Half of women cannot make decisions about their reproductive health and bodily autonomy

Shobha Shukla *

In the lead up to 2025 World Health Day, it is important for us to review why almost half of women are not able to make decisions pertaining to their own reproductive health and bodily autonomy.

All governments had promised to deliver on UN Sustainable Development Goals (SDGs) by 2030, one of which is SDG indicator 5.6.1. “This indicator measures a woman's ability to make her own decisions about her sexual and reproductive health. Initial analysis suggests that over half (56%) of the married or in-union women are now in the driver's seat. But it also means that when it comes to these fundamental aspects of their lives, 44% of partnered women cannot make these essential decisions about their own healthcare, contraceptives, or their sexual health and rights,” said Dawn Minott, Advisor on gender and gender-based violence at the United Nations Population Fund (UNFPA).

Dawn Minott was among the experts of a special side event organised recently on the margins of the UN Commission on the Status of Women (CSW69), by Global Center for Health Diplomacy and Inclusion (CeHDI) and partners.

Gender equality and women’s empowerment at the heart of development

She added: “Over 30 years ago, the International Conference on Population and Development (ICPD)’s Programme of Action of 1994 and the Beijing Declaration’s Platform for Action of 1995 were remarkable because they both placed gender equality and women’s empowerment at the heart of development. These conferences established that a woman's control over her fertility is fundamental to all of her rights. The vision that also drives the 2030 SDGs Agenda and the call for universal sexual and reproductive health and rights is central to achieving SDG5 on gender equality and SDG3 on good health and well-being.”

Access to sexual and reproductive health empowers women and girls, leading to improved health, economic opportunities and her stronger agency. It is important for us to celebrate the wins as a start because we have made strides. Globally maternal mortality has fallen by 34% in the past 30 years. Modern contraception use has doubled and as a result this has reduced unintended pregnancy in adolescent girls. There is also more recognition of gender-based violence with 162 countries globally having enacted laws against domestic violence now.

See stark determinants by segregating data by race or geography

But there are enormous challenges too. “There's a UN study that says it will take us 300 years to get to gender equality at the pace at which we are progressing. Maternal deaths have plateaued globally, but more alarming is that maternal mortality is on a rise in some regions. Inequalities in access to sexual and reproductive health services also persist. Gender-based violence remains rampant. We have one in five girls that are married before they are 18 years of age, and a woman dies every two minutes due to pregnancy or childbirth. In this day and age, a woman should not die giving life. When we bring in the race and geography, then we see stark determinants. Women in Sub-Saharan Africa are 130 times more likely to die from pregnancy or childbirth than women in Europe or North America. Even within the Americas, African-descendent women and girls face higher rates of obstetric mistreatment contributing to significantly worse maternal health outcomes,” said Dawn Minott.

“These inequalities sadly extend also to gender-based violence. When we break data down by age, sexuality, race and ethnicity, we see alarming trends,” said Minott.

We are not reaching those who are furthest behind

A recent UNFPA report highlighted a very concerning trend. “Progress that we have seen or that we have made has largely benefited those who are already close to accessing sexual and reproductive health programmes and services. This means that the gap in terms of inequality to access is greater if we are reaching those who are already closer to service. This is why we need to move away from a ‘one-size fits all’ approach and really focus on reaching those who are furthest behind,” explains Dawn of UNFPA.

To reach those who are furthest behind we need to know who it is that is left behind and how far behind they are being left. That underpins the importance of data. “If we truly want to advance sexual and reproductive health and rights we need to have national (and subnational) data systems that have the ability to inform us better. This also means that we need to make the investment in collecting data, which is disaggregated by age, ethnicity, race, disability status, sexual orientation, among other indices. We also need competencies to interpret and analyse the data and how we put it to use to inform our policies, programmes and services,” she added.

Woman's control over her fertility is fundamental to all of her rights

“We are seeing rapid demographic changes which are unfortunately leading to increased population anxieties and policies aimed at controlling fertility rates. These approaches often undermine fundamental human rights and disproportionately target women's bodies. We need a fundamental shift away from controlling fertility and towards empowering individuals and respecting their reproductive rights. Humanitarian crises that the world is facing is also a major threat. It is critical for us to integrate sexual and reproductive health (SRH), and gender-based violence (GBV) prevention and response services into all phases of humanitarian responses. Both, SRH and GBV prevention and response services must be essential, along with food and water and others,” said Dawn.

Anti-rights push is threatening to reverse gains made in gender equality

“We're also facing resistance on efforts to push forward human rights and gender equality. I do not want to say ‘push back’ anymore, I want to talk about ‘push forward’ now. And I think the more we put our energy and our efforts into designing and defining what a push forward strategy looks like the less power we give to the push back. The push back is threatening to roll back progress on bodily autonomy, sexual and reproductive health and rights, comprehensive sexuality education, and protection from gender-based violence. There is more hope now. For example, there are so many networks of indigenous women who are leading the charge for environmental justice and recognising its deep connection to sexual and reproductive health and bodily autonomy. There are so many young people passionately campaigning for climate justice and linking it directly to sexual and reproductive justice. We have the power of cross movements. The silo approach has never worked, and it will not work this time too,” shares Dawn Minott.

We need to amplify these diverse voices and recognise that sexual and reproductive health, rights and justice is fundamentally intertwined with the broader fight for social justice.

Every US$ 1 invested in maternal health has a return on investment of $ 8.40

We also need to resist polarisation. “We need to ensure that the health system is held accountable for upholding bodily autonomy and advancing sexual and reproductive health, rights and justice. This demands a fundamental shift in resourcing sexual and reproductive health, rights and justice,” said Dawn.

“We need to put our monies in the places where the needs are greatest. Investing in sexual and reproductive health, rights and justice is a powerful driver of progress. UNFPA estimation shows that return on investing every dollar in family planning and maternal health in developing countries is US$ 8.40. Currently, health financing is inadequate. In 2022 less than 1% of global aid went to stopping gender-based violence. Only 1% of health research focussed on non-oncology female-specific conditions. So, we must prioritize sexual and reproductive health and rights in health budgets, explore innovative financing and direct more resources to women-led and feminist organisations,” she said.