Two hundred and twenty five million women do not want to have a baby right now. Some want to finish school, while others want to rest before having another child. Many find themselves trapped in war zones, or forced to flee violence. Sadly, none of these women has access to the contraception that would give them control over their bodies and their lives.
Contraception is a proven way to save lives, reduce health costs, and empower women. It is a particularly effective life-saver for women affected by humanitarian crises. So why are 225 million women across the world, who don’t want a baby, still not using it?
Access to contraception is hampered by predictable problems: the cost, especially in poor countries; a shortage of supplies; or a dearth of trained health care workers. But there is a subtler, more pernicious, barrier that is preventing women accessing contraception and driving up maternal mortality: unfounded assumptions about what women want.
Over the years, I have repeatedly heard ― from governments, aid donors, and NGOs ― three painfully misinformed assumptions about why their organization won’t provide basic contraception.
The first assumption is that women from certain religions, or conservative cultures, don’t want access to family planning. This is nonsense. Evidence shows that women of all faiths use and want to use contraception. A 2011 study of American women found that 98% of Catholic women had used a modern contraceptive method, despite formal opposition from their church.
In the Democratic Republic of Congo, my organization, the International Rescue Committee (IRC) is providing contraception to thousands of women. One of the most ardent advocates is a nurse who happens to be a Catholic nun, and who says she has seen too many women die from complications of having children too young, too close together or simply too many. Muslim countries like Indonesia, Morocco and Algeria, meanwhile, have some of the most successful contraception programs.
The second misinformed assumption I hear is that women, especially those who are living in or have fled warzones, want to have more children to replace those killed during conflict. This sentiment, however, is diametrically opposed to what we hear from women themselves.
I am reminded of the story of a 25-year old woman who recently fled the Central African Republic with her husband and eight children. When she arrived at an IRC health facility in southern Chad, she immediately asked for an intrauterine device. She told the nurse that the ordeal of fleeing with eight children was enough, and choosing not to have another baby was one thing in her life that she could control.
The third assumption is that other people simply know what women want, better than the affected women themselves. The IRC works with millions of women and whether they are living in the United States or a Syrian refugee camp, they routinely tell us the same thing: that they want easier access to contraception; good family planning counseling; and more contraceptive options. Girls, in particular, say they want information about avoiding the hazards of early pregnancy ― rather than being ignored by health workers because they are unmarried. In short, women want us to listen to them.
And when we do listen, women tell us, with surprising consistency, that they want choice and control. They want power over their own lives. Contraception is an important way to help them. We do a grave disservice to women across the world when we make assumptions on their behalf, rather than simply ask them, about what they want.