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November 29, 2012

Why birth control is still a big idea

I spent most of my time this year advocating for better access to family planning around the world. Early on, I told everybody who would listen that I wanted to help put contraceptives back on top of the global health and development agenda. Visiting women in developing countries, however, I realized that this framing didn't quite capture my message.

Contraceptives are tools, and the development agenda is an abstract construct. What was missing were human beings, the women across the world who have told me over and over again that having access to birth-control methods that work for them would change their futures. Now I tell people that I want to help put women at the center of global health and development work, and better contraceptives are one of their top priorities. Listening to women shouldn't still be a revolutionary idea in 2012, but it is.

When I visit family-planning wards at health clinics in African countries, there are always plenty of free condoms available. Condoms are vitally important, especially because they also help prevent the spread of sexually transmitted diseases like AIDS. But there's a problem: The overwhelming majority of African women can't rely on condoms for birth control because their husbands refuse to use them.

In the same way that American women prefer contraceptive pills, which they don't have to negotiate with their partners, African women favor contraceptive injections over condoms. But because of supply constraints, supply-chain problems and outdated public policies, these injections are frequently out of stock. To take one example, in Kaduna, Nigeria, a city of some 1.5 million people, there were 226 days last year when not a single public health clinic had injections available.

If you are focused simply on making sure contraceptives are available, you can stockpile condoms and call it a day. But if your goal is helping women build the lives they want for themselves and their families, the bar is higher.

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