A woman holds contraceptive pills in Moaga, Burkina Faso. Photo by: Nairobi Summit on ICPD25 / CC BY-NC-ND

NEW YORK — Slightly more than half of women are able to make their own decisions about accessing health care, using contraception, and having sex with their husband or partner, new research from the United Nations Population Fund shows.

“We had expected access levels [for sexual and reproductive health and rights] to be low, but we hadn't expected it to be that low.”

— Emilie Filmer-Wilson, human rights adviser, UNFPA

The findings, released Wednesday, offer the first detailed update on specific sexual and reproductive health targets within the Sustainable Development Goals, revealing a mixed picture of progress across regions and demographics.

“For the first time, we have measures on SRHR [sexual and reproductive health and rights] that go beyond looking at just services,” said Emilie Filmer-Wilson, human rights adviser at UNFPA. “It is a big step in terms of giving us a more comprehensive picture of the situation of SRHR.”

The findings should be a wake-up call on unsteady progress, Filmer-Wilson said.

SDG 5, which seeks gender equality and empowerment of all women and girls, includes a specific target on universal access to sexual and reproductive health and rights. 2019 data from the U.N., collected across 51 countries, has shown that 57% of women and girls aged 15 to 49 make their own decisions about sexual relations and use of contraceptives and health services.

UNFPA’s latest findings were surprising, according to Filmer-Wilson.

“We had expected access levels to be low, but we hadn't expected it to be that low,” Filmer-Wilson said. “If a woman cannot decide to leave the house to go to a health care center, we cannot achieve this development goal.”

UNFPA’s data from 57 countries offers more detail on factors that influence access to SRHR. It shows that a quarter of women are not able to make their own decisions about accessing health care, and a quarter of women are not empowered to say no to sex with their husband or partner. Nearly 1 in 10 women are not able to make their own choices about contraception.

Together, just 55% of women and girls who are married or partnered and aged 15 to 49 can make their own decisions about all three of these factors.

Empowerment over decision-making varies across regions, with less than 40% of women making their own decisions in West and Middle Africa. That figure rises to nearly 80% in some countries in Europe and Southeast Asia.

Education levels impact women’s decision-making abilities across all of the surveyed countries, with age and wealth being two other key factors. Older women and women in richer households are more likely to make their own decisions, according to Mengjia Liang, technical specialist at UNFPA’s population and development branch.

In about 40% of the surveyed countries, women’s decision-making power is regressing. In Nepal, for example, 59.5% of women were able to make their own decisions in 2011, while 47.7% did so in 2016, according to the new report. In recent years, women’s reported rates of decision-making over their health have also dropped in Jordan, Ethiopia, and Senegal, while Lesotho, Namibia, and Albania have seen gains.

“In this very basic and intimate area of women’s lives, not being able to exercise their autonomy has an impact not only on sexual and reproductive health, but on other development outcomes,” Filmer-Wilson said. “It is a wake-up call for the gender equality community. For us at UNFPA, it is a real encouragement to do further work on the area of gender equality.”

UNFPA is aiming to broaden its data collection pool to reach women and girls in 110 countries, including more middle- and high-income countries, according to Liang. More than 100 countries do not have available data on women’s decision-making power around their sexual and reproductive health or on laws guaranteeing access to reproductive health services and information.

“Many times, we feel like this is an issue for only the lower- and middle-income countries, but we see with SRHR that this is an issue for the high-income countries as well,” Liang said. “For many of the high-income countries, we don’t have data.”

About the author

  • Amy Lieberman

    Amy Lieberman is the U.N. Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.