Lina AbiRafeh
7 min readFeb 21, 2023


Contraception Perception: Why Do Some Countries See Reproductive Rights as a Threat?

We’d like to think we have the right to make decisions that impact our bodies and our lives, because it is our right, right?!

Nope. In most of the world, we don’t. Meaning, we don’t get to make informed and independent choices about some of the biggest things in our lives. I’m talking about stuff like marriage — deciding when and who to marry, or if we even want to get married at all! And kids — if we want them, how many, and when.

All around the world, women are not free to make those decisions for themselves. Meaning, they don’t get the right information — or any information at all — and they certainly don’t have access to the kinds of services they need to support their choices.

In our world of 8 billion people (OMG!), 257 million women do not have access to family planning. Meaning, they don’t have the ability to decide if they want children or not. Family planning gives women power. And powerful women are a threat.

The latest State of World Population report, published by the United Nations Population Fund (UNFPA), reminds us that the challenges we face — lack of awareness, lack of information, lack of access — are made far worse by myths and wrong beliefs about side effects, as well as the risk of stigma and opposition from family and community.

This is true in too many countries. Yes, even in the US. A study by the Guttmacher Institute focusing on lower-income women in the US revealed that 39% would start using contraception if cost were not a factor. What’s more, American women are trapped between a new wave of abstinence-based education, an absence of fact-based sex education, and increasing restrictions on our rights to safe abortion. This weighs especially heavily on young women, and women from marginalized and vulnerable communities.

At the same time, we’ve made some progress. The State of World Population report from 2022 — dedicated to the need for action to end unintended pregnancy — tells us that global contraceptive use has increased, and so unmet need has decreased. Good stuff.

Of the 1.1 billion women who want to limit their childbearing, three quarters are using contraception. But that means that one quarter are not. And that’s still a lot of women who don’t have access to what they need, who don’t have the ability to control their own lives and choices.

COVID has made this worse, by reducing access to services, support, and medical professionals. As a result, 12 million women in 115 countries lost access to birth control, resulting in as many as 1.4 million unplanned pregnancies.

So what does this look like around the world today?

Globally, one in four pregnancies end in abortion every year, with 25 million unsafe abortions. Every year. We’ve all said this over and over: abortion rates are the same whether or not it is legal or not legal. What changes is whether or not the abortion is safe or unsafe. Countries that restrict abortions result in more unintended pregnancies a year. And, they are more harmful to women.

Let’s start with the US. Today, 62% of American adults feel abortion should be legal. And there are over 20 abortions for every 1,000 women. The District of Columbia has the highest abortion rate in the country, followed by New Jersey and New York.

Access to abortion was already rocky, even prior to June 2022, when the (mostly-male, mostly-white, mostly-conservative) US Supreme Court overturned Roe v. Wade, removing our federal right to access abortion. And today… I could just scream.

Reminder to the US and other countries, in the words of Human Rights Watch: The rate of unsafe abortions is nearly 45 times higher in countries with highly restrictive abortion laws than in countries where abortion is legal and unrestricted.

Reproductive rights are human rights. And those are my rights. Who gets to decide about my body? ME. That’s who.

OK, onward.

In Afghanistan, another country I’ve lived in and love, women’s rights are being stripped away every day. In fact, there’s not much left. This month, the Taliban stopped the sale of contraceptives in two major cities. They have threatened midwives and demanded that pharmacies clear their shelves of any form of contraception. Meanwhile, one in four Afghan women dies from pregnancy-related problems. The country is one of the most dangerous places in the world to give birth.

Important to note that the Qur’an does not prohibit contraception, or the right of couples to control and plan the size of their families. In fact, a gap between pregnancies is encouraged.

On the opposite end of the spectrum is Sweden, where abortion is legal, contraceptive counseling is free, and emergency contraception is sold over the counter. If you need numbers to make the point, here are some. Sweden’s policies mean that 17,851 maternal deaths have been avoided, 1,971,251 unsafe abortions have been prevented, 6,408,600 unintended pregnancies have been prevented, and 10,415,565 adolescents were reached with sexual and reproductive services. So… this stuff works. Feminist legislation makes a difference.

