INTRODUCTION

Over the past three decades, women around the world have increasingly sought to space and limit their childbearing, and millions are now using modern methods of fertility regulation. Although women pioneered the family planning movement and make up the majority of contraceptive users, they have had little or no hand in the design and introduction of modern fertility regulation methods. Nor have they been significantly involved in establishing policies relating to fertility regulation methods. Many women have encountered problems with these methods and the systems used to provide them. Lack of accessible information about how methods work, experience with and fears about method safety and side effects, along with documented cases of coercion, have led some women to question the appropriateness of particular fertility regulation technologies and to distrust family planning programmes.

As a result, over the past 15-20 years, women in different parts of the world have taken up issues of reproductive health. Their concern has been to empower women to control their own fertility and sexuality with maximum choice and minimum health problems by providing information and alternative services, and by campaigning for women's right to make informed choices about their fertility, for improved services and for more appropriate technologies. Such activities, among others, have become known as "women's health advocacy".

Recognizing the importance of these concerns and of consumers' views, researchers, policy-makers and service providers have recently begun to seek dialogue and collaboration with women's health advocates. In 1990, an external evaluation of the Special Programme of Research, Development and Research Training in Human Reproduction of the World Health Organization (WHO) recommended that the Special Programme consult with women's groups about its work. As a first step, the Special Programme and the International Women's Health Coalition (IWHC) jointly organized a meeting between scientists and women's health advocates to define how women's needs and perspectives can be brought to bear on the work of the Special Programme and of other organizations concerned with fertility regulation. The International Women's Health Coalition, committed to engaging women's health advocates in the design and development of public policy on reproductive health, saw the meeting as an opportunity to narrow the distance between institutions that formulate policy and the consumers affected by policy.

It was agreed that the meeting should focus on only one aspect of fertility regulation - the selection and introduction of fertility regulation technologies - because the field is vast and complex and because it was thought that the selection and introduction process offers significant opportunities for collaboration between scientists and women's health advocates.

The specific objectives of the meeting were to :

To ensure a balance of perspectives, similar numbers of scientists and women's health advocates were invited to participate. Eight international scientists (one from Africa, three from Latin America, two from Asia, and two from Western countries) who collaborate with the Special Programme, and eight staff of the Special Programme attended. Most of the scientists are physicians, working in a range of disciplines including epidemiology, reproductive biology, obstetrics and gynecology, biochemistry, and social science. The six women and ten men were selected for their expertise on contraceptive safety and efficacy, sexually transmitted diseases, provider-dependent methods such as implants and intrauterine devices (IUDs), and the introduction of new methods.

The fourteen women's health advocates included three women from Africa, four from Latin America, three from Asia, and four from international women's health advocacy organizations. They were chosen on the basis of their long experience in working with women and their ability to represent a broad range of women's views. Some are physicians who work in clinic or other service settings; others are involved in counseling and referral, information exchange and networking. Most work closely with low income women in both urban and rural settings.

The overall theme was addressed in four parts - selection of fertility regulation methods, method introduction, the research process, and women's participation - on which both women's health advocates and scientists were invited to prepare formal comments. Following plenary discussion of these issues, the participants worked in groups to develop recommendations, which were then discussed and agreed upon in a final plenary session. Debate was spirited and rich as participants candidly related their experiences and views, which were often quite divergent. Many questions which participants brought to Geneva were answered, but some remained unresolved and important new questions emerged.

This report is a synthesis of the presentations and discussion at the meeting. It aims to clarify key issues and encourage continued discussion and action at local, national and international levels. It is addressed to all those involved in fertility regulation who wish to make their policies and programmes more responsive to women's needs.


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