About the Consultation at Bellagio

The EngenderHealth-led RESPOND Project recently sponsored an experts consultation—A Fine Balance: Contraceptive Choice in the 21st Century—at The Rockefeller Foundation’s Conference Center in Bellagio, Italy, September 4–8, 2012, to deliberate on how to move contraceptive choice from rhetoric to reality. This event is part of a long-term effort to realize informed choice in practice by increasing equitable access to the widest possible range of family planning method options and preventing both coercion and barriers to access. The meeting examined issues influencing choice through the lens of a particular method, female sterilization, which is at once the most widely used method worldwide and the most controversial, and the availability of which varies among and within countries. Because female sterilization is highly effective, safe, and convenient, it is an excellent choice for those who have achieved their desired family size and want no more children. Not all couples will choose this method, yet its availability among contraceptive options should be assured for all as a matter of equity and reproductive rights.

This consultation is timely. It has been a decade since the last major review of trends in contraceptive sterilization. During that time, there have been major shifts in the environment for family planning programs worldwide, most notably the shift in international donor funding and emphasis on public health threats such as HIV and AIDS. There are also significant barriers to ensuring access to voluntary, quality sterilization services, particularly because they require a well-functioning service delivery system. Challenges include weakened health systems and inadequate human resource capacity to support routine delivery of clinical family planning services; normative and gender barriers that impede family planning access and decision making; political and economic contexts that compromise informed and voluntary choice (e.g., stigmatization of HIV-positive persons, performance-based financing of family planning programs); and persistent misconceptions and misapprehensions about sterilization. Incorrect information about the method and both past and recent reports of coerced or involuntary sterilization contribute to a negative image that constitutes a barrier to both access and use.

The reemergence of family planning as a global health priority, as evidenced by the recent London Summit on Family Planning, also makes this consultation timely. The renewed commitment to funding family planning service programs calls for a redoubled effort to make sure that clients have a range of methods from which to choose and that their decisions about whether and when to use family planning are both informed and voluntary.

The experts’ consultation in Bellagio brought together a diverse, multidisciplinary group of experts to focus on the challenge of ensuring informed choice in family planning. Eighteen experts representing different perspectives (service delivery, policy, community, demography, gender, rights, and media), and geographic regions explored factors that affect people’s access to family planning options and their ability to exercise their right to choose.

The consultation was informed by the latest data on contraceptive needs and use, information about clients, policies, service delivery, and technologies that affect method availability and use, emerging challenges, and lessons from program experiences. This evidence base provided a foundation for the group’s deliberations. Specifically, they:

  • Addressed the question “How much method choice and availability is enough?”
  • Examined what contraceptive choice looks like in selected national family planning programs from different regions
  • Explored the tensions and trade-offs that policymakers need to balance
  • Reflected on what contraceptive choice means to clients
  • Considered the impact of investing (or not) in making specific family planning methods, such as female sterilization, available

Recommendations from the experts that will help the reproductive health community realize contraceptive choice include the following:

  1. An operational definition of contraceptive choice that enables program leaders to assess and strengthen informed choice in their programs
  2. Clear messages for policymakers and communities about how to balance the various tensions that affect voluntary choice with respect to female sterilization
  3. Actions that donors, policymakers, and program managers can take to ensure that programs protect clients’ right to equitable access to female sterilization as one contraceptive option, within the context of free and informed choice

Please click here for the Consultation Final Report (PDF, 1.76MB).