• Editors' Summary
• Credits

1. Why Informed Choice Matters
2. Making Family Planing Decisions
• The Individual in the Community
• Household Influences
• Individual Values and Personal Characteristics
• Informed Choice Strategy
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.

Making Family Planning Decisions

The principle of informed choice focuses on the individual. Yet most people's family planning decisions also reflect a range of outside influences. These include household influences and community norms, government laws and policies, information available, and access to family planning methods and services. People often are unaware of the factors that affect their ability to make informed choices, because these factors are indirect.

Governments influence people's family planning decisions both indirectly, as when laws affect women's ability to make independent decisions, and directly, as when policies regulate access to contraceptive information, supplies, and services (67). The information and values communicated in the mass media and from person to person affect how much people know about family planning and how interested they are in it (81, 345). Access to contraception—the number of methods that are available and how easy they are to obtain—affects people's ability to use the methods they prefer (143) (see Figure 1).

While counseling has long been considered a key to ensuring informed choice, what happens before people visit a service provider may be even more important. In general, people make their family planning decisions incrementally over the course of their reproductive lives, rather than as a single choice (438).

A person's biggest family planning decisions—whether to control one's fertility and whether to use a family planning method—usually are made before the person ever seeks contraception or meets with a service provider. By the time people become family planning clients, they usually also have a particular contraceptive method in mind and already have some information—or misinformation—about it (244). For example, in each of 50 countries with DHS data, among currently married women who planned to start using family planning in the next 12 months, at least 80% said that they had a preferred method in mind. In 26 countries the percentage was over 90% (see Table 1).

In the six-country study previously mentioned (see Continued contraceptive use in chapter 1.2), 75% to 100% of women had a specific method in mind when they arrived at the family planning clinic (193). Also, in Ecuador, Uganda, and Zimbabwe, over 94% of clients had a preference for a specific method before they received counseling from a provider (407). In Kenya at least 46% of new clients arrived at the clinic with a strong preference for a specific method (244). In a Nigerian clinic 55% of new clients asked for a specific method (7).

The more that policy-makers, program managers, and service providers know about how people make family planning decisions and the factors, both direct and indirect, that influence people's family planning decisions, the better they can help people make informed choices.

Danielle Baron, JHU/CCP In Senegal women come together at a community meeting to discuss their health. Community values and norms shape people's attitudes. They determine whether it is socially acceptable to use contraception and whether people can make family planning decisions for themselves.