* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
By Jennifer McCleary-Sills
International Center for Research on Women
The 28-year-old Zambian woman I met at the medical clinic with two of her three children in tow had a clear mission: “I came today to get a 5-year method,” she told me. “I don’t want another child yet.”
The fact that she could articulate her desire, knew what contraceptive method she wanted – a Jadelle implant – and made it to the clinic makes her somewhat of an anomaly worldwide. Even rarer, her husband was on board with the decision. “My husband encouraged me [to get the implant] and supports me,” she said. “Child spacing is important to me because my husband doesn’t work, so resources at home are a bit difficult.”
It’s this kind of scenario, this type of self-awareness that public health experts, global development practitioners and government officials attending this week’s Family Planning Summit in London must ultimately strive to create for women around the globe.
The Summit could become a watershed moment in the field of reproductive health and rights, potentially re-energizing long dormant discussions, funding and political support for women’s right to decide whether they want children, when to have them and how many. Rightly, the Summit aims to tilt the conversation toward what women need, instead of how to control population growth.
Spearheaded by the Bill & Melinda Gates Foundation and the UK Government, the Summit’s goals include expanding the availability of family planning services, information and supplies to enable 120 million more women in the world’s poorest countries to use contraceptives by 2020.
While we wholeheartedly applaud and celebrate this effort, we also urge those gathering in London to remember that reaching 120 million more women will require stimulating greater ‘demand’ for contraception as well as increasing its ‘supply’. In other words, we can provide more clinics and information, more condoms and pills, and we should. But there are numerous intangible forces at work in women’s lives that prevent them from taking advantage of these services.
Without addressing the often invisible – yet powerful – barriers that block access to contraception, the international community will very likely fail to deliver on commitments it makes in London to give women better access to effective contraceptive methods.
More often than not, societies’ expectations of women significantly derail them from controlling their reproductive lives. In certain societies, cultural norms and gender inequities prevent women from simply recognizing that they have such options and rights. And even if they did, acting on the desire to have fewer children or wait longer between pregnancies could prove impossible within the confines of their personal circumstances.
In many cultures, motherhood holds critical importance, and women are keenly aware of the cultural expectations around childbearing. Women are pressured to prove their fertility soon after marriage or puberty. They are generally valued more, treated better in their marriage and face less risk of being abandoned when they have large families. Even better, if they give birth to sons.
These types of expectations around womanhood and motherhood can paralyze women from even acknowledging a desire to limit and space births.
Meanwhile, research shows that many women who do not use modern forms of contraception – such as the pill, IUDs and implants – say it’s because they didn’t know these methods existed, let alone understand the reproductive process. But even if women are aware of their contraceptive options, they still may not use them out of fear of side effects, social stigma, or disapproval from others, including those who may characterize them as shirking their social responsibility to become mothers.
And what about those women who have no such fear and know what they want? The challenge for them is whether they can access the local clinic or the village health worker that distributes family planning methods. Women may not have the means to pay for the transportation needed to receive such services. Their in-laws or husbands may disapprove or prevent their efforts to use contraceptives. Or their culture may demand that no man other than their husband can see them naked, but at the same time, the only health care provider they can find is male.
We must empower women to make informed decisions about when they get pregnant, how many children they have, and how often they have them, if at all. Tearing down the physical barriers that prevent universal access to contraceptives is a critical first step. But unless the more insidious social barriers are also removed, the benefits of science and technology will only go so far.
The family planning field must first understand – and address – the ways in which these social influences can affect a woman’s ability to exercise control over her reproductive life, and the way they can inhibit her desire to use contraception to that end. We also have to invest in measuring women’s understanding of contraceptive methods so we can better determine what they do and don’t know, as well as begin to develop new methods of contraception that best meet their real needs. And we must reconsider how and when to involve men in family planning decisions – like our couple in Zambia – so that they can decide together what is best for their family and for their futures.
McCleary-Sills recently co-authored the ICRW report, Women’s Demand for Reproductive Control: Understanding and Addressing Gender Barriers
