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Contraception Around The World
The Debrief: Women’s experiences of contraception vary wildly depending on where we happen to have been born – and that needs to change
Developed in partnership with and sponsored by HRA, manufacturer of ellaOne. The healthcare professionals included in the discussion do not endorse any specific brands.
Contraception methods around the world reminds us just how lucky we are.
I remember when I took my first pill. I popped the sugary yellow sphere out of its tiny oblong shaped plastic packet, where each day was clearly marked out for me. I was 16. Everyone was ‘going on the pill’, even though few of us were having sex. We’d all taken our school’s sex ed equation ‘Beware: man + woman = sex = baby’ to heart and were taking the necessary precautions.
And the fact is, as a young woman living in the UK today, I am very lucky. I have made choices. I have control over my body. And the number of choices available to us is constantly increasing.
Two generations ago my story could have a very different ending. In Britain the NHS has only provided the contraceptive pill since just after its invention in 1961 and specific contraception services since 1973. The Morning After Pill has only been available since 2001. In my adult life I have always been able to access contraception and information about my reproductive choices whenever I have needed it, for the most part (although not always) without shame or stigma and, always, without having to pay for it.
Around the world, it’s a different story...
According to Marie Stopes International in developed countries such as the UK, contraceptive use has plateaued between 60% and 80%. In east Africa, if current trends continue, it will take another 45 years for usage to reach 60%. In west Africa, the same rates will not be achieved for 500 years by their calculations.
It’s estimated that there are around 225 million women worldwide right now who would like to be able to access contraception but can’t. Women’s experiences of contraception vary wildly depending on where we happen to have been born.
Jagdish Upadhyay, Chief of the Commodity Security Branch for the United Nations Population Fund, tells me on the phone from his office on Third Avenue in New York, ‘I went to Mali with one of your ministers. We were standing in a queue outside one of our centres in a rural area. There was a young girl, in her teens, the minister started talking to her, asking why she was there. She was in high school, she wanted to finish high school, she said. She was married, she wanted to use a long term method of contraception so that she could finish her education before becoming pregnant.’
‘It’s a human rights issue’, he says. ‘If we can provide these women who want and need [contraception] with it we can reduce maternal mortality, empower women, make them equal, allow them to complete their education, give them the choice to decide when they want to have a child – it’s her right and if she can’t do this then she can’t contribute to a better life for her family. That’s why this is important.’
According to the Global Poverty Project women make up a staggering 70% of the world’s poor, earn only 10% of the world’s income and only half of what men earn. All of this despite making up more or less half of the world’s population. For Joan Summers, the International Programmes Support Director at Marie Stopes, this is why access to contraception is key. ‘From a more general, global perspective’ she says, it’s about ‘planning, resource allocations and strong economic development with women’s participation’. ‘Contraception’ she says really is ‘a cornerstone piece in development work.’ If women do not have control over their own bodies, over when they have children, how many they have and who they have them with it’s difficult for them to have control over their own destiny.
As American feminist activist Gloria Steinem said most women are ‘one man away from welfare’ and that holds true wherever you are in the world if you become pregnant at the wrong time, under the wrong circumstances, with the wrong person. The only caveat being that in many parts of the world there is no welfare to fall on.
￼In Zambia nearly 30% of all teenage girls fall pregnant before their 18th birthday. This is compounded by high rates of child marriage, with 45% of girls already married by 18 and 65% by the age of 20. The availability of contraception is key here because of such cultural factors.
￼Both Jagdish and Joan tell me that the main barriers to providing contraception in countries where there is no organised state healthcare like our NHS are geographical (in countries where rural towns are very far apart and infrastructure is not always in place) and cultural. It’s about logistics and attitudes.
