Charting a Path for Adolescent Reproductive Control
24 May 2013
Anne McPhersonVice President, Global Communications [email protected]
Consider this: Half of the world’s population – more than 3.5 billion people – is under 30 years old. In the next decade, approximately 142 million girls will be married before the age of 18 and many will likely be pressured to prove their fertility soon after their nuptials. Indeed, of the nearly 16 million girls between the ages of 15 and 19 who give birth each year, 90 percent are married.
Given this reality, it is critical that the women’s health and rights communities gathering May 28-30 in Kuala Lumpur, Malaysia for the Women Deliver conference commit to involve young people – especially young women – in ensuring universal access to comprehensive sexual and reproductive health.
At last year’s London Family Planning Summit, governments and others promised to expand the availability of family planning services, information and supplies to enable 120 million more women in the world’s poorest countries to access contraception by 2020. Later in 2012, the International Conference on Population and Development Global Youth Forum, in Bali, Indonesia, brought together nearly 1,000 youth and experts on youth to chart a path toward ensuring that young people have access to the sexual and reproductive health information and services they need, and that societies respect young people’s sexuality and rights, while supporting youth to act as advocates for their own rights.
The international community attending Women Deliver must build on the advancements made in London and Bali. In particular, to bridge the tremendous gap that still exists between reproductive knowledge, desires and behaviors, we must better understand women’s and adolescent girls’ demand for reproductive control, the subject of a recent study by ICRW. In other words, we must optimize the ability of women and girls to effectively define their childbearing intentions and to use safe and effective contraception and abortion services in line with these intentions.
More often than not, societies’ expectations of young women derail them significantly from controlling their reproductive lives. In certain societies, cultural norms and gender inequities prevent young women from even recognizing that they have the right to do so. And even if they do, acting on the desire to delay their first pregnancy, have fewer children, or wait longer between pregnancies could prove impossible within the confines of their socially-derived personal circumstances.
Motherhood holds critical importance in many social contexts, and girls are keenly aware of the cultural expectations around childbearing even before they marry or become sexually active. Women are generally valued more, treated with more respect in their families and communities, and face less risk of being abandoned if they have a large number of children. Even better, if they give birth to sons. These types of expectations around womanhood and motherhood can prevent young women from acknowledging and expressing a desire to limit and space births.
Meanwhile, many young women who do not use modern forms of contraception say it is because they don’t know these methods exist, let alone understand the reproductive process. Girls often have very limited access to reproductive health information and thus cannot make educated decisions regarding their health needs. And even if young women are aware of the options for preventing or ending unintended pregnancies, they may not use these out of fear of side effects, social stigma, or disapproval from others, including those who may characterize them as shirking an imposed social responsibility to become mothers.
And finally, for young women who are not barred by these fears and who know what they want, the challenge is in accessing the right clinic or village health worker that distributes the appropriate family planning methods or, when needed, provides safe abortion services. Young women may face barriers such as lack of money or transportation, and providers or the law may require parental consent for services. Their in-laws or husbands may prevent their efforts to delay or avoid a pregnancy or seek an abortion. Their culture may demand that no man other than their husband sees them naked, but the only health care provider they can find is male.
As the young leaders in Bali noted, we must empower young women to be able to make – and act on – informed decisions about whether and when to get pregnant. Tearing down the physical barriers that prevent universal access to contraception and safe abortion is a critical first step. But unless the more insidious social barriers are also removed, the benefits of science and technology will go only so far.
Indeed, to effectively act on their reproductive demands, young women must first become aware that they have the right to control their childbearing. They must have knowledge of contraceptive methods and how to access them, and finally, they must have an enabling environment that allows them to effectively utilize contraception and abortion. Only through investing in efforts that target these multiple layers of demand for young women, will we be able to reduce unmet need, uphold the commitments of the London Family Planning Summit, and meet the recommendations of the Bali Declaration. Now is the time to deliver for the women of the next generation by ensuring that they are free to determine their reproductive paths and empowered to make these intentions a reality.
Jennifer McCleary-Sills is a senior social and behavioral scientist.