What does it mean to have the freedom to decide, when it comes to contraceptives? Last week, I was honored to have conversations with a few women in Uttar Pradesh, India, to understand more about the decisions many women face when it comes to why and how they plan their families in particular ways.
Johra is one of those women. She has five children and along with her husband and her mother-in-law, she agrees that they should not have any more children, to better provide for the children they have.
But Johra didn’t know she had options; that she could decide not to have more children until she met a frontline health worker from the Urban Health Initiative (UHI) and found out about family planning options. She chose a long-term method of contraception-- a 10-year intrauterine device (IUD) as her family agreed that they wanted no more children but her religion doesn’t allow the permanent method of sterilization.
Johra was convinced that this was the right method for her, but was nervous about the procedure of having the IUD inserted. She took on a peer educator role and talked to a couple of her friends about this new information she had on how to prevent pregnancies. Her friends decided to pursue the same option and all three went together to support each other during placement of the device at a nearby clinic that the UHI frontline health worker referred them to.
Now, all three of them appear happy and are excited with the opportunity to make decisions around the choice of contraceptives and their use of an IUD. Johra has gone on to assume the important mother-in-law role with her son’s wife, but she brings new information to the relationship. At 15 years old, her daughter-in-law is about to give birth to their first child. And after the birth? They have decided to also use an IUD to wait a few years before the second.
So for Johra, the freedom to decide is about having information to plan when and how many children to have, being informed of the best individual option, and then having access to that method. It’s an informed choice made together with her husband.
Jhamela has three children. She and her husband decided not to have more children because of the high cost of living. For them, education for their children is a priority and gives hope for a brighter future. So they are sending their children to a private school for access to better education. In their opinion, they would not be able to do this if they had more children. They decided to use contraceptives.
Jhamela was taking the pill but would often forget the daily ritual. Through frontline health workers from UHI, she learned of other birth control methods and could choose which one was right for her. She and her husband decided on an injection once every three months for Jhamela, much easier to remember than a daily pill.
From Jhamela’s perspective, the freedom to decide is about knowing the available contraceptive options to prevent more pregnancies, and not having more children so she can provide the best education for the children she already has.
For every two women like Johra and Jhamela who can make an informed choice, there are millions more who do not have the information about the importance of planning their families, knowledge of the best contraceptive for them, or access to those contraceptive products. And that is not acceptable.
We will continue this important conversation on family planning in hopes that one day women and men around the world, no matter where they are, will have the correct information, knowledge, and access to contraceptives to make an informed choice about the timing and size of their family. Not everyone will use contraceptives; but everyone at least should have the knowledge and power which allows them the freedom to decide for themselves.
Are you inspired to act on behalf of women who desperately need access to family planning education and contraceptives? Keep an eye out for ongoing information about, and ways to pledge support for, the upcoming Family Planning Summit on July 11, 2012. The Summit is being hosted by the Gates Foundation and the UK’s Department for International Development (DFID) with the aim of addressing the unmet need for contraceptives for the 200 million women in the poorest countries who want and need, but don’t have access to them. It’s about putting family planning front and center on the global agenda. Follow @Gatesfoundation and check Impatient Optimists regularly for details.