￼Joan says that religious beliefs play a big part in the use of contraceptives. ‘In Pakistan, for instance, women often move in with their husband’s family after marriage’, she says. Using contraception is seen by some to be against the teachings of the Qur’an and traditionally Islam has favoured withdrawal (which of course relies on you trusting your partner to pull out in time), although the Conference on Islam and Family Planning has agreed in recent years that it can be used under some circumstances. ‘In a culture like this where women live more communally, taking the pill is very obvious and your mother-in-law might not like it whereas getting the injection is more discreet, there’s less stigma. Women tell me they go for this because it’s invisible’, she added.
Last year in Zimbabwe (a country where 70,000 unsafe abortions are carried out every year and 21% of adult women carry the burden of being HIV positive) the country’s Registrar General, Tobaiwa Mudede, publicly urged people to stop using contraception, saying it was as bad as genetically modified organisms. 'So you want an injection or a tablet to interfere with that natural process created by God?', he said.
Jagdish says that one of the biggest challenges he has witnessed is gender-based violence when it comes to women choosing to use contraception. Writing in the Guardian, Faustina Fynn-Nyame, Kenya country director at Marie Stopes International says ‘women in Kenya and Ghana are brave because they are challenging the status quo... they are challenging what their mother and grandmother, religious leader and husband tells them. Their husband may not be happy about their choices, he may even beat her until she’s black and blue but they are determined to create real change.’
￼￼￼Myths, misconceptions and a lack of education are also big obstacle in many countries, according to Joan. She says the IUD (coil) is often not well received, ‘I’ve heard myths about children being born with them in their hands, or IUDs travelling through women’s bodies and hurting their hearts. For us counselling women about their choices is key.’ In Columbia last year a 22-year-old woman was rushed to hospital with stomach pains. She had inserted a potato into her vagina to avoid becoming pregnant.
￼The ultimate consequence of not having access to contraception or emergency contraception, wherever you are in the world, is unwanted pregnancy. Joan says in west Africa ‘225 women die every day from childbirth in ways related to unsafe abortion’. Today, there are six nations across the world where abortion is not allowed under any circumstances – the Holy See, Nicaragua, Malta, the Dominican Republic, El Salvador and Chile. Chile, where abortion is illegal even in cases of rape, unviability of the foetus or danger to a mother’s life, hit the headlines this summer as the country debated whether to allow it in ‘extreme’ cases. Currently women there face a five-year prison sentence for having an abortion, and an estimated 120,000 Chileans seek illegal terminations every year.
Closer to home, in Ireland, abortion is illegal except for when the mother’s life is in danger.
￼￼Joan says ‘what we know is that a woman will access the termination of pregnancy if that’s what they need and they will attempt many things that are very unsafe. Many individuals will offer these women in need options that are not safe – horrendous protrusions into women’s vaginas’. Contraception in the first instance is about choice and, in more extreme cases she says, ‘about preventing avoidable situations which endanger women’s lives.’
But access to safe, reliable, affordable contraception, is about so much more than preventing pregnancy. Having reproductive rights ensures that women’s bodies are left in their own hands, that their destinies are under their own control. These choices are just that, a right. A right to health, not a privilege.
Here in the UK, most of us grow up with plenty of information about safer sex and access to contraception. However, the choices available to us grow and evolve year on year. Sex education doesn’t stop at school, so it’s worth regularly researching contraception and speaking to your GP and pharmacist so that you stay informed and use the options that are best for your body and situation.
As well as the Pill, we now have the implant, the injection, the patch and the contraceptive ring. And if we do make a mistake, it’s never been simpler to access the Morning After pill over the counter at the chemists, with some pharmacies even offering the option of ordering it online. Sometimes life happens, and no matter how much we know about contraception, we make a mistake or our contraception lets us down. We’re lucky to live in a country where accidental unprotected sex doesn’t have to be life altering. The Morning After pill isn’t a long term choice, but it does put us back in control of our bodies - and our lives.
Contraception is what makes it possible for women all over the planet to finish their educations, make a living and have control over what happens to their bodies and when. Hopefully one day, women around the world will have as much education and access to contraception as we do in the UK. But it’s worth remembering that we’re incredibly lucky to have the resources to be responsible when it comes to our sex lives and our bodies.
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