• Editors' Summary
• Credits

1. Why Informed Choice Matters
• Understanding Informed Choice
• Benefits of Informed Choice
• Evolution of Informed Choice
2. Making Family Planing Decisions
3. Policies for Informed Choice
4. Communication for Choice
5. Improving Access
6. Managing for Informed Choice
7. Client-Provider Communication

• Figures
• Table
• Side-bars
• Bibliography

• What can be done?
• Women know what they want
• Why communities matter
• Eliminating targets
• More methods, more choices
• "Your health is in your hands"
• Do clients have choices?
• Please Ask!
• How much guidance?
• Active clients, better choices
• Counseling continuing clients

• POPLINE
• Media/Materials Clearinghouse
• Other Reports
• To Order
• CCP Home Page

Published by the Population Information Porgram, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.

In the term “informed choice,” each of the two words refers to an essential aspect of family planning decision-making (182). Being informed is necessary to making a well-considered decision. But being informed is not sufficient; a person also needs choices—including access to a range of contraceptive methods, convenient sources of supply, good-quality services, and the ability to continue or discontinue using the method as desired (103).

People can make informed choices only when prevailing social policies and community and gender norms support personal decision-making regarding family planning. Such support helps people have the confidence and opportunity to make their own family planning decisions, rather than have these decisions imposed on them, whether by medical personnel, family members, community pressures, or others. Of course, people have varying levels of access to information and to choices. Educational attainment, family background, social class, and providers' attitudes are among the factors that can either aid or hinder a person's ability to make informed family planning choices.

Informed choice has many benefits. The ability to make informed family planning choices increases people's control over their own lives, encourages people to take more responsibility for their own health, and invites a trusting partnership between clients and providers (306).

Continued contraceptive use. Having an informed choice encourages continued contraceptive use. People use a family planning method longer if they have chosen it for themselves (316, 318). A six-country study—in Guatemala, Hong Kong, Jordan, Kenya, Nepal, and Trinidad and Tobago—conducted between 1984 and 1987 among over 11,500 women found that continued use of a contraceptive method was strongly associated with obtaining the method that the client had in mind, as well as with a client's motivation to avoid pregnancy and the knowledge that her partner would agree with her choice of method (193). Similarly, a 1988 study in Indonesia found that 91% of women who obtained their preferred method were still using that method after one year compared with 28% of other women (317). A number of studies in the US have found that people who make their own health decisions are more likely to carry out those decisions (105, 110, 137, 168).

Offering many method choices encourages use of contraception, making it easier for people to choose a method they like and to switch methods (170). For each additional contraceptive method that is widely available in a country, the percentage of married women using contraception increases by an average of 3.3 percentage points, according to analysis of Demographic and Health Surveys (DHS) data from 44 countries (45, 351).

Many people switch contraceptive methods at least once during their reproductive years, and some use many different methods over a lifetime (165, 174, 281). When the family planning project in Matlab, Bangladesh, began to offer a full range of family planning methods, 80% of women were still using a family planning method after one year compared with 40% when only condoms and pills were offered (466).

Good-quality care. Informed choice is a key aspect of good-quality family planning. In the quality-of-care framework developed by Judith Bruce in 1990, two of the six elements that characterize good quality—choice of methods and information given to clients—are central to making informed choices (59). For family planning programs, attention to providing good care attracts clients and increases client satisfaction by offering services, supplies, information, and emotional support that clients need to meet their reproductive goals (256, 445). (See Population Reports, Family Planning Programs: Improving Quality, Series J, No. 47, Nov. 1998.)