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Family planning for Girls: The get it right checklist.
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Family planning for Girls: The get it right checklist.



The FP2020 commitments were bold and ambitious. This checklist can help us all achieve them. ...

The FP2020 commitments were bold and ambitious. This checklist can help us all achieve them.

In summer 2012, donors, policy makers and implementing partners gathered at the London Summit on Family Planning. The outcome was FP2020 - a political and financial commitment to provide 120 million underserved girls and women with the opportunity to freely, reliably and safely use modern contraception by 2020. It was an ambitious goal. This checklist can help us all achieve it.



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    Family planning for Girls: The get it right checklist. Family planning for Girls: The get it right checklist. Presentation Transcript

    • 3 INTRODUCTION In summer 2012, donors, policy makers and implementing partners gathered at the London Summit on Family Planning. The outcome was FP2020 – a political and financial commitment to provide 120 million underserved girls and women with the opportunity to freely, reliably and safely use modern contraception by 2020. It was an ambitious goal. This checklist can help us all achieve it. 3 | GIRLEFFECT.ORG
    • 4 OUR AIM Of the 120 million people that FP2020 is aiming to reach, 26 million are adolescent girls. We need to make sure their voices, needs and rights are not forgotten. This checklist outlines steps that enable you to make strategic investments that expand family planning to adolescent girls, especially the most vulnerable. It’s a resource that can transform the way we think about and deliver family planning services to girls. 4 | GIRLEFFECT.ORG
    • GIRLS ARE CURRENTLY BEING IGNORED ‘Business as usual’ in family planning has marginalised girls’ needs and sidelined their voices. Cultural beliefs that girls should not be sexually active or in charge of their reproductive choices are used to justify denying them access to information about puberty, reproductive health and contraception. Social stigma, limited decisionmaking power and cost are common barriers to adolescents’ access to services.1 6 | GIRLEFFECT.ORG
    • GIRLS ARE HAVING SEX AND HAVING CHILDREN Research shows that unmet need for family planning is highest among the 300 million adolescent girls (15-19) around the world.2 Globally, about 16 million adolescent girls (15-19) give birth every year; 95% of them in developing countries where half of all first births are to adolescent girls.3,4 Among girls younger than 18 years, 90% of first births occur within marriage.5 Studies in four Sub-Saharan African countries have found that at least one in four adolescents (24-44%) are not aware of any source for obtaining contraceptives.6 7 | GIRLEFFECT.ORG
    • DOING NOTHING PUTS GIRLS’ LIVES AT RISK Medical complications from pregnancy and childbirth are the leading cause of death among girls aged 15-19 – more than 70,000 adolescent girls die each year in pregnancy or childbirth.7,8 Adolescent girls who give birth before their bodies are physically ready for childbirth are twice as likely to die during pregnancy and childbirth compared with women over 20.9 Girls aged younger than 15 are five times more likely to die during pregnancy or childbirth. 8 | GIRLEFFECT.ORG
    • INVESTING IN FAMILY PLANNING FOR GIRLS IS SMART ECONOMICS AND SAVES LIVES Targeted family planning for adolescent girls is a strategic, cost-effective investment that empowers girls: preventing a pregnancy in adolescence costs $17 per year, saves $234 per year and contributes to growing economies by hundreds of millions.10,11,12 Girls who have access to family planning information and contraception are older when they first have sex, are less likely to experience coerced sex if they have a supportive social network of adults and peers and are more likely to use contraception when they do have sex.13 Reliable access to adolescent-friendly family planning changes girls’ individual life trajectories, breaks cycles of poverty across generations and accelerates economic growth in developing and developed countries alike. This transformative process is the girl effect. 9 | GIRLEFFECT.ORG
