Almost two decades have passed since a groundbreaking global conference on population and development in Cairo declared that women had the right, alone or with a partner, to make decisions about the number of children they wanted. Nearly 20 years is long enough for a 14-year-old girl – in a rural Ethiopian village, a vast Indian slum or a small town in Laos – to have been married off to an older man she might never have met and to give birth in poverty to half a dozen or more children.
Tragically, that is exactly what has happened to millions of girls in many poor countries since the 1994 Cairo conference, because in the years since, international support for family planning, the key to keeping the Cairo promise, plummeted. Women’s rights, not the absence of contraception, became a rallying cry as billions of dollars were raised to combat the HIV-AIDS epidemic, an undeniably urgent cause but one that may have unintentionally siphoned money from other areas of family health.
By conservative estimates, at least 215 million women who learned about contraception and want to use it have no access to it now. Sometimes cultural factors – threats of domestic violence or male insistence on bearing sons – are the barrier; other times the simple fact is that a growing demand has outstripped the global supply of contraceptives available in poor countries.
A turnaround may be coming. In July, the British government’s Department of International Development and the Bill and Melinda Gates Foundation will sponsor a family planning “summit” in London to spark a renewed commitment to the basic needs of women’s reproductive health, an interest not seen for decades.
On April 5, Melinda Gates launched a Web page on the TEDxChange site asking women around the world to share their stories on the importance of contraception and family planning. It asks, “How have contraceptives changed your life?” Melinda Gates is now making this issue central in her work around the world.
The issue of contraceptive shortfall globally is not only about the rights of women but also about the uphill struggle to reduce maternal mortality and ensure access to family planning, the Millennium Development Goal (No. 5) that many experts say is least likely to be met by 2015. For countless women, this is a right-to-life problem first and foremost.
For each woman forced by circumstances to bear more children than she wants or can safely deliver, the result is often anemia, malnutrition, daily exhaustion and often physical damage, a leading killer of the youngest mothers still in their early teens. Abortions, a majority of them dangerous in the poorest countries, remain too high because there are no alternatives to another birth.
A fact-packed summary of contraception worldwide was recently published online by the Earth Policy Institute in Washington. The author, Brigid Fitzgerald Reading, using mainly United Nations Population Division figures, surveyed both the unmet needs and voluntary contraceptive preferences in regions around the globe. She found that African women – one in four — are most likely to lack access to family planning tools. In Africa, women who do benefit from family planning services most often choose the “pill” or an injectable contraceptive, the latter undetectable if social pressures are a bar.
Reading’s summary reports that globally, 34 percent of couples using modern contraceptive methods choose sterilization (led by India and China) or intrauterine devices, preferred by 80 percent of women in Asia. Nearly another third of couples choose condoms or pills. The pill is the most prevalent reversible contraceptive in Europe, Australia, New Zealand, the South Pacific and the Americas.
These and other regional differences outlined by Reading suggest that when leading population and reproductive health experts meet in London in July, one topic likely to be considered are these geographical preferences. Understanding them, and the cultural environments in which they are found, can help tailor family planning assistance to countries and societies.