Population Matters

Re-Examining the Global Barriers to Reproductive Freedom

April 17th, 2014

Every woman in the world should be able to space or limit her births. At a minimum, that means every woman should have access to the contraceptive method of her choice, whether it’s a female condom, birth control pills, an IUD, sterilization or a long-acting injectable. But physical access to contraception does not guarantee reproductive freedom. For many women in the developing world the real barrier to the exercise of reproductive choice is male opposition, religious teachings, social norms, or misinformation about contraceptive options.

There has always been some truth to the idea that supply creates its own demand: make modern contraceptives more available and more women will want to use them. But in male-dominated societies where religious teachings or social norms promote large families, there are practical limits to how far supply will drive demand. And that’s particularly true in areas where child marriage is still prevalent. When a girl is married at an early age, and her husband demands a large family, the mere availability of contraceptives does not guarantee that she can exercise reproductive choice. In societies where violence against women is widespread the exercise of reproductive freedom can even result in physical violence or even death.

The problem is, and it’s a significant one, is that countries with the highest fertility rates and the lowest rates of contraceptive use tend to be male-dominated societies where gender inequality prevails and religious teachings or social norms dictate larger families. Add to that ignorance or misinformation about contraceptive options, and women, in practice, may have little or no reproductive choice… even if modern methods of contraception are available. Girl brides, in particular, seldom exercise any real degree of reproductive freedom; any decision about childbearing is effectively out of their control.

Demographic and Health Surveys (DHS),commissioned by USAID, underscore the scale of the problem. In Ethiopia, where women still have nearly five children on average, the 2005 DHS reported that less than 1 percent of young married women (ages 15-24) not using contraception cited lack of access to a contraceptive method as their reason for non-use. In fact, nearly one out of four said they wanted to have as many children as possible. 7.1 percent cited male opposition to contraception as a reason for non-use; 14.3 percent cited religious opposition. 12.8 percent reported health concerns or fear of side effects as their reason for non-use, and 16.9 percent indicated lack of knowledge.

Similar results are found throughout sub-Saharan Africa. The 2008-09 DHS in Kenya found that only 1.2 percent of married women (age 15-49) reported cost or lack of access as a reason for non-use of contraceptives. More than three out of ten cited health concerns (14.9 percent) or fear of side effects (15.8 percent) as their reason for non-use, while 9.0 percent cited religious prohibition and 6.0 percent attributed their non-use to their husband’s opposition.

In Sierra Leone, where women on average have five children, the 2008-9 DHS found that only 1.6 percent of married women (ages 15-49) attributed their non-use of contraceptives to cost or lack of access. One out of seven (14.4 percent) reported male opposition as their reason for non-use, while 9.3 percent cited religious prohibition. In Mauritania the most recent DHS survey indicated that one out of four women not using contraceptives were deterred by religious prohibitions. In Liberia, Ghana, and Uganda, a fear of side effects stops one out of four non-users from using contraception.

These findings do not diminish the importance of ensuring that women in developing countries have access to a wide array of contraceptives. As contraceptives become more widely available and women become more informed as to the benefits of spacing births, more women will opt to use a contraceptive method. But in many countries the cultural or informational barriers to contraceptive use loom much larger.

The United Nations has declared that access to reproductive health services is a universal right and, as part of the Millennium Development Goals (MDG5b), it set 2015 as the target year for achieving universal access. The target will not be met. While the MDGs have achieved great success in many areas, progress with respect maternal and reproductive health has been disappointing. Any hope of achieving universal access to reproductive health care anytime soon will require much greater investments on the part of donor countries.

But it will take more than expanded access to contraceptive services to ensure that all women are capable of spacing or limiting their pregnancies. So long as a woman’s reproductive freedom is constrained by her husband’s opposition, religious prohibitions, or misinformation, she will not be fully capable of exercising that freedom. And because reproductive choice is so important to a woman, her family, and her community, the empowerment of girls and women — a high priority in its own right — takes on added importance.

