Remarkable gains have been made in sexual and reproductive health and rights championed by governments, civil society, and international organizations over the last several decades. But despite progress, hundreds of millions of women today still face economic, social, institutional,and other barriers that prevent them from making their own decisions about whether, when how often and with whom to become pregnant.
The basic human right to determine freely and responsibly the number and the spacing of one’s children has been recognized in numerous international human rights agreements over the past five decades. During this same period, the world has seen a vast expansion in the availability of effective, modern contraceptives — one of the greatest public health achievements in recent history. However, even in 2022, women don’t have control on their fertility. As in the recentUnited Nations State of the World Population report, nearly half of all pregnancies in the world are unintended, amounting to 121 million pregnancies every year. Globally, 48% of all pregnancies were unintended, 61% of which ended in induced abortion. 67% of abortions have been termed unsafe putting women and young girls at risk. For the women affected, the most life-altering reproductive choice – whether or not to become pregnant – is no choice at all.
Yet this crisis is largely invisible, in part because it is so very common. It’s happening everywhere, including right here. Nearly everyone knows someone who has experienced an unintended pregnancy.
Kalpana from Tripura was pregnant at age 15. Rahmat in Rajasthan was married and pregnant before she finished her first year of high school. Sunita from Bihar was a married professional using contraception; she was shocked to discover she was five months pregnant less than a year after delivering her first child. And Rani from Uttar Pradesh had not received any sexuality education when she faced a coercive situation.
Unintended pregnancies are personal issues for the women affected, health issues for women, families and societies, and human rights issues for countries and the world. Of course, just because they’re unintended doesn’t mean they are unwelcome: Many unintended pregnancies are met with joy. Many unplanned babies are deeply loved. Yet while celebrating fortunate outcomes, we must also acknowledge the denial of choice that gave rise to the pregnancies to begin with.
And it would be wrong to ignore the unwelcome outcomes. Unwilling pregnancies leave women and girls struggling to deal with a situation they did not affirmatively choose, at a time they did not choose, under conditions they did not choose – or even with a partner they did not choose. Globally an estimated 60 per cent of unintended pregnancies are decidedly unwanted and end up in abortion, far too often unsafe abortion – a major driver of maternal deaths. A sizable proportion of unintended pregnancies ended up in abortion clinics with India registering 16.4 million abortions per year according to a 2015 nationwide survey, which was the last such survey carried out on abortions.
For far too long, humanity has accepted this denial of women’s autonomy as normal. Whole systems – law, custom, traditions, family rules – continue to assign men control over women’s bodies and fertility. It was not until 1968 that the international community recognized the right of all people to freely choose the number and spacing of their children. And it was only in 1993 that marital rape was recognized as a violation of human rights.
Unintended pregnancy is a major cause of maternal deaths. While India’s maternal mortality ratio (MMR) has improved to 103 in 2017-2019, there are seven Indian states (Rajasthan, Uttar Pradesh, Madhya Pradesh, Chattisgarh, Bihar, Odisha and Assam) with high maternal mortalityat 130 and above. The rates of unintended pregnancy strongly correlate with gender inequality, with lower socioeconomic development, and with more restrictions on sexual and reproductive rights. It shows the steep costs associated with unintended pregnancy: worsened health, lost education, lost income and increased family hardships. Unintended pregnancy costs billions of dollars in increased health system expenditures, and worse outcomes for future generations.
How much does the world value women and girls beyond their reproductive capacities? We see from research studies and in data that shame, stigma, fear, poverty, gender inequality and many other factors undermine women and girls’ ability to exercise choice, to seek and obtain contraceptives, to negotiate condom use with a partner, to speak aloud and pursue their desires and ambitions. Recognizing the full worth of women and girls, and enabling them to contribute fully to their societies, means ensuring they have the tools, information and power to make this fundamental choice for themselves.
It is impossible to fully ascertain, let alone quantify, the overall toll of unintended pregnancies. Yet a growing body of evidence points to massive opportunity costs — from correlations tying unintended pregnancy rates to lower human development scores, to billions of dollars in related health-care costs, to persistently high rates of unsafe abortion and related maternal deaths. Unsafe abortion is one of the leading causes of the more than 800 maternal deaths occurring each day. This is a price tag the world simply cannot afford.
Now is the time to accelerate, not retreat, to transform the lives of women and girls and reach those furthest behind. Preventing unintended pregnancies is a nonnegotiable first step. When individuals are able to exercise real informed choice over their health, bodies and futures, they can contribute to more prosperous societies and a more sustainable, equitable and just world.
To solve the problem of unintended pregnancy, we must call on policymakers and community leaders to change priorities, to expand choices and resources for women and girls. Raise up the value of women and girls, listen to their voices, invest in the contraceptive services and information that they say they want and need – services that are stigma-free and supportive of bodily autonomy. Don’t just promise gender equality – model it in your actions.
We know these actions can produce real change. We can see it in change that is possible in the lives of the girls. Kalpana from Tripura is receiving the support she did not have as a girl, from a mentor with a local NGO, and she has been able to resume her education. She wants to be a teacher. Rahmat from Rajasthan is determined to give her daughter options that she did not have herself. And Sunita from Bihar is raising two boys to reject gender-unequal norms and speak openly about issues like contraception.
Yet the burden of addressing this crisis should not fall on the shoulders of the women who experience unintended pregnancy. That’s a responsibility that belongs to me, to you, to all of us. It is up to all of us to act. We see action when health systems prioritize the prevention of unintended pregnancy and maternal death, and when governments and civil society work together to empower women and girls. Only when each of us has the power to make this fundamental decision about our health, bodies and futures will we be able to secure a more just, equitable and prosperous world.
(About the Author: Dr. Farah K. Usmani, Global Health & Development Expert, New York.)