    • 10 THE CHECKLIST The checklist contains six key goals that we should all aim to achieve in order to deliver better family planning for girls. For each goal we have highlighted key questions that need to be asked and how you’ll know if you’ve got it right. GOAL 1: MAKE IT WORK FOR EVERY GIRL GOAL 2: INVOLVE GIRLS GOAL 3: COLLECT, ANALYSE AND REPORT ON SEX AND AGE-DISAGGREGATED DATA GOAL 4: RESPECT GIRLS’ RIGHTS GOAL 5: TRANSFORM HER WORLD GOAL 6: MEASURE IMPACT AND SHARE LEARNING 10 | GIRLEFFECT.ORG
    • GOAL 1: MAKE IT WORK FOR EVERY GIRL Why Girls as a group are vulnerable, especially when they are sexually active and/or married.14 And the most vulnerable among them have the greatest needs and must be actively targeted and recruited.15 It’s the most vulnerable girls whose needs are greatest, whose lives will improve the most and who will yield the greatest return to their families and communities. Key Questions Do your investment strategies, plans and programmes articulate which girls are the most vulnerable to early pregnancy and the circumstances under which they become pregnant? Does your organisation have knowledge, human capacity or investments in locations where the most vulnerable adolescent girls with high unmet need for FP are living in poverty? You’ll know you’ve got it right if… Plans differentiate between, and invest in, separate interventions for married girls and unmarried girls. Family planning information and contraceptive services explicitly aim to reach vulnerable, hard-to-reach girls across the following categories: Domestic workers Child brides and married adolescents Child mothers Out-of-school girls Orphans Girls with disabilities 11 | GIRLEFFECT.ORG
    • GOAL 1 (CONTINUED): MAKE IT WORK FOR EVERY GIRL You’ll know you’ve got it right if… (Continued) Survivors of violence Very young adolescent girls (10-14) Girls living with HIV Funds invested in programming for specific vulnerable populations of adolescent girls are tracked. 12 | GIRLEFFECT.ORG
    • GOAL 2: INVOLVE GIRLS Why Girls have clear ideas of the obstacles they face and ideas about what needs to change for them to have their needs met.16 Girls’ isolation and vulnerability can make them hard to find. There are different ways to both look for them and invest in them, for example linking a family planning programme to a different profile of a girl who has need for information and services. Key Questions Have you meaningfully involved girls in all aspects of policy, programme investment, design, implementation and evaluation? Does your organisation earmark funds to support targeted recruitment of adolescent girls? You’ll know you’ve got it right if… Adolescent girls are involved in a way that cultivates and strengthens their voice, including the girls who are most vulnerable to early pregnancy. Quality of participation is assessed and monitored according to Hart’s Ladder – an internationally recognised measure of youth participation.17 At a minimum: adolescent girls share in adult-initiated decision-making on how to meet their needs (level 6) 13 | GIRLEFFECT.ORG
    • GOAL 2 (CONTINUED): INVOLVE GIRLS You’ll know you’ve got it right if… (Continued) Funds are earmarked for different recruitment strategies that target every girl, from the most to least vulnerable. Girl-to-girl: relying on girls to spread the word among peers who have similar social circumstances, especially beneficiaries of targeted family planning programmes, can reach all profiles of girls House-to-house: engaging women leaders in a community to visit households and request girls’ participation can reach the most vulnerable Community structures: using public activities such as civil society or religious groups may not reach the most vulnerable Existing programmes/schools: focusing here has limited reach Following up with girls who access family planning information and services through supported programmes is integrated into the evaluation framework. 14 | GIRLEFFECT.ORG
