Contraception is something that many Canadians take for granted. Whether you’re running to the walk-in clinic to get a prescription for birth control pills, or picking up a box of condoms at your local drugstore, it can be very easy for many of us to access multiple forms of birth control. But for many in the global south, access is not only difficult – it is a matter of life and death.
Girls like Fanos, 15, are often married off in Ethiopia. Because they are so young, their bodies are often too underdeveloped to give birth, which can lead to health complications and pre-term birth. Photo: World Vision
Contraception is a human right and it is also one way to prevent children from being born too soon. Through the use of contraception, pregnancies can be prevented in young girls who are not developed enough to give birth and can be spaced for women who are planning to have children.
In this series of three blogs, we’ll give you a glimpse into the communities the Born on Time partnership works within Mali, Ethiopia and Bangladesh to target preterm birth risk factors, like lack of access to contraception. For this first article, here are some of the things that women and girls we spoke to told us about using contraception in their communities.
“MY HUSBAND DOESN’T WANT ME TO USE BIRTH CONTROL”
By far the greatest barrier for women to use contraception is their own husbands. Although some participants said that their husband suggested contraception for financial reasons or that they made decisions about birth prevention and spacing together, for many of the women and adolescent girls we interviewed, this was not the case.
In Mali, one married teenage girl told us that her husband could “declare war” on her for bringing up contraception. “It is always necessary to have the agreement of the husband,” one girl said. The older women (ages 20-49) agreed, saying that if they took birth control without their husband’s knowledge and suffered complications, the responsibility would be on the women. “They don’t even want to hear about it,” several of them told us.
In Ethiopia, numerous women told us that they were using contraceptives without their husband’s knowledge. A girl in the 15-19-year-old category said that her husband “rejected” her idea to use contraception. “I am concealing (it) from him,” she confessed.
In both Mali and Ethiopia, women and girls cited their husbands’ desire to have more children as one of the main reasons their husbands didn’t want them to use contraception. This was also a concern from women who worried that other women would “have more children” than them if they were to use contraception. In many societies, children are prized as wealth and a blessing, even when they come at a cost to women’s health.
Born On Time works in these communities to ensure that women have a say in their own health and well-being, especially when it comes to childbirth. Our interventions focus on changing the culture of male dominance in this area to one of equitable decision-making in family planning.
“SOME PEOPLE SAY THAT IT CAN MAKE YOU STERILE, OR CAUSE OTHER PROBLEMS”
A woman visits a health clinic in Mali, where she receives vital care and information about her medical options. Photo: Save the Children
Misinformation about the side effects of contraceptives is a huge problem for women around the world. In Bangladesh, an adolescent girl told us, “Someone in the community told me that by taking the pill, I shall not be able to have a child in the future.” Another girl in her age category echoed her thoughts, saying that “There are women who are afraid of family planning because...they say that it makes a woman sterile.”
Other things we heard were that contraception “could provoke abortion” (Mali 15-19); “harm the health of women” (Mali 20-49); “is painful” (Ethiopia 20-49); causes “health problems” (Bangladesh 15-19).
Women aged 20-49 in both Mali and Ethiopia cited concerns about abnormal and excessive bleeding as a potential side effect of contraceptives. “I saw a case where the bleeding continued for 15 days,” said one woman. “Women want to do family planning, but they are afraid of side effects. If we had a health centre, the doctors could explain to us,” said another.
Born On Time is working towards strengthening health systems with training, equipment and supplies to provide quality, responsive care. We work with local governments and community stakeholders so that women and adolescent girls understand what a modern method of contraception might be right for them. Most importantly, the project works with women, girls and male partners to ensure they have the correct information needed to make informed decisions about the use of contraceptives to prevent, delay or space their pregnancies.
“CONTRACEPTION IS SEEN AS IMMORAL”
In Mali and Ethiopia, some religious leaders believe that contraception is a sin, and exclusively for the prevention of pregnancy, and they teach this to their constituents. This creates a climate of fear for women, who believe that other community members may expose them.
An adult woman in Mali said that when a woman is known to take contraception, she “is often treated as an infidel”, or someone who does not follow the Muslim faith.
In Ethiopia, adolescent girls talked about how priests teach against using contraception. “Religion doesn’t allow us to use contraceptive,” one said. “We use it hiding from religious leaders.” Another chimed in, “It is considered as destroying souls.”
Born On Time is working to change these attitudes by engaging local religious leaders in our training on the health benefits of ‘delaying and spacing’ pregnancies and the risks of preterm birth. We also advise them on the importance of couples’ joint decision making and debunk the many myths and misconceptions surrounding modern contraceptives. This is having a significant impact, with many religious leaders reporting that they no longer oppose contraceptives in their communities.
“IT’S EASIER TO TALK ABOUT CONTRACEPTION WITH OTHER WOMEN”
Girls in Bangladesh take part in a peer discussion. Photo: Plan International Canada
Many women we spoke with face negative societal stigma around women and sexuality. One woman told us that the perception in her community is that women who use contraception “like sex too much”. Faced with this kind of push-back, is it any wonder that many are afraid to speak up about their needs?
When they do choose not to remain silent, a few women preferred to speak about contraception with their husbands. But many said that they were more comfortable talking with other women.
“I prefer to discuss it with my friends,” said an adolescent girl from Ethiopia. “My husband and my family are saying don’t use it. But with my friends, I am worried about having many children and being unable to feed them. My friends are like me. They are married, and they told me freely.”
In addition to providing accurate information and combating myths about contraceptives, Born On Time provides opportunities for women and adolescent girls to discuss these issues in a safe space through support groups and community outreach.
All women and girls should be empowered to realize their sexual and reproductive rights, including having access to accurate information and quality reproductive health services that respond to their specific needs, including modern methods of contraception.
Speaking up like these women and adolescent girls takes an extraordinary amount of courage, and we are so grateful that they shared their stories. As Born On Time continues to work in their communities, we will strive to address their concerns and needs, so that every mother can have a healthy, full-term pregnancy, and every child can be born on time.
The Born On Time public-private partnership targets risk factors related to unhealthy lifestyle/behaviours, maternal infections, inadequate nutrition, and limited access to contraception that can lead to babies being born too soon.
The information provided in this blog was taken from Qualitative & Gender Equality Assessments conducted in all three Born On Time countries in 2017. The quotes provided here are only a sample of what we heard in these assessments and do not necessarily represent the views of all the women and adolescent girls who were interviewed.