Marginalized women need family planning services too!

Woman shows a condom during training

IPPF has pledged to reach 60 million new users of contraception between 2012 and 2020, and is committed to reaching the most underserved populations. 

By Daniel McCartney, Technical Adviser on HIV/STIs with a focus on key populations at the IPPF Central Office

Women from key populations and other marginalized groups, including people living with HIV, sex workers, people who use drugs, and lesbian and bisexual women, have the same reproductive health rights as all other women. Often their needs are understood to be solely related to HIV or sexually transmitted infections (STIs) and not reproductive health and family planning needs. 

In 2014, the World Health Organization released consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Within these guidelines is a comprehensive package of evidence-based HIV-related recommendations for all key populations. This package includes not only HIV-related interventions but also specific recommendations to better manage sexual and reproductive health (SRH) including STIs, contraceptive, safe abortion, and cervical cancer screening services. 

The inclusion of SRH-related recommendations in the WHO consolidated HIV guidelines for key populations is a game changer. Women from key populations are made especially vulnerable by widespread discrimination, stigma and violence, combined with the particular vulnerabilities of power imbalances in relationships and alienation from family and friends. These factors increase the risk that they may engage – willingly or not – in behaviours that put them at risk of HIV, other STIs and unwanted pregnancy. 

However, family planning services for these marginalized women are often limited to the provision of condoms, or even forced sterilization. While male and female condoms are the only contraceptives that are effective for preventing unintended pregnancies as well as the transmission of HIV and other STIs, there is a need for the simultaneous promotion of and access to the many other forms of contraceptive methods. The need to discuss fertility and contraceptive options is often misunderstood by service providers. This is especially important among women living with HIV, women who use drugs, women who have sex with women, and female-to-male transgender people. 

All people have the right to make their own choices about fertility and to choose if, when, how and with whom to have children [1]. It is critical that family planning services are available, voluntary and non-coercive for all people. By integrating family planning and other SRH services with HIV services, there remains a greater possibility of addressing these often unmet needs.