The human right to control one’s own childbearing means people can both make and act on reproductive decisions. A human rights-based approach to contraception emphasizes the importance of supporting individuals and couples to make decisions, regardless of what they choose. Yet a gap exists between valuing individual choice and what programs are held accountable to in practice. There is a lack of robust rights-based measures and a continued prioritization of contraceptive use rather than rights-based benchmarks of success.

In a new commentary, researchers with Innovations for Choice and Autonomy identify areas for innovation in defining and measuring contraceptive agency and offer a new framework.

6 opportunities for innovation in defining and measuring contraceptive agency

• Focus on contraceptive-specific issues rather than broader indicators or reproductive autonomy.
• Shift away from equating covert use of contraception with disempowerment, recognizing that an empowered person could choose to use contraception without telling anyone.
• Include people’s consciousness of their rights and how societal injustices like gender inequality and poverty may be constraining them.
• Broaden the approach to sources of interference, recognizing that other people besides partners may interfere in contraceptive choices, particularly for adolescents whose parents may be involved or people who live with extended family including in-laws.
• Develop universally applicable measures that are not gender specific and can support reproductive health and rights for all.
• Shift away from equating contraceptive use with empowerment.

Contraceptive agency framework

A person of any gender with high levels of each of the 8 constructs in this new framework is considered to have high contraceptive agency, whether or not they decide to use contraception and regardless of what method they choose.

Agency in decision-making related to avoiding or delaying pregnancy:

1. To be clear about one’s personal values related to doing or not doing something to avoid or delay a pregnancy.
2. To have information and support in accordance with one’s preferences to make choices about doing or not doing something to avoid or delay pregnancy.
3. To be conscious of the right to contraceptive choice, including:
   1. Entitlement to use, not use, switch, or stop using contraception
   2. Right to have access to a wide range of contraceptive methods and to choose which method, if any, to use
4. To exercise critical reflection and be aware that intersecting social constructions can constrain or enhance individuals’ ability to exercise the right to choices related to doing or not doing something to avoid or delay pregnancy.
5. To believe one has control over decisions related to doing or not doing something to avoid or delay pregnancy, including who they would like to be involved in those decisions.
6. To have confidence in one’s ability to form and act on preferences related to doing something or not doing something to avoid or delay pregnancy.

Agency in acting on decisions related to avoiding or delaying pregnancy:

7. To be able to act in accordance with one’s preferences related to doing or not doing something to avoid or delay pregnancy.
8. To have control over who and to what extent others are involved in and aware of one’s preferred actions related to avoiding or delaying pregnancy.

This framework can serve as a guide for centering people’s ability to make and act on their own contraceptive choices, regardless of what those choices are, in contraception program design and implementation. Innovations resulting from the framework will be critical to help move the family planning field toward implementing, and holding ourselves accountable for, progress toward rights-based principles that are recognized but not always put into practice and measured.