Evidence that policy barriers to equitable and affordable reproductive health services and information have been identified, addressed and/or removed
This indicator focuses on identifying the barriers that prevent the implementation of family planning/reproductive health (FP/RH) policies and developing strategic plans to eliminate obstacles to accessing RH services.
Policy barriers may affect participants in the policy process, service providers, and/or potential clients. They may affect both the public and private FP/RH sectors (such as restrictions on particular contraceptive methods or eligibility requirements for RH services) or may affect primarily the private sector. There are five categories of regulatory barriers:
- Regulations that constrain contraceptive options;
- Tax and import policies;
- Advertising and promotion regulations;
- Other regulations affecting the commercial sector; and
- Regulations affecting non-profit organizations.
Added to these are restrictions on access to training and exclusions from policy formulation meetings and other arenas in which policies are made. To read more about operational policies in RH and how to address them, see Reforming Operational Policies: A Pathway to Improving Reproductive Health Programs.
Evidence of a new/updated policy document such as a policy, strategy, operational plan, etc. that has addressed restrictions in the old policy. If the policies are addressing inequity, there should also be evidence that the new/revised policies focus resources or other attention on addressing the inequities identified.
This indicator can be quantified in several ways. As a baseline measure, it may be expressed as the number and type of policy barriers that significantly hinder provision of RH services. To measure change over time in a country application, the evaluator should count and qualify the policy barriers identified at baseline, which were subsequently removed. Evaluators can measure change through naming and counting those identified policy barriers that do not appear in the new policy. Evaluators should link clearly the barriers identified at baseline, the policy interventions carried out, and the barriers identified at follow-up.
Because policy barriers by their nature tend to be very specific, evaluators can readily assess whether the new policy removes them. For example, if the barrier removed is import duties on contraceptives, evaluators can interview commercial distributors to determine if they no longer pay duties.
Legal and regulatory reviews; actual policy documents with evidence of government approval or submissions for approval of changes. Key informant interviews can be conducted to identify other ways in which policy barriers were addressed, such as the creation of new operational policies, involvement of civil society and other stakeholders in addressing the policy barriers, and any strategic plans that have been developed to address those barriers.
The purpose of this indicator is to measure the extent to which policy barriers have been identified through the development of new policies, operational policies, and/or strategic plans and addressed through the implementation of these policies, strategies and guidelines. It highlights how policy reform can increase access to RH services for all sectors of the population. For example, removing client eligibility requirements– such as marital status, minimum age, or parity for receiving FP methods or RH care– empowers women and youth to demand the services and products they want. In another example, private sector participation in policy development may ensure that RH programs address the needs of all different groups in a population (e.g., women, men, commercial sex workers, men who have sex with men). The private sector can also be an important provider of RH services, especially in countries where government programs are either overburdened by demand or are unable to reach certain population groups.
Although a policy barrier may have legally been removed, the change may not be effectively practiced as attitudes and behaviors of the policy implementers can lag behind. For example, if a barrier constraining contraceptive options is eliminated– such as requiring parental consent to provide services to unmarried youth under age 18 — in addition to conducting a legal and regulatory review, evaluators should also interview providers to assess their awareness of the barrier removal as well as interview youth to assess their ability to obtain services.
If those interviewed are not forthright, the evaluators may not be aware of policy barriers those implementing the policy may face in the field. Evaluators also need to identify and interview those with institutional knowledge to document how policy barriers were identified and addressed. In some instances, a policy barrier may have legally been removed. However, it may be much harder to change attitudes and behaviors of those implementing policies.
Identifying and addressing policy barriers in an iterative process. Addressing one set of barriers will lead to the recognition of another set of barriers which will require further interventions. Hence, it is challenging to measure this process.
Fear of discrimination, or a breach of confidentiality, discourages many marginalized people from approaching health care providers. This is compounded by a lack of information tailored towards sexual minorities and a lack of capacity to provide specialized health services (IPPF, 2011). Because access to health interventions is inequitable for sexual minorities, the result is a disproportionately heavy burden of ill health among the socially disadvantage, which is positively associated with poverty.
A gender perspective on policy barriers examines the question, do the plans recognize the common and different barriers women and men face in access to health care. It also ensures that strategic plans made to address these barriers are gender sensitive.