Policy Brief: Quality of Care in the Context of Rights-Based Family Planning

The anticipated outcome of improved service quality is likely to be an improvement in the effectiveness and duration of contraceptive use and an improvement in women’s and men’s ability to achieve their own reproductive intentions.


Every individual has the right to have children, if and when they want (UN, 1968; UNFPA, 1995). Many individuals, however, cannot implement this right in part because of community, familial, and religious impediments and in part because of obstacles they face in accessing and using family planning (FP) services. Rights-based approaches to health, sexual and reproductive health (SRH), and FP drew attention to many of these impediments including the AAAQ (Available, Accessible, Acceptable, and Quality) framework (UNCESCR 2000, 2016; Hardee et al. 2014; WHO, 2014; FP2020). Thus, rights-based FP includes quality but the reverse is not true because Bruce’s (1990) quality of care framework (hereafter referred to as QoC framework) applied to the users of services and did not include the other AAA dimensions of services. Admittedly, services must be available before one can inquire about other dimensions of services, e.g., how acceptable, and of what quality.

The term quality has been used in many ways (see Box 1). The QoC framework largely focused on client-provider interactions. Since the General Comment 14 on right to health proposed good health as the main outcome, quality in this formulation largely focused on technical, clinical, or medical aspect of services. The VRBFP framework attempted to combine the two—a step in the right direction. However, subsequent articulation of quality in General Comment 22 on the right to SRH and FP2020 went back to a primary focus on the clinical aspect of services. The articulation of quality in these rights-based approaches to some extent is circular as quality is defined in terms of services of ‘good quality.’

As there is a conceptual overlap and some differences among these articulations of quality, there is a need to compare and, if possible, to reconcile the elements of quality to ensure that the conceptualization, measurement, and monitoring of quality are coherent and not encumbered by redundancy. Kumar (2015) concluded that “With some modification, the widely accepted Bruce quality framework, which has guided international FP for twenty-five years, could continue to serve us well going forward.” This policy brief suggests five modifications to the QoC framework, which are based on the comparison of quality across frameworks, past experiences, and issues faced in measuring quality.