In nearly every corner of the globe, you can find women taking contraceptives for family planning purposes. In just 40 years, the percentage of women who are using various forms of contraceptives has nearly doubled. Despite these increases, there are still pockets of women around the world who employ these methods at significantly lower rates than women elsewhere. This begs an interesting question: which factors play a role in the choice to utilize birth control?
As I write, I am sitting in a small village in central Uganda where contraceptives are not commonly used. The percentage of Ugandan women who choose to use contraceptives in any form is roughly 30%, while the international average is nearly 64%. Upon hearing of this huge disparity, I began to wonder what impact culture has, if any, on these decisions.
It’s important to note that as of 2011, 40% of the Ugandan population identified as Catholic and 14% identified as Muslim. The widely held understanding that Catholics tend to shy away from modern forms of contraceptives holds up in Uganda, but it is not the only identifiable rationale for women who opt out of using these methods. Other significant features of Ugandan society that directly impact these decisions are educational attainment, socioeconomic status, and geographical location. Urban women in Uganda are 19% more likely to use contraceptives than their rural counterparts; researchers mainly attribute these disparities to education levels. In rural areas, girls are likely to be pulled from school prior to full completion in order to help with household duties. The gender disparity in educational attainment—that is the preference for families to send boys to school before girls—directly impacts the use of birth control methods here.
Additionally, and not surprisingly, wealthy women tend to use contraceptives at a higher rate than women living in poverty. In many low-income countries, including Uganda, women with higher incomes and higher standards of living tend to desire smaller families, often because they prioritize their own careers. Conversely, women on the lower end of the socioeconomic spectrum tend toward larger families to help with household duties. Where lower-income women want to avoid large family sizes, they might not be able to afford costly contraceptives anyway. Thus, socioeconomic status is another direct determinant of birth control use.
These different elements of Ugandan society are interesting on their own, but I have been fortunate enough to experience them first hand. Whilst completing an internship at a non-profit organization here in Uganda, I have witnessed women making these difficult decisions first hand. For many of us in the western world, picking up contraceptives is often as easy as going to the nearest pharmacy and paying less than $10, and sometimes paying nothing. That’s not to say that women in the U.S. don’t have to fight for birth control but, compared to other parts of the world, obtaining birth control is relatively easily. For women here, the choice is not as simple. Where birth control options are available, they can be expensive and difficult to locate. For many women, the choice to purchase an intrauterine device involves weighing the choice to give up something else that might be of equal, or even greater, value like school fees for a term, or propane for cooking.
Gender relations in Uganda can also explain some of these decision-making processes. While gender equality is on the rise here, it is reminiscent of many patriarchal societies where women do not enjoy freedom of choice, even in respect to their own sexual and reproductive health. Especially in rural areas, the duty of a woman is to reproduce and rear her children while the man is expected to act as the primary bread winner. In these types of familial structures, women do not have the power to make decisions; thus, if the male head of household wants more children, she must oblige. Consequently, the choice for a Ugandan woman to use contraceptives may be seen as a source of power and control over her own destiny.
Contraceptive use in Uganda mirrors that of many other low-income countries, but not all. In Cuba, for example, abortion is very commonly used as a form of birth control. While typical methods like the birth control pill or injections are not as common, reports suggest that women often rely on abortions to terminate unwanted pregnancies. Interestingly, the public healthcare system is run by the state and abortions are provided free of charge. Another interesting case is Vietnam. Like China, Vietnam has historically adhered to a strict one or two child policy to help curb population growth. In order to promote this policy, the government offered various forms of birth control and free or heavily discounted costs; consequently, the rate of contraceptive use in Vietnam is roughly 78%.
These cases all present interesting insights into the decision-making processes women in the developing world face in relation to their sexual and reproductive health. While there is a range of societal features that impact a woman’s choice to use birth control, their physical location, socioeconomic status and cultural affiliations are extremely influential. It’s important for us, as global citizens who reside in the west, to take a look at the decision-making processes that women around the world face on a daily basis. Perhaps these sneak peeks into other societies will help us better understand and appreciate our own power and the beauty that resides in each and every one of us.
Courtney Tucker’s background is in international development, with specific emphasis on community-led projects that support women and children. She’s currently living in central Uganda and working with a small group of women who are living with HIV/AIDS. She enjoys cross-cultural exchange and believes there is much to be learned from sharing and growing with women of the world.
Photo Credit: The Economist