1. ASSESSMENT

CHECKLIST

Understanding the country context will improve the effectiveness of family planning programming. To accelerate progress, programmes must be contextualized to meet the differentiated needs of diverse population groups, including those left behind. An assessment of the country context helps to ensure a deep understanding of the country and/or region, the diversity of needs, and the specific challenges and barriers that are impeding progress.

This section provides guidance on how to use the most recent disaggregated data and the best available evidence to position the country in one of more contraceptive prevalence categories. Based on the specific country context(s), UNFPA country and regional offices are then encouraged to identify structural barriers to family planning in the country, to review and assess the status and effectiveness of current or recent intervention approaches, and to reflect on implementation gaps and opportunities available for improving the programme. UNFPA tools for specific issues are available (via links) to facilitate this assessment process.

The section is supported by a checklist to help UNFPA country and regional offices further reflect on programme needs, gaps and key areas for action. The checklist will link users to the relevant section of the acceleration plan for priority actions and programmatic options. Assessments identify key needs and/or areas where urgent action is needed.

Analyse the current situation

Conduct a desk review of the situation in the country regarding sexual and reproductive health, including family planning. Review current interventions and indicators on access, coverage and equity; where possible, use data from these UNFPA tools:

In addition, use tools available from external partners such as the following:

The desk review should identify existing gaps and bottlenecks in expanding access and utilization of family planning information and services.

Box: Leaving no one behind

The principle of leaving no one behind (LNOB) has become a cornerstone of organizational policy and practice across UNFPA. It informs pathways to achieve the ICPD Programme of Action and efforts during the Decade of Action to realize the Sustainable Development Goals. Leaving no one behind is a fundamental principle underpinning the 2030 Agenda for Sustainable Development. In essence, it implies a shift away from aggregate numbers and averages, and towards focusing much more energetically on who has not yet been reached. The UNFPA Strategic Plan, 2022–2025 specifically focuses on leaving no one behind and reaching the furthest behind as integral to setting a vision and charting a path to the three transformative results, including ending the unmet need for family planning. Success is to ensure that “those furthest behind enjoy equality in sexual and reproductive health rights”.

To use this principle in practice, UNFPA applies an equity lens throughout its operational approaches to reach women and girls and the most underserved. For family planning programming, this means:

Assessing access barriers for all population groups using disaggregated data
Identifying policy and service gaps in both quality and reach
Focusing family planning programmes to expand access to those with greatest need and furthest behind.

The UNFPA commitment to “leave no one behind” requires that we ensure that family planning programmes in the country reach those in need through programmatic efforts by UNFPA or our partners. UNFPA does not need to take the lead on all priority actions in the acceleration plan. Where other organizations are better positioned to lead, we advocate and encourage others to fill programmatic gaps. Together, with partners, we can ensure that everyone has access to family planning when they need it, including those furthest behind.

Understand the environment

Analyse where family planning is positioned within the political and economic landscape of the country context. Assess the status of the Government’s sectoral planning and policymaking cycles at national and subnational levels, and the current dialogue on plans for achieving universal health coverage (UHC).

In alignment with the Country Programme Document and Multi-country Programme Document (CPD and MCPD) processes, review the positioning of family planning (including key barriers and facilitators) within existing frameworks, strategies and plans, including National Development Plans, Country Common Analysis, SRHR National Strategy among others. This could include reviewing adherence to national policies, international standards and global commitments, e.g. inclusion of family planning in Essential Packages of Health Services, adherence to human rights principles and gender transformative approaches, and progress towards achievement of ICPD commitments and the targets of the Sustainable Development Goals.

Box: A differentiated approach through the human rights and equity lenses

The human rights-based approach places people – especially women and girls – at the centre. This is explained in the ICPD Programme of Action, para 7.3: “Rights-based family planning is driven by the needs and rights of the people the programme is meant to serve, rather than the programme’s structure, systems, staff or numeric goals” to meet the “basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children” (Kumar 2014).

A human rights-based approach to family planning is a requirement in all efforts to accelerate progress in making family planning accessible, available, acceptable, and of quality for all women and girls who desire it. Those least likely to have access are often those with the fewest options, power and autonomy to make decisions in their own right.

