Bill & Melinda Gates Foundation

Women, Girls on Making Important Reproductive Health Decisions

November 13, 2013

Whenever I travel to developing countries I always ask around to get a sense of the state of family planning from the perspective of women I meet. I have long since learned that family planning is vital to the health and well-being of women. We read about the need for family planning services in the developing world all of the time, but hearing from women validates the numbers and puts a real face on those who desperately need the help of NGOs and local organizations that provide education and family planning to both men and women.

There is no doubt that women and girls want more control over their bodies and would like to space their pregnancies or not become pregnant at all. Coming to that decision can be fraught with difficulty especially when many cultures value children as a symbol of a woman’s worth and a man’s virility. Make no mistake: seeking family planning services is not an easy decision made by women and girls in many cases. What is important, though, is ensuring women and girls around the world have family planning options available to them should they seek it.

On a trip to Johannesburg last month, I visited Alexandra Township to learn more about a women’s collective, Rebecca’s Well. During my visit I walked with a local guide, Linky, through the one million people strong, overcrowded township to learn more about the area and to get a feel for the history and people who live there. 

 Make no mistake: seeking family planning services is not an easy decision made by women and girls in many cases.

As we walked through narrow corridors with small tin homes on both sides I asked Linky about the availability of health services for women. In Alexandra there is no hospital, only seven satellite clinics. Linky told me that the clinics are full every day and that people start lining up for services at 4 AM. It is no wonder Linky also told me that teenage pregnancy is rife in the township. Culture, unemployment around 70 percent, and an overcrowded health system all contribute to this unfortunate outcome for teenage girls. 

Later that week at a family planning clinic I was shocked to my core to hear that some of the female workers had been raped by men who were angry that their wives had come in for services.  Do you know what these men’s logic was for sexually assaulting the women? If their wives couldn’t get pregnant then these women would have their babies.  Yes, their logic was utterly ridiculous and criminal and they were successfully prosecuted, but this is a telling story exemplifying how difficult a decision it is for some women to commit to spacing or preventing pregnancies. 

Now the clinic must take measured precautions about providing services for men including male circumcision and condom use education. The clinic has to go to extreme lengths to protect the women who come to them for services from never releasing general patient information over the phone to giving women generic family planning materials like brochures and business cards without the name of the clinic or its logo on it. And I was told that many women simply hide their contraceptives from their boyfriends and husbands in fear of violent retaliation. 

After visiting Marie Stopes’ Gandhi Square clinic on my last family planning stop in Johannesburg I relished speaking to Palesa Khandi, the Head of Marketing and Sales for Marie Stopes South Africa. She summed up why seeking family planning services can be difficult for some women.

“The whole issue of emancipation is a touchy issue especially in the home,” Khandi said. “There is still a lot of oppression in the home. It’s almost as if you don’t own your body or the children you bear. And if you don’t have children it’s really tough.”

One of the things I do not want to do is paint South Africa with a generalized brush. There are some women who can easily make decisions about their reproductive health while others struggle with it. I do believe it is important to underscore how difficult it can be for women and girls to choose to space and prevent pregnancies. It is up to the global health community to ensure women globally have access to family planning services when they seek it and that there are enough commodities available to accommodate the needs of the community. 

These same issues about reproductive health and family planning are being discussed in Addis Ababa, Ethiopia at the International Conference on Family Planning this week. Follow the discussion at #ICFP2013 and #ICFPLive.

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