What Happens When A Woman Is Denied Birth Control

As a consistently insured, city-dwelling American woman, I saw birth control access as a given for most of my life — so much so that I took it for granted. That is, until two years ago, when I found myself 9,500 miles from home, trying to explain to a skeptical male pharmacist that I needed the pill, and fast. In French. I was living in Burundi — a tiny, developing, Catholic country in East Africa that has recently been rocked by violence — and working for a local nonprofit on issues including maternal and reproductive health. These are urgent priorities there: The WHO reports that pregnancy-related causes kill 740 women per 100,000 births in Burundi, making the country's maternal mortality ratio the world’s fifth-highest, largely due to lack of access to contraception. That lack was an issue external to me, until it wasn’t. The pharmacist refused to sell me the pill, which I’d earlier been told the pharmacy stocked. And that day, I needed four pills as emergency contraception — because the night before, my best-laid condom-use plans had gone awry. As they sometimes do.

Unlike millions of Burundian women, though, I was able to head to Bumerec Hospital, where foreigners like me, a.k.a. abazungu, and wealthy Burundians went to receive private care that outstripped the standards of other local centers. At Bumerec, I was ushered into an office to greet another male face, but this one was friendly. "Amahoro," I began — "hello," one of the few Kirundi words I had mastered, a courtesy because of course the doctor spoke French. I switched to French and rushed to explain my situation as the doctor listened gravely. “Well,” he ventured, “I do have something for you,” and he produced a pack of contraceptifs oraux from his desk drawer. The relief on my face must have been unmistakable. He didn’t charge me for the pills. We spoke for a few moments about how the doctor had no problem dispensing birth control, though many of his colleagues in medicine objected on moral and religious grounds. I thanked him and left, promising myself I would get an IUD as soon as I got back to the States. (A few months later, I did — from a caring provider in a comfortable office, free of charge thanks to my insurance.)

I was both relieved and more conscious than ever that in so many places around the world, birth control is treated as a privilege, not a right — and that the stories of untold numbers of people with female bodies diverge drastically from mine. A friend of mine in Burundi — who grew up there and is two days younger than me — never got the pill and never got an IUD. She studied hard and hoped to maybe get a business degree. But the year after I left the country, she had an unplanned pregnancy and then a baby, with a man who has since disappeared. She returned to school briefly before mounting insecurity pushed her out; the violence in Burundi is the worst the country has seen since the end of its 12-year civil war in 2005. My friend's life — without school and with a one-year-old at home — is not unfolding as she planned. In Burundi and elsewhere, her story is familiar. Of family planning needs around the world, 78% are unmet, despite the fact that women with access to birth control live longer and healthier lives than women without. The same holds true for the children of these women.

Women with access to birth control also make 40% more money than women without, which leads to smaller, healthier, wealthier families and communities worldwide. I thank birth control not only for the gains it has provided women — myself included — and communities, but for the immeasurable heartbreak, sickness, and death it has helped us avoid. Every single woman on this planet, without exception, must have the education, autonomy, and healthcare access to determine whether and when she bears children. This issue is not “external” to anyone.

I'm one of the lucky ones. Since my first IUD was inserted, I’ve enjoyed two years of worry-free sex. Okay, I won't say worry-free: I've worried that one partner and I weren't having enough sex; I've worried that sex with a different partner was neither passionate nor connected; I've worried alternately that I've pushed my own sexual boundaries too far and that I haven't pushed far enough. That's the life stuff — the tough, open-ended, emotional, sometimes-annoying life stuff — that no pill or implant can solve. But it's stuff that, thanks to birth control, I have the freedom to think and talk and text and cry and laugh about, instead of fearing that my partner won't let me use a condom, or that the nearest abortion clinic is 300 miles away, or that I haven't picked up diapers on the way home. Whether the sex we have will lead to conception before we're ready shouldn't be on any woman’s worry list. With birth control, it doesn't have to be. And when we remove birth control from women’s lives, we face a future that should worry us all.