Voluntary Participation and Informed Choice in Family Planning

For nearly 40 years, USAID's assistance to family planning programs has been guided by principles of voluntarism and informed choice. These principles reflect basic American values and are contained in legislation, program guidelines, and regulations (see Box 1). Under these principles:

• People have the opportunity to voluntarily and freely choose whether to use family planning or a specific family planning method.



• Individuals have effective access to information on a wide variety of family planning choices and services.



• Information including the benefits of using family planning and the health benefits and risks of particular methods is provided to help inform their choice.

In addition, long-standing laws and policies require that clients of USAID-funded programs be offered, either directly or through referral, a broad range of methods and services, and that the voluntary and informed consent of any clients choosing sterilization be verified by a written consent document signed by the client. In October 1998, Congress enacted an amendment initiated by Rep. Todd Tiahrt (R-KS), reaffirming and further elaborating standards for voluntary family planning service delivery projects to protect family planning "acceptors," that is, the individual clients receiving services (see Box 2).

USAID Compliance With the Tiahrt Requirements

Working with government agencies and private organizations, USAID has provided assistance to national family planning programs to help them put the needs of clients first.

• Training. USAID has trained hundreds of thousands of physicians, nurses, and other health workers to provide family planning services. This has included training to improve technical knowledge of contraception and strengthen counseling skills so that providers give accurate information and communicate effectively with clients.



• Service delivery guidelines. Since 1993, USAID has supported development and dissemination of new family planning service delivery guidelines in approximately 50 countries and other activities to make programs more responsive to clients under its Maximizing Access and Quality of Care (MAQ) Initiative.



• Choice of methods and information on benefits and risks. USAID spends from $50-60 million annually to provide contraceptive supplies in more than 60 countries so clients can access methods suited both to their childbearing goals and health needs. Funding also supports materials that inform providers and clients about different family planning methods through print, broadcast, and electronic media.



• Research to improve family planning methods and quality of care. USAID is the leading donor in biomedical research on improved contraceptives in developing countries. All USAID programs comply with federal research guidelines. USAID also supports extensive data collection, service delivery research, and monitoring and evaluation activities designed to improve quality of care and informed choice.



• Policy dialogue. USAID promotes informed choice in all of its family planning activities. Programmatically, informed choice includes effective access to (a) information on family planning options and (b) the counseling, services, and supplies necessary to help individuals decide when to obtain or decline, or simply consider their service options. For example, in an effort to expand the use of family planning options for both women and men, USAID-supported advocacy efforts led the Government of the Philippines to adopt natural family planning methods as part of the Ministry of Health’s official family planning program methods. Similarly, USAID assistance helped persuade Bolivia’s Ministry of Heath to include the Standard Days Method among its recommended family planning options.

Implementing Tiahrt Requirements

In consultation with Congress, USAID incorporated the Tiahrt provisions into all agreements with organizations that assist family planning service delivery projects and has communicated the restrictions to USAID staff, implementing partners, and host country counterparts. Additional measures have also been taken to help ensure that essential information materials on contraceptive methods will be available on demand at every service delivery point of projects receiving USAID assistance. USAID monitors compliance with the Tiahrt amendment requirements as part of its routine monitoring of program implementation.

USAID must report to Congress within 60 days on any violation and corrective actions taken, or, in the case of (4), report on a pattern or practice of violations.

Prepared June 2004