Hesperian Health Guides
Make family planning accessible
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What would it look like for a community to have fully accessible family planning? All women and men, including adolescents, would have easy access to reliable information about all types of birth control methods. Family planning services would be affordable, and available to all women — married and unmarried — who want to use these services. Family planning services would make different methods available, so a woman could use the type of birth control method she prefers and that best suits her needs. Finally, both information and services would reach everyone including youth, unmarried women, and those who live far away from a health center.
This section gives some ideas about ways to organize action to make family planning accessible to every woman in the community.
Learn about women’s experiences
To help make family planning more accessible in your community, you can begin by asking women about their experiences using birth control. If some women have had positive experiences, it can be helpful for other women to learn about them. Hearing from women who are satisfied with the method they use helps get rid of myths and fears about contraceptives. This can encourage other women to learn more and to consider if family planning fits their own situations.
Learn about the difficulties women and adolescents have had getting access to family planning information and birth control methods. You can begin gathering information about obstacles by asking about what types of methods are available and what they cost. Where do people get information about family planning and family planning services?
Here are some other questions that you can use to learn from women’s experiences:
- Are services offering birth control methods easy to get to and easy to use?
- Is it difficult for married women to get information and supplies for birth control? Why?
- Is it difficult for adolescents or unmarried women to get information and supplies for birth control? Why?
- How do most men feel about family planning? Are they willing to use contraceptives? If not, why not?
- How does the government promote or discourage family planning? Be sure to talk with many different kinds of people when getting this information.
Discuss obstacles to family planning
After learning about women’s experiences, it will probably be clear that there are many reasons why women cannot or do not use family planning!
A Problem Tree activity is a good way to help a group discuss obstacles to family planning, and look at the underlying or root causes that prevent full access to birth control. Clarifying the root causes and seeing how they are related then makes it easier to identify which issues are most important to address and the best actions to take.
Activity A Problem Tree to discuss obstacles to family planning
Draw the tree on a big piece of paper, cloth, a chalkboard, or even in the dirt. Leave the branches and roots simple and blank. Prepare pieces of paper (½ sheet is a good size) to write ideas about causes or obstacles and also consequences of the lack of family planning. Some people use sticky notes because they are easy to move around.
Write the health problem, in this case, "No Family Planning" on the trunk.
- Introduce the tree and the idea of root causes.
If the group is unfamiliar with the idea of root causes, you might use the example of weeds and the importance of pulling weeds out at the roots to clear a garden.
- Discuss underlying or root causes.
Ask the group to talk about the different causes or obstacles they have found for why women are not able to use birth control to prevent unintended pregnancies. (If the group has difficulties with this, you can also prepare a story that illustrates some of the causes or obstacles to accessing family planning in your own community, and ask the group to reflect on the story.) Write people’s ideas about causes or obstacles on pieces of paper that you can stick on or around the roots with masking tape, or place on the ground near the roots. Give everyone a chance to name something that causes or leads to lack of access to family planning.
- Group the root causes.
Read out loud all the different causes or obstacles that the group has thought of. Ask the group to talk about the ideas and put the ones that most relate to each other together on the different roots. Looking at the groups of obstacles you can then help the group see different categories of root causes. Label the roots with the names of these categories.
Another way to do this is to label the roots ahead of time. As people name different obstacles to family planning, put them near the root that they most relate to. (See Root causes of lack of access to family planning for types of root causes you can use.)
- Look at the consequences.
You can continue the activity and ask the group to name the different consequences of the lack of access to family planning for women, their families, and the community. These can be written as leaves and then placed on the branches of the tree. You can ask people to organize the branches by putting related ideas close together.
Root causes of lack of access to family planning
Grouping the different obstacles or reasons together into categories (using the Problem Tree or some other activity) can help the group begin to think about ways to improve access to family planning.
Political obstacles. If the government does not encourage family planning, services are usually limited and fewer methods are available. Community leaders that disapprove of family planning can make access difficult.
Economic obstacles. Birth control methods may cost more than women can afford to pay. Women may also be discouraged from using family planning if the community considers that children — especially boys — have economic value for the family.
Social obstacles. Rigid gender roles often mean that women cannot make decisions about their own health, and men may believe that using birth control makes them less masculine. Adolescents may not be able to talk with their parents, teachers, and health workers, and so do not get information about sexuality, sexual health, and preventing pregnancy.
Cultural or religious obstacles. Strong opposition by religious groups can make it difficult for people to get reliable information and contraceptives. Health workers may not understand or respect cultural and community traditions about family planning.
Environmental obstacles. If health services are far away or difficult to reach, women may not have regular or reliable access to family planning methods. In communities where infant mortality is high, women may feel they need to have more babies in hopes that at least some will survive.
Emotional obstacles. Women may lack self-esteem or a sense of control over decisions that affect their lives. Women may not trust health workers to treat them well and to respect their privacy.
Physical or biological obstacles. Women with health problems, for example high blood pressure, may not have access to the methods that are best for them.
Identify solutions to improve access
Having looked at the underlying causes, a group can then come up with solutions or actions that can improve access to contraceptives for all women. To select actions on which to to focus organizing, it helps to think about all possible actions that can be taken at the level of individual women, their families, and the broader community.
Activity A yarn toss to brainstorm solutions
To introduce the activity, ask the group to look at the Problem Tree activity above to see the obstacles or reasons why women do not use family planning, including the root causes. Explain that this activity will help brainstorm solutions that can be taken on individual, family, and community levels (referring to the branches of the Problem Tree). For this activity, you will need to remove the "consequences" leaves from the Tree first so you can replace them with "solutions."
- Ask the group to stand in a circle. The facilitator should stand outside the circle. To begin, ask one person to hold the end of a ball of yarn, and ask that person to name one of the obstacles to family planning. Then ask for someone else in the group to think of a solution to that obstacle.
- The first person holds onto the yarn end and tosses the ball of yarn to the person who has an idea for a solution. Ask that person to describe the solution and to say if it can be taken at the individual, family, or community level. Ask if anyone else has an idea that could be used to address the obstacle at another level (individual, family or community) not already mentioned. The second person holds onto the yarn, and tosses the ball to the next person who then shares an idea.
- As solutions are being named, write them on pieces of paper (which can be cut into the shape of leaves if you want). Tape them onto the tree in the areas of branches that represent individual, family, or community levels of action.
- Ask for someone else to identify another obstacle to family planning. Then ask others to share ideas for solutions to that new obstacle. Continue the activity until the group has created a web of yarn and everyone in the group has named either an obstacle or a solution.
- To conclude, reflect with the group on the range of possible actions they can take on all 3 levels, and on the meaning of the web they have created. Place the yarn web on the ground and gather around the solutions (leaves) on the tree. You can then use Voting with dots to select which actions to work on first, and the activity Making an action plan.