Also on the cool end of the spectrum is Spain, where a brand-new law now allows for menstrual leave to be treated as paid sick leave. That makes Spain the first country in Europe to take these measures, alongside Indonesia, Japan, South Korea, Taiwan, Vietnam, and Zambia.

Also part of this law, schools and other public buildings will provide free menstrual products. And — wait, there’s more! — health centers will offer the contraceptive and morning-after pill for free. Free. This was championed by Spain’s Equality Minister, feminist fighter Irene Montero. We need Irenes everywhere.

In the meantime, I’m going to start making a countries-that-give-a-shit-about-women list.

I also lived in Sierra Leone. In 2022, the country unanimously approved a safe motherhood bill protecting the sexual and reproductive health and rights of women and girls. While there has been increased use of modern contraceptives, Sierra Leone still has one of the highest rates of teenage pregnancy in the world. This bill makes a difference.

And now Sierra Leone joins other African nations — Benin, Cape Verde, Democratic Republic of Congo, Kenya, Mozambique, Tunisia, South Africa, Zambia — in protecting the rights of women and girls to safe abortions. Their rights to decide.

Lots of countries and lots more to say, but these days Syria and Türkiye are on my mind. On February 6 and again on February 20, these countries experienced severe earthquakes that killed 47,000, injured tens of thousands, and affected over 13 million people. We don’t even know the full extent of it.

In my work in emergencies, we’ve always said that safe sexual and reproductive health is a critical lifesaving intervention. And we know that women and girls are more vulnerable and more at risk in emergency situations — even for years after the emergency seems to have abated. This means allowing for safe pregnancies and deliveries, ensuring access to family planning, preventing and treating sexually-transmitted infections, and preventing and responding to violence against women.

Even before the earthquakes, things for women in these countries were tough. In Syria, abortion is illegal, and punishable. And 7.3 million women and girls were in need of lifesaving sexual and reproductive health services. This number is now far higher.

In Türkiye, although abortion is legal, it is currently under threat. By law, abortions should be provided in public hospitals for free. In practice, however, that’s not the case. There’s a de facto ban on abortions, with women being forced to seek support in private clinics. Meaning, they have to pay. Meaning, women who can’t afford to pay are going to be turned away — and forced to carry a pregnancy they did not want. Even those who can afford it are facing discrimination and abuse — obstructed from accessing their right to safe and legal abortions.

Do we need to keep making the case that family planning is essential? It seems we do. Family planning is not an add-on or a luxury. It is a right. And it is lifesaving. There’s so much research on this, I don’t even know where to start.

As one of a bazillion examples, access to family planning dramatically reduces maternal mortality. UNFPA estimates that every dollar invested in ending preventable maternal death and the unmet need for family planning will yield $8.40 in benefits by 2050.

It baffles me that we still have a problem with maternal mortality — and that women have to risk their lives — and to die! — in order to give birth. But that’s the subject of another blog.

We need to do better — do more! — to innovate, to ensure that all women and girls have access to what they need, even in constraining circumstances. We’re doing more with tele-health stuff for consultations, screenings, and support. And, some countries and communities are creating conversations around sexual and reproductive health, putting an end to the so-silly stigma around women’s bodies. Adolescents and youth in particular are benefitting from these conversations, especially when they are online, confidential, and informed by facts and science. These safe spaces help avoid the shame-and-blame based sex education that too many young girls receive. Because, in the words of UNFPA Executive Director Dr. Natalia Kanem, these conversations “too often devolve into fights over women’s bodies and attempts to undermine their rights and agency.” To this, she says: “Not on our watch.”

Here’s the point: Too many women are being denied their right to get what they need. And women all over the world are paying too high a price. Communities — and countries — also pay a price. Healthier women, healthier societies, and so on. We’ve made this case for decades.

And here’s another point: Our sexual and reproductive health is our right. What’s at stake? Quite literally, our lives.

Afghan woman sitting beside Band-e Amir lake



Lina AbiRafeh

Global women's rights expert, author, speaker, aid worker, feminist activist with 25 years of experience in 20 countries worldwide - and lots of stories!