I consider myself a strong advocate for the wide availability of family planning methods, and of women being able to decide if and when they want to become pregnant. However, in discussing my dissertation topic—family planning use in sub-Saharan Africa—with one of my professors a couple of weeks ago, I found myself saying, “Actually, I don’t really care whether women are using contraception or not.”
He looked at me strangely for a minute.
“I mean, I do care,” I went on to explain. “But what I care more about is that women have the right to decide when to get pregnant and how many children to have, about fewer women dying in childbirth, about fewer babies dying . . .”.
As family planning advocates, I think we need to remember that family planning is the means to an end, not an end goal in itself. We should care about the estimated 222 million women who want to avoid pregnancy but are not using an effective method of contraception—because we care about their reproductive rights, and the health and well-being of these women and their families.
Health and Social Benefits of Family Planning
On September 26, we commemorated World Contraception Day, a global campaign with a mission to improve awareness of contraception and recognize the importance of access to contraception for women around the world. The event also promotes the availability of accurate, unbiased information to prevent unplanned pregnancies, as well as empowering young people to make informed decisions about sexual and reproductive health.
Family planning has multiple health and social benefits. As summarized in the 2012 Guttmacher Institute and UNFPA report, Adding It Up: Costs and Benefits of Contraceptive Services, about which I wrote in June, the availability and use of family planning services can improve the health of women, the status of women in society, the health of infants and children, and the overall well-being of families. Among other findings, the report noted that an estimated 222 million women who want to avoid pregnancy are not using an effective method of contraception, and if these women were using contraception, it “would prevent an additional 54 million unintended pregnancies, including 21 million unplanned births, 26 million abortions (of which 16 million would be unsafe) and seven million miscarriages; this would also prevent 79,000 maternal deaths and 1.1 million infant deaths.”
Why Women Use/Don’t Use Contraception
Why do women choose to use contraception? And why are 222 million women around the world not using contraception, despite the fact that they don’t want to get pregnant in the near future?
A recently released report, Reasons for Using Contraception: Perspectives of U.S. Women Seeking Care at Specialized Family Planning Clinics, by Jennifer Frost and Laura Lindberg of the Guttmacher Institute, which interviewed more than 2,000 women across the country, shows that women in the United States use contraception because it allows them to plan their lives. Most participants said that contraception has allowed them to take better care of themselves or their families (63 percent), support themselves financially (56 percent), complete their education (51 percent), or keep or get a job (50 percent). Women also said that unintended pregnancy could have negative consequences on their lives and those of their families. Women with children said that being able to care for their children was a reason to use contraception.
Contraception in America, a study report released last week, showed that although 98 percent of OB-GYNs and 88 percent of primary care physicians report talking about contraception with their clients of reproductive age, “many women are not familiar with the differences between contraceptive methods; do not know which methods fall under different categories; or which method best meets their requirements.” As a result, many women in the United States who don’t want to get pregnant are not using contraception. As blogger Emma Gray pointed out in the Huffington Post a few days ago, in “Birth Control Study: Over 2 in 5 Women in The United States Don’t Use Contraception,” the study’s results indicate that women are underestimating the likelihood of getting pregnant accidentally and have misconceptions about birth control methods, including emergency contraception.
Reading about contraceptive use in the US, reasons that women cite for using family planning methods, and the knowledge gap about different methods made me think that perhaps how women make choices about family planning isn’t so different in this country than in other countries around the world.
The Link to Women’s Empowerment
A study recently published in International Perspectives on Sexual and Reproductive Health analyzed data from Demographic and Health Surveys conducted in several African countries between 2006 and 2008 and linked the data to a scale of women’s empowerment. According to data from Ghana, Namibia, Uganda, and Zambia, the more “empowered” women are, the more likely they are to use contraception. The study showed an association—but not causality.1 Which comes first: empowerment or freedom in reproductive choices?
It is important to continue to reflect on how we can ensure that more women—and men—have access to the information and services they need to make decisions about family planning. And how we can support health workers to have the skills and knowledge they need to help their patients make informed choices.
Supporting family planning also means supporting efforts that empower women to make those choices. Ideally, it means encouraging couples to communicate openly about childbearing and contraceptive choices. But it also means considering all of the other factors related to empowerment—including literacy, education, and economic well-being—that allow women to make the reproductive choices they want to for themselves and their families. Yes, access to information and services is critical, but increasing the use of contraception starts and ends with supporting the broader goals and rights of women.
1. Mai Do and Nami Kurimoto. Women’s Empowerment and Choice of Contraceptive Methods in Selected African Countries. International Perspectives on Sexual and Reproductive Health, 2012, 38(1):23–33.