    • GOAL 3: COLLECT, ANALYSE AND REPORT ON SEX- AND AGE-DISAGGREGATED DATA Why Girls’ family planning needs to vary by age, sexual activity and marital status. You can’t reach them if you can’t count them or see the ‘big picture’ relationships between girls’ family planning use and their social circumstances. For example, data maps illustrate where unmet need intersects with high prevalence rates of child marriage and girls’ education levels. Key Questions Do your plans articulate which segments of adolescent girls are at risk of early pregnancy, and rank risk level by segment? Do you report on the girls you serve by tracking sex, age and marital status? You’ll know you’ve got it right if… You collect, analyse and report on sex- and age-disaggregated data on for all girls, including 10-14 year olds. You use national and sub-national data for girls 10-14 years and 15-19 years to structure interventions: Age at marriage Age at first birth HIV status Unmet need Knowledge, attitudes and use on contraception, HIV and violence. 15 | GIRLEFFECT.ORG
    • GOAL 3 (CONTINUED): COLLECT, ANALYSE AND REPORT ON SEX- AND AGE-DISAGGREGATED DATA You’ll know you’ve got it right if… (Continued) School grade for age Legal age of marriage, employment and consent to sexual relations You rely on data correlations between adolescent girls’ family planning knowledge, use and unmet needs, and their social circumstance to structure interventions: Marital status Place of residence, eg urban vs rural disparities Educational achievement and/or school enrolment status Attitudes on violence Your results, impact and lessons learned are data-disaggregated by sex and age where applicable. 16 | GIRLEFFECT.ORG
    • GOAL 4: RESPECT GIRLS’ RIGHTS Why Adolescent girls, like all women, have the right to choose when, how often and with whom to have sex; to access and use sexual and reproductive health services, information and education; to live in equality and free of discrimination. Girls face a double vulnerability stemming from their youth and their sex. International human rights and national laws and policies can help girls access family planning information and services only if they are in place, if they are enforced and if girls are aware of them.18 Key Questions Are girls’ rights to available, accessible, acceptable, high-quality care respected and are their family planning needs met?19 Are girls aware of their internationally recognised right to access and use high-quality contraception when they need it – and do they know the benefits associated with exercising that right? You’ll know you’ve got it right if… 17 | GIRLEFFECT.ORG Girls who participate in FP programming know their rights to, and the benefits of: 20 Information, informed consent and refusal Health services Contraception Freedom from harm and ill-treatment Dignity and respect A satisfying and safe sex life Liberty, autonomy, self-determination and freedom from coercion Marriage of their own choice
    • GOAL 4 (CONTINUED): RESPECT GIRLS’ RIGHTS You’ll know you’ve got it right if… (Continued) Non violence Refusal of unwanted sexual touching and sexual activity A national plan for providing family planning with a full range of contraceptive options that includes provision of family planning for girls is in place, along with necessary oversight and accountability mechanisms. National plans, strategies and programmes to prevent violence against girls as well as services to meet the needs of survivors are in place.21 Girls’ access to family planning information and services is not hindered by: Cost Distance to services Transport difficulties Laws prohibiting access to information and services by age Health service norms, protocols and guidelines support girls’ informed choices, girls’ decision-making and their right to confidential, affordable contraception of the highest quality. Interventions and services are adolescent-friendly – meeting the World Health Organisation standards: Girls have access to information about contraceptive options Girls have access to contraceptives Girls feel comfortable going to services Providers foster decision-making by girls Community-based contraceptives distribution includes girls as both distributors and beneficiaries 18 | GIRLEFFECT.ORG
