I’ve just returned from Dar es Salaam where I spent two weeks seeing EngenderHealth’s programs at work. At one of the health clinics I visited, I met Dr. Kornel Huyaa, an earnest, soft-spoken physician who is helping women and couples access a wide range of family planning services. Dr. Huyaa and his clinic are living proof that it is not only possible for women to have contraceptive options to fit their needs at various times throughout their lives, but also that these methods—including female sterilization—can be offered in a manner that fully supports women’s rights. Yet, why is such a situation still out of reach for so many women and couples?
Contraceptive choice is not about having an “ideal” method mix, but rather about ensuring that women and couples can exercise their fundamental right and ability to choose contraceptive methods that meet their needs and preferences, without barriers or coercion. When it comes to contraceptive choice, however, certain methods, such as female sterilization(when the fallopian tubes are blocked),are often left by the wayside.
The right to decide whether to have children, how many to have, and when to have them is a core right for women everywhere.
Depending on where they live, the growing number of women who want no more children may not have access to female sterilization as an option. It is the most widely used contraceptive method worldwide and is safe and highly effective; however, its availability varies both among and within countries. Female sterilization is also the method most often associated with rights abuses, which has (understandably) created sensitivity that has led to reduced investment and availability.
Female sterilization’s legacy of coercive practices mars the history of many family planning programs in both developed and developing countries. These abuses are not only an affront to human dignity, but also a profound betrayal of medical ethics and a dire human rights violation. Instances include women being forced to sign consent forms as a prerequisite for maternity care and women being coerced into giving consent based on inaccurate or incomplete medical information. While the vast majority of female sterilizations performed today are safe and ethical, the risk of coercion persists. Recent examples however of forced and coerced sterilization of HIV‐positive women in Namibia and of Ethiopian women in Israel serve as reminders that there is still much more work to do.
The simple truth is that it is easier for governments and providers to offer other contraceptives services, such as pills or injectables. But that isn’t reason enough to dismiss an option for women and couples who have decided that their families are complete. Female sterilization should therefore be available among many options by programs that protect informed choice and quality of care.
Ensuring that female sterilization is made available involves overcoming several barriers, including limited capacity and commitment among health providers, a lack of dedicated space and time in overcrowded facilities, the up-front cost of the procedure, and a dearth of accurate information. And because female sterilization is a permanent method, health care providers must also receive excellent training on a regular basis so they can counsel women effectively about all contraceptive options and ensure that women are never coerced into choosing any particular method.
Even in the most remote settings, we know that with proper training, health care providers like Dr. Huyaa can ensure that all women, regardless of their economic status, can maintain control of their health. Providers like Dr. Huyaa should be the norm, not the exception.
The right to decide whether to have children, how many to have, and when to have them is a core right for women everywhere. We must therefore redouble our efforts to bring women access to information and services about all available methods of contraception. And we must ensure that coercive practices cease. Both are equally important human rights.