Identify key partners and strategic allies

Identify key stakeholders, and map strategic partners’ family planning initiatives within the framework of reproductive, maternal, newborn, child and adolescent health at different levels of the health system, such as national, sub-national, district and community. Recognize the alignment and harmonization of approaches by donors, funding opportunities and funding gaps. Document existing family planning-related governance frameworks and platforms, as well as entry points and opportunities to engage in continued dialogue with key stakeholders. A key strategy to increase funding and strategic partnerships is through a strong investment case.

Contextualize your approach and prioritize areas of intervention

Country contexts evolve, change and often coexist at the same time. For example, most low- and middle-income countries will transition to higher economic status yet inequities will continue to exist among population groups. Climate change and epidemiological threats will affect countries differently. Gains will be lost due to instability and crisis.

The most effective way to accelerate family planning progress is to take a differentiated approach to programming. This requires an understanding of the various contextual needs of population groups. The acceleration plan provides priority actions and specific programmatic options that can be undertaken by UNFPA or by partners for specific and more generalized contexts. An understanding of the different contexts will be important as UNFPA Country Offices decide what to do next. Five distinct contexts are defined based on modern contraceptive prevalence rate (mCPR), fertility level and setting.

Tailored intervention strategies are needed both for expanding access and for reducing unmet need. Expanding access and use of family planning will require addressing the need for family planning among women who would like to delay or avoid pregnancy but are not using modern contraception (called “unmet need”). In low fertility settings, or among low fertility sub-groups, family planning needs may be focused on ensuring availability of long acting contraceptive for women who do not want children, or for birth spacing. In some cases, two or more demographically different groups or geographic regions with different mCPR rates coexist in the same country, highlighting existing disparities at the subnational level. Information about mCPR can be used to assess the reach of various programme components. This also points to the need for developing new approaches and directions when programmes fall short in reaching those furthest behind.

Assessing programmatic needs and priorities

Policymakers often face difficult decisions about how to allocate scarce resources, balancing equity, effectiveness and efficiency. Building on the existing evidence and data (including at the subnational level) and the different inequalities identified within the context analysis, build consensus among key stakeholders including the government, for addressing the family planning needs of the most marginalized and vulnerable groups.

Recognizing that a country might not have the resources to respond effectively to all needs in the diversity of contexts. Prioritization of actions and a wide range of programmatic options is key. The prioritization of specific focus areas and the selection of programmatic interventions should respond to the country needs, in alignment with the programming principles that guide UNFPA family planning policy and programming.

As countries/regions will be at different stages of the programme cycle when implementing the Acceleration Plan, assessing programmatic needs and priorities may vary in depth and scope for each case. Identifying entry points throughout the program cycle to strengthen evidence-based programming and re-assessing the allocation of resources is an exercise that can improve the expected outcomes, regardless of the stage of the programme cycle.

Table: FAMILY PLANNING CONTEXT: Considerations and UNFPA suggested focus

Low mCPR context

Low mCPR is usually present in low-income countries. It is also present in some middle-income countries with high disparities at the subnational level.

UNFPA suggested focus: Changing harmful gender and social norms around FP, stimulating demand and establishing an enabling legal, policy and financial environment to ensure the access and availability of infrastructure and availability of infrastructure and resources needed to deliver quality FP services.

Growth mCPR context

Growing mCPR represents increasing demand for contraception but limited capacity to guarantee access and availability of quality family planning services and contraceptives.

UNFPA suggested focus: Eliminating barriers to services by ensuring contraceptive availability, high-quality FP services and continued demand generation. Countries may want to achieve and maintain rapid growth to maximize their ability to transform their population and benefit from the demographic dividend.

High mCPR context

Countries or areas with high mCPR might also experience inequities among subpopulations and de-prioritization of family planning investments.

UNFPA suggested focus: Prioritize equity in mCPR among different groups to ensure that no women are being left behind. Programmes focus on long-term sustainability, continued improvements in service quality, and expanding the range of methods available.

Low fertility context

Countries with low fertility rates do not necessarily have high mCPR or low unmet need for FP. These countries might experience de-prioritization of FP and adoption of pronatalist policies.

UNFPA suggested focus: Advocate for a human rights-based approach for FP and secure FP services provision is accessible and equitable for all in need, particularly for the most underserved and as part of a basic package of SRH services under a UHC context.

Humanitarian and fragile settings context

Large population groups experiencing life-threatening situations with limited access to basic services, including to quality family planning services.

UNFPA suggested focus: Saving lives at the onset of a crisis by implementing the MISP and later reestablishing access and availability for a comprehensive package of SRH services, including FP.

CHECKLIST

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