In 1956, 200 poor women from Puerto Rico became pioneers in the use of the contraceptive pill without them knowing it. Five years earlier, the founder of the American Federation of Family Planning, Margaret Sanger, had achieved a final financial boost for the research of this drug: this group of women was chosen to implement it on a large scale for the first time. They were hardly informed of the side effects and many dropouts occurred. Three years later, the pill was already on the market.
Today women exercise control over their reproductive life greater than at any other time in human history. 58% of them worldwide use modern methods of contraception, a percentage that drops to 37% in the poorest countries. The latest report on State of World Population, which each year produces the Population Fund of the United Nations (UNFPA), analyzes advances in the history of family planning, but also the stumbling blocks that still exist to decide on fertility. "The fact of being able to decide the number of children and when to have them has opened the doors [a las mujeres] to a life not dominated by motherhood and the upbringing of children, and has contributed to reducing gender inequality, "reads the analysis.
Rasamee holds an important position in one of the largest companies in his country, Thailand. She returned to work two months after giving birth to her first child (could take up to three). Her grandparents emigrated from China and thought that the school was only for children, that's why her mother did not pass primary school, but she could graduate from university. "Women can work and take care of themselves and do not need to depend on their husbands," she says. In his country there are planning policies and contraceptives are within reach. "Today it seems unthinkable to think that there is a country where women have to access family planning in secret, like my mother, who do not pay attention to abortion and who are discriminated against because they are poor. that 25 years ago most of them did not have laws or sexual and reproductive health programs, "says Luis Mora, responsible for Gender, Human Rights and Culture of the UN.
Of the 82% of Chinese women who use contraceptive methods to 7% of the inhabitants of Chad and South Sudan, there is a world of obstacles to reach a health center, to access a condom, to the pill, to a gynecologist, or to receive sex education at school. The focus now is on how women decide when, how and how many children to have and on reducing inequality between different contexts. "What has happened in the last 50 years gives us confirmation that making decisions and executing them changes the situation." In Spain, at the beginning of the 20th century, women had an average of five children and 500 women out of every 100,000 died in childbirth, now there are five ", explains Isabel Serrano, of the Federation of State Family Planning. 68% of Spanish women use contraception methods. "In Spain there are still poor people and we can not forget that, and we are terrified of the strengthening of anti-selection groups throughout Europe," he adds.
When we analyze scientific research agenda we realize that we will give little choice to women in the future. There are no studies on contraception in men
Not only is it essential to have an outpatient clinic where there are condoms, for example, but there is real access to planning. "There may be a clinic nearby, but the service provider, due to his or her prejudices, may refuse to give contraceptives to a young person or a single woman." That same clinic may also offer only one or two options, but not the preferred one by some women or there may be laws that block access, or that husbands forbid their women to use any type of method, "the report analyzes. Natalia Kanem, Executive Director of UNFPA, I remembered in an article that "for every dollar that is invested in reproductive health services, 2.20 are saved on health expenses related to pregnancy." In addition, he adds that "postponing motherhood allows women to participate in the paid workforce for more time, thus stimulating the economy."
21% of the world's population marries before the age of 18 (42%, in some parts of Africa). In the vast majority of cases, it is the girls who reach marriage before the age of majority. "When a girl gets married, she is less likely to go to school, complete her studies or move freely out of her home without a companion, more likely to be a victim of gender-based violence, and less likely to count. with knowledge about their body and their rights, "recalls the UNFPA report. In Bangladesh, almost 80% of girls get married before they are 18, compared to 8% of boys. It is followed by Chad, Ethiopia and Guinea as the countries where this practice prevails, with very similar percentages.
An international commission of experts from the prestigious scientific publication The Lancet included last year in health standards issues such as the right to control one's own body, define sexuality, choose the couple and receive confidential and quality services. "The bodies of women continue to be the battlefields where ideological discussions are fought with devastating results," commented Richard Horton and Elizabeth Zuccala, editors of the magazine.
The world soon became aware of the need to facilitate the option of deciding the number of children. In 1976, more than 100 governments already provided information and services. In 2015, the percentage of those who they did not support for family planning it was only 6%, but it did allow the private sector to provide services on its own. However, the possibility of deciding is always influenced by the economic level of families. Mediha Besic, a 35-year-old Bosnian, has five children. She gave birth to the first with 16. She and her husband do not have money to buy contraceptives, so they resort to traditional practices, which are not always effective. "It would have been easier to raise two children," says Besic.
"Women from the poorest households can find themselves in situations where there is little or no no access to sexual and reproductive health services. This translates into unplanned pregnancies, an increased risk of illness or death due to complications associated with pregnancy or childbirth, and lack of assistance by medical, nursing or midwifery personnel and the consequent need to give birth on their own. ", summarizes the experts of the UN An evaluation of the World Health Organization in 24 countries carried out in 2017 indicated that in the family planning services the stocks of some contraceptive methods are exhausted approximately three quarters of the time.
"When we analyze the scientific research agenda we realize that we are going to give women little choice in the future, there are no studies on contraception in men, we continue to hold women accountable for this work," says Mora. In some cases there are extreme situations: five years ago, the scandal of the Mass sterilization of women in India, a country in which vasectomy is not accepted.
What should be done to eliminate inequalities? "National legislative systems must eliminate the discriminatory provisions that still exist, such as obstacles that hinder the access of young people, single people, migrants, people with different sexual orientations and gender identities, and others, to services and contraceptive methods. " The analysis also refers to fertility difficulties and urges governments to "untie in vitro fertilization of the parents' ability to pay".
In family planning services, stocks of some contraceptive methods are depleted about three-quarters of the time, according to an evaluation by the World Health Organization
A study by the Alan Guttmacher Institute estimated that for quality reproductive, maternal and neonatal health services worldwide, a 37% increase in funding for contraceptive staff would be required, while care for mothers and newborns would demand an increase of around 20% with respect to current levels.
The studies also support the role of men as active agents in the reproductive processes. UNFPA proposes actions such as counseling couples, in order to promote communication and conflict resolution, and "comprehensive sexual education that emphasizes the empowerment of women and the roles and obligations of men".
Karan Singh, who served as India's Minister of Health and Family Planning in the 1970s, said: "Development is the best contraceptive."