Globally, 45% of women are not in control of decision-making related to sexual and reproductive health rights, 27% do not have access to reproductive health care information and education, and 19% of births remain unattended by skilled health care personnel — contributing to a maternal mortality ratio of 211 for every 100,000 live births.
The State of the World Population 2021 report, released by the United Nations Population Fund on April 14, paints a concerning picture of women’s rights to bodily autonomy in 2021 — with conditions for women and girls continuing to deteriorate.
“What was previously bad is now worse with the COVID-19 pandemic, which has resulted in increasing sexual violence, more unintended pregnancies, and new barriers to health access along with job and education losses,” Natalia Kanem, UNFPA executive director said at the launch of the report. “Gender inequality is the most insidious and pervasive impediment to bodily autonomy. It starts from the cradle.”
An analysis by the Center for Global Development of over 400 studies conducted since the pandemic found that women in low- and middle-income countries have paid a disproportionately high price for the pandemic.
While the global figures are alarming, it is women in the lowest-income countries that suffer the most — and the report provides detailed data on the regions where gender will determine the right to health care, education, and employment, as well as the right to live a life free from violence and safe from child marriage.
Interactive visualization of State of the World Population 2021 Data. Source: UNFPA.
What does the data say?
Access to health services, including access to contraceptives, is a growing area of concern during the pandemic. Globally, the prevalence rate of women using contraception is 49% and 37% for women who are married or in a union. This rate is higher for high-income countries and drops to just 32% for all women and 42% of women married or in a union for the world’s low-income countries.
For all women, the rate of contraceptive use is lowest in South Sudan, with a prevalence rate of just 6%. This is followed by Chad (7%), Eritrea (9%), Gambia, and Sudan (both 11%). Finland, Canada, the United Kingdom, and Switzerland were the leading countries for prevalence of contraceptive use, with rates of 72% and over.
“The question is not do they have that right, it’s rather when will that right come to life. How many women can actually claim they have the power to exercise that right?”— Natalia Kanem, executive director, United Nations Population Fund
Rates using modern contraceptive methods, which have the most advanced science and reproductive knowledge to support women with family planning, are lower. 45% of all women and 57% of women married or in a union use modern contraception globally — dropping to just 28% of women in low-income countries. The prevalence rate is just 4% in Albania, 5% in South Sudan, and 6% in Chad.
Social norms and policies contribute to further barriers. In making decisions for a woman’s own sexual and reproductive health, just 7% of women in Niger and Somalia report self-determination, and 8% in Mali. Data on the prevalence of female genital mutilation exists for just 30 countries in Africa and the Middle East — but shows its practice is highest in Somalia with a prevalence rate of 97% among girls aged 15 to 19.
Child marriage by age 18 is reported in 124 countries, led by Niger, where more than three-quarters of all girls are entered into marriage. For girls aged 15 to 19, this means a higher adolescent birth rate. Among countries reporting high adolescent birth rates, Central African Republic reported the highest with 229 births for every 1,000 girls, followed by Mozambique (180) and Chad (179). In both North and South Korea, there is one birth for every 1,000 girls.
This sees access to health challenges increase for women and the risk of death increase. In Chad, less than one-quarter of women give birth with the assistance of a skilled health professional leading to 847 deaths for every 100,000 live births.
All of this contributes to lower life expectancies for women. In Central African Republic, Chad, and Nigeria, the life expectancy for a girl born in 2021 is 56 years — a 32-year difference to a girl born today in Japan and Hong Kong, where the life expectancy is 88 years.
Why the data matters
“Women have the right to make their own decisions about their own bodies,” Kanem said. “The question is not do they have that right, it’s rather when will that right come to life. How many women can actually claim they have the power to exercise that right?”
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The data, she said, showed that there was still much work to do to achieve equality, both for health and economic benefits and to help countries as they seek to recover from the COVID-19 pandemic. But progress depends on upending the social and economic structures that perpetuate inequality — which requires men to become allies, she added.
Institutions and leaders — both in politics and within communities — are also needed to support a change in social norms with laws, education, access to health services, and monitoring progress among the solutions recommended in the report. Improved education, it says, is more likely to help women and girls make better decisions about sexual and reproductive health and to say no to unwanted sex.
Laws providing rights to women and girls need to be implemented with financing behind it along with enforcement powers to be more than just a check in the box. Detailed gender-disaggregated data can help monitor the impact of policies on women and girls’ lives for the benefit of all.
“Realizing bodily autonomy for everyone will bring us a giant step closer to a world of greater justice, equity, opportunity, dignity, and wellbeing,” Kanem said.