Too many children, too few choices

Ugandan women seldom get to choose the size of their family. CIAT under a Creative Commons Licence

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You can’t choose the family that you are born with, but you can choose the family that you create – right? For many women around the world, having a say about the number of children they bear is not entirely in their hands, not only through lack of birth control, but also lack of knowledge and education on contraceptive methods available and their rights to control their own reproductive lives.In Uganda for example, of the 2 million pregnancies every year, roughly one third are unintended. The reasons include failed birth control, no access to birth control, or incest, rape and fear of using contraceptives. A study has shown that more than 50 per cent of women are scared of discussing family-planning issues with their husbands and approximately 297,000 of the 2 million pregnancies result in unsafe abortions, while 85,000 suffer from reproductive health-related complications each year.Even in situations where women have access to birth control and are supported by their partners to use whichever method works best for them, birth control is never 100 per cent effective. Many women find themselves pregnant when they don’t want to be and can’t afford the burden of more children. Rather than risk their health and the wellbeing of the families they already support, abortion is the only option available, and unsafe abortion performed by ‘back street’ abortionists is often times the only option for most – even if they have the funds available to pay for a medically performed abortion.Lack of access to birth control and clarity on abortion laws mean that women in Uganda on average bear nearly two children more than they want. Add to that the dearth of healthcare providers in rural areas and financial constraints faced by women in these locations and you have a situation where women are not even close to being in control of their own reproductive destinies.According to the 2006 National Policy Guidelines and Service Standards for Sexual and Reproductive Health and Rights, pregnancy termination is permissible in cases of foetal anomaly, rape and incest, or if the woman is is HIV positive. In 2003, an abortion was estimated to cost a woman between $25 and $88, if performed by a doctor, a huge financial outlay in a country where the average monthly income is just $14 per household. Even when performed by a traditional healer the cost is estimated to be $12-$34.With one of the highest maternal mortality rates in sub-Saharan Africa, along with a very high fertility rate, the Ugandan government needs to address the issue of contraception and abortion laws and access to both if they are going to meet their goal of decreasing maternal and infant deaths by 75 per cent and universal access to reproductive health by 2015, just 7 months from now.It’s not just abortion that needs to be made safe and legal under wider circumstances, but contraceptives too. To really make a difference these facilities and methods of controlling fertility need to be made available, either freely or at a hugely reduced cost to put them within reach of those who need them most. Clarifying when abortion is and isn’t legal is also a major part of the solution. A big task is ahead of the Ugandan government if it wants to improve the health of its nation and future generations.works for the International Women’s Initiative IWI is holding a charity art auction with a series of unique pieces illustrating the diverse beauty and resilience of women on 31 May – more details on their website