Written by: Paula Koller-Alonso
Edited by: Abigail Goh
Designed/Illustration by: Sneha Grace
Disclaimer: Please find additional resources on contraceptives and other sexual health matters here or check out ‘Ease Healthcare’. If you have any questions about contraception the best thing you can do is speak with a doctor at a local clinic or visit the DSC Clinic (Singapore).
Contraceptives can be a life-changing tool for all women.
Yet they are still not available to mass amounts whose use could help lift them out of poverty and save their lives.
Melinda Gates boldly stated that contraceptives are “the greatest life-saving, poverty-ending, women-empowering innovation ever created”. Although it may seem like a bold statement, researching deeper into how contraceptives can change a woman’s life, one comes to believe her.
Contraceptives can have two different definitions. Firstly, they are methods or devices used to prevent pregnancy. But secondly, they are a tool for women’s empowerment. That is because they let women choose whether and when they want to be pregnant. And this choice gives women the right and ability to decide over their own bodies. That is an empowerment little else can provide us with.
Contraceptives help alleviate women and families from poverty. They allow women to progress in their careers and life. They solve serious health problems and ailments for women. Yet, despite these life-saving, poverty-ending and women-empowering possibilities, contraceptives are not available to all women who might want or need them.
Historically speaking, birth control and contraceptives have always been used alongside general reproductive health. In ancient Greece and Rome, the Egyptian and Byzantine Empires, different methods were used to prevent pregnancies. It was only until women’s bodies became belittled to little more than child-bearing and -producing machines, that birth control was politicised and seen as an immoral and indecent mechanism.
The first mass-produced birth control pill wasn’t developed in the West until the 1950s (during the Economic Revolution). Yet, the journey from Ancient Greece to the mid-20th century did not come without a continuous attempt of patriarchal and capitalist control. However, the fight of individuals, groups and feminists enabled consistent, albeit slow, development. For example, Margaret Sanger aided the progress of using contraceptives when she opened the first birth control clinic in the U.S., which eventually developed into what we now know as Planned Parenthood.
The Planned Parenthood organisation distributed information and contraception across the US. Image courtesy of BBC.
Yet, even she faced a wave of criminalisation, with heavy resistance from religious and conservative groups, and the general public, who still believed that women’s bodies should solely be connected to reproduction, rather than pleasure. Thus, it comes as no surprise that the development of the pill and its widespread use went hand-in-hand with the second wave of feminism and sexual revolution of the 1960s.
These innovations - both in the medical sphere and cultural norms - allowed women to use birth control that would enable them to choose when and if they want to become pregnant. The direct effect of their availability was evident in sheer numbers. While in 1938 only one in nine women never had children, this number grew to one in five by 1965.
Nowadays, this revolution has allowed 922 million women to use contraceptives. Yet, this large number is only out of 1.9 billion women of reproductive age (15-49) who could be using contraceptives. That means less than 50% of women who could, are.
Moreover, these 922 million women are not evenly distributed across low and high-income countries. It is no surprise that most contraceptives users are found in liberal, more gender-equal and less religious countries. Despite this large number of birth control users, it is still illegal in 45 countries to distribute female contraceptives over the counter.
Contraceptives are often culturally and religiously frowned upon in many countries, involving a matter of secrecy and shame in their intake.
Sub-Saharan Africa has the lowest percentage of women using birth control. The main reason for this opposition is traditional beliefs about women’s childbearing roles and widespread medical myths about the effects of contraceptives on the female body. But one does not even have to look at low-income countries to understand that a general opposition exists.
Especially in religious communities, there is a belief that contraceptives are immoral, as they block “natural” pregnancies. Women are meant to uptake the “traditional gender role” of childbearing mothers and not block this process through medicine. Consequently, this belief boils down to the fact that women's sexual activity is an "indecent act”, if separated from the natural functionings of childbearing.
On top of tradition, a lack of education and awareness oftentimes exists. A study in Singapore found evidence that “women have poor knowledge of a few contraceptive methods, such as hormonal IUD and vaginal ring”.
As such, it is imperative that more effective ways of educating women on contraceptives are found, to not only break the stigma, but also “increase the uptake of reliable methods of contraception and improve reproductive health”.
In Singapore, for example, the government has tried to tackle this dearth of education through the use of educational campaigns over the years. In the 1960s, health campaigns created awareness of family planning and provided a platform for open discussions on contraceptives.
1978 - Family Planning Campaigns. Image courtesy of Mothership.
Furthermore, contraceptives are oftentimes confused with abortion - as both surround the topic of changing pregnancies. However, there is a large difference between preventing pregnancies from occurring in the first place, and terminating them once they exist.
But contraceptives have actually shown to lower abortion rates. There is a positive correlation between facilitating contraception purchases and abortions, as well as contraception purchases and teenage pregnancies. To no surprise, contraceptives reduce the rates of needing to terminate a pregnancy.
