Annually, September 26 represents World Contraception Day (WCD), a worldwide campaign to ensure that “every pregnancy is wanted.” Internationally observed for nearly a decade, WCD seeks to improve knowledge and awareness of contraception and family planning, while enabling and empowering people (particularly women) to make informed choices about their sexual and reproductive health.
The key, underlying focus of WCD is on the protection and promotion of reproductive health and reproductive rights. Reproductive health refers to a state of complete physical, mental and social well-being (not simply an absence of disease or illness), in all areas relating to the reproductive system, and its functions or processes.
Moreover, reproductive rights include: the right of all couples and individuals to be informed and have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law; to decide freely and responsibly the number, spacing and timing of their children; the right of access to appropriate health care services and facilities that will help enable women to go safely through pregnancy and childbirth; and the right to attain the highest standard of sexual and reproductive health. Importantly, reproductive rights also include the right of all people to make decisions concerning reproduction, free of discrimination, coercion and violence (ICPD 1995: 7.1-7.2).
Worldwide, although considerable progress has been made in promoting and improving women’s sexual and reproductive health, there still remain over 225 million women (particularly within the developing world) who want to avoid a pregnancy, yet are not using safe or effective family planning or contraception methods. Generally, this is due to a variety of factors, including a lack of access or supplies, significant socio-cultural and political barriers, and a poor standard of services.
Beyond representing a significant gender and health rights issue, this is especially problematic since a considerable body of research illustrates that expanding access to contraception and investments in family planning can save lives, and improve maternal and child health. Moreover, these steps can help contribute to an array of other important socio-economic and developmental goals. Simply, protecting and promoting reproductive health and rights can help break the debilitating cycle of poverty, and help put families, communities, and states on a positive path toward tangible, sustainable progress and development.
For example, young women or girls who give birth are far more likely to drop out of school and earn a considerably lower income; a single year of primary school boosts women’s wages later in life by 10 percent to 20 percent, while the boost from female secondary education is 15 percent to 25 percent (Psacharopoulos and Patrinos 2002). Additionally, young women or girls who give birth are also at a much higher risk of suffering various pregnancy-related complications or dying.
In Eritrea, the healthcare system aims to improve the health status, general wellbeing, longevity, and economic productivity of all Eritreans. Importantly, considerable progress has been made in terms of improving sexual and reproductive health. For example, through a variety of initiatives (such as radically increasing the number of hospitals and health facilities), antenatal coverage in the country has dramatically increased.
While in 1991 the percentage of women who had made at least one healthcare visit during pregnancy was 19 percent, by 2013, the figure had dramatically increased to 93 percent (see Figure 1). Effectively, this has helped the country significantly reduce maternal and child mortality ratios, and achieve the associated UN Millennium Development Goals (MDG). Additionally, Eritrea’s access to emergency obstetric care services increased from 21 percent in 1995 to 88 percent by 2013, while the country’s general focus on improving sexual and reproductive health has led to great strides in combating and controlling the prevalence and spread of HIV/ AIDS. Not only did Eritrea achieve the UN MDG related to combating HIV/AIDS, malaria, and other diseases, its HIV/AIDS prevalence rate is distinguished as amongst the best, both within the region and comparatively across the continent.
Encouragingly, knowledge of family planning and contraceptive methods is quite high among women and men, within both rural and urban areas (the pill, male condoms, and injectables are generally the most widely known modern methods). As well, the majority of women and men who use contraception make the decision to use contraception jointly with their partners or spouses, offering a positive indication of the acceptability of family planning. Reflective of the importance of education and equitable access for females, women’s level of education is positively associated with joint decisions; specifically, the higher the level of a woman’s education, the higher the frequency of joint decisions being made.
However, although access to and use of contraception and family planning in Eritrea have improved in recent years (for all methods), there is still a considerable unmet need that thus represents an important opportunity to expand access and support. Simply, family planning should be affordable, and easy to understand, access, and utilize, and free of any stigma, discrimination, or harmful myths. For Eritrea, a low-income, developing country, family planning and contraception can represent important investments. Specifically, by helping women and couples avoid unwanted pregnancies through expanded access to family planning and contraception, the country can greatly reduce costs of providing healthcare. For comparison, globally, it is estimated that if all women wanting to avoid a pregnancy used modern contraception, the resulting decline in unintended pregnancies would considerably reduce the costs of providing care from $10.5 billion to $2.7 billion (UAP 2016).
Ultimately, Eritrea and its partners (including various UN agencies and international health and development organizations) should continue to promote reproductive health and rights throughout the country. Expanded access to and adoption of family planning and contraception in Eritrea will not only support the realization of gender-based and health rights (encouraging autonomy and allowing women to manage their fertility and lives), it will also save the lives and considerably improve the health of many women and girls, and ultimately play a key role in promoting broader socio-economic growth and sustainable development.