The Importance of Furthering Access to Modern Contraceptives

by Emily Peacock | @emilydpeacock

Modern contraceptives do much more than just prevent unwanted pregnancies; they ensure the health, well-being, and bodily autonomy of menstruating people. Unfortunately, the majority of the world lacks adequate access to these important tools. This paper explores just how imperative modern contraceptives are to gender equality and equity, what the barriers are to accessing them, and how to overcome them. (Photo credit: rhsupplies on Unsplash)

 

Introduction 

Access to modern contraceptives prevents unwanted pregnancies and abortions but also gives menstruating people more autonomy over their bodies and, therefore, their lives. Due to various factors, though, existing barriers to contraceptive access continue to grow, hindering hundreds of thousands of women and girls from accessing various reproductive opportunities and rights.

This paper will examine these barriers, regional and global use of modern contraceptives, international policies and laws regarding contraceptives and family planning, the United States’ influence on accessibility and attitudes towards contraceptives, and the current solutions to furthering contraceptive access. The data suggest that access to modern contraceptives is imperative to advancing gender equality, that patriarchal values and systems are a primary barrier, and that human rights should be at the center of global and national law and policy. 

Background and Purpose of Use

Contraceptives, otherwise known as birth control, are devices or drugs used to prevent pregnancy (Dictionary.com., n.d.). Birth control is by no means a new concept. For centuries, birth control use can be seen across all kinds of societies. The primary reasons for using birth control are the high physical and economic costs related to pregnancy and childbirth (Good, 2022). 

During pregnancy, it is not uncommon for the person carrying the child to experience various adverse and potentially fatal physical changes. These include anemia; urinary tract infections (UTIs); depression and anxiety; diabetes; infections; morning sickness (Center for Disease Control and Prevention, 2022); preeclampsia, or high blood pressure; eclampsia, a severe complication of preeclampsia; cardiomyopathy, or heart disease; embolism, or a clot in an artery; sepsis, or extreme infection; or respiratory distress; among many other symptoms (Trends in pregnancy…, n.d.). 

Natural childbirth is a “uniquely painful and difficult experience for humans.” Giving birth was historically done with the help of midwives, as many societies considered it wrong or problematic to have men present for delivery. The midwives would use herbal remedies for pain, oils to stretch the tissues of the birth canal, and tools such as forceps to retrieve the baby, which often did more harm than good. Very few documented or reliably tested methods for child delivery were also known or used (The history of childbirth, n.d.).

There was often no way to prevent the deadly obstacles that childbirth brought. Some examples include uterine ruptures; shoulder dystocia, or when the baby’s shoulders become stuck in the birth canal; umbilical cord prolapse, which cuts off the baby’s oxygen supply; chorioamnionitis, a bacterial infection of the amniotic fluid; or fetal macrosomia, when the baby is too large for vaginal delivery; (Most dangerous delivery room complications, n.d.) among others. It is for this reason that until the 15th century, roughly one in three women died due to birth-related issues (The history of childbirth, n.d.). Today, more technology than ever ensures giving birth is safer and less painful. Heart monitors, ultrasounds, epidurals, prenatal vitamins, medications, and antibiotics, make it easier to handle and prevent complications.

Despite these technologies, even when planned, giving birth continues to be dangerous. This is especially true in areas lacking access to modern healthcare and underserved communities. For these reasons, there were still 152 maternal deaths per 100,000 live births worldwide in 2021 (Goalkeepers inspires the thinkers and doers, n.d.), equating to roughly 295,000 maternal deaths per year, most of which take place in lower- to middle-income countries (The U.S. Government and International…, 2022).

Then, if the baby and parent survive, there are medical bills and other costs of raising the child to consider. Cost estimates for raising a child to adulthood range from $16,200 to $500,000, with a global mean of $168,384 spent until age 18 (Stefan, 2021).

Aside from preventing pregnancy, contraceptives also regulate periods, relieve premenstrual syndrome (PMS), relieve cramps, assist with issues related to anemia, relieve endometriosis and prevent ovarian cysts, clear skin from acne breakouts, treat polycystic ovary syndrome (PCOS, which can be very painful), and decrease risks of ovarian and uterine cancer (Noncontraceptive benefits of birth control pills, n.d.). Additionally, nonbinary or transgender people can use certain contraceptives to halt menstrual cycles altogether and assist with issues of gender dysphoria (LeDuc, 2020). 

