In an article for Natural Womanhood, an anti-contraception website, Nadja Wolfe responds to a piece in the Wall Street Journal by Bill and Melinda Gates, in which they raise awareness of the need for contraceptive access in poorer countries like Senegal.
Wolf criticizes the Gateses for imposing American healthcare on a culture that (supposedly) values pregnancy and childcare more than we do, yet fails to see the irony in imposing her lack of medical knowledge on women everywhere.
She makes several problematic claims in her piece, the first one being that Senegalese women apparently don’t want birth control:
A 2016 report published by the Guttmacher Institute, a strong supporter of increasing contraception use, found that most women in the sub-Saharan African countries surveyed knew about contraceptives and could access them… The report presented itself as an answer to “unmet need for contraception,” a figure calculated by the number of fertile women who are sexually active, want to delay pregnancy, but aren’t using “modern methods of contraception.” This number is often used to justify increasing funding to improve contraceptive access.
Yet most of the women surveyed had reasons that increasing access won’t address. These included infrequent sex, not having returned to fertility following pregnancy, and sub-fecundity… A quarter of married women also cited personal objections to contraceptive use, and of those women, three in five said they personally opposed using contraceptives… Among unmarried women, very few cited cost or lack of awareness for non-use, but over a quarter of unmarried women in the African countries in the study said they were concerned about side effects, health risks, or inconvenience…
Wolf doesn’t cite the exact percentage when she claims “most women,” but the number of women who don’t want birth control don’t override the ones that do. What Wolf doesn’t seem to understand is that making birth control available is simply that: making it available to women who want it. No one is implying that all women should be forced to use it. Furthermore, what medication doesn’t come with side effects or health risks? Wolf writes as if there’s only one-size-fits-all form of birth control, which couldn’t be further from the truth.
The Guttmacher Institute even notes on the very same page that “Many of these women’s perceptions about not needing contraception may be incorrect” and that “unless these women are practicing postpartum abstinence, they may be underestimating their risk of becoming pregnant.”
Preventing pregnancy is only one aspect of reproductive health care; perfect contraception access is not a substitute for skilled birth attendants, prenatal care, or adequately stocked clinics for childbirth.
Yes, birth control access is just one building block of women’s healthcare. Rome wasn’t built in a day: it’s not possible to completely reform Senegalese healthcare overnight, but making birth control readily available is a pretty good start for a country threatened by the Ebola and Zika viruses, which can cause severe birth defects or death.
Complete reproductive care is the ultimate goal. Wolf would be pleased, then, by this information from global development website Devex.com:
Senegal has a shortage of health workers, but it has done a great job of getting creative with the ones it has. For instance, the government has been working with us at IntraHealth International to rehire some of the huge cohort of out-of-work or retired midwives to help boost family planning throughout the country.It also instituted the Bajenu Gox Initiative in 2009. Bajenu gox (which means paternal aunt or godmother in Wolof) are traditionally very influential family members. Each community seems to have such a woman who acts as a social leader. So the government came up with a strategy to partner with local bajenu gox across the country and enlist them to provide sound advice for basic health and family planning. And it has worked.
But the possibility of side effects seems to be Wolf’s favorite dwelling point, as she keeps coming back to it in her piece. It would be dishonest to claim that side effects to birth control (although she never specifies which) don’t occur, and can be life-threatening in some instances, but it’s equally dishonest to not mention the scores of women whose health has improved by taking contraceptives. The latter outweighs the former, and data from Senegal proves it:
Since 1992,vaccinations in Senegal have soared, infant mortality has been cut in half, and the modern contraceptive prevalence rate has rocketed from under 5 percent to 20 percent.
And that last point is crucial, because contraception affects so many other aspects of health. As global use of modern contraceptives rose from 55 percent in 1990 to 63 percent in 2010, global maternal mortality fell by a staggering 45 percent. Countries that embrace family planning and build it into their health systems enjoy not only greater health, but greater gender equality and economic prosperity. And Senegal has made this a priority. As a result, the median age at first marriage for women has risen from 16 to 20, which means more women and girls stay in school longer and have a greater chance of joining the workforce and contributing to their families’ incomes…
Running low on better arguments, Wolf rehashes one of her previous points about the dangers of “imposing” first-world medicine on a third-world culture:
At the least, we shouldn’t impose our healthcare and family planning solutions onto women through foreign aid. If we fail to respect these differences in culture and values, we risk turning our good intentions into a new form of colonialism.
It’s absurd to say that making birth control accessible to women who want it is somehow forcing our ways upon their culture. (I question how free many women actually are to make these choices, since the culture is patriarchal, but that’s another story.) As Wolf even admits, there are Senegalese women who do want it and would greatly benefit from it. It’s like saying that chemotherapy shouldn’t be available because the majority of a country’s citizens don’t have cancer and perhaps never will.
But by far the most laughable part of Wolf’s article is her conclusion:
When we take the focus off the pill and put it onto women, where it belongs, it becomes clear that the real shortage is of knowledge. By educating women and doctors about hormonal health, we can help women improve their health and achieve their fertility goals.
In other words, if we just educate those women about their menstrual cycles, there’s no way they can get unintentionally pregnant. They just have to refrain from sex during certain times of the month, and that advice has always worked for women everywhere.
What’s next? Her dissertation on the pull-out method?
Yes, lack of knowledge is definitely a problem. But who are you going to believe: Wolf, whose medical opinions aren’t informed by any science, or the doctors who actually study reproductive health for a living? And who is Wolf to get in between a woman and her doctor? If she’s really for informed choice, she should respect that not all women will make the same ones she does.
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