    • GOAL 5: TRANSFORM HER WORLD Why Child marriage, sexual coercion, gender inequality and access to education are all factors that can impede girls’ access to information and services. Placing contraception within walking distance of girls is insufficient. Family planning for girls has to complement nonhealth interventions that give girls the social and economic assets to demand and use family planning. Key Questions How does the environment where girls live affect their access to information and services? How does your programme reflect knowledge of the conditions of girls’ lives? How do social and cultural factors, as well as the daily routines that influence where and how girls spend their time restrict agency, mobility and access to resources? You’ll know you’ve got it right if… Your programme builds on knowledge of the following dimensions of girls’ social connectedness/isolation: Girls’ living arrangements (with parents, husbands, in-laws, as domestic servants etc) Nature of gender norms and community support (among parents, teachers, traditional leaders and others) for girls and their equality and rights Policy, regional and school-level support for girls’ education Family planning programming for girls is linked to creative, girl-led community campaigns that target the people girls live with – parents, brothers, sisters, husband, in-laws, among others. 19 | GIRLEFFECT.ORG
    • GOAL 5 (CONTINUED): TRANSFORM HER WORLD You’ll know you’ve got it right if… (Continued) Campaigns aim to transform gender and cultural norms, redefining a new way forward for girls (and boys) – how and where girls spend their time, the value of education and delayed marriage, and the roles that men and women play in creating opportunities for girls to thrive. FP programming for girls is linked to mass media campaigns that challenge gender stereotypes and promote comprehensive sex education (in schools and other settings).22 Mass media campaigns recruit influential figures – community and religious leaders, athletes and female leaders Family planning programming for girls increases and tracks girls’ social networks among adult mentors and peers. Family planning programming for girls increases and tracks girls’ savings, safe (non-exploitative) income and her decision-making control over daily purchases. 20 | GIRLEFFECT.ORG
    • GOAL 6: MEASURE IMPACT AND SHARE LEARNING Why Shared learning is critical to reaching family planning goals. Driving forward progress to achieve FP2020 goals cannot occur without reporting what does and does not work for girls. Key Questions How can the global community design better interventions and share information to increase access to family planning information and services for girls? Are girls’ opinions, suggestions, achievements and apprehensions reflected in impact evaluations and summary reports? You’ll know you’ve got it right if… The intervention includes baseline and end-line data collection, allowing for post-intervention evaluations and sharing of evidence-based knowledge. The intervention builds upon evidence and recently published literature. The programme is designed and funded with scale-up in mind from the onset.23 Investments and programmes include public dissemination plans eg publish or otherwise share the process and the results (success or failure). The programme increases access to information and services for girls. For example: What percentage of adolescent girls have accurate knowledge of menstruation, and the privacy and means to handle it? What percentage of voluntarily sexually active adolescent girls seek to avoid pregnancy? What percentage use contraception? What percentage use condoms during high-risk sex? 21 | GIRLEFFECT.ORG
    • YOUR FEEDBACK We want to know how you’ve used this checklist, what you’ve learned and how you think it could be improved. Email us at info@girleffect.org 22 | GIRLEFFECT.ORG