Posted by Robert J. Walker, president

Originally posted on the Huffington Post on April 16, 2014

Climate Change: The Least We Can Do

April 8th, 2014

As the IPCC’s Fifth Assessment Report makes clear, we are long past the point of avoiding climate change. The best we can do now is to avoid the worst effects. The situation is more dire than previously projected and the consequences of inaction more starkly drawn than ever before:

Warming of the climate system is unequivocal, and since the 1950s, many of the observed changes are unprecedented over decades to millennia. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, sea level has risen, and the concentrations of greenhouse gases have increased….Over the last two decades, the Greenland and Antarctic ice sheets have been losing mass, glaciers have continued to shrink almost worldwide, and Arctic sea ice and Northern Hemisphere spring snow cover have continued to decrease in extent (high confidence)…. Continued emissions of greenhouse gases will cause further warming and changes in all components of the climate system. Limiting climate change will require substantial and sustained reductions of greenhouse gas emissions.

In a perfect world, the IPCC’s report would summon forth our best efforts at mitigating climate change and its effects. We would be doing whatever is necessary and prudent to avoid a human and environmental catastrophe. By now, however, it is evident that governments — and the people they represent — are shrinking from the challenge. Hope for concerted global action on any kind of meaningful scale has largely evaporated.

Instead of asking what is the most that can be done to mitigate climate change and alleviate its consequences, perhaps we should be asking, “What is the least that can be done?”

The “least” we can do is to mitigate the scale of human suffering and displacement, and the single most cost-effective means of doing so is to prevent unplanned pregnancies. Nearly 40 percent of all pregnancies in the world are unwanted or unintended, and preventing them would make a valuable contribution to climate change mitigation and adaptation.

Giving every woman the power to avoid unwanted pregnancies would dramatically lower projected population growth rates. According to the latest UN population projections, world population, currently 7.2 billion, is likely to reach 9.6 billion by mid-century and continue rising, but if the total fertility rate (i.e. the average number of children per woman) were to fall by just half a child, world population would rise to only 8.3 billion and gradually decline during the second half of the 21st century.

It’s particularly important to prevent unplanned pregnancies in the United States, where our carbon footprints are, on average, nearly twice as high as they are in many European countries and twenty or more times higher than many developing countries. A study released five years ago found that the average “carbon legacy” of a child born in the U.S. would produce about 20 times more greenhouse gases than the mother or father would save by adopting a lower carbon lifestyle (i.e. driving a highly fuel efficient vehicle, using energy efficient appliances, etc.).

But even where carbon footprints are relatively small, no one should discount the contribution that birth control could make to lowering projected greenhouse gas emissions. A 2010 study of energy use and demographics by Brian C. O’Neill concluded that slowing global population growth “could provide 16-29% of the emissions reductions suggested to be necessary by 2050 to avoid dangerous climate change.” That is not insignificant.

Even if preventing unplanned pregnancies in developing countries contributed absolutely nothing to reducing future greenhouse gas emissions, there is a compelling moral case to be made for expanding international family planning services and information. That’s because women and children in countries like Mali, Niger, Somalia, Uganda, Bangladesh, and Ethiopia find themselves on the front lines of climate change. Subsistence farmers, in particular, are vulnerable to the crop damage that will be inflicted by heat, drought, flooding, and rising seas. Some of the most vulnerable and food insecure countries in the world — countries that are already in a struggle for survival — could likely see their populations double or even triple in the next half century. Denying women in these countries the ability to space and limit their pregnancies will compound the suffering that is likely to be caused by climate change. Large families in environmentally-stressed communities will be less resilient and inevitably suffer more from disease, food insecurity, and water scarcity.

Access to reproductive health services is recognized by the United Nations as a universal right, but in many parts of the developing world it is far from being a reality. Making that right a reality for women everywhere may not save the world from climate change, but it would go a substantial way toward alleviating the human suffering that will accompany it. The costs of empowering women and providing family planning services are trivial compared to the benefits that would result from giving women reproductive choice. It really is the least we can do…for climate change…and for the women and their families who will endure some of its worst effects.

Posted by Robert J. Walker, president

Originally posted on the Huffington Post on April 7, 2014