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Natalia Kanem

By Dr. Natalia Kanem
UNITED NATIONS, Jul 11 2019 – Every year on World Population Day (July 11), UNFPA receives queries from journalists about the total number of people around the world. Numbers are indeed important because they help governments develop policies that respond to evolving needs for services such as education and health.

While global population is currently around 7.7 billion, what is perhaps more important than the numbers is the bigger story they tell–a story about sex: who has it, when they have it and under what circumstances. It is also a story about agency.

Oscar Wilde once said, “Everything in the world is about sex except sex. Sex is about power.” Whether a woman or teenage girl has the power to decide about sexual relations will have a profound impact on her life.

UNFPA statistics from 51 countries show that only three in five married women make their own decisions about intimacy with their partner, use of contraception, and their healthcare. In some of the least developed countries, it is only 1 in 14 women who have such power.

Lack of agency, or power, in these areas can translate into forced sex, unintended pregnancy, teenage pregnancy, and families that are larger than a woman wants. And with these consequences can come long-term harm to a woman’s health and the denial of her rights.

This is what a lack of agency meant for one young woman in Burundi: Charlotte was 17 when she was forced to marry and leave school, closing out opportunities for higher education, employment and economic independence.

Her husband deserted her after she became pregnant, and Charlotte was left to manage serious complications during delivery by herself. In the end, she lost her baby and fell into a coma for four days.

Unfortunately, she developed an obstetric fistula, a normally preventable condition, that caused urinary and fecal incontinence. Charlotte’s father then forced her to live in a brick hole in their backyard for nine years because he couldn’t bear the stench.

Thanks to UNFPA, Charlotte finally got the surgery she needed, but she will never get back the nine years she lost. A lack of agency early in life kicked off a calamitous chain of events that robbed her of her dignity and health and derailed her future.

Lack of agency in sex is often linked to child marriage. Every day, 33,000 girls become brides against their will and in violation of their rights. About 95 per cent of teenage births occur in developing countries, and 9 in 10 of these births occur within a marriage or union.

Millions of girls around the world pay a high price every day due to lack of access to comprehensive sexuality education and taboos around speaking openly about sexual and reproductive health.

There are 214 million women in developing countries who want to prevent a pregnancy but are not using contraception. Without family planning information and services, these women lack the power to make their own decisions about whether, when or how often to become pregnant.

And this amounts to a violation of their rights affirmed through international agreements and resolutions dating back as far as 1968.

We have ample evidence of how a lack of agency negatively impacts a woman’s health and well-being. But there is also abundant evidence of an economic impact as well.

Societies where women have the power to make decisions about the timing and spacing of pregnancies and in other aspects of their lives also tend to be more prosperous, equitable and resilient.

Twenty-five years ago, at the International Conference for Population and Development (ICPD) in Cairo, 179 governments recognized the importance of agency in sexual relations and promised to empower women and girls in every aspect of life to enable them to chart their own futures.

Central to the ICPD’s Programme of Action was a commitment to achieve universal sexual and reproductive health and to protect every woman’s right to make her own decisions about the timing and spacing of pregnancies.

Since then, the world has made impressive gains in bolstering agency, particularly through expanding access to contraception. Still, there are hundreds of millions of women and teenage girls who have been left behind, especially in poor, rural or marginalized communities.

We cannot accept defeat. We must take action to fulfill the commitments made at the ICPD and achieve the world we imagined: one where every pregnancy is wanted, where people choose freely whom to marry as adults, where no one is subjected to gender-based violence, and all girls are protected from violence and the harm caused by practices such as female genital mutilation–a world where agency, especially when it comes to sex, is a reality for all.

This world can be a reality, but it requires more than hope. It demands conviction, courage, partnership and dedication from us all. That’s why this November, UNFPA and the governments of Kenya and Denmark are co-convening the Nairobi Summit on ICPD25 to finish the job we started in 1994.

On this World Population Day, I call on all governments to join us in Nairobi, to look beyond the numbers, and to breathe new life into the global movement to achieve the world we imagine.

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