Despite progress, the vision of the International Conference on Population and Development to achieve universal access to sexual and reproductive health services, including contraception, remains unfulfilled. Transforming our world: the 2030 Agenda for Sustainable Development acknowledges the continuing need for sexual reproductive health and contraception by including two goals with targets aimed at universal access to contraceptive services. Realizing these goals will require greater focus and investment, to understand and address the barriers that millions of women and girls currently at risk of an unwanted pregnancy face in accessing and using voluntary family planning.
The partnership on High Impact Practices in Family Planning synthesizes and translates evidence and learning in family planning programmes to assist stakeholders in making evidenceinformed decisions to maximize the impact of resources and extend voluntary, high-quality services to everyone. A persistent challenge in realizing this vision is reaching those not well served by current programmes. To communicate the evidence base to better support countries in addressing this challenge, the partnership reviewed existing definitions, frameworks and evidence from intervention studies, and secondary analyses of national surveys, policy papers and grey literature relevant to equity in family planning.1 The review identified eight single-intervention studies on overcoming inequities conducted in low- and middle-income countries (Afghanistan, Burundi, Cambodia, Kenya, Pakistan, Rwanda and United Republic of Tanzania) between the years 2000 and 2018, as well as many analyses of national surveys. The eight studies, which showed mixed results, revealed variations in how equity is defined, with most addressing economic barriers to contraceptive use.1 Secondary analysis of national surveys analysed across time showed more consistent reductions in the equity gap for key family planning outcomes.1 While this type of analysis implies these programmes have been successful in expanding access to key populations, it does not elucidate how this success was achieved.
Drawing on these findings, we propose a more comprehensive approach for examining and addressing inequities in family planning. We aim to challenge researchers and advocates to expand their vision of equity towards a more inclusive and insightful analysis; to encourage managers and evaluators to incorporate a more nuanced approach in defining and evaluating success; and to support implementers in thinking more creatively about the root causes of inequity and programme responses, rather than to set out indicators or provide programmatic guidance in their use. We recommend expanding how inequities are characterized and how they are measured and evaluated to go beyond wealth as the sole driver of inequity and contraceptive use as the primary outcome.