Bill & Melinda Gates Foundation

Empowering Women and Girls Through Access to Contraceptives

February 28, 2013

In my line of work—improving the health and well-being of women and girls—“empowerment” is both the end we seek and the means we use to get there. 

Our vision is that women and girls around the world are empowered to make decisions that benefit them and their families. But we also know that women’s ability to decide between different options is key to bringing that vision into being.

The stakes can be high for an empowered woman. 

So often, they make choices that fly in the face of the expectations set by their family and community. I recently met a young mother, Sharmila Devi, who is in the process of making these difficult choices in the poor village where she lives in Patna.

Melinda with Sharmila Devi with her newborn daughter at her home in Dedaur village in Bakhtiarpur block of Patna district in India.

We were talking outside on an unseasonably cold day, and she was holding the youngest of her four children, a four-month old girl named Babita, under her sari. I told her I’d love to see Babita, but she’d been meeting with her local health worker and learned the importance of keeping her baby warm. She wasn’t about to bring her out from under her sari, and I thought, “I wouldn’t let my baby get cold for a total stranger either!”

After Babita was born, Sharmila talked with her health care worker about the benefits of birth spacing and decided she wanted to space her children further apart, even though her husband and husband’s parents wanted her to follow tradition and have her next child right away. Sticking to her preferences, she learned more about the options available to her and decided to use an Intrauterine Contraceptive Device (IUCD), which lasts for up to ten years.

She talked to her husband about why she wants to space their children and how the IUCD works, and she convinced him to support her. Then she and her husband talked it over with his parents together. When they still didn’t approve, Sharmila made the call and had an IUCD inserted without their consent.

Now, as the whole family focuses its limited resources on giving Babita and her siblings a nutritious diet and a good education, even Sharmila’s husband’s parents are happy about her choice. 

In India, the decision making power structure in the family has been defined by husbands and by mothers-in-law for generations. Sharmila’s courage in seeking outside information and advice, bringing her husband along, and even defying her parents-in-law represents a huge leap forward for many women in India. 

It’s also just one of many examples of courageous women I’ve met in recent years.

Sharmila’s empowerment is also a story about a functioning health system that enabled her to get good information when she needed it. While Sharmila was brave enough to reach out, she also knew that good options were available—and where to go to take advantage of them.

There are many more practical pieces to get right to ensure Sharmila and millions of other women can access and use contraceptives when they need them. Can IUCDs be manufactured in India? Can they be cheaper? Can more people be trained to insert them safely? Are there other contraceptives—including some that have yet to be developed—that are more appropriate for Indian women?

These practical issues and the overall effectiveness of the health system will be pivotal, because they will determine whether or not the risks of breaking social norms for women are worth it.  If Sharmila sought information but found none, her courage would have been for nothing and she might have suffered greatly from the disapproval of her family and community.  

If we can come up with good answers together, then women around the world will use new knowledge, new technology, their own networks, and their growing sense of confidence to start changing the social norms that prevent them from having more power over their own lives.

 
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