Contraceptive Autonomy: Conceptions and Measurement of a Novel Family Planning Indicator

Abstract

Since the 1994 International Conference on Population and Development, there has been increased attention to high‐quality and rights‐based family planning, but these concepts have been difficult to measure. Perhaps due to an intellectual history intertwined with population control, contemporary family planning programs and researchers often use (modern) method use as a primary marker of success, with indicators focusing narrowly on contraceptive use and fertility. This results in a fundamental misalignment between existing metrics and the stated family planning goals of promoting reproductive health and rights. This report describes the rationale for a novel family planning indicator called “contraceptive autonomy” and proposes a methodology for measuring this concept at the population level. Defining contraceptive autonomy as the factors necessary for a person to decide for themself what they want in relation to contraception and then to realize that decision, this indicator divides the contraceptive autonomy construct into subdomains of informed choice, full choice, and free choice. By acknowledging that autonomous nonuse is a positive outcome,aiming to maximize contraceptive autonomy rather than use could help shift incentives for family planning programs and reduce some common forms of contraceptive coercion, as our measurement approach is realigned with our focus on high‐quality rights‐based care.

Incorporating Method Dissatisfaction into Unmet Need for Contraception: Implications for Measurement and Impact

“…Reformulation of an unmet need metric might also incorporate what Leigh Senderowicz terms “contraceptive autonomy” (Senderowicz 2020), a concept which combines informed choice and access to choice with women's own perceptions of contraceptive need. Senderowicz's work builds upon previous conceptualizations of contraceptive “acceptability” (Severy and Newcomer 2005) by emphasizing respect for women's autonomy as a prerequisite for met need.…”

The poverty balancing equation: Expressing poverty of place as a population process

“…First, these results show that those who are poor are more likely to have children in every state in the South. This highlights the need to make aid available to growing families while also ensuring reproductive autonomy among women, wherein birth control methods, if desired, are accessible and affordable (Senderowicz, 2020). Second, although some of the growth in poverty in North Carolina was clearly due to in-migration, the poor were more likely than the non-poor to both move in and out of the state.…”

Reproductive justice: A radical framework for researching sexual and reproductive issues in psychology

“…Under the growing influence of the SRHR paradigm, family planning initiatives across the world prioritised voluntary, rights‐based approaches to contraceptive care (Senderowicz, 2020). Researchers responded by investigating limits on reproductive autonomy understood, for instance, as people's ‘ability to choose and act on their own choice’ (van den Akker, 2012, p. 10) or the ‘power to make personal health‐related decisions that impact their lives and well‐being’ (Msetfi et al., 2018, p. 252).…”

“…Some research has considered contextual aspects like systemic barriers (Msetfi et al., 2018) or organisational issues (Senderowicz, 2019, 2020). For example, Senderowicz (2019, 2020) explored the extent to which contraceptive coercion exists in family planning programmes in sub‐Saharan Africa and the forms it might take.…”

“…Some research has considered contextual aspects like systemic barriers (Msetfi et al., 2018) or organisational issues (Senderowicz, 2019, 2020). For example, Senderowicz (2019, 2020) explored the extent to which contraceptive coercion exists in family planning programmes in sub‐Saharan Africa and the forms it might take. Her participants shared stories of coercion that varied in type and severity, ranging from subtler practices (e.g., biased or directive counselling, dramatically limited contraceptive method mix, scare tactics, provision of false medical information) to more overt action (e.g., refusal to remove provider‐dependent methods, and the non‐consented provision of long‐acting methods).…”