Nevertheless, there is still a large bout of resistance against contraceptives. And this resistance can be deadly for some women. Especially in low-income countries, childbirth can be a deadly process for women. The main reason for this is that many women are usually getting pregnant too early (think, for example, child marriage), or too often (think high infant mortality) for their bodies to handle.
Yearly, one million teenage girls die or are injured in childbirth. This makes pregnancy the number one cause of death for teen girls. That fact alone should shut down the resistance for the vital need of contraceptives to prevent numerous pregnancies.
The Gates Foundation has shown that access to contraceptives would cut the number of mothers who die in childbirth by one-third. Moreover, when women in low-income countries space their births, each baby that is born is almost twice as likely to survive their 5th year of life. That means that contraceptives - i.e. the ability to choose when and if to get pregnant - can drop maternal and infant mortality and improve the mother’s and child’s health. And this isn’t only the case in low-income countries, minority women in high-income countries face similar statistics: pregnancy-related deaths are 4 times higher for black than white women in the U.S.
However, contraceptives can also be life-saving in a manner not connected to pregnancy. They have shown to aid against heavy menstrual bleeding, ovarian cysts, anaemia, PMS, and even acne. They can prevent cancer and help against heavy cramps. They can help alleviate serious health ailments—step one: a life-saving tool.
No country in the last 50 years has emerged out of poverty without expanding access to contraceptives. The continued resistance to contraceptives is actually preventing many women and families from using them as a tool to lift themselves out of poverty. Having many children can be a financial burden on any family, especially one already faced with a low socioeconomic status. Many families cannot afford to have more children. In this case, having more children might mean not being able to feed all children.
Therefore, contraceptives can help prevent pregnancies, which can allow for the family’s resources and finances to be more equitably distributed amongst the already present children. As such, the best thing a mother can do for her children is to not have more children at all. These extra finances can then be used to allow all children to visit school, effectively raising their chances to exit extreme poverty. Step two: a poverty-ending mechanism.
Nevertheless, we have to be careful in remembering that while contraceptives taken willingly and voluntarily can be a poverty-ending mechanism, other practices encouraging a decrease in child-bearing have also pushed women to lose control over their own bodies. Under the banner of “Population Control” or “Family Planning”, developing countries, supranational institutions, such as the World Bank, or NGOs, have often begun programmes, such as forced sterilisation, in order to reduce populations.
On the one hand, these have often led to yet another westernised imposition of norms and values onto the ‘Global South’. On the other hand, it has also pushed for the popularisation of sterilisation, leading to 24% of females in reproductive age, choosing it as their preferred method of contraception. And this number would be acceptable if sterilisations were not very dangerous, especially in low-income countries. In India, for example, 700,00 deaths were reported in just one year due to sterilisation surgeries.
As such, it seems safer to grab for oral contraceptives, instead of sterilisation. If it weren’t for their high costs. This does not just apply to low-income countries, in high-income countries, contraceptives are sometimes not available to all women. In countries, such as the U.S., where state-funded, national health insurance schemes do not exist, women who cannot afford insurance cannot rely on their coverage of contraceptives. Although in many countries health insurances now cover birth control at no cost to patients, this is by no means universal.
The High Costs of Birth Control 2012. Image courtesy of Center for American Progress
However, progress is being made to make contraceptives more accessible and affordable. Startups are being built, such as the Singaporean company 'Ease Healthcare' who try to make contraceptive pills more accessible via their App (online subscription-based delivery), therefore, lowering the access barrier to birth control. Birth control can be very expensive, but can, in the long-run, allow women to space out their births, but also time them effectively. This can allow them to delay pregnancy and continue prospering and progressing in their careers - especially in countries where maternity leave coverage is not comprehensive and efficient. As such, women can see themselves becoming more financially independent and successful with the help of contraceptives. Step three: a women-empowering instrument.
Knowing how helpful and life-changing contraceptives can be, what should be done?
There needs to be a radical acceptance globally that contraceptives are vital to reproductive health.
Cultural and societal norms need to be reconsidered within the traditions that amass such resistance to contraceptives. This also means that we need to ensure to close the knowledge gap around this topic. It means finding ways to educate communities and especially women and young girls, to open their eyes to the ways in which birth control can be a tool for progress and improvement. But this education must not happen from the top down - from the Global North to the Global South - but from within. It has to ensure that we also educate the men, who currently hold much decision-making power in communities, and let them see the benefits of contraceptive use.
Contraceptives need to be viewed as a simple instrument that can help women decide whether and when to have children. This means, maybe deciding to place a woman’s career before having children, in order to progress her success. This means waiting to have another child in order to save enough money so that your current children have enough food on the table. This means being able to decide not to have children at all because a woman’s role in the world is not solely defined by motherhood.
Moreover, we need to allow women to have the right, choice, and ability to choose over their own bodies. Pregnancy is a body/life-altering process, and every woman should have the right to decide when, how often and if she wants to enter that process.