SWOP Report 2021 - Autonomy

What is bodily autonomy?

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Bodily autonomy means that we have the power and agency to make choices over our bodies and futures, without violence or coercion. This includes when, whether or with whom to have sex. It includes when, whether or with whom you want to become pregnant. It means the freedom to go to a doctor whenever you need one.

Yet women and girls—and indeed, all people—face constraints on their bodily autonomy. The consequences to their health, well-being and potential in life can be devastating. Intertwined with bodily autonomy is the right to bodily integrity, where people can live free from physical acts to which they do not consent.

This may affect her mental health, social well-being and her relation with her partner…

Bodily autonomy and bodily integrity are violated when a husband prevents a woman from using contraception. They are violated when a person is forced to exchange unwanted sex for a home and food. They are violated when people with diverse sexual orientations and gender identities cannot walk down a street without fearing assault or humiliation. Bodily autonomy and integrity are violated when people with disabilities are stripped of their rights to self-determination, to be free from violence and to enjoy a safe and satisfying sexual life.

Some of these violations, such as rape, are expressly criminalized and universally condemned. But many other forms are perpetuated by norms, practices and even laws, most of them driven by deeply rooted gender inequalities.

There's a universal involved here, and it is male entitlement to control female partners.

License To Violate

An incomplete list of ways societies excuse violations of bodily autonomy

Virginity testing and forced anal testing

2018

Afghanistan bans non-consensual virginity tests

Virginity testing and forced anal testing

Virginity testing (invasive and unscientific tests to “prove” whether a girl or woman has had sexual intercourse) and forced anal exams (invasive and unscientific tests to “prove” homosexual conduct) violate individuals’ human rights and dignity. When performed without consent, they amount to torture. Yet they remain pervasive in many parts of the world.

Forced sterilization and contraception use

87%

of countries

require full, free, informed consent for contraceptives/sterilization*

Forced sterilization and contraception use

Forced contraceptive use and forced sterilization have a grim and global history. In countries around the world, persons with disabilities, indigenous communities and persecuted minorities, and in some cases women in general, have been subjected to forced contraception or sterilization for reasons ranging from eugenics to population control. Involuntary sterilization or contraception is a violation of human rights and medical ethics.

*Out of 104 reporting countries

Homophobic and transphobic rape

About

300M

People

worldwide identify as LGBTI

Homophobic and transphobic rape

Rape and other sexual violence that targets gender-non-conforming individuals and people of diverse sexual orientations is often deemed by perpetrators to be “curative” or “corrective.” This violence is often met with impunity by communities or legal systems.

Forced and child marriage

About

12M

girls

are married off each year

Forced and child marriage

Child marriage is widely prohibited by law, yet it continues to affect significant proportions of the world’s girls. Those subjected to child marriage are often denied their right to make decisions about, or lack accurate information about, their sexual and reproductive health. Forced marriages are driven by institutionalized patriarchal practices, where brides become a commodity, or property, to be owned, bought, sold or traded, with no regard for their rights or autonomy. Forced sex and early and frequent pregnancies are closely linked to high maternal and infant morbidity and mortality rates, as well as poor mental health.

Female genital mutilation

Every year, at least

4M

girls

are at risk of female genital mutilation

Female genital mutilation

Female genital mutilation is a violation of women’s and girls’ human rights and an extreme form of discrimination and violence directed exclusively at girls and women, aimed at controlling their sexuality, their bodies and their sexual and reproductive rights. While families and communities cite cultural, religious and social reasons for practising female genital mutilation, justifications centre on the need to reduce women’s sexual desire.

"Honour" killings

There are about

5,000

of these murders every year

"Honour" killings

Honour killings occur in communities where the so-called “honour” of the family is considered to be more important than the life of the person, usually a woman, who violates certain so-called norms or codes. Rationalizations for honour killings have included separation from a spouse who paid a bride price, refusing to enter into an arranged marriage, entering into a relationship with a person from a different religion, ethnic group or caste, engaging in premarital or extramarital sex, being the victim of rape or assault, or being identified as gay.

Marital rape and "Marry-your-rapist" laws

43

countries

have no laws addressing marital rape

Marital rape and "Marry-your-rapist" laws

Forced or nonconsensual sex with one’s spouse has only recently begun to be acknowledged as a concept. In the past, patriarchal norms held that once a marriage has taken place, a man “owns” his wife’s body and can use it for sex whenever he wants. Today, marital rape is increasingly recognized as an egregious human rights violation. Yet some countries continue to permit a husband to have intercourse whether the wife wants it or not, and there are countries where a man who rapes a woman can escape penalties if he marries her.

Reproductive coercion

15-25%

the estimated prevalence of reproductive coercion in the United States

Reproductive coercion

Reproductive coercion is any behaviour that a person uses to exert control over another person’s reproductive health or decision-making. This can include attempts to nonconsensually impregnate a partner against their wishes, coercing a partner to have an abortion, or interfering with family planning methods such as “stealthing” (the nonconsensual removal of a condom during sex). Reproductive coercion can be perpetrated by intimate partners, families or community members.

