State of World Population 2012 - UNFPA Haiti

tDr. BabatundeOsotimehin, ExecutiveDirector of UNFPA,speaking at theLondon Summit onFamily Planning.©Russell Watkins/UK Department forInternational DevelopmentActivities that support the right to familyplanning may include:• Changing norms to generate long-termchange in demand, for example, workingwith men and boys to delay marriage andsupport female partners;• Mobilizing people to demand their rightsand to hold providers accountable for thequality of services;• Overcoming obstacles to access; for example,helping develop community transportationsystems.Some activities aimed at increasing demandfor family planning, such as encouraging malesto be more supportive of their female partners’family planning use and raising awareness ofthe health and economic benefits of being ableto space and time pregnancies are sometimesincluded in cost estimates because they aredirectly related to use of family planning.Efforts to change gender and other normsultimately related to sexual and reproductivehealth outcomes can be costed, but the “credit”they can take for increasing contraceptive use isdifficult to measure. This makes it hard to assesstheir cost in relation to family planning, eventhough they may ultimately have effects not onlyon family planning and other aspects of sexualand reproductive health but on other areas ofhealth and development. One example of anorm change intervention with concrete effectson clinical outcomes is the “Stepping Stones”curriculum, developed in sub-Saharan Africaand now adapted for use in dozens of countriesaround the world (Welbourn, 2003). The curriculumworks to alter the balance of power asit plays out in relationships between and amongmen and women in the community in waysthat impact health. Stepping Stones affectedgender-related attitudes in ways that reducedHIV incidence and increased condom use,among other outcomes, even measured a yearafter the intervention.There has so far been little rights discourse indiscussions about how much it costs to providefamily planning to all who want it. There have,however, been some instances in other fieldswhere the costs of ensuring human rights arefactored in to overall costs. A recent study ofcosts associated with treating HIV, for example,included estimates for supporting activities thatwould ensure the effectiveness of investment inproviding antiretroviral therapies. These activitiesincluded actions to protect the human rights ofpeople receiving treatment (Jones et al., 2011).A recent study attempts to calculate thehuman rights costs of offering antiretroviral94 CHAPTER 5: THE COSTS AND SAVINGS OF UPHOLDING THE RIGHT TO FAMILY PLANNING: