This piece originally ran on allafrica.com
Access to birth control, which empowers women with the agency to decide if, when, and how many children to bear, is a fundamental human right.
While increased use of contraception among women in low- and lower-middle-income countries has successfully prevented over 141 million unintended pregnancies, curbed 29 million unsafe abortions, and averted nearly 150,000 maternal deaths, only 1 in 4 women in these developing nations can realize their desired fertility intentions. This means that an unacceptably large number of women are still having more children than they want – with dire consequences.
Every 2 minutes a woman loses her life due to pregnancy or childbirth-related complications. In conflict settings, this number doubles, illustrating the exacerbated risks faced by women in fragile environments. Even for those in relatively safe economic, social and political spaces, the physical, emotional and mental burden of carrying an unwanted pregnancy presents health risks that threaten the wellbeing of both mother and child.
Family planning has immense and far-reaching advantages. Women with access to modern contraception are often more empowered to choose their futures. They can pursue education and careers, participate more meaningfully in economic development, and should they decide to have children, can make decisions on when to do so, how many children to have, and how to space them – all decisions with considerable bearing on their health.
Yet in many African countries today women continue to face barriers to access, often encountering religious objections, controlling behaviours from partners that manipulate reproductive choices, and societal pressure to have children or keep having them until a male heir arrives. In addition, stigma around the use of contraceptives persists alongside reinforced falsehoods regarding their safety, which have fuelled misconceptions about their long-term effects on fertility.
Many of these barriers are rooted in patriarchal structures that seek to disenfranchise women. Women who are denied agency over their own reproductive health are often less likely to engage in meaningful employment, forcing them to rely on their partners for their livelihoods and leaving them more vulnerable to poverty and abuse. This is the fate of over 40 percent of women worldwide who are still denied the right to make autonomous and informed decisions concerning their sexual and reproductive health.
While some women are fighting back by keeping their use of contraceptives a secret (12,2 percent of women use contraception covertly in Kenya), they shouldn’t have to resort to such extremes to reclaim their autonomy. True autonomy, after all, cannot be enjoyed in secret.
Denying women this right is an affront to their agency and their standing as equal members of society. Depriving them of the opportunity to make decisions regarding their bodies is a form of oppression that we must stand up against. We must stop politicizing women’s health. Pregnancy and childbirth – or the decision not to experience these life events – could mean the difference between life, the quality of life, and death. Such weighty matters should not be reduced to a hot topic on a campaign trail or a footnote in a budget statement.
East African governments for example allocate up to five times more funds to debt repayment than health expenditures, including those which are essential to women. In Kenya, the government has cut health funding in the 2023/2024 budget by KES 5.6 billion (close to 39 million USD), further jeopardizing reproductive health services. This state of affairs threatens to reverse the hard-earned gains in healthcare achieved over the past decade. It is also evidence of the lack of female representation at decision-making tables.
Studies have shown that when women are involved in health decision-making at the highest levels of government, there is higher expenditure on health, education and social protections. For every extra dollar spent on contraceptive services, we could save three dollars in pregnancy and newborn care expenses.
Equitable representation at health decision-making tables is therefore not just about ticking the gender representation box; it’s an economic development strategy. Better reproductive health means better survival outcomes for children, which impacts the demographic dividend. Economic modeling has suggested that in Kenya, Nigeria, and Senegal, the national income per person would increase by 31 to 65 percent if unmet family planning needs were met. Such models have a greater chance of being realized if we reimagined the face of health leadership and empowered more women to lead across all levels of health decision-making – from the boardrooms to the bedrooms.
We are living in extraordinary times. The impact of the COVID-19 pandemic on our economies and health systems, conflict and climate change present additional challenges that further threaten hard-won progress in enhancing access to sexual and reproductive health rights for women and girls.
As we celebrate World Contraception Day, we must unite in our efforts to address these challenges and advocate for more equitable access to quality, accessible and comprehensive reproductive health care.
By including the voices of those most affected by health policies on access to contraception, we can enrich the lives of women, their families and entire communities. In doing so, we can also accelerate progress toward the achievement of the Sustainable Development Goals.
