The assertion seems simple enough – all people, regardless of race, class, gender, or locale, should be free to decide when they have children. And yet, as Melinda Gates aptly observed in her recent TEDxChange talk, “a totally uncontroversial idea [has] unfortunately…become incredibly controversial”.
In the Berlin talk last week, Gates spoke about the importance of family planning as a tenet of the global health agenda. She quickly debunked the widely held belief that access to contraception is a mere woman’s issue. Without question, family planning (or lack thereof) has social, political, and economic implications that redound throughout the global community. Studies have repeatedly shown that when men and women are able to make the conscious decision to have (or not have) children, rates of impoverishment fall, maternal and child health dramatically improves, and even carbon emissions are reduced.
Despite the apparently incontestable benefits of what Gates deems a “totally uncontroversial idea”, questions of universal access to contraception often seem to incite nothing but controversy.
According to Gates, those who suffer most from a lack of family planning capacities are the people of sub-Saharan Africa and the poorest parts of South Asia. Fewer than 20% of sexually-active youth in Africa use contraception and more than 200 million women in Africa and Asia live without adequate family planning services. And although the rates of contraception usage in developing regions rose from less than 10% to 60% between 1960 and 2000, birth-rates in many developing countries still average upwards of 6.
Hundreds of millions worldwide want to control their fertility and yet fail to consistently use contraception. Why? Because it is simply not available. Yet it would cost no more than $3.9 billion a year to make family planning tools available. This seems a minimal cost considering the magnitude of benefit.
One of the major resistances to universal availability are the opponents of family planning, who make up a numerous and powerful group. Some suggest that the value of human life is immeasurable and that reproduction must occur unimpeded. Others assert that family planning often translates, or inevitably slides, into practices akin to eugenics (consider Mississippi appendectomies, Margaret Sanger’s Negro Project, and more recently UN funded campaigns to sterilise disabled women).
The challenge today is to examine the issue in its entirety, properly assessing it within our present socio-political context. What does this mean? According to Melinda Gates, it means acknowledging the past but also understanding that “in region after region, parents have again and again decided to have smaller families”. And that “there is no reason to believe that African women have innately different desires from the rest of the women in the world. Given the option, they will bring their overall fertility down.”
Of course one cannot know for sure what women in Africa and South Asia would do if contraceptives were readily available. But this is not the issue. The issue as posed by Gates is about ensuring a certain quality of life for all of the Earth’s inhabitants by protecting every individual’s right to determine the trajectory of his/her existence. Universal access to contraception, Gates suggests, is an important part of the protection of this right. If a family decides they want three children as opposed to seven, should they not have the freedom to make this choice?
Perhaps attempting to drown out the polemic cacophony that surrounds the issue of family planning, Melinda Gates packaged universal access to contraception as an “uncontroversial idea”. But, in reality, it seems controversy will inevitably follow the issue wherever it leads. And, given the ongoing heated responses to the notion of family planning, this is perhaps to be welcomed.
It is only through public dialogue that issues can be brought to the fore, myths debunked, and stigmas deconstructed. And there is a chance that from this dialogue will spring effective action.
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