• Editors' Summary
• Credits

1. Why Informed Choice Matters
2. Making Family Planing Decisions
3. Policies for Informed Choice
• International Consensus for Informed Choice
• National Support for Informed Choice
• Policies That Promote Access
• Eliminating Targets, Incentives, and Disincentives
• Social and Economic Policies
• Donor Agencies
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.

National Support for Informed Choice

National governments can help insure the right to informed choice by putting the principle into law. For example, as amended in 1974, Article 4 of Mexico's constitution states that every individual has the right to decide in a free, responsible, and informed manner the number and spacing of his or her children (376). Reflecting this principle, in the same year Mexico established the National Population Council (CONAPO), made up of eight Ministers of State, to ensure that people in every social group and in every region have access to family planning and other reproductive health services (428).

In several other countries, including Malaysia, Peru, and Zambia, laws explicitly protect informed choice (71, 131, 344). Similarly, a city law in Buenos Aires, Argentina, passed in 2000 recognizes “sexual and reproductive rights free of violence and coercion as basic human rights” and guarantees women's and men's access to contraceptive information, methods, and services (473). When governments incorporate informed choice standards into their laws, the courts can enforce them (87).

National laws and other policies for informed choice work best when they have the support of top government officials. During his career in public service, for example, former Philippine Secretary of Health Juan Flavier was an ardent supporter of people's right to make their own family planning decisions—for example, launching a national communication campaign to tell people about their family planning choices (18, 377). Under his leadership between 1992 and 1994, family planning funding quintupled, programs offered a wider variety of contraceptive methods, and the number of people using family planning increased substantially (347).

National governments play the major role in developing and enforcing standards for health services in both the public and private sectors, including guidelines for service delivery (67, 426). National family planning guidelines are most accurate when they are based on international consensus documents such as the medical eligibility criteria developed under the auspices of WHO (467). As of 1998, 54 countries were in the process of updating or disseminating new service delivery guidelines, in part to eliminate barriers that unnecessarily prevent or restrict access to services (280). Many of these new guidelines state that all people, including adolescents regardless of their marital status, shall have the right and access to family planning information and services (177, 396, 412, 432).

Government policies often determine which contraceptive methods are available in a country and how they should be made available. Such policies include approval and registration of contraceptive products; prescription requirements; inclusion on the essential drugs list; regulations on sales, distribution, or delivery of services; restrictions on private medical practice; and policies on advertising (93, 205, 224).

Government limitations on service delivery can make it difficult for people to obtain family planning,for example, if the pill is available only by prescription, or if condoms can be sold only through pharmacies (236). Tax and import policies that increase commodity costs—for example, import tariffs, quotas, and exchange controls—often limit choice and access by deterring private and nonprofit sectors from providing contraceptives (94, 132, 133). Policies supporting decentralization or local decision-making, however, can increase access to family planning by responding better to needs specific to the community (185).

Government restrictions on advertising and promotion of prescription drugs or of family planning methods or brands usually mean that people have less family planning information (5, 236). When governments deregulate contraceptive advertising and increase broadcast airtime, people can obtain more information that helps them make family planning decisions for themselves (72).

Policies that prohibit certain methods entirely restrict choices. Japan banned oral contraceptives for family planning until 1999, when advocates for women's rights won a repeal of the ban on the basis that women needed more contraceptive choices. Some legislators argued that permitting the pill would decrease condom use and thus increase STIs including HIV/AIDS. Now, providers in Japan who prescribe the pill are required to advise women that the pill does not protect against STIs and to counsel pill users to use condoms for dual protection if they are not monogamous (302, 430).

Some countries—China and India, in particular—in effect have limited contraceptive choice through policies that promote long-term and permanent contraception over temporary methods (78, 463). Although the government of India now advocates a wider contraceptive method mix, some family planning providers still are ill equipped to offer the pill and other temporary methods (153, 199).