By: Arushi Singh

Why does a young, unmarried woman need access to any contraceptive other than condoms?

This was the question I heard repeatedly from sexual and reproductive health (SRH) service providers in South Asia when I was working for an international SRH organization. The socio-cultural context of conservative South Asia, where sexuality is taboo and women shouldn’t be sexual unless they are married (even then they shouldn’t be seen to actually enjoy sex), means that service providers frequently bring their values and biases into their service provision.

But this is not endemic to South Asia. There are other adults (mostly men!) in other parts of the world who have decided that young women and men don’t need to know about the different ways they can control their fertility. Other than condoms – which are now considered okay because of their role in preventing HIV – many providers think that young people shouldn’t be given tools like long-acting contraceptives, or (shock! horror!), information about and access to safe, legal abortion. Keeping young people ignorant about matters concerning sex under the garb of keeping them ‘safe’ and ‘innocent’ is the dominant narrative across the world.

As one of my dear colleagues and mentors says, “the one thing we should be grateful to the Bush administration for is to provide us with all this evidence that abstinence-only education doesn’t work!” And there’s more and more such evidence available all the time.

We know that comprehensive sexuality education (CSE) enables young people to be in charge of their bodies and sexuality by giving them the knowledge, attitudes and skills they need. Even UN agencies have reviewed the literature around this and endorsed a truly comprehensive set of learning objectives for sexuality education (don’t just take my word for it, see this UN document). Specifically, it says, “The omission of key topics will lessen the effectiveness of CSE. For example, failure to discuss menstruation can contribute to the persistence of negative social and cultural attitudes towards it. This may negatively impact the lives of girls, contributing to lifelong discomfort about their bodies and leading to reticence in seeking help when problems arise. Other examples include: sexual intercourse; scientific information about prevention of pregnancy; the SRH needs of young people living with disabilities or HIV; unsafe abortion and harmful practices such as CEFM and FGM/C; or discrimination based on sexual orientation or gender identity. Silencing or omitting these topics can contribute to stigma, shame and ignorance, may increase risk-taking and create help-seeking barriers for vulnerable or marginalized populations.”

Despite this, we have a situation where, not only are there socio-cultural barriers to discussing sexuality, contraception, abortion, and pleasure, but we also have policies like the Global Gag Rule that stop sexuality educators in the Global South from explaining safe and legal abortion to young people. This, despite the fact that:

  • Unsafe abortion constitutes one of the five key reasons for nearly 75% of all maternal deaths

  • About two-thirds of all maternal deaths take place in sub-Saharan Africa, followed by Southern Asia. Nigeria and India alone account for one-third of global deaths.

  • As of 2010-2014, an estimated 36 abortions occur each year per 1,000 women aged 15–44 in developing regions, compared with 27 in developed regions. In much of the world, 20–24-year-old women tend to have the highest abortion rate of any age-group, and the bulk of abortions are accounted for by women in their twenties.

  • Adolescent girls have a particularly high risk of death in childbirth. In fact, complications in pregnancy and childbirth, together with unsafe abortion, are the biggest killers globally of girls aged 15 to 19.

When sexuality education cannot be truly comprehensive by addressing young people’s realities, their desires and fears, their relationship concerns, their need to know more about their bodies and how to have agency over these bodies, and by telling the truth about sex (its mostly fun!), it cannot be of much use in the real world (a bit like calculus – unless you are an architect or building engineer of some sort).

Learning about how to stop a pregnancy that is neither wanted nor intended, and how to deal with a pregnancy that has occurred without meaning for it to and without wanting it to continue, are essential life skills for anyone with a uterus. In fact, silence, secrecy and stigma around abortion results in (mostly young) people with a uterus being unable to seek life saving health care, and a lot of unfounded myths about abortion.

This argument has been made before, but at the risk of turning it into a cliché, I want to say – when we teach children and young people a new thing, we usually demonstrate, encourage trial and experimentation, urge caution where required but understand that at some points self-awareness of risk comes from experiencing or near-experiencing it or learning from others’ experience of it. Think about learning to climb stairs, cross a road, or ride a bicycle. Only when it comes to sex (and calculus), does it suddenly become purely theoretical, biomedical and non-messy (as opposed to what its like in real life), and accompanied by warnings, achtungs and don’t try this at home (though I wish calculus came with the same warnings too).

Instead of openly discussing issues like abortion, where to get a safe and legal one, how to support someone who needs one, or how not to perpetuate abortion stigma, very few sexuality education programs even mention abortion as an option for unwanted pregnancies. We are nearly 20 years into the twenty-first century; it’s time to get real.

Want to know how to actually talk about abortion? Check out this cool animation and be part of changing how young women and men understand their bodies and themselves.

Photo via Flickr