    • SOURCES 1 Biddlecom AE et al., Protecting the Next Generation in Sub-Saharan Africa: Learning from Adolescents to Prevent HIV and Unintended Pregnancy, New York: Guttmacher Institute, 2007. 2 Greene, ME, S Joshi and OJ Robles. (2012a). By Choice, Not by Chance: Family Planning, Human Rights and Development (State of World Population). New York: UNFPA. 3 Melvin, A. and U. Uzoma. (2012). Adolescent mothers’ subjective well-being and mothering challenges in a Yoruba community, Southwest Nigeria. Social Work in Health Care. 51 (6): 552-567. 4 Bruce, J. Reaching The Girls Left Behind: Targeting Adolescent Programming for Equity, Social Inclusion, Health, and Poverty Alleviation. Prepared for: ‘Financing Gender Equality; a Commonwealth Perspective, Commonwealth Women’s Affairs Ministers’ Meeting, Uganda, June 2007, http://www.popcouncil.org/pdfs/Bruce2007_ Commonwealth_FullText.pdf 5 Bruce, Judith and John Bongaarts (2009). The new population challenge. New York: Population Council. Calculations by Bongaarts. 6 Biddlecom AE et al., Protecting the Next Generation in Sub-Saharan Africa: Learning from Adolescents to Prevent HIV and Unintended Pregnancy, New York: Guttmacher Institute, 2007. 7 Patton, G.C., et al. “Global Patterns of Mortality in Young People.” The Lancet 374.9693 (2009): 881-892. Retrieved from http://download.thelancet.com/pdfs/ journals/lancet/PIIS0140673609607418.pdf?id=e16241398b8eb460:61453979:12f087a24d6:-14711301520582196 8 Brown, G. (2012). Out of wedlock, into school: Combating child marriage through education. London, UK: The Office of Gordon and Sarah Brown. www. gordonandsarahbrown.com 9 WHO. (2011). WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes among Adolescents in Developing Countries. Geneva, Switzerland: WHO. 10 Sewall-Menon, Jesssica, Judith Bruce, Karen Austrian, Raven Brown, Jennifer Catino, Alejandra Colom, Angel Del Valle, Habtamu Demele, Annabel Erulkar, Kelly Hallman, Eva Roca, and Nadia Zibani (2012). The cost of reaching the most disadvantaged girls: Programmatic evidence from Egypt, Ethiopia, Guatemala, Kenya, South Africa, and Uganda. New York: Population Council. 11 World Bank (2011). World Development Report 2012: Gender Equality and Development. International Bank for Reconstruction and Development. Washington DC: The World Bank. 23 | GIRLEFFECT.ORG
    • SOURCES 12 Chaaban, J. and W. Cunningham (2011). Measuring the Economic Gain of Investing in Girls: The Girl Effect Dividend. Policy Research Working Paper, No. 5753. Human Development Network, Children and Youth Unit, and Poverty Reduction and Economic Management Network, Gender Unit. Washington DC: The World Bank. 13 Temin M and Levine R (2009). Start with a Girl: A New Agenda for Global Health. Washington DC: Center for Global Development. 14 New Population Challenge; Bruce and Bongaarts 15 Girl-Centered Program Design: http://www.popcouncil.org/pdfs/2010PGY_AdolGirlToolkitComplete.pdf 16 Greene, M., L. Cardinal, E. Goldstein-Siegel, Girls Speak: A New Voice in Global Development. International Center for Research on Women; Girls Count Series. www. coalitionforadolescentgirls.org. 17 Hart’s Ladder: http://www.myd.govt.nz/documents/engagement/harts-ladder.pdf 18 Ibid. 19 Adapted from Hardee, K., J. Kumar, L. Bakamijian, K. Newman, M. Rodriguez, K.Wilson. (2013). Framework for Voluntary, Human Rights-based Family Planning Programs: Ensuring that They Respect, Protect and Fulfill Rights: A Conceptual Framework. 20 Drawn and adapted from Respectful Maternity Care Advisory Council, White Ribbon Alliance. 2011. “Respectful Maternity Care: The Universal Rights of Childbearing Women.” Retrieved Jan. 20, 2013. 21 For best practices and evidence, see: www.endvawnow.org. 22 Kirby, D., B. Laris and L. Rolleri. (2007a). “Sex and HIV Education Programs: Their Impact on Sexual Behaviors of Young People throughout the World.” Journal of Adolescent Health 40 (3): 206-217; UNESCO (United Nations Educational, Scientific and Cultural Organization). 2009a. UNESCO’s Short Guide to Essential Characteristics of Effective HIV Prevention. Paris, France: UNESCO. www.unesco.org/aids; UNESCO (United Nations Educational, Scientific and Cultural Organization). 2009b. International Technical Guidance on Sexuality Education: An Evidence-informed Approach for Schools, Teachers and Health Educators. Volume 1: The Rationale for Sexuality Education. Paris, France: UNESCO. www.unesco.org/aids. 23 ExpandNet: Scaling Up Health Innovations: http://www.expandnet.net/tools.htm; Cooley, L., R. Ved, K. Fehlenberg (2012). Scaling Up – From Vision to Large-Scale Change: Tools and Techniques for Practitioners (http://www.msiworldwide.com/wp-content/uploads/Scaling-Up-Toolkit.pdf) & A Management Framework for Practitioners (http:// www.msiworldwide.com/wp-content/uploads/Scaling-Up-Framework.pdf). 24 | GIRLEFFECT.ORG