"International Women’s Day: A Look at the Global Landscape Shows that Reproductive Health Care Matters"
Our guest bloggers are Jessica Arons, the Director of the Women’s Health & Rights Program at the Center for American Progress.
International Women’s Day is a good time to hit the pause button on all the debate swarming around abortion and contraception in Congress, the states, and on the campaign trail, and consider what our country would look like if antichoice zealots had their way in further restricting access to contraception and abortion.
Right now, around the world, women are suffering in countries where they have no access to basic reproductive health care and no say over when, whether, and under what circumstances they have children.
Let’s start with the unmet need for family planning. According to the United Nations Population Fund, at least 200 million women want access to safe and effective contraception but lack information, services, and family or community support. Even worse, this unmet need is expected to grow by 40 percent over the next 15 years. The lack of access to voluntary family planning services means that these women cannot plan the timing and spacing of their pregnancies in order to improve health outcomes for themselves and their children. The result: high rates of maternal and infant mortality, fewer opportunities for women to obtain education and income to support their families, and significant strain on family and community resources.
In much of the world, childbirth is also still a highly dangerous event. Globally there are approximately 350,000 maternal deaths per year, averaging out to about 1,000 deaths per day. Hemorrhaging, infections, eclampsia (a condition that may involve seizures or coma), obstructed labor, and unsafe abortion are the most common reasons women die in pregnancy or childbirth. And all could be averted with timely access to skilled care. But only 58 percent of women in the developing world are able to labor with assistance from a doctor or midwife and only 4 in 10 give birth in a health facility.
While those statistics are startling enough, the number of women injured in childbirth is 20 times higher than the number of those who die. Obstetric fistula (tearing of the birth canal from prolonged and obstructed labor), anemia, infertility, damaged pelvic structure, chronic infection, perinatal depression, and impaired productivity are among the many health complications women may experience. Some of these conditions, especially when left untreated, can lead to social isolation, marital problems, increased poverty, and suicide or shortened life spans. And, again, many of these conditions could be treated if appropriate medical care were available.
A lack of access to family planning services also leads to more women choosing abortion, even when it is illegal. In fact, more than 50 million of the 190 million women who become pregnant each year terminate their pregnancies, often in unsafe conditions. Estimates of deaths from unsafe abortion range from 47,000 to 74,000 a year. Complications from unsafe abortion comprise approximately 13 percent of all maternal deaths, making unsafe abortion one of the top three direct causes of maternal death. This phenomenon is especially tragic given that it is probably the easiest problem to solve—legalizing abortion reduces the rates of maternal death quickly and dramatically. For those who survive clandestine abortion, around 8.5 million experience injuries that require medical attention but 3 million must go without the care they need.
Women’s status and their ability to fully participate in society are directly related to their access to reproductive health services. Women who cannot plan their families and who are in poor health generally experience higher levels of illiteracy and poverty than men, are less likely to own property or have access to credit, are more likely to be victims of domestic violence, and are less likely to be civically and politically engaged.
In contrast, consider the United States, where 60 percent of women are now the primary or co-breadwinner for their families. Twelve Fortune 500 companies have female CEOs, 11 of whom are mothers. And though women are still far from achieving parity in elected office, 16.6 percent of the U.S. Senate, 17 percent of the U.S. House, 21.6 percent of statewide elected positions, and 23.3 percent of state legislature positions are held by women.
Progress for women in the United States is due, in large part, to their access to reproductive health care. Ninety-nine percent of sexually active women in the United States have used birth control, and 62 percent are using it at any given time. The U.S. abortion rate is lower than in countries where abortion is illegal, and the death rate from abortion, at 0.6 deaths per 100,000 procedures, is virtually zero. While women in the poorest countries have an average of 4.5 children in their lifetime, the typical U.S. woman has only two.
Of course, this situation was not always the case. Before widespread access to contraception, our birth and mortality rates were much closer to those in today’s global south. At the beginning of the 20th century, our maternal mortality rate was approximately 65 times higher than the current rate. And in the 17th and 18th centuries, one in eight U.S women died from childbirth and the average woman had five to eight children.
As recently as 1965, before the 1973 Roe v. Wade decision legalized abortion throughout the country, illegal abortion accounted for at least 17 percent of all officially reported pregnancy-related deaths, with access to safe abortion care often depending on race and class. For instance, between 1972 and 1974, the mortality rate from illegal abortion was 12 times higher for women of color than for white women.
In short, access to family planning, abortion services, and maternity care is one of the critical differences between the global north and south and between our great-grandmothers’ generation and our own. It is the difference between women being forced to live in separate spheres or able to fully participate in society. It is the difference between having small, healthy families where each child can be nourished, sheltered, educated, and loved or having numerous children whose lives and futures are fragile and often fraught with affliction. And it is sometimes quite literally the difference between life and death. It is unimaginable that we would want to undo the advances women have made in our society, and we should resolutely reject any policy agenda that would take us there.