• 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.

Government policies for social and economic development can improve people's ability to make informed family planning choices, particularly women's. Policies that improve women's status help them to make decisions for themselves, no matter what their age, class, race, or educational level (107).

Laws governing women's autonomy can foster informed choice by allowing women to make decisions for themselves, including decisions about family planning. In some countries, however, legal codes, based on strict interpretations of customary law, require that wives always obey their husbands, fathers, or sons (86).

Education and literacy policies and programs are crucial to foster reading, writing, and problem-solving skills. Particularly when girls receive more education, these policies and programs impart new attitudes and skills that enhance informed choices in many aspects of people's lives, including family planning. Women with more education typically have more autonomy and are better able to make decisions for themselves (27, 218, 297). Also, people who can read have more access to printed information about family planning and contraceptives (128).

Policies that encourage economic opportunities for women also encourage informed family planning choices. In 1995 research in Bangladesh found that participants in a microcredit program for women were more likely to communicate with their husbands and to have more autonomy and more decision-making authority than other women. This result held true even after researchers took into account differences between the characteristics of women who joined microcredit programs and those who did not (12).

Luthern World Relief In Ecuador young people study in a rural classroom. When policies promote education and literacy, particularly among girls, they help build reading, writing, and problem-solving skills needed to make informed choices, including those about family planning.

Donor Agencies

Most major family planning donors have official policies on informed choice that programs they fund must follow. Donor agencies with such policies include the United Nations Population Fund (UNFPA), the British Department for International Development, the United States Agency for International Development (USAID), the German Ministry of Cooperation and Development, and the European Commission (79, 95, 101, 161, 363, 433).

In October 1998 the US Congress passed an amendment, proposed by Congressman Todd Tiahrt, writing into national legislation many of the informed choice provisions that were already USAID policy. The legislation now requires that USAID formally include the policy in all agreements with organizations that assist family planning service delivery projects (433).

Donor agencies, like governments, need to ensure that their program priorities do not send mixed messages about informed choice (175). Some donors prescribe that programs simultaneously address such contradictory objectives as couple-years of contraceptive protection and informed choice (16, 260). The tension between different program objectives can mean that family planning programs must decide which objective takes precedence.

Family planning donors have long played an essential role in encouraging choice by ensuring that family planning programs have adequate supplies of contraceptive methods. Funding for donated contraceptive commodities is falling, however. In 1999 total donor support for commodities amounted to US$130.8 million, a decrease of US$12.4 million, or about 9%, from the previous year (431). Governments, donors, and programs that are committed to meeting the needs of the people will give high priority to informed choice principles and to providing the means for people to realize their choices (22).