There is a growing recognition of the need to integrate such services into primary healthcare and to afford them priority when it comes to reform and decentralisation. Take the example of the Islamic Republic of Iran, which in 1989 integrated a national family planning programme into its extensive primary healthcare system. This move not only led to increased access, but also helped to promote greater choice of contraceptive use. It proved to be a successful strategy. Measuring access to reproductive health services is anything but straightforward, since not only do questions like proximity to delivery points, the types of services available and their affordability have to be taken into account, but consideration also has to be given to the extent to which women feel free to utilise the available services.
Contraception is a case in point.
Its use increased in all regions in the 1990s but Africa lags markedly behind other regions, especially in the poorest African countries. Expanding the use of contraception clearly depends on access and information, but gender relations and power balances within couples are also important. Reproductive health depends on the extent to which men discipline their own sexual behaviour and support their partners rights and health. Power relationships are often embedded in culture and customs, which is why education plays such a determining role. Another major challenge is to increase access to reproductive health information and services for adolescents.