Choice Interrupted: Politics and Complacency Undermine Access to Basic Contraception

Healy Thompson is a policy analyst and outreach coordinator for the Center for Health and Gender Equity (CHANGE).

Almost half of the women in sub-Saharan Africa who want to delay their next pregnancy or have no more children don't have access to modern contraception or other family planning services. Some of those women want to use contraception to space or limit births, because they're too young or too old or too sick or too tired to add new members to their families. Some have other aspirations for their lives right now than childbearing. Whatever the reason, a woman who doesn't want to get pregnant should be able to choose to use contraception and should have access to that contraception and to all reproductive and sexual health care services.

In addition to being able to choose when to be pregnant (or not pregnant), women who are pregnant should have access to prenatal care, safe delivery, and postnatal care and effective HIV prevention information and services. Reproductive and sexual health services provided in family planning and antenatal clinics are essential to the prevention of HIV and other sexually transmitted infections. A woman who is having unprotected sex is not only at risk of an unplanned pregnancy but also of HIV infection. In fact there are 4.3 million new HIV infections a year and in sub-Saharan Africa, women are 1.5 times more likely to be living with HIV than men. Male and female condoms are an essential method of contraception and HIV prevention that can be made available to women around the world when family planning programs are fully funded.

Every year, 525,000 women die from pregnancy or childbirth-related causes and 99% of those deaths are in the global South. An additional 8 million women endure serious health complications as a result of pregnancy and childbirth.

In the face of this extensive unmet need for reproductive and sexual health care, President Bush cut funding for international family planning programs by 25 percent in his budget for fiscal year 2008.

Now, I realize that I may not see eye to eye with the President on a lot of things, but I would think we could at least agree that childbirth should be a chosen and healthy experience for women.

But then again, adequately funding international family planning programs (which we weren't doing even before the 25 percent cut) might be interpreted as saying that a woman should have control over whether or not she has children. Someone could interpret it as suggesting that a woman's value should not be defined by, diminished by, or enhanced by the fact that she is or isn't a mother, is or isn't pregnant. And people might even go as far as to think that it means that reproductive and sexual health and agency is a basic human right.

And those are things that you just aren't going to get people to agree on.

After all, the oft-blamed Religious Right hasn't supported those things. But conservatives aren't the only ones to blame on this. Many moderates and liberals have checked their support for reproductive and sexual health and rights at the political door. So have many members of the global AIDS advocacy community who fear raising these issues will irk conservatives with whom they have cultivated relationships and result in losses for "more important and less controversial" things, like funding for treatment access. But those who choose to remain silent on reproductive and sexual health and rights do so despite the centrality of those issues to women's well being, in general, and to HIV prevention more specifically.

Whether they remain silent because they fear the controversy or because they mistakenly believe sexual and reproductive health to be outside their purview, moderates and liberals give permission, in their silence on the issue, for the devastation of international reproductive health and family planning programs to continue. This silence reinforces the mindset that providing women basic health care and allowing them control over their procreation is politically subservient to other goals and is a nice thing to do if we have extra money but that it isn't necessary, lifesaving work. This silence also becomes complicit in the spread of HIV infection, unintended pregnancy, unsafe abortion, and a raft of other means through which women suffer higher rates of mortality and morbidity than men. In effect, silence equals death for millions of women and girls worldwide, deaths that are no more or less important if they occur due to complications of AIDS or complications of labor and delivery, unsafe abortion, vesico-vaginal fistula, or violence against women who dare to use contraceptives to forestall bearing another child.

Reproductive and sexual health and agency is fundamental. It is fundamental to human rights. It is fundamental to the health and autonomy of 100% of the population and especially to the 50%+ of the population that has the ability to become pregnant. In addition, reproductive and sexual health and agency, especially that of women, is fundamental to infant and children's health, to HIV prevention, to economic and social development, and to environmental preservation.

Some advocates in the U.S. do recognize the fundamental nature of reproductive and sexual health and rights and have come together across differences to support family planning funding. A diverse and growing coalition of organizations—women's rights, faith-based, environmental, health, etc—are supporting the Focus on Family Health Worldwide Act, for instance. This bill, which is even more necessary in the face of the President's requested 25% cut, would authorize an increase in funding for international family planning programs through the U.S. Agency of International Development (USAID).

On March 1, more than 30 leading advocates from around Washington, DC are heading to Capitol Hill to meet with the offices of more than 40 members of Congress about family planning funding and to ask for passage of the Focus on Family Health Worldwide Act.

But as impressive as this coalition is, it is still too small for the significance of this issue. This is not just an issue for organizations that have the phrase "reproductive and sexual health and rights" in their mission statement.

Everyone who works on any issue that relies on healthy women needs to support family planning funding. Everyone who supports women's economic, social, or legal rights needs to support family planning funding. In fact, everyone who believes "women are people, too" (or is too embarrassed to admit they don't believe it), needs to support family planning programs. Additionally (and I'll just throw this out there to stir up trouble) anyone who has ever had sex where the intention wasn't procreation needs to support funding for family planning.

Go ahead, you can do it, pick up your phone (right now) and call your U.S. Representative and ask him or her to become a co-sponsor of the Focus on Family Health Worldwide Act, H.R. 1225. Then send an email to "the decider" in your office and explain why you think your organization should sign on in support of the Focus on Family Health Worldwide Act (you can email me with your organization's endorsement). If you don't work for an organization, or even if you do, find organizations in your community that might sign on (a place of worship, a community organization, etc.) and get them on board.

And if for some reason, the Focus on Family Health Worldwide Act isn't the vehicle for you or your organization, you still need to write to Congress and the media and explain why we must increase, not decrease, funding for family planning programs worldwide.

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