What if the most life-altering reproductive choice is no choice at all?

An unseen crisis

Half of all pregnancies are unintended: that is 121 million unintended pregnancies every year, more than 300,000 unintended pregnancies every single day. These pregnancies take place in the bodies of people who do not deliberately choose pregnancy or motherhood.

For these women and young girls, as well as transgender and non-binary people, the most life-altering reproductive choice – whether or not to get pregnant – is no choice at all.

Over 60% of these pregnancies end in abortion. With 45% of all abortions performed worldwide being unsafe, it is one of the leading causes of maternal death.

An aspiration or an inevitability?

The SWOP 2022 report shows that globally, an estimated 257 million women who want to avoid pregnancy are not using safe, modern methods of contraception. And in 47 countries, about 40% of sexually active women are not using any contraceptive methods to avoid pregnancy.

Bringing these numbers to life, Odette Hekster (Managing Director PSI Europe) explains that “the use of modern contraception is influenced by a person’s position in a relationship, in a family, in a community and by a person’s dreams in life.” She stresses how “exercising basic rights goes beyond the right to sexual and reproductive health. It has to do with the right to bodily autonomy, the right to be free from violence, but also the right to other aspects of human development including access to education and decent work.”

This means that there is little point in talking about contraceptives before we know if a young girl or woman “sees motherhood as something inevitable or as a real life-choice?” (Beatriz de la Mora – UNFPA).

Franka Cadée (International Confederation of Midwives) questions the role of the health care professionals – specifically midwives – in a women’s journey through pregnancy. She proposes ”Shouldn’t we then – as healthcare professionals (red.) – ask women different questions when they come to us? So not ask them about their pregnancy, but ask them about their life. What do you want with your life? We just stick to sexuality. Of course, our work is broader than that as midwives, but I think all of us should start talking more broadly about life.”

A global crisis with global costs

Pascalle Grotenhuis (Director of Social Development and Ambassador for women’s rights and gender equality, Ministry of Foreign Affairs of the Netherlands) confirms the timeliness of the SWOP 2022 report: “Our Minister has felt it from the start. Sexual and reproductive health and rights (SRHR) are on our agenda for all the right reasons. We will never be silent on this topic.” She also stresses that SRHR is not only important for human rights, but also “for development, for education, for economics, and for life. And it’s for men ánd for women.”

Her colleague, Joris Jurriëns (Head Health and Aids Division, Ministry of Foreign Affairs of the Netherlands) elaborates: “It is important to focus on the chances and possibilities of young women… All these women and young girls make small and individual choices, that is what we aim for, but the impact of their choices is larger dan just SRHR. They have a tremendous impact on the progress of society as a whole, on economic production, technology and possibilities to improve.”

All guests agree that the effect of family planning and the cost-effectiveness of investing in contraception is huge. It does not only affect the well-being of the women and girls involved but on their relationships, their families, communities and society as a whole.

Bodily autonomy in times of crisis

During the first 12 months of the COVID-19 pandemic, the estimated disruption in contraceptive supplies and services lasted an average of 3.6 months, leading to as many as 1.4 million unintended pregnancies worldwide.

Our guest Brain Ssekajja (Reproductive Health Uganda) shares his experience from the past two-and-a-half years: “Uganda had the world’s longest lockdown: the schools were closed and health facilities were partially locked for almost all of 2020. This affected access to SRHR services, including family planning services.” He continues: “The ‘SRHR and COVID-19 study’ shows that the surge in unintended pregnancies in Uganda was bound to happen. We need to scale up our efforts to improve women’s decision-making power in family planning services. Also, we need to improve access to age-appropriate and accurate information. And last, SRHR services should be prioritised and considered essential services that should continue during a pandemic.”

Beatriz de la Mora (UNFPA) adds: “The whole health service was strained, and contraceptive services were disrupted dramatically. Not only because of the supply chain but because resources were deployed elsewhere. Here, you can see that we had created a demand for contraceptives. During the pandemic, there were women that had to move to specific a centre to meet their healthcare workers that would bring her the contraceptive method she had gotten used to, that worked for her. It was very, very hard to keep that in place. And why wouldn’t she still have access to that method that worked for her? That put us all on our toes.”

Joris Jurriëns (Ministry of Foreign Affairs of the Netherlands): “COVID-19 has had a highly negative impact on health and SRHR worldwide. There is more, financial services are under pressure as well. For example, half of the budget of Burkina Faso goes to the response to COVID… On the other hand, because of COVID-19 health is high on the International agenda. We can turn this into an opportunity. We should be strong in debating the indirect impact of covid on the health and rights of women and girls. In this way, it could help us get back on track again.”

Unintended pregnancies are of all times, this is nothing new. They are a private matter, but they should concern all of us. Because it’s not just a personal issue, but also a health issue, a human rights issue, a humanitarian issue, a development issue: it’s a global crisis.

In that sense “COVID-19 is a lens to problems that were there before,” concludes Lisa de Pagter (Rutgers).