Regardless of the reason for using contraceptives, they are a tool that has the potential to give menstruating people more autonomy over their bodies and lives. If modern contraception were more accessible, one-third of maternal deaths would be prevented, as would 26 million abortions (16 million would be unsafe), 7 million miscarriages, 79,000 maternal deaths, and 1.1 million infant deaths (New Study finds little progress…, 2022).

Forms of Contraception 

Contraceptives can be placed into two categories: modern and traditional. Examples of modern birth control include the Nexplanon implant, a small rod placed in the arm that releases hormones with 99% effectiveness that lasts up to three years; and intrauterine devices (IUDs), which are 99% effective and last up to five years (Parenthood, n.d.). Emergency contraception, otherwise known as Plan B or the morning-after pill, is another form of modern contraception but is taken one to five days after having unprotected sex rather than before intercourse (Parenthood, n.d.).

Earlier forms of birth control included using sea sponges as diaphragms, lemon juice as a spermicide, rocks as IUDs (Good, 2022), and silphium as an oral contraceptive, among others (Dr. Andrei Marhol, n.d.). While not all of these are considered traditional forms of birth control in discussions of law and accessibility, the use of herbs and tinctures as folk medicine is (Current use of contraceptive methods, n.d.). It is important to note that the effectiveness rates of older, homeopathic birth control depends on strict lifestyle habits, which are not always possible for people to maintain depending on their home life, spousal relationships, age or number of children, and education. Overall, modern birth control methods are considered far more reliable and safer than traditional forms, which are unregulated and thus regarded as more dangerous (Mulugeta, 2022).

Facts and Figures: Birth Control Methods and Needs by Region

More people today are using contraceptives than ever before (World contraception day…, 2021), with 842 million people worldwide using modern birth control methods (Mulugeta, 2022). The Global Disease Burden Study analyzed 1.2 billion menstruating people to summarize birth control needs by region from 1970 to 2019 and demonstrated there had been a steady increase in contraceptive needs since 1970; in 2019, 48% of birth control users were using modern methods, compared to 28% in 1970. More than half of this change comes from sub-Saharan Africa and South Asia (The Lancet, 2022). Still, as of 2019, 163 million women who want to avoid pregnancy worldwide have unmet contraceptive needs (The Lancet…, 2022), while more than 200 million women are using traditional contraception to prevent pregnancy (World contraception day…, 2021). 

Despite being the individuals with the most demand for birth control, girls aged 15 to 19 have the most unmet needs of all age groups (Mulugeta, 2022). Globally, women and girls aged 15 to 19 have 65% of period-related needs met, including birth control, while women aged 20 to 24 have 72% of needs met (The Lancet…, 2022). Because of this, high rates of adolescent births, defined as girls between 10 and 19 years old giving birth (Early childbearing and teenage pregnancy…, 2023), continue worldwide, especially in lower-income countries.

Worldwide, there are 41.2 adolescent births for every 1,000 births. In sub-Saharan Africa, the rate is 100.5 per 1,000; in Central Asia, it is 31.1 per 1,000; in Latin America and the Caribbean, it is 60.7 per 1,000; in Europe, it is 11.6 per 1,000, and in North America, it is 15.8 per 1,000 (The U.S. Government and International…, 2022).

To exemplify the range of needs from a wealthy country to a poorer one, 88% of needs were met in Norway, while only 2% were met in South Sudan (The Lancet…, 2022). Types of contraceptives used also vary by region, depending on accessibility and cultural acceptability. In Latin America and the Caribbean, oral pills and condoms are the most common. In Central Europe, Eastern Europe, and Central Asia, IUDs and condoms are most used. In South Asia, female sterilization, or tubal ligation, amounts to half of all contraceptive use. Within the 69 countries studied, 28 showed more than half of the women using the same method. The Global Disease Burden Study hypothesized that this might be due to a lack of options in those areas and could be a reason for concern as that means a lack of suitable options is keeping people from using modern contraceptives (The Lancet…, 2022). Further, the study found that the country’s socioeconomic status dramatically influences the types of contraceptives offered and their accessibility (World contraception day…, 2021).