Denial of comprehensive sexuality education

about

56%

of countries

have laws/policies supporting comprehensive sexuality education*

Denial of comprehensive sexuality education

Taboos against comprehensive sexuality education and fears of “sexualizing” young people mean that many adolescents reach adulthood without accurate information about their bodies and sexual health. As a result, they are unable to make informed responsible choices about themselves and their relationships.

* Out of 98 countries reporting complete data

2018

Afghanistan bans non-consensual virginity tests

Virginity testing and forced anal testing

Virginity testing (invasive and unscientific tests to “prove” whether a girl or woman has had sexual intercourse) and forced anal exams (invasive and unscientific tests to “prove” homosexual conduct) violate individuals’ human rights and dignity. When performed without consent, they amount to torture. Yet they remain pervasive in many parts of the world.

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Threatened by a woman’s sexuality

Female genital mutilation is not simply a health issue. It is a sexuality issue.
Original artwork by Naomi Vona; photo by Hana Lopez on Unsplash.

Culture, tradition and religion are among the most commonly cited motivations for performing female genital mutilation. Yet curtailed sexual desire is almost universally understood to be an outcome of the practice and, in fact, it is also a key motivator. Many proponents of female genital mutilation have argued that unbridled female sexuality is somehow a threat to chastity, honour and virtue (Berg and Denison, 2013).

Frank conversations about female sexuality, bodily integrity and bodily autonomy may offer an unexpected antidote to the practice, experts say.

Efforts to end female genital mutilation have historically underscored the physical harms caused by the practice, which can include haemorrhage, sepsis, future childbirth complications and even death. Emphasis on the physical consequences is more easily received in conservative communities, where discussing female sexuality is often taboo. But a sole focus on physical harms may risk inadvertently leading to the medicalization of the practice, or the practice of alternative types of cutting, rather than its abandonment altogether (Powell and Yussuf, 2021).

Broadening these conversations to include an honest accounting of the sexual harms caused by female genital mutilation has helped Wafaa Benjamin Basta, an obstetrician and gynaecologist in Egypt, convince parents to reject the practice. Clearly articulating harms, like inability to experience orgasm, pain during intercourse, and aversion to sex due to post-traumatic stress disorder, has been an effective deterrent, especially “if the mother had a very bad experience while undergoing female genital mutilation when she was young or had troubles in her marital life because of the circumcision,” Dr. Basta said.

She speaks with ease about the social and psychological repercussions women can experience. “This may affect her mental health, social well-being and her relation with her partner, which may affect deeply the concept of the family itself.”

One reason Dr. Basta is able to have these forthright discussions is her role as a physician. “There is this bond between the patient and the doctor,” she said. But even more critical is the growing acceptance of women’s rights and empowerment in Egypt. “Minds are changing, especially for the new generations.”

As fears of female sexuality diminish, and sexual well-being is increasingly considered within the frame of psychological and social health, it becomes easier to rethink the practice of female genital mutilation.

Dr. Basta says her observations are limited to the confidential conversations she is able to have with her patients, and that comfort with these topics will vary by community and practitioner. Still, she has seen great progress in recent years, and is hopeful about the future, both for ending female genital mutilation and for promoting women’s sexual health and well-being. “There’s no shame to talk about that,” she said.

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The language of violation

Leidy Londono has worked in person, over the phone and via online chat to provide support and information to survivors of sexual assault.
Original artwork by Naomi Vona; photo © UNFPA/R. Zerzan.

In her years as a survivors’ advocate in the United States, Leidy Londono has grown accustomed to the language of shock, fear and shame that people use when grappling with the aftermath of sexual assault. And she has listened to people struggle to put into words one particular form of sexual violation, a phenomenon that is pervasive yet poorly understood, even by those who experience or perpetrate it: reproductive coercion.

“It involves behaviours that a partner or someone uses to maintain power and control in a relationship that are connected to reproductive health,” explained Londono, who has accompanied survivors to hospitals and provided hotline counselling. She now works as an educator and programme manager at Planned Parenthood in Washington, DC. “It can take a lot of different forms. There are explicit attempts to impregnate a partner against their own wishes. It could be about controlling the outcomes of a pregnancy, coercing a partner to have unprotected sex, interfering either explicitly or implicitly with birth control methods, or lying or deceit around birth control methods.”

Survivors lack a common language to describe the specific violation felt when they are denied ownership of their fertility or sexual health, whether or not they consented to a sexual encounter. Without the words to identify this experience, they often express confusion and self-recrimination. Londono recalled one young person who discovered that their partner had secretly removed a condom during consensual sex—a practice known as stealthing. “At first they were like, ‘Am I just exaggerating this?’”

The concept of reproductive coercion is relatively new, with most studies on the topic taking place in the last 20 years, often in the United States, where the prevalence of reproductive coercion is estