Why we have to #BeBoldForChange on reproductive health care

International Women’s Day is a day both to celebrate the wonderful women in all of our lives, and to highlight those issues that harm, disadvantage or impact women and girls in particularly negative ways. A year on from starting this blog, we’ve explored a few of these issues, including political representation, the world of work, and child marriage. But to me, one of the most basic steps any society can take towards achieving gender equality is ensuring that women have access to contraception and family planning services. The theme for IWD 2017 is Be Bold for Change and I cannot think of a more fundamental change that needs to happen than for women to have the right and the ability to make decisions about their bodies and their lives the world over.

 

What is reproductive health care? 

According to the UNFPA, having access to reproductive health care implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so. That means that both women and men should be able to protect themselves against sexually transmitted diseases, have access to contraception, and the ability to choose when to have a pregnancy.

Why is reproductive health care so important?

Reproductive care is important on a number of levels:

  1. Reproductive rights are human rights. Before we get into any conversation about why this issues is so important for gender equality, it is worth noting that access to reproductive care is first and foremost a human right. That is, that simply by virtue of being human, women and men both have the right to make decisions about their fertility and sexual well-being.
  2. Reproductive care is particularly important for women’s health. Given that it is women whose health may be impacted by too many pregnancies, not enough time between births, complications due to pregnancy or even maternal mortality (death relating to pregnancy), it is women who bear the brunt of the negative consequences of inadequate reproductive healthcare. The most recent WHO figures estimate that everyday 830 women die from preventable causes related to pregnancy and childbirth, 99% of these women live in developing countries.
  3. Control over reproductive health is vital in the fight for gender equality. Teenage mothers for example are of course far more likely to drop out of school with all of the knock on effects this has for their futures and for their children’s prospects. Moreover, because of the high cost of childcare and the expectation that women will do majority of the unpaid care work in the world, many mothers are effectively barred from entering the workforce or end up in low paid part-time work that they can fit around their children’s needs. Ensuring that women can control their own bodies would be a powerful practical change, but it also helps to undermine the patriarchal idea that women can be reduced to some biological function or that their role as mothers/ carers in some way makes them less than full and equal citizens. In order to ensure lasting change, 2 things need to happen simultaneously. Women must have control over their bodies so that they can choose how reproduction fits into their wider lives; while at the same time, the world around them needs to recognise that reproduction is a fact for both men and women and that women must be enabled to lead fully and happy lives in which reproduction is only one component.

These are just some examples of how lack of access to reproductive healthcare disproportionately disadvantages women and has far reaching knock-on effects for the rest of their lives. So, what does the data tell us about access to reproductive healthcare?

Contraceptive Prevalence

In 2016 the United Nations pulled together the data on the prevalence of contraceptive use around the world. The map below shows the prevalence of the use of any method of contraception in the most recent year for which each country provided data (click on the map for interactive version). What is startlingly clear is that contraceptive use is lowest in sub-Saharan Africa, with the lowest rate of contraceptive use being in South Sudan on just 4%. This means that just 4% of the women age 15 t0 49 (internationally agreed reproductive ages) reported that they used any form of contraception.

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Unmet Need for Family Planning

Of course, some people argue that a low contraceptive prevalence rate is not necessarily a problem, and may be as a result of women’s choice not to use contraception. Helpfully, the UN dataset used to make the map above also includes data on the unmet need for family planning. Effectively women are asked whether they want to stop or delay childbearing but do not have access to contraception.  Getting right to the heart of this issue then, we can see from the map below (click for interactive) that in the countries with very low contraceptive prevalence, a very high proportion of women reported that they wanted access to contraception but this need had not been met. Sticking with South Sudan as an example, while we saw above that only 4% of women had access to contraception, but 26.3% reported that they wanted to stop or delay childbearing but couldn’t. That means that a quarter of the women in the country feel that they do not have access to resources to control when and if they get pregnant.

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Where Does Abortion Policy Fit In? 

Abortion is undoubtedly a subject that many people feel very strongly about. For all of the reasons that I have outlined above, I see abortion services as a necessary and at times vital part of a suite of reproductive healthcare options. Not only because it is a human right and because it gives women control over their bodies and signals to societies that women can be trusted with this control, but also for this simple reason: banning abortion does not stop it from happening, it just makes it less safe. In 2016, United Nations experts called on countries around the world to repeal anti-abortion laws, estimating that this would save the lives of 50,000 women a year globally.  “Restrictive legislation which denies access to safe abortion is one of most damaging ways of instrumentalizing women’s bodies and a grave violation of women’s human rights. The consequences for women are severe, with women sometimes paying with their lives”. In 2016, the UN also made a landmark ruling that lack of access to abortion in Ireland was a violation of women’s human rights.

An argument that is often made against making abortion available is that it will lead to an increase in the number of abortions taking place. But according to these experts, “it has been demonstrated that countries where access to information and to modern methods of contraception is easily available and where abortion is legal, have the lowest rates of abortion.” 22 million unsafe abortions take place each year according to the WHO.

The Pew Research Centre has produced the below map from UNFPA data that looks at the circumstances under which women can legally obtain abortions around the world. Click on the map to see interactive version.

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Be Bold for Change

Since attending January’s record breaking women’s march I have been heartened by the renewed energy behind the movement for gender equality and the momentum for change. I commend every individual, group, organisation and country who will stand today for the issues that they care about, that impact them most, and work to make lasting and impactful change for women.

In particular I’d like to dedicate this blog to anyone whose lives have been negatively impacted by lack of access to reproductive healthcare, and to add my voice to those that are calling today for safer and fairer contraception, family planning, and abortion services around the world.

 

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