With the world’s rich-poor gap under increasing scrutiny these days, this is a stark one: the wide divide between women, trapped by circumstance and culture, who have more babies than they want or can support, and women who desperately want a baby they cannot create.
The latter group resides in wealthier nations, where costly fertility treatments are on the rise among affluent, professional women who delayed families and marriage to have a career. But what made those choices possible is what the first group, an estimated 222 million women in developing countries, can’t access: proper family planning education and contraception. Providing these programs would prevent 16 million unsafe abortions a year, and significantly reduce maternal and infant deaths.
“The numbers are staggering,” says Gary Darmstadt, who heads the family health division at the Bill and Melinda Gates Foundation, which is co-hosting an international summit on family planning in London this week. “This is an extremely important human-rights issue. It comes down to putting the situation in the hands of women.”
The UN is using this year's World Population Day – to be commemorated July 11 – to call attention to the dire need for and benefits of contraceptives.
Since the 1980s, both local and foreign-aid resources for reproductive issues shifted to reducing the spread of HIV, especially as family planning initiatives in developing nations have become a political target. In 2009, President Barack Obama rescinded the executive order put in place by his Republican predecessor George Bush, which restricted federal funds for international groups that provided or promoted abortions – a move Bill Clinton also made, to overturn actions by Ronald Reagan. Canada received praise for highlighting maternal health at the 2010 G8 summit. But the Conservative government has also attached restrictions to programs that provide abortions, although, after government statements to the contrary, Prime Minister Stephen Harper clarified that contraception would be included.
According to a new study by the Guttmacher Institute, a U.S.-based organization that researches reproductive health, access to contraception in developing nations has been stalled since 2008 – and single women have an even harder time getting it than their married counterparts. But aside from being an important women’s-rights issue, expanding access and increasing education “is one of the most cost-effective investments a country can make,” says Dr. Darmstadt, citing research which suggests that for every dollar spent in Sub-Saharan Africa, as much as $6 are recouped in health and economic benefits. (In South Asia, the savings may be as high as $13.)
For women, having more reproductive choice means fewer children, spaced farther apart, and, as a result, a reduction in deaths during childbirth. The health of babies improves because they are breastfed longer and raised in smaller families with more resources since mothers are able to work, or acquire more education. Four out of 10 pregnancies, in developing countries are unplanned. The Guttmacher study estimated unplanned pregnancies in 2012 would result in 21 million abortions, as well as the deaths of nearly 80,000 women and 1.1-million infants.
But family planning requires ongoing and comprehensive programs, points out Jacqueline Darroch, co-author of the study. “This is not something you cure with a vaccine,” she says. “It needs to be part of general health care.”
Profile of an unwanted pregnancy
In a too-common story in her village of Kisiwa in Tanzania, Maria Mwaya found herself unexpectedly pregnant at the age of 16. When she tried to continue to attend school, she was ordered home: she was seen as a mother, and no longer a student. The father of her son “ran off,” and she has no idea where he is. The youngest daughter among five siblings, she expected a life like her mother’s trying to cook and care for larger family than she might have wanted.
Today, Ms. Mwaya, now 19, is a peer health educator, instructing other young people in her village about contraception and sexually-transmitted infection. Along with her work collecting and selling wood through a supplier, she visits classrooms and leads gatherings under a tree in the village, as part of a family planning program funded by the African Medical and Research Foundation, partly with Canadian funds. She gives out condoms that young people are reluctant to pick up at the clinic themselves, and speaks to girls about their personal rights about relationships and sex. Discussing reproductive health, and making contraception more easily accessible is necessary to empower young women, especially when getting pregnant forces them to leave school, explains Ms. Mwaya, in Sawhili, on a cellphone from her village. (Her comments were translated by Rita Mbeba, the project manager of the family planning program.) “Girls are also able to make their own decisions in terms of marriage, and able to say no.”