The Ethics of Contraception: Acknowledging Fundamental Human Rights in Birth Control

Adapted from: World Health Organisation. Ensuring Human Rights in the provision of contraceptive information and services: Guidance and recommendations [Internet]. Geneva: WHO Press; 2014 [cited 2014 Mar 16]. Available from: http://www.who.int/reproductivehealth/publications/family_planning/human-rights-contraception/en/

Pregnancy and childbirth, while a truly wonderful and natural process of human life, may produce an incredible source of stress and burden onto the mother, the family and the greater community into which the child will be born. A child raised in such conditions will be disadvantaged, often through a lack of resources or sociocultural rejection. In least-developed countries, 60% of women who do not wish to (currently) become pregnant still do not use any form of contraception; even lower is the proportion which use contraception effectively. The need for increased contraceptive access is highest among the vulnerable and disadvantaged populations in society; including adolescents, the poor, those living in rural areas and urban slums, people with HIV and internally displaced people (this refers to individuals who are forced to flee their home country, yet remain there regardless).

While achieving the highest attainable standard of health for all (including that of sexual and reproductive health) is the primary objective of the World Health Organisation, this cannot occur without respecting, protecting and fulfilling the fundamental human rights of the individual. This requires educating and advocating populations about gender equality, and prioritising the distribution of goods to the poor and under-served (commonly termed the inverse care law), and was highlighted in Target 5b of the Millennium Development Goals: "access to effective reproductive health should be universal by 2015".

The lack of contraception (resulting from a variety of barriers as discussed below) in developing countries is often underestimated by unknowing citizens of developed nations; according to recent WHO estimates, 222 million women are unable to use contraception. This translates to 54 million unintended pregnancies, 26 million abortions (16 million of which would be considered unsafe by international standards), 7 million miscarriages, 79,000 maternal deaths and 1.1 million infant deaths every year. While reducing maternal, foetal and infant deaths (not to mention curbing the exponential growth of the global human population) are obvious advantages of allowing access to effective contraception, it promotes sexual freedom and therefore psychological well-being.

According to WHO, 80% of global governments have embraced the legal enforcement of at least four of the principle human rights as accepted by international law. Whilst progressive movements with regards to human rights in the face of contraception have, and are constantly being made (such as increasing legal obligation to provide timely and affordable access to high-quality sexual and reproductive health education and contraceptive services whilst maintaining patient dignity, autonomy, privacy and confidentiality), this is not apparent in many countries and states around the world.

Although some progress has been made, the global improvements to women's sexual health have so far been woefully insufficient. The major barriers to effective contraception include the practical/logistical difficulty in providing contraceptive devices to certain geographical regions, the inflated prices as a result of this (unaffordable to those in need), a lack of sexual education of these populations, misunderstandings about reproductive and sexual health in women and the continued presence of gender inequities (ultimately preventing disadvantaged, uneducated women to make decisions about sexual activities). The lack of perceived choice may stem from strong social, cultural or religious pressures/outright threats to avoid contraception, or by coercive governmental policies and forces (the sterilisation of uneducated men and women alike without informed consent in developing nations is a common issue), and either way violates the fundamental human rights of an individual.

In response to the continued need for governmental regulation and guidance, the WHO have recently (March 2014) compiled an extensive list of recommendations following a systematic review of recent literature (high-quality evidence articles of the last two years, as assessed by the GRADE scale, were used to amend data of previous similar WHO guidelines) with focus upon the availability, accessibility, acceptability and quality of contraceptive health services. The reorganisation and reformulation of existing recommendations produced the 10 principles for ethical provision of contraceptive information and services as seen below;

International intervention and support of contraceptive services through implementation of these WHO recommendations may assist in reducing the negative implications of unintended pregnancy. This may be achieved through both education, reducing the stigma associated with existing social, cultural and religious beliefs, and increasing the actual physical accessibility of effective contraceptive devices. Benefits of effective contraceptive accessibility include reducing maternal, foetal and infant deaths, preventing global over-population, allowing individual sexual freedom, psychological well-being and thus greater health of the individual, family and greater community, particularly those vulnerable and disadvantaged populations.

Guy Armstrong: Medical Student