The Legality of Contraceptives

Human rights are guaranteed in international treaties, national laws, and constitutions. These include the “the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination” (Ensuring human rights…, n.d.). These interdependent rights have consistently been applied to issues of sexual and reproductive health, including contraceptive access and information, by United Nations treaty-monitoring bodies, courts on both regional and international levels, supreme courts, and constitutions. Since the adoption of the Universal Declaration of Human Rights in 1948, every country in the world has ratified at least one human rights treaty, with 80% having ratified at least four (UN Treaty Body Database, n.d.). This means their governments are legally bound to alter their national laws, policies, and practices to be consistent with the obligations to human rights entailed under international law. It also means that their governments must take action to implement institutions and services that uphold their citizens’ rights, such as healthcare access or adequate training for healthcare providers (Ensuring human rights…, n.d.). 

September 26 is World Contraception Day. In 2021, the U.N. High Commissioner for Refugees (UNHCR) issued a statement declaring, “Under international human rights law, States must ensure sexual and reproductive health services, including modern forms of contraception, and information and education on family planning” (World contraception day…, 2021). Further, the statement highlighted the need for non-discrimination, equality, privacy, bodily integrity, autonomy, dignity, and the well-being of people being treated for reproductive health issues. 2022 marks 10 years since the U.N. announced that “access to contraception is a universal human right that could dramatically improve the lives of women and children in poor countries” (CBS Interactive, 2012).

The Committee on the Elimination of Discrimination Against Women (CEDAW) also recognizes contraception as essential for reproductive healthcare. As a part of its COVID-19 response, CEDAW stated that states must provide “confidential access to gender-responsive sexual and reproductive health services, including modern forms of contraception” (World contraception day…, 2021). This response is supported by the Beijing Platform for Action, which states, “the human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence” (Sexual and reproductive health and rights, n.d.). The Human Gamete Embryo and Stem Cell Research Committee further validates these items by sharing that, “to repeal or eliminate laws, policies and practices that criminalize, obstruct or undermine access by individuals or a particular group to sexual and reproductive health facilities, services, goods and information” (Sexual and reproductive health and rights, n.d.).

With these powerful entities’ declarations, and as supported by the ratification of CEDAW by 187 of the 197 UN member states, modern contraceptives should be made easily accessible and impossible to deny (Rutherford, 2021).

Barriers to Accessing Contraceptives

While international law outlines that modern contraceptives are imperative to the well-being of women and girls, states that have ratified human rights treaties do not always align their laws, policies, and practices with the obligations set forth by the treaties. Some states limit access to emergency contraceptives or may not have regular access to affordable stocks or adequate distribution systems (Ensuring human rights…, n.d.). These economic barriers, social stigmas, and discrimination still detrimentally affect access to modern contraceptives. Other constraints include a lack of access to information, a lack of sexuality training, and harmful gender stereotypes and norms (World contraception day…, 2021). 

Immigrants, women with disabilities, low-income women, lesbians, and sex workers, in particular, are the most likely to face issues of discrimination and inaccessibility (World contraception day…, 2021). This inequality is due to myriad reasons, including low-income people needing to prioritize resources; anxiety and depression disproportionately affecting marginalized communities; immigration status discouraging women from seeking family planning or health services; trauma or negative experiences with health care providers, as is the case with many sex workers; and a lack of funding for family planning clinics in low-income countries and communities (Beyond the numbers…, 2019).

Sexual education is imperative to empowering people, especially girls and women, to make informed choices regarding their bodies. A lack of sex education results in young girls being misinformed about their bodies and cycles, vulnerable to manipulation, and unaware of contraceptive options. Information is a critical first step in getting women to utilize family planning and modern contraception options (Beyond the numbers…, 2019).

Those who know about contraceptive options may not always be able to afford them. In states that do not have national health care coverage, paying out-of-pocket can be expensive. For example, uninsured women in the U.S. who cannot afford contraceptives out-of-pocket do not get to utilize them, which is a blatant form of economic discrimination (World contraception day…, 2021). 

The pro-life rhetoric that right-leaning groups use to denounce contraceptives is patriarchal at its core and, scientifically, a stretch. As highlighted by William Newton in Contraceptives and Abortion: Fruits of the Same Rotten Tree, right-wing ideology connects emergency contraception to abortion, using it as a “testimony to how contraception ‘naturally’ extends its inner logic toward abortion.” Religious pro-lifers also believe that viewing pregnancy as a potential disaster is inherently “anti-life” (Newton, 2015).

U.S. congresswoman Marjorie Taylor Greene, R-Ga., stated that “contraception stops a woman from becoming pregnant. The Plan B pill kills a baby in the womb once a woman is already pregnant.” This statement is untrue, though, as Plan B inhibits a woman from ovulating to prevent the pregnancy, and thus a fetus cannot form (Jong-Fast, 2021). Therefore, there is a clear distinction between emergency contraception and abortion. Still, religious advocates against contraception find other ways to oppose its funding, such as by arguing that birth control allows people to have sex without consequence, which they claim is immoral (Newton, 2015). Morals, though, are subjective and should not be decided upon by one demographic for the greater good. 

These attitudes towards birth control are not new. Robin Marty, the author of The New Handbook for Post-Roe America, said that “the anti-birth control sentiment has been building for over a decade” since 2010, “when the Tea Party fought Obamacare by saying IUDs, Plan B, and contraception itself were, as they called it, the biggest expansion of abortion in the nation” (Jong-Fast, 2021). 

As mentioned, the U.S. influences international family planning initiatives. With the country’s political polarization, though, family planning and reproductive rights support can sway dramatically every four years. President Donald Trump, in particular, caused several setbacks in support nationally and internationally for family planning, including contraceptive access. The repeal of Roe v. Wade and two restrictive bills sparked global fear for family planning and access to birth control. 

In the wake of the repeal of Roe v. Wade, several states permitted pharmacists and doctors to refuse to prescribe birth control, mainly emergency contraceptives, for religious reasons (Stock & Blum, 2022). Despite this, the U.S. recently passed legislation ensuring contraceptive access with a 228 to 195 vote in favor (Karni, 2022). Still, the effects of the Trump administration exist through the Defend Planned Parenthood Act and the Mexico City Policy. 

In 2017, President Trump, building upon the 1973 Helms Amendment that banned U.S. funds for overseas abortion as a method of family planning, signed a “global gag rule.” This gag rule is otherwise known as the Mexico City Policy. It blocked any U.S. funds from going to overseas organizations giving abortion care and advice (Guardian News and Media, 2019) under the guise of the “Protecting Life in Global Health Assistant” policy (The U.S. Government and International…, 2022). Additionally, the proposed Defund Planned Parenthood Act of 2021 would limit funding for Planned Parenthood Federation of America, Inc., or any of its affiliates for one year (H.R.541 – 117th Congress (2021-2022), n.d.). These actions furthered the pro-life narrative that deliberately limits menstruating people from their right to bodily autonomy. They are not acts in favor of life but in favor of control. 

Additionally, and more recently, in a global context, the COVID-19 pandemic has exacerbated gender and health issues, including decreasing contraceptive and family planning access (The U.S. Government and International…, 2022). This new barrier resulted in 12 million women losing access to contraception, and 1.4 million unintended pregnancies occurred across 115 low- and middle-income countries (World contraception day…, 2021).

Existing Suggestions for Overcoming Barriers 

Existing solutions for advancing contraceptive access are being shared widely and developed regularly. Commonly recommended solutions for governments and institutions include assessing baseline contraceptive access, creating an improvement plan for accessibility, stocking a range of contraceptive methods, providing patient-centered counseling, implementing same-visit systems for contraceptive provision, and accepting diverse payment options (Increasing access to Contraception Toolkit, n.d.). 

