Understanding the importance of reproductive autonomy
Universal access to sexual and reproductive healthcare, including family planning (FP), is a global priority. However, measuring the success of FP programs has traditionally focused on tracking contraceptive use rather than evaluating whether individuals’ contraceptive preferences are being met. This approach fails to capture the critical element of reproductive autonomy – the ability for individuals to make informed decisions about their fertility that align with their personal goals and values.
Recognizing the limitations of contraceptive prevalence as a measure of FP program performance, researchers have proposed new rights-based metrics that prioritize self-perceived contraceptive autonomy. One such measure is ‘preference-aligned fertility management’ (PFM), which assesses the concordance between an individual’s desired and actual contraceptive use.
This article explores the insights provided by PFM through the lens of a study conducted among married adolescent girls in Northern Nigeria. By understanding the experiences of this population, we can gain valuable lessons about the importance of centering reproductive autonomy in FP programming and evaluation.
Prioritizing reproductive autonomy in Nigeria
Nigeria has made strides in expanding access to FP services, yet significant barriers to contraceptive use persist, especially among young, married women. Sociocultural norms, limited decision-making power, and concerns about side effects all contribute to the complex landscape of FP use in the country.
To better understand these dynamics, researchers conducted a prospective cohort study with married adolescent girls (aged 15-19 years) who were newly initiating modern contraception at public health facilities in Northern Nigeria. The study aimed to assess the prevalence of PFM in this population and to identify factors associated with alignment between contraceptive preferences and behaviors.
Measuring preference-aligned fertility management
PFM is a promising new metric that captures the extent to which an individual’s current contraceptive use matches their desired use. Unlike traditional measures of contraceptive prevalence, PFM places the individual’s preferences and autonomy at the center of the assessment.
In the Nigerian study, PFM was measured through a series of questions asked at a 3.5-month follow-up survey:
- “Do you currently want to be using a method to delay or avoid pregnancy?”
- “Are you (or your partner) currently doing something or using any method to delay or avoid getting pregnant?”
Participants were classified as practicing PFM if they:
– Wanted to use contraception and were currently using it, or
– Did not want to use contraception and were not currently using it.
Participants were classified as not practicing PFM if they:
– Wanted to use contraception but were not currently using it, or
– Did not want to use contraception but were currently using it.
The researchers also explored an additional measure, “satisfaction-adjusted PFM,” which incorporated participants’ level of satisfaction with their current contraceptive method. This provided a more nuanced understanding of reproductive autonomy, as dissatisfaction with a method can also indicate a lack of alignment between preferences and behaviors.
Insights from the Nigerian study
The study found that 97% of participants were practicing PFM at the 3.5-month follow-up, indicating a high level of concordance between desired and actual contraceptive use in this population. However, the researchers also identified important exceptions:
- 5% of participants reported not wanting to use contraception, but more than half of this group were currently using a method.
- An additional 3% of participants were currently using a method but reported dissatisfaction with their contraceptive method.
These findings highlight that even in a context with high contraceptive prevalence, a significant proportion of individuals may not be exercising full reproductive autonomy. The discordance between preferences and behaviors, as well as dissatisfaction with methods, provides valuable insights for FP programs to better support individuals in aligning their contraceptive use with their personal goals and values.
Implications for FP programming
The results of this study suggest several important considerations for FP programs seeking to promote reproductive autonomy:
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Shift from use-focused to rights-based metrics: Incorporating PFM into routine monitoring and evaluation can help identify instances of non-autonomous contraceptive use, allowing programs to direct targeted support to participants who are unable to act on their preferences.
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Address barriers to method satisfaction and continuation: Understanding the reasons behind method dissatisfaction, such as side effects or access barriers, can inform interventions to ensure individuals are able to use their preferred contraceptive method comfortably and consistently.
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Emphasize informed choice and personalized counseling: PFM underscores the importance of FP services that empower individuals to make voluntary, informed decisions about their fertility management, rather than prioritizing uptake of specific methods.
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Tailor services for adolescents and young people: Continuous contraceptive use may not be a relevant or desirable outcome for many adolescents and youth. PFM can help capture the nuances of their reproductive preferences and behaviors.
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Complement other rights-based measures: PFM provides a valuable, pragmatic complement to other emerging rights-based indicators, such as the Contraceptive Autonomy Scale, which explore the enabling conditions for free and informed contraceptive choice.
Conclusion: Advancing reproductive justice through PFM
The Nigerian study demonstrates the utility of PFM as a promising metric for evaluating the success of rights-based FP programs. By centering individual preferences and autonomy, PFM can help identify and address barriers to self-perceived contraceptive autonomy, ultimately advancing the goal of universal access to sexual and reproductive healthcare.
As the global FP community continues to grapple with the limitations of traditional use-focused metrics, measures like PFM offer a valuable pathway to reorient the field towards a true reproductive justice approach. Through the widespread adoption of PFM and other rights-based indicators, FP programs can ensure that individuals, especially marginalized populations like married adolescent girls, are empowered to make informed, voluntary decisions about their fertility.
For more information on Stanley Park High School’s approach to sexual and reproductive health education, please visit our school website.
