• 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.

The concept of informed choice can be traced to the late 1700s, when several prominent physicians in the US advocated demystifying medicine by giving people more access to medical information and educating patients about their conditions. The rationale, however, was that informed patients would better comply with physicians' recommendations, not that patients would be able to make informed decisions for themselves (125).

Since the advent of the family planning movement early in the 20th century, many advocates for good reproductive health have sought to expand people's access to medical information and widen their family planning choices (84). In the late 1960s the first US legislation providing government financial support for family planning programs in developing countries, through the United States Agency for International Development (USAID), strongly endorsed the voluntary practice of family planning in all such programs (433, 435).

The term informed choice itself first appeared in the family planning literature in the early 1970s (210, 233, 457), applied mainly to increasing access to family planning. In 1982 the concept of informed choice came to the forefront of international family planning policy when USAID stated that its “support for fam-ily planning service programs is based on two fundamental principles: voluntarism and informed choice” (434).

One of the first international symposiums for family planning leaders on voluntarism and choice took place in 1984, sponsored by the World Federation of Health Agencies for the Advancement of Voluntary Surgical Contraception. The focus was on the importance of voluntary choice in decisions about sterilization (24, 409).

In 1987 the Task Force on Informed Choice convened with a focus on informed choice for all family planning methods. Sponsored by USAID, the task force had representation from 17 organizations, including the United Nations Population Fund (UNFPA), the International Planned Parenthood Federation (IPPF), the World Bank, and Cooperating Agencies of USAID (411). Later, at the 1994 International Conference on Population and Development in Cairo, 179 countries agreed that informed choice in family planning is based on human rights (426). Today, most family planning programs around the world subscribe to the principle of informed choice.

Centro de Orientación Familiar (COF)

This Bolivian poster says, "Family planning is the right of everyone." For decades, programs, governments, and donors have been expanding access for all who want it.

Informed choice and informed consent. The concepts of informed choice and informed consent are related but quite different in their intent. Informed consent means that a client understands the medical procedure proposed and the other options and has agreed to receive the proposed care. Informed consent alone does not constitute informed choice, however. The purpose of informed choice is to ensure that all clients decide for themselves on health care that best meets their needs.

In contrast to the evolution of informed choice, informed consent largely reflects legal opinions, beginning in 1767 in England, when a court ruled against a pair of physicians who used an experimental device on a patient without the patient's knowledge or consent (125). The term “informed consent” itself first appeared in US case law in 1957, and the medical community gradually became aware of the legal requirement to obtain the informed consent of patients to their medical treatment (231). Today, one purpose of obtaining informed consent is often to protect the health care provider from false accusations of wrongdoing, including lawsuits alleging malpractice.

In the US the concept of informed consent as it relates to family planning evolved in the late 1960s in response to policies and practices involving sterilization without consent (23). Today, in family planning programs informed consent usually is required only for sterilization, because it is a permanent method. Informed consent often involves a written statement that the client signs to verify understanding of the method, medical procedure, and risks.

Practical questions. Informed choice has become a goal in many family planning programs. Practical questions persist, however, about how best to make informed choice a reality for everyone. For example, how much does a person need to know to make an informed choice? How much can this knowledge vary from one person to the next? How much should a person know about other contraceptive methods before deciding to choose a particular method? (see How Much Information? How Much Guidance?)

Questions remain for providers, too. How can providers best guide clients to make informed choices without interjecting their own preferences and values? Does the provider have responsibility for judging whether the client has made an informed choice? What is the best way for a provider respectfully to confirm that the client's understanding is accurate? These and other practical questions concern programs trying to make informed choice a reality for clients.