The Marginalization of Women in Health Care:
Who Controls Reproductive Rights?
Sign advocating family planning services outside FIMRC
Sharing Her Story
It was the day of the tubal ligation and vasectomy clinic in our pavilion. Staff from Marie Stopes International had arrived, and I helped set up a makeshift operating room in the clinic's pavilion with other volunteers and staff members. About twenty-five women had gathered in the pavilion to receive information on the services offered, which included tubal ligation and implants providing contraceptive for 3 or 5 years for women and vasectomy for men (see image below). Although services were offered to men, none took advantage of these services. It was not surprising, considering the patriarchal structure of the local community and the value attached to men having many wives and many children.
I was heading up to the clinic from the pavilion when I stopped to chat with a young woman. She had three children with her, all very young. Upon asking if she was there for the tubal ligation clinic, she informed me that she was in a tough situation. She had approached her husband regarding her wishes to cease childbearing; though she had only three young children with her, she informed me that she had a total of five children already. Her husband had forbidden her from seeking family planning services, and she did not know what to do. She told me that it was hard enough for her to take care of all five children and that she did not want any more, yet she knew her husband would not react favorably if she defied his wishes. While I do not know what this woman ultimately decided, I know that she faced a difficult choice. She told me her options: choose not to use family planning services or use family planning services and leave her husband. As an outsider with no long term ties to the community and a continually growing understanding of the challenges faced by women, I did not want to influence this woman's decision. Though I strongly believe that women should control their reproductive rights, I knew her situation would be tough if she chose to leave her husband. In a community where most families struggle economically, it is hard to imagine the challenges that would face a single mother with five children. I acknowledged the fact that she indeed faced a difficult choice, and I wished her the best of luck. Although I do not know what she decided, the conflict facing this woman illustrates the lack of autonomy women possess in their reproductive choices.
It was the day of the tubal ligation and vasectomy clinic in our pavilion. Staff from Marie Stopes International had arrived, and I helped set up a makeshift operating room in the clinic's pavilion with other volunteers and staff members. About twenty-five women had gathered in the pavilion to receive information on the services offered, which included tubal ligation and implants providing contraceptive for 3 or 5 years for women and vasectomy for men (see image below). Although services were offered to men, none took advantage of these services. It was not surprising, considering the patriarchal structure of the local community and the value attached to men having many wives and many children.
I was heading up to the clinic from the pavilion when I stopped to chat with a young woman. She had three children with her, all very young. Upon asking if she was there for the tubal ligation clinic, she informed me that she was in a tough situation. She had approached her husband regarding her wishes to cease childbearing; though she had only three young children with her, she informed me that she had a total of five children already. Her husband had forbidden her from seeking family planning services, and she did not know what to do. She told me that it was hard enough for her to take care of all five children and that she did not want any more, yet she knew her husband would not react favorably if she defied his wishes. While I do not know what this woman ultimately decided, I know that she faced a difficult choice. She told me her options: choose not to use family planning services or use family planning services and leave her husband. As an outsider with no long term ties to the community and a continually growing understanding of the challenges faced by women, I did not want to influence this woman's decision. Though I strongly believe that women should control their reproductive rights, I knew her situation would be tough if she chose to leave her husband. In a community where most families struggle economically, it is hard to imagine the challenges that would face a single mother with five children. I acknowledged the fact that she indeed faced a difficult choice, and I wished her the best of luck. Although I do not know what she decided, the conflict facing this woman illustrates the lack of autonomy women possess in their reproductive choices.
Only 58% of Ugandan women said
that they make their own decisions
about health care and education
(Chamberlain et al. 2007).
that they make their own decisions
about health care and education
(Chamberlain et al. 2007).
Applying the Principle of Indivisibility to Reproductive Rights in Bududa, Uganda
Women and children awaiting care at the clinic
It is easy to imagine the implications of the principle of indivisibility in the poor, rural Bududa District in Uganda (Petchesky 2000). As women suffer from insufficient education and economic disenfranchisement, they become dependent on their husbands; this dependency perpetuates the gender inequality and poverty apparent in the region. Patriarchal Ugandan society marginalizes women so that they are pressured to acquiesce to their husbands’ demands, often in terms of sexual acts that result in pregnancy—often unintended. The restricted agency of Ugandan women prevents their use of available family planning services and contributes to high fertility rates, which propagates the cycle of poverty in rural areas; the cyclic nature of poverty can be tied to poor educational facilities and inadequate economic opportunities.
The implications of the principle of indivisibility create additional complications for development. It suggests that services that do not align with local cultural norms and power structures can be at least somewhat futile. This is supported by the low utilization of family planning services in the region I worked in, despite their availability, government promotion, and free cost. It seems that the dependent status of women decreases their use of these services, especially for the sake of their husbands’ desires. Yet, it remains important to provide these services for the women who are able to access them, either by virtue of their own empowerment or with the permission of their partner. My encounter with the woman at the tubal ligation clinic who was debating long term family planning via implant illustrates the need to provide these services despite a lack of widespread acceptance. Although her husband forbade her from utilizing family planning services because he wanted a large family, this woman realized that it was her choice and she could leave him if he disapproved, though she would suffer economically. This shows that services are indeed important, although not accessible to all due to cultural restrictions barring many women from using the services.
The barriers to family planning services arose from the cultural norms of the rural, patriarchal society in which I worked. Application of the principle of indivisibility shows that improvements in education and economic empowerment for women can generate higher use of these services by creating easier access to reproductive care. These restrictions on women’s empowerment over their reproductive rights were observable during my time spent at the clinic and conducting surveys in the villages, and it is important for comprehensive initiatives (i.e., improvement of educational systems) to indirectly address these issues, which play a large role in reproducing the impoverished circumstances of the villagers.
The implications of the principle of indivisibility create additional complications for development. It suggests that services that do not align with local cultural norms and power structures can be at least somewhat futile. This is supported by the low utilization of family planning services in the region I worked in, despite their availability, government promotion, and free cost. It seems that the dependent status of women decreases their use of these services, especially for the sake of their husbands’ desires. Yet, it remains important to provide these services for the women who are able to access them, either by virtue of their own empowerment or with the permission of their partner. My encounter with the woman at the tubal ligation clinic who was debating long term family planning via implant illustrates the need to provide these services despite a lack of widespread acceptance. Although her husband forbade her from utilizing family planning services because he wanted a large family, this woman realized that it was her choice and she could leave him if he disapproved, though she would suffer economically. This shows that services are indeed important, although not accessible to all due to cultural restrictions barring many women from using the services.
The barriers to family planning services arose from the cultural norms of the rural, patriarchal society in which I worked. Application of the principle of indivisibility shows that improvements in education and economic empowerment for women can generate higher use of these services by creating easier access to reproductive care. These restrictions on women’s empowerment over their reproductive rights were observable during my time spent at the clinic and conducting surveys in the villages, and it is important for comprehensive initiatives (i.e., improvement of educational systems) to indirectly address these issues, which play a large role in reproducing the impoverished circumstances of the villagers.