Juliet Dobson: Delivering access to contraception worldwide

Current economic and political climates are posing a threat to women’s sexual and reproductive rights

juliet_dobsonThis week the 2017 Family Planning Summit took place in London. Policymakers, donors, and advocates from all over the world gathered to discuss efforts to increase global commitment to ensuring that 120 million more women and girls have access to modern methods of contraception by 2020.

Ahead of the launch of the summit, I spoke to Katja Iversen, executive director of Women Deliver—an organisation that advocates for the health, rights, and wellbeing of girls and women—to discuss the Family Planning Summit and the threats that current economic and political climates are posing to women’s sexual and reproductive rights.

Despite the current challenges, Iversen found much to be positive about. She described the summit as a chance to take stock of progress that has been made so far, an opportunity to think of ways to accelerate progress, and a time to assess new challenges. She said that this a “good” moment to underscore women’s ability to make decisions about their fertility and pointed to recent figures from Guttmacher Institute, which show that more contraceptives are being given. There are still 214 million women in developing countries who want to avoid pregnancy, but are not using a modern method of contraception—but three years ago it was 225 million women. This highlights the need for the availability of family planning choices and the right mix of options. In some countries, it is not just a question of access or availability, but information. We need to make sure that women aren’t too scared about the side effects of contraceptive methods to use them, and also reduce any stigma around using contraception.  

Since Donald Trump reinstated the Global Gag Rule on his third day in office as president of the US, however, the climate in which organisations such as Women Deliver operate has become much tougher. The executive order blocks US support to any organisation that even discusses abortion as a form of family planning. The huge effects of this in terms of funding have been widely discussed.

On this point, Iversen was frank: “It is going to be tough,” she said, “We saw this last time.” Abortion rates actually increase when a global gag rule is in place. She is predicting two notable consequences. There will be “self censorship,” as people won’t even want to talk about family planning for fear of repercussions. There will be political pressure. Lower middle income countries will step away from providing family planning and reproductive health for fear of the political and trade effects.

The most important way to prevent abortion is by providing full access to family planning, she said. But we also have to acknowledge that family planning can fail, and therefore a health system that delivers must provide access to safe abortion as well. Complications from an unsafe abortion are still among the top five causes of maternal mortality worldwide, further underlining not only the need for access to safe abortions, but also for family planning.

One of the few positive effects of these tougher times, is the increased political awareness. Iversen especially pointed out the “She Decides” campaign. And in terms of funding, other countries, organisations, and people have already stepped up to pledge funding.

Women deliver focuses on young people in particular. “We mustn’t betray a generation,” said Iversen. Meeting young people’s family planning needs and providing them with the right information has an impact on their health, on communities, and on the planet. When mothers’ thrive, communities thrive as well. Women invest more in their families. Girls and women spend 90% of their earned income on their families, while men spend only 30-40%. Women Deliver is using networks in 108 countries to provide information, advocacy, and training.

I left our meeting feeling positive. Despite the current threats, much has been and continues to be achieved to improve women’s sexual and reproductive rights. I do believe that recent events have raised awareness and made women across the world stand-up more for their rights. We saw this so memorably with the women’s marches across the world the day after Donald Trump was inaugurated as president. But nevertheless I am feeling uneasy about what is to come. In the same week when we heard the news that a 19 year old woman has been sentenced to 30 years in jail under El Salvador’s extreme anti-abortion law after experiencing obstetric complications when delivering the baby, it is all too clear that there is still a long way to go. 

Juliet Dobson is digital content editor, The BMJ