Executive summary

Reproductive choice and women’s empowerment

To choose when and whether she has children is a fundamental right belonging to all the world’s women.
Despite this, even conservative estimates acknowledge that at least 200 million women are denied this right and do not currently have access to the family planning information and services they want and need.1 The UK government has rightly taken a stand, recognising that women’s ability to control when and whether they have children is fundamental to the achievement of all the Millennium Development Goals (MDGs), particularly those on promoting gender equality and empowering women, reducing child mortality and improving maternal health.

The government’s current approach concentrates on the provisions gap: seeking to improve the supply of contraceptives in developing countries and to reduce their cost. This work is critical; as is making sure that women and girls are able to choose from a range of contraceptive options that best meet their particular needs. That said, improving supply is only one of the issues that will need to be addressed if the goal of universal access to contraception is to be realised.
Many women and girls, even where contraceptives are available, will be prevented from accessing or using them by a myriad of social barriers caused by gender inequality. These include:

A lack of services that cater to women and girls’ needs: the attitudes and prejudices of service providers may hinder certain groups of women and girls from fully accessing services, including those who are unmarried, adolescent, disabled or living with HIV.
Providers may provide partial or misleading information to direct the choices of women and girls according to their own perception of the appropriateness of certain methods.

A lack of decision making power: violence prevents women and girls from refusing sex and negotiating contraceptive use, and many women and girls’ sexual experiences are forced and unwanted.
Often there is an expectation that husbands make decisions about family size and can compel their wives to have unsafe sex. Fear of violent reprisals can prevent women and girls from attempting to raise contraception with their partners or attempting to use it without their knowledge.

Difficulties in accessing contraception: women and girls may need permission from their husband or family to travel outside the home or community to visit a health clinic and may not have money at their disposal to pay for services or supplies, or for transport. For unmarried women and girls, the stigma associated with being seen at a clinic can prevent them attending at all.

For these reasons, approaches to family planning that focus solely on supply are destined to fail. Family planning interventions need to tackle gender inequality, combat violence and promote women’s rights if they are to have substantial and sustainable impact. We must ensure that women and girls have real access to contraception, exercising free choice over the methods they use and when they use them without fear of reprisal.

This report tells the stories of four women and girls that ActionAid works with in sub-Saharan Africa (Uganda, Liberia and Tanzania) who have been denied choice over their reproductive lives. Their experiences highlight some of the key barriers to increasing access to family planning that affect real women and girls’ everyday experiences – and how important the power dynamics between women and men are when it comes to making sexual and reproductive choices.
The stories demonstrate why interventions that empower women and girls to negotiate the terms of their sexual relationships are so desperately needed.
The UK government and its partners could radically progress this agenda by:

1. Promoting choice: ensuring the fundamental aim of their approach is to support women’s right to choose whether and when to have children.

2. Financing women’s rights: ensuring funding is available to further the empowerment of women and girls.

3. Promoting national change: ensuring national legal and policy changes that promote women’s rights.

4. Strengthening national health systems: ensuring adequate investments so they can better deliver family planning services to more women and girls.

5. Recognising the needs of all women and girls: ensuring the rights of all women and girls to access family planning are met regardless of age, race, ethnicity, caste, language, disability and marital or HIV status.