Women's Voices, Women's Lives: The Impact Of Family Planning

Future Directions

In almost all societies, women bear the major responsibility for the welfare of their families. It is not surprising, therefore, that most women desire some measure of control over their fertility. Yet, the extent to which women are able to turn their intentions into actions -- to make reproductive decisions, to obtain services, to use methods effectively -- and the consequences of those actions, vary according to the context of women's lives. Taking control of fertility through the use of family planning is one of many strategies a woman can employ to exercise autonomy in other aspects of her life. However, as the Women's Studies Project has shown, family planning decisions can have both positive and negative outcomes for women.

Women's reproductive intentions -- desired family size, the timing and spacing of pregnancies -- are conditioned by numerous sociocultural factors, including gender norms. Using many different voices, women participating in the WSP told interviewers that to attain their family planning objectives, they needed supportive partners, adequate information, unobtrusive methods, and respectful services.

The WSP was designed before the Cairo and Beijing conferences highlighted the paradigm shift from research on contraceptive use to research to improve women's reproductive health and gender equity. An important contribution of this Project is the provision of new data on women's perspectives, which can inform reproductive health policies and programs. While the WSP did not conduct cross-country comparisons, future longitudinal studies could be used to explore how women's perceptions of family planning change throughout their lives.

The WSP found that women's collective and individual contraceptive needs are diverse and ever-changing. In addition, findings suggest that women do not compartmentalize their needs; they see reproductive health as related, not separate, from other aspects of their lives. And women's early contraceptive decisions affect their later life. As providers and policy-makers consider ways to improve family planning programs, they may want to consider the following questions raised by WSP research.

Addressing Gender Issues

• Gender norms greatly affect women's access to reproductive health services and their use of contraceptive methods. What types of changes are needed in health programs and policies to make them more "gender-sensitive?" What types of training are needed for providers?

• Men influence women's contraceptive experiences. How can policy-makers and program managers educate men that family planning is a shared responsibility? How can policy-makers and program managers educate men that they, too, have reproductive health needs? How can providers make more services and methods available to men? What types of programs are needed to train health workers to provide comprehensive reproductive health care for men? How can programs help women and men improve their communications skills?

• Domestic violence affects many women and is sometimes associated with the use or non-use of contraception. How can reproductive health programs and policies improve women's safety?

• Through use of family planning, increasing numbers of women are having fewer children and, therefore, potentially more time for themselves. How might strategic interventions help to remove institutionalized forms of gender discrimination (in the home, work place or the political arena, for example) that prevent many women from realizing the full benefits of lower fertility?

• Some WSP studies attempted to capture information about women's community and political activities, given effective use of contraception. It appears that younger women especially have little time to devote to these areas. How then can women's participation in the broader community be encouraged?

Improving Service Delivery

• As family planning programs evolve into reproductive health programs, how are women in different contexts best served? What do they want from new services? How should family planning, STD prevention and treatment, and prenatal care be managed, given constraints on staff time and resources? How will expansion to other reproductive health areas affect quality of care?

• In some countries, reproductive health services are not available to unmarried women. How can the service system be best expanded to provide age-appropriate services to these women, given the cultural and political environment?

• Reproductive health services are often focused on maternal and child health care. How can programs be expanded to meet the needs of women who are not pregnant, including older women?

• Adolescents, whether sexually active or not, need counseling on their options for the future. How can they be encouraged to take advantage of educational and vocational opportunities? How can they be helped to see the long-term consequences of their short-term decisions?

• How can family planning programs accommodate the changing roles of women? How can programs reach women whose work burden is increased by responsibilities inside and outside the home? How can programs provide services for women who have little spare time?

Improving Effective Use of Methods

• While providers have tended to minimize contraceptive side effects, women see them as a critical factor in determining which methods they will use, whether they will continue a method, or whether they even start contraception. How can providers become more attentive to these concerns? How can they be trained to counsel and treat clients more effectively? How can health programs meet the mandate to expand services to huge and increasing numbers of clients who need contraceptive services, but still address the concerns of specific individuals?

• Some WSP participants saw abortion as a remedy for contraceptive failure and were willing to risk unsafe abortions to end their pregnancies. How can health policies and programs prevent unsafe abortions? How can postpartum and postabortion counseling programs be strengthened?

While research findings are important, the WSP believes lessons learned from the research process can be useful as well for future projects. The process built upon the idea of partnerships. The model of the WSP triangle of policy-makers and providers, researchers and women's advocates could be used or adapted to design research projects. In addition, the WSP triangle also could be a useful model in designing health programs and policies. Collaboration among these three groups could provide a practical link among those who study population issues, those who provide reproductive health services, and those who use health services.

In the coming months, the WSP will continue further data analyses and dissemination. Many WSP investigators are still exploring quantitative and qualitative data from their studies, and their analyses and interpretations of findings will continue. A special area of focus for the WSP will be analysis of psychosocial variables in contraceptive use. At the same time, researchers will look further at the total synthesis of the WSP. Where subprojects in more than one country have data on similar issues, researchers will compare their findings -- reanalyzing where appropriate -- to investigate similarities and differences. Questions raised in one subproject are stimulating questions in another, leading to new paths of inquiry.

In the Philippines, future research will examine the relationship between family planning use and women's economic well-being. With funding from USAID's POLICY Project, investigators from FHI and the University of San Carlos in Cebu, the Philippines, will seek to better understand the economic impacts of various patterns of family planning use and childbearing on women throughout the life course. They will explore how these effects vary with gender roles and expectations, with women's demographic and socioeconomic characteristics, and with changing employment opportunities and policies.

As the Women's Studies Project concludes, investigators hope implications from research findings and lessons learned from the research process will extend beyond the 14 countries that participated directly in the Project. We believe the conclusion of the WSP should not be the end of discussions on the impact of family planning on women's lives, but the beginning.

return to top

return to index page