When we talk about reproductive health and rights, we often talk about access to contraception.
Indeed, access to and information about contraception is a foundation of realizing reproductive health and rights. But there is so much more in the equation – and what it all boils down to, in the end, is choice.
Fully realizing reproductive health and rights means people can choose freely and for themselves the number of children they want, when they want to have them, and how they parent them. And this requires more than access to contraception – it means breaking down the social, economic, and institutional barriers that inhibit free or informed choice.
In its annual State of World Population report, The Power of Choice, the UN Population Fund (UNFPA) examines those very barriers, country by country, that limit choices for women and families around the world. As UNFPA acknowledges in its report: no country has yet made reproductive rights truly a reality for all. The barriers are different in different places – some are larger, some are harder to resolve, than others. But they exist everywhere, meaning millions of women are having more or fewer children than they want.
In some cases, at an institutional level, health systems fail to provide access to a full range of contraceptive choices, or technology to assist women having trouble conceiving. Legal systems limit who can access essential services, including safe abortion, and when. Education systems fail to inform young people of their reproductive rights. And policies on parental leave and available, quality childcare are lacking.
Other times, economic barriers, like jobs with long hours and low pay, or health or childcare services that are unaffordable, put reproductive rights out of financial reach. And, around the world, persistent social barriers and gender inequality put women in a position where they may not be able to fully know or exercise their rights, or have the power and independence to make the choices they want.
To bring these complexities to life, UNFPA outlines a number of case studies of countries with different barriers – and, in some cases, solutions – to realizing reproductive rights.
Here are a few to consider:
Case study: Rwanda – Engaging men
After Rwanda’s horrific genocide, the government took a new approach to reproductive health, focused on making voluntary family planning more accessible for all. This led to an unprecedented increase in voluntary contraceptive use among women who were married or in a union – from 10% to 45% in just five years. In addition to increasing access, the government spearheaded campaigns to shift attitudes, including men’s views about family planning. Rwanda saw a significant increase in contraceptive use and tripled its per capita GDP from 2000 to 2016. According to findings from demographic and health surveys, it also became the only sub-Saharan African country where the proportion of men who say they want no more children is higher than that of women.
Case study: Bolivia – Empowering youth
Almost a third of the 35,000 inhabitants of Punata, Bolivia are young people. In 2012, Bolivia passed a law that established youth councils to give young people a voice in policies and governance. The first youth council was in Punata, where teenagers are helping bring conversations about reproductive rights out into the open to educate young people about sex, pregnancy, and contraception. As young people become more empowered and informed, they have more agency to make their own choices about their bodies, their futures, and their rights.
Case study: Belarus – Family-friendly policies
Olga and Andrey, a couple in Minsk, Belarus, have one daughter, Yulia, age three. They’d like to eventually have two or three kids, says Olga, but cannot afford it. Nationally, the average wage is about $430 a month, while the cost of living for a family of four is about $1,600 a month. Many couples, like Olga and Andrey, cannot afford to have the number of children they want. In 2002, the government launched a program to provide couples with financial support when they have children, from incentives for antenatal check-ups and birth, to full-pay maternity leave, to a monthly family allowance for up to three years of parental leave. The program has helped many families like Olga and Andrey start a family, but has not removed all obstacles along the way to a larger family – including barriers related to gender inequality in the workplace post-parental leave, and the lack of comprehensive sexuality education in schools to educate the next generation on their rights.
Case study: Thailand – The fertility spectrum
In Thailand, about 1.6 million babies were born to teenage mothers in the past 15 years. Kate was one of those teenage mothers. She did not learn about contraception before becoming unexpectedly pregnant as a teenager. While comprehensive sexuality education was taught in most high schools around the country, the quality varied. But now, a new law requires all high schools in Thailand to adopt the same curriculum. On the other end of the spectrum is Sanit, who focused on school and work in pursuit of economic stability. Now, at age 40 and recently married, Sanit is faced with challenges conceiving and has limited – and expensive – fertility treatment options.
Case study: Sweden – Investing in parental leave
Sweden’s investment in offering robust parental leave for both parents – a total of 480 days with a daily stipend – encourages shared parental responsibility. Ninety days are dedicated to each parent, the remaining 300 may be shared by the parents, and up to 30 days can be taken at the same time, allowing both parents to be home. This creates a good foundation for gender equality in the parental partnership, and parents in Sweden don’t need to choose between a career and a family.
These case studies illustrate the multidimensionality of reproductive rights – that the barriers, and the solutions, go beyond contraception. In reality, it is a combination of access to contraception and many other factors, including women’s empowerment, gender equality, inclusive economic development, and sound institutions and policies, that help couples make their own choices about family size.
As long as women and couples around the world are having more – or fewer – children than they want, reproductive rights are not universally fulfilled. Progress, then, is not in reaching an “ideal fertility” for the world. It’s reaching ideal fertility at a human level – the well-being of girls, women, and families who can freely and fairly exercise their reproductive rights and their power of choice.
Learn more about the Universal Access Project and get involved at http://www.universalaccessproject.org.
Photo: Olga and Andrey of Belarus with their three-year-old daughter, Yulia. © UNFPA, Egor Dubrovsky