When Alima was 15-years-old she travelled to the Ghanaian capital to work as a head porter in the market, planning to save money to buy household items for her marriage. But girls working in the market often end up sleeping rough. Some end up pregnant because they are raped or forced to exchange sex for somewhere warm to sleep.
Fortunately, Alima heard about our clinic from peer educators who we had trained to raise awareness in the market. She went for counselling with the nurse and decided to take up a method. Alima spoke to our team about what she could do. We made some suggestions, and in the end she chose a five-year implant. Instead of buying crockery with her savings, she decided to go home and enroll in school.
Working in clinics in Ghana and Kenya, I have seen the consequences when contraception is not available. I’ve seen women dying in childbirth, mutilating their bodies or risking their lives with backstreet abortions. In developed countries such as the UK, contraceptive use has plateaued between 60% and 80%. In east Africa, if current trends continue, it will take another 45 years to reach 60%. While in west Africa, where I am from, the same rates will not be achieved for 500 years. That’s the year 2515.
I believe that being able to choose if and when to have children is a basic human right. Economically, it makes sense; for every additional pound invested in contraception, the cost of pregnancy-related care is reduced by £1.47. In fact, just last year a leading economist associated with the Copenhagen Consensus Centre think tank rated investments in sexual and reproductive health as “phenomenal” and described family planning as “inexpensive with clear benefits”.
But you also cannot underestimate the significance of contraception in giving girls and women control over their lives and futures. When girls have the choice, like Alima, they have children later. This means they can finish their education, become financially independent and contribute to society. They can space their births further apart, which means healthier lives for them and their babies.
Women in Africa want contraception. While the west waffles on about providing aid for family planning, Africans are asking for it. I met one woman called Hawa in a remote village in Kenya who knew about contraception but was living far from a clinic. She hadn’t been able to use it and was struggling to feed her five children. She was very angry and felt her life could have been very different if only she had access to contraception. Women and men see the importance of making our own choices and determining our own future. It’s not the west telling us to do something.
In my jobs as country director for Marie Stopes in Kenya and Ghana, I have met amazing girls and women whose stories make my heart swell. Women like Miriam who, after having four children one after the other, was at risk of becoming homeless when her husband became too ill to support them. Then she met one of Marie Stopes’ community workers and decided to use a copper IUD to protect her for years to come. We were also able to put her in contact with a women’s microfinance company that helped her find the money to set up a kiosk selling tinned food, soft drinks and biscuits. She told me : “Now I am using contraception I am finally in control of my life. Instead of begging on the streets, I can go to work and look after myself, my husband and my children.”
Yet 225 million women around the world who don’t want to get pregnant are not using any form of contraception, with some areas much worse affected than others. As a result, every day, around 800 women are dying from preventable causes related to pregnancy and childbirth. When a mother dies her children’s best hope for survival dies with her.
As someone who has lived and worked in clinics from Brixton to Accra, the main difference I see is that women in the UK are empowered. They can take control of what happens to their body and what they want from their futures. In countries such as Ghana and Kenya that agency is not there. But the women in Kenya and Ghana are brave because they are challenging the status quo. I meet girls with hope in their eyes and ambition in their voices, who give me the sense things can really change. They are challenging what their mother and grandmother, religious leader and husband tells them. Their husband may not be happy about their choices, he may even beat her until she’s black and blue but they are determined to create real change.
Women in the UK have such an advantage and they don’t even know it. They are far more educated about contraception and can make more informed choices. We need to make sure that girls the world over have the same opportunities.