in-family-planning-programming/.

21 High Impact Practices in Family Planning (HIP). Adolescents: Improving Sexual and Reproductive Health of Young People: A Strategic Planning Guide. Washington, DC: USAID; 2015 September. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/guides/improving-sexual-and-reproductive-health-of-young-people/.

22 High Impact Practices in Family Planning (HIP). Engaging Men and Boys in Family Planning: A Strategic Planning Guide. Washington, DC: USAID; 2018 January. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/guides/engaging-men-and-boys-in-family-planning/.

23 World Health Organization. Quality of Care in Contraceptive Information and Services, Based on Human Rights Standards: A Checklist for Health Care Providers. Geneva: World Health Organization; 2017. Accessed January 9, 2025. Available from: https://iris.who.int/bitstream/handle/10665/254826/9789241512091-eng.pdf.

24 High Impact Practices in Family Planning (HIP). Contraceptive Method Introduction to Expand Choice: A Strategic Planning Guide. Washington, DC: HIP Partnership; 2022 March. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/guides/contraceptive-method-introduction/.

25 High Impact Practices in Family Planning (HIP). Immediate Postpartum Family Planning: A Key Component of Childbirth Care. Washington, DC: HIP Partnership; 2022 May. Accessed January 9, 2025. Available from: https://www.family-planning/.

26 High Impact Practices in Family Planning (HIP). Postabortion Family Planning: A Critical Component of Postabortion Care. Washington, DC: USAID; 2019 March. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/briefs/postabortion-family-planning/.

27 High Impact Practices in Family Planning (HIP). Mobile Outreach Services: Expanding Access to a Full Range of Modern Contraceptives. Washington, DC: USAID; 2014 May. Accessed January 9, 2025. Available from: http://www.fphighimpactpractices.org/briefs/mobile-outreach-services/.

28 High Impact Practices in Family Planning (HIP). Digital Health for Social and Behavior Change: New Technologies, New Ways to Reach People. Washington, DC: USAID; 2018 April. Accessed January 9, 2025. Available from: http://www.fphighimpactpractices.org/briefs/digital-health-sbc/.

29 High Impact Practices in Family Planning (HIP). Knowledge, Beliefs, Attitudes, and Self-Efficacy: Strengthening an Individual’s Ability to Achieve Their Reproductive Intentions. Washington, DC: HIP Partnership; 2022 May. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/briefs/knowledge-attitudes-and-beliefs/.

30 High Impact Practices in Family Planning (HIP). Economic Empowerment: A Pathway for Women and Girls to Gain Control Over Their Sexual and Reproductive Health. Washington, DC: USAID; 2017 January. Accessed January 9, 2025. Available from: https://www.fphighimpactpractices.org/briefs/economic-empowerment/.

31 High Impact Practices in Family Planning (HIP). Social Accountability to Improve Family Planning Information and Services. Washington, DC: HIP Partnership; 2022 August. Accessed January 9, 2025. Available from: https://fphighimpactpractices.org/briefs/social-accountability/.

32 UNFPA, World Health Organization. Ensuring Human Rights Within Contraceptive Service Delivery: Implementation Guide. New York: UNFPA; 2015 March. Accessed January 9, 2025. Available from: https://www.unfpa.org/sites/default/files/pub-pdf/Ensuring_human_rights.pdf.

33 FP2030. Family Planning 2020: Rights and Empowerment Principles for Family Planning. Washington, DC: FP2030; 2014. Accessed January 9, 2025. Available from: https://www.fp2030.org/resources/resources-family-planning-2020-rights-empowerment-principles-family-planning/.

34 World Health Organization. Ensuring Human Rights in the Provision of Contraceptive Information and Services. Geneva: World Health Organization; 2014 June. Accessed January 9, 2025. Available from: https://iris.who.int/bitstream/handle/10665/102539/9789241506748_eng.pdf.