The Zika virus outbreak in Brazil had some public health experts calling for the 2016 Summer Olympics to be moved from Rio de Janeiro or postponed. Some world class female athletes, including U.S. soccer team members, considered staying home, or hunkered down in their hotel rooms between games, to avoid the disease that can cause profound birth defects in children of infected women.
But what of the millions of Brazilian women of childbearing age, especially those in the poor and overcrowded neighborhoods, which the World Health Organization has advised travelers to avoid? The advice from health experts: don’t become pregnant. Unfortunately for women in Brazil and many other developing nations, birth control can be hard to obtain. And research shows that millions of people around the world want more access to family planning.
Enabling women to control how many children they have, and when they have them, brings enormous benefits not just to mothers, but also their children and their communities. Unplanned pregnancies can create severe economic hardships that perpetuate poverty, and they result in millions of abortions every year, many of them performed under unsafe conditions by untrained people. Having one baby after another often causes complications and even death. Inadequate pre-natal care and unsafe births and abortions are among the biggest killers of women globally.
Women have the right to decide when to get pregnant. To exercise that right, they need access to contraception and information about family planning. Unfortunately, too many women lack those important tools. Approximately 137 million women worldwide have an unmet need for family planning. These are women who are either married or in a partnered relationships and who want to delay or stop having children, but aren’t using contraception.
Cost is one factor, but it’s not the biggest. Family planning supplies cost about $1.55 per user per year, according to the Population Reference Bureau, which means we could address the entire unmet need for about $212 million. On the other hand, delivering those supplies to where they are needed would actually cost far more—between $2 and $35 per year per person.
A bigger obstacle is the lack of knowledge, particularly in developing nations, about family planning. Many women fear the potential side effects of contraceptives. They may not understand the risks that come with pregnancy and how to minimize them. Concerns about reactions from husbands or families, as well as religious beliefs, also prevent many women from using birth control. Education and counseling go a long way toward overcoming these obstacles.
The digital tools we take for granted are unavailable to millions of women in poor, remote areas, where knowledge can only be transferred in person – human to human. For many women, the first opportunity to learn about family planning comes during a visit to a clinic to have a baby, an abortion or treatment for a miscarriage. It’s essential to seize that opportunity and present information on how to delay or prevent another pregnancy to any woman who wants it.
Why is that so important?
Women who become pregnant less than five months after giving birth are 2.5 times more likely to die during their next pregnancy than women who wait 18 to 23 months. The risks are far greater in poor nations than in rich ones. The developing world accounts for 99 percent of all maternal-related deaths – estimated at 536,000 per year -- with 86 percent occurring in sub-Saharan Africa and south Asia.
To look at it another way, one in 7,300 women in developed countries die during pregnancy or childbirth, compared to one in 75 in developing countries and one in 22 in sub-Saharan Africa.
Reducing unwanted pregnancy also reduces abortions, which are a major threat to women’s health in poor countries. Of the 210 million women worldwide who become pregnant each year, nearly 80 million do not intend to. Slightly more than half of those unintended pregnancies – about 42 million -- end in abortion. Many of those abortions are performed under unsafe conditions, contributing to the deaths of nearly 67,000 women each year, along with injuries and complications that scar millions more for life. According to a Guttmacher Institute study in 2009, modern contraceptives could reduce unplanned births in developing countries by 22 million and maternal deaths by 90,000 each year.
In addition to improving health outcomes, family planning reduces gender inequality, enabling girls and women to stay in school and find better employment. Better educated girls and women are better equipped to understand and make their own life choices and less dependent on their families and husbands. Children from planned families often benefit from greater parental attention, nutrition and other resources, helping them grow and develop into more productive adults with a better chance of breaking the cycle of poverty. Their communities, in turn, have reduced need for social services, allowing them to spend scarce resources on more productive development programs.
Family planning delivers important benefits and shouldn’t be controversial. Enabling women to make their own decisions about bearing children is an important step toward improving health standards and economic outcomes for hundreds of millions of people.
Dilys Walker, MD, is Obstetrician Gynecologist, Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, Bixby Center for Global Reproductive at the University of California San Francisco and founding member of PRONTO International.