By heeding these recommendations, not only would accessibility increase, but each person’s contraceptive preference would be considered and allocated for. This is essential as “considering the contraceptive preferences of different groups and diversifying options to suit each group’s needs is a key part of unlocking the social and economic benefits of contraception” (The Lancet…, 2022). To do this, health policies should include those they aim to impact in developing the programs. This inclusive planning has a greater impact on health outcomes relative to traditional top-down approaches (Ensuring human rights…, n.d.).

And with personal meetings with healthcare providers, women and girls are more able to address individual needs that might otherwise go unaddressed. Same-day access to contraceptives with diverse payment options also makes an incredible difference for those who have limited access to transportation and funds, ensuring that no one goes without their contraceptive needs met (Increasing access to Contraception Toolkit, n.d.).

A range of initiatives support these actions being undertaken at the national and international levels by governments, non-profits, and non-governmental organizations. The Family Planning Initiative (FP2030) aligns with Sustainable Development Goal (SDG) No. 3, which seeks to achieve universal access to reproductive health and incorporate family planning into national public health strategies. FP2030 works to increase the number of women using modern contraceptives by 120 million women across 69 countries by 2030. Currently, there are 51 million women lacking such access (The Lancet…, 2022).

Several countries, including China, Greece, India, Turkey, Mexico, Russia, South Africa,  and South Korea, have eliminated considerable economic barriers to contraceptives by regulating over-the-counter birth control options at local pharmacies. This access ensures that contraceptives are affordable by saving people from needing insurance and time off from work for doctor’s appointments to get prescriptions. The United Kingdom also made emergency contraception available, free of charge, at sexual health and contraception clinics, and regular contraception prescriptions are subsidized through the Nationals Health Service (NHS) (LeDuc, 2020). The elimination of third-party authorization requirements for contraceptives respect women’s rights to autonomy and privacy and is expected to increase access to family planning services (Ensuring human rights…, n.d.).

While the U.S. does not have national subsidies for contraception, the Biden administration has recently committed to restoring its U.N. Population Fund (UNFPA) funding for family planning organizations. The U.S. also partnered with the U.K., the Bill and Melinda Gates Foundation, UNFPA, several civil society organizations, developing countries, donor governments, private-sector organizations, and multilateral organizations in an effort to provide family planning to 120 million more women and girls in developing countries by 2030. In the 2021 fiscal year, the U.S. allocated $608 million in funding to these efforts (The U.S. Government and International…, 2022). 

Conclusion 

In recent decades, access to and the use of modern contraceptives has steadily increased. Still, many menstruating people are left unprovided for and unknowing of their options. Many barriers, including right-wing, conservative values and policies, prevent universal access to contraceptives from becoming a reality.

This idea that birth control should be regulated is highly problematic, as birth control is a multi-purpose medication that should be accessible to all women, girls, and trans/nonbinary people. Regardless of marital status, occupation, or sexual activity, contraceptives are imperative for many women and girls’ well-being around the world. Having access to contraceptives gives them autonomy over their reproductive health. It ensures their academic opportunities, careers, and personal development are not impeded by unwanted pregnancies due to consensual intercourse or assault. It also has the potential to save thousands of lives and would if it were more easily attainable (New Study finds little progress…, 2022).

To dissolve the persistent financial, social, cultural, and educational barriers that continue to hinder contraceptive access, a more systematic human rights integration must be added to program, law, and policy development. Governments and institutions need to address “the underlying determinants of health, such as gender inequality, and the establishment of participatory, transparent and responsive processes” (Ensuring human rights…, n.d.). This response includes more transparency and accountability for states that have ratified human rights treaties and encouragement to the U.S. to ratify CEDAW. With its significant influence on reproductive health funding, the United States’ refusal to abide by CEDAWs recommendations leaves a lack of security for the future of contraception and family planning around the world (Rutherford, 2021).

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Emily Peacock is a second-year M.S. student at NYU studying global affairs and global gender studies. Previously, Emily was the news editor at New York Tech’s Manhattan Globe, where she graduated with her B.F.A. in global and electronic journalism with a minor in culture and literature. Currently, Emily works as a graduate assistant to Dr. Sylvia Maier; is a co-president of the CGA’s gender working group; is a Dean’s Scholar; and works as an executive assistant to the president of the Desai Foundation, an NGO dedicated to aiding women and children in India and the United States.

 

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