Carine is 14. She lives in a small village in southern Benin, with her in-laws, in a concession of clay huts with iron roofing. Her parents’ village is 50 km away. She was a victim of a forced marriage at 13 and very rapidly became pregnant. She is the third wife of a husband who is about 25. “I would have liked to have been left to grow up”, she tells everyone who is willing to listen to her.
This life course is not unique. Millions of women around the world experience similar stories. Their lives are strongly marked by the lack of access to sexual and reproductive health information and services, as well as the violation of their most intimate rights.
According to the high-level working group for the International Conference on Population and Development (ICPD), “Sexual and reproductive rights are fundamental human rights. They are the rights of everyone to make free, informed and responsible decisions and have full control over very basic aspects of one’s private life – one’s body, sexuality, health, relationships, and if, when and with whom to marry and have children – without any form of discrimination, stigma, coercion or violence. This includes rights to enjoy and express one’s sexuality, be free from interference in making personal decisions about sexuality and reproductive matters, and to access sexual and reproductive health information, education and services.”
SRHR, which are currently too often challenged by the conservative forces very much to the fore in the international arena, are consequently fundamental human rights that are essential to women’s empowerment. The consequences related to the violation of these rights (early marriages, sexual abuse, unwanted pregnancies, unsafe abortions, maternal deaths…) are crucial in determining the life paths of women. They also have a direct impact on society. Individuals who cannot maintain good health and safety in their sexual and reproductive life and who cannot make informed choices in this respect are less likely to have access to education and work and have more difficulties in participating in the development of their family and their community.
Adolescence: The key age for moving sexual and reproductive health and rights forward
Why work with adolescent girls? Because for them, in addition to gender-related discriminations, there are age-related discriminations: in gerontocratic and patriarchal societies, adolescent girls are highly exposed to violence, and their right to speak and their access to resources are very limited. At adolescence, boys gain independence, while at the same age, young girls sometimes permanently lose their prospects of independence: their relationships, their movements, their access to knowledge or their bodies are subject to increased family and social control. It is also because it is at this age that the information and services they can benefit from will have the most significant impact on their life paths. For the action to be effective, it needs to be conducted while there is still time.
A few figures alone demonstrate the importance of the issue: 16 million young girls aged between 15 and 19 and a million under 15 give birth every year. Pregnancy or childbirth-related complications are the second leading cause of death for these young girls. For girls between 10 and 19, the likelihood of dying from violence is significantly above the average. In certain regions, over one girl in three has been raped before the age of 18. But while adolescent girls have significant needs, they are systematically underrepresented in attendance at health facilities and often left out of health and family planning programs.
This challenge can be addressed by taking several decisive steps. Firstly, it is important to secure budgets for access to contraception for young girls. Without specific means, it is difficult to move from the stage of good intentions to the implementation of concrete actions. Furthermore, the strategies developed must combine several approaches: education and information, training of service providers and the adjustment of services, communication within communities. In all cases, adolescent girls must be systematically involved in their preparation, implementation and supervision. Finally, investments in reproductive health for adolescent and young girls would benefit from relying more on research results. Approaches which have not proven their effectiveness must be reconsidered and, conversely, it is necessary to invest massively in what works, such as comprehensive sexuality education whose impact has been proven. Finally, it is necessary to support the relevant ministries and local NGOs (which Equilibres et Populations has been doing for about fifteen years): for example, assisting them in the collaborative preparation of projects, the mobilization of resources or capitalization on experience will be crucial to the success of such approaches.
Bring about changes in social norms: The only sustainable way forward
In terms of promoting sexual and reproductive health and rights, both the strength of taboos related to sexuality and the unequal social representations between men and women cannot be ignored. Questioning the norms and sharing of power is consequently a prerequisite for sustainable change.
To achieve this, it is necessary to invent new mechanisms for action to train all stakeholders in gender (staff of development agencies, ministries and NGOs, education and health agents, community workers), stimulate the emergence of citizen debates via mass communication, promote the leadership of women and girls, and involve men at all levels of society. Consequently, decompartmentalizing approaches and combining, as much as possible, actions for health and the promotion of rights guarantees the effectiveness of programs.
These innovations can only be led jointly by all stakeholders, the men and women who devise and implement actions, but also those who finance them. This requires operating in longer investment cycles as “it takes time to move from the possible to the conceivable” as Françoise Héritier likes to say. Ideas gradually move forward. This being said, society has been adapting and changing since the beginning of time. What appears like utopia today may tomorrow be endorsed by texts and practices. This also requires reviewing how actions and their societal impact are evaluated. There is still a long way to go in this respect: alongside quantitative indicators, it is necessary to draw on the field of social sciences in order to invent tools that give a better understanding, for example, of the changes in mentality or women’s empowerment.
Finally, what if investing in sexual and reproductive health and rights not only had the potential to transform the lives of millions of women, but also development practices?
The opinions expressed on this website are those of the authors and do not necessarily reflect the official position of their institutions or of AFD.