Dispatches from Women Deliver: Breaking Taboos For Women’s Health

Ed note. This is a special guest post from Morra Aarons-Mele, who is attending the Women Deliver conference underway in Kuala Lumpur. 

Kuala Lumpur, Malaysia – The hidden subtext of the Women Deliver 2013 Conference in Kuala Lumpur Malaysia, the largest global health event of the decade, is all about breaking taboos: Taboos about women and power, about sex, about relationships between men and women, and about the role of global institutions in quite simply talking about sexual health.

According to Marie Stopes International, 222 million women around the world have an unmet need for family planning. Access to this care would prevent unnecessary deaths and reduce poverty.

The consensus of over 4,000 highly educated and sensible people that “Reproductive health is a human right” feels revolutionary to an American in our current political climate. But at Women Deliver, family planning is depoliticized. Everyone here addresses sexual and reproductive health and rights as absolutely key to the health of global economies.

The connection between a healthy and economically sustainable planet and sexual and reproductive health is clear, proven again and again by data, but difficult to discuss, in almost every country.

As Melinda Gates said at Women Deliver, “There’s nothing more inspiring than hearing a woman or girl raise her voice.” It’s time to raise our voices as American women in support of global reproductive health for all women worldwide. This means girls, adolescents, women of childbearing age, and women as they age.

Underpinning this all is the right to plan when you have children. Gates notes, “We have to understand that contraception is the means to a more fulfilling life.”

Yet up to ¼ of girls in sub-Saharan Africa, for example, drop out of school because of unplanned pregnancy. And the reality of providing quality access to contraceptives is limited by everything from low stock to lack of care providers; lack of will among governments to address many real taboo topics is also a huge barrier.

Women who have the power to decide when to get pregnant also have the power to decide their future. Brave leaders are fighting huge taboos, from cultural barriers to faith-based concerns. In the Philippines, a heavily Catholic country where 80% of the population uses modern contraception enacting rights to reproductive health into law took 15 years.  There were 11 challenges submitted to Supreme Court to suspend the reproductive health bill in Philippines but leaders committed to overcome opposition, and they did.

As Melinda Gates notes, we have the same situation in the US- over 99% of Catholics use contraception but the Conference of Bishops and the Church hierarchy fights it. At the same time, Gates notes, many religious entities have a strong social justice mission and so in some countries are willing to focus on a shared agenda of saving women’s lives.

Religious leaders have been involved successfully in support of a family planning program in Senegal, an overwhelmingly Muslim country. In Kenya, a group called Catholics for Choice is fighting for family planning and there is a tug of war right now, notes Njeri Rugene from the Daily Nation. The fight to bring contraceptive choice to women is shared from the US to many countries worldwide. It’s a fight we will win if we stand together. And we can use data.

In Bangladesh, for example, Gates pointed to research that followed two villages: one with contraceptive access and one without. The families with access were healthier over 20 years, and wealthier. When children are planned there is a whole benefit that scales up from the village, to county to country. There is a “demographic dividend”: a cohort of educated children who have more choice and drive GDP.

Beyond institutional barriers, there’s the taboo of bringing men into the conversation, but this too is changing. “Husband groups” are emerging, throughout Africa in particular. These groups are facilitated to talk just to men about the importance of women’s health- from basic questions of contraception to asking the big questions, as in Malawi for example: “Why aren’t we taking women to clinic to deliver a baby?”

In Sierra Leone, a new program knows reproductive health is about a relationship between men and women. For a woman to be healthy during pregnancy but men need to be fully on board too. Reverend George Buannie developed a “husband school,” where men teach other men to respect women’s rights and sexual health. The villages where his NGO FINE works have seen a 60% decrease in rape and gender based violence, and maternal mortality decreased by more than 60%. Contraceptive use has increased from 30 to 51%.

The taboo of sex hangs over many global health crises. I met  Helena Nangombe, a young woman from Namibia who is a global Women Deliver Youth Leader and the mother of a nine year-old son. Helena is an activist those in Namibia living with HIV, as she has for 17 years. She was raped and infected at 10 years old. Now she fights HIV discrimination. Discrimination against those with HIV leads to people being isolated, scared to access medication, and not least, often unable to date or find relationships, and of the challenges of disclosing your status when dating someone. Helena spoke to me of the fear of not finding someone to marry because you are HIV positive.  There is the fear of losing one’s work because of the HIV taboo; 4 weeks ago Helena spoke up for a woman working in a hotel who got fired once her boss knew her status.

Helena wants to open up a center and reach out to young people. She wants to meet young people and encourage an open community conversation, by speaking out not only through social media such as Facebook but to include people who are unable to read via television.

Says Helena, “Women are vulnerable and men are the cause of that, so to be successful in fighting the stigma you need to be working with men. [Because now in Namibia] women don’t have a choice- you can’t talk about sex. It’s taboo to talk to men about sex.”

But we need to talk about sex. Women and girls have a right to sexual and reproductive health and to choices. As Melinda Gates said, “If she doesn’t have the life she desires for her family the world suffers.” Reproductive health is key to the future of our planet and we must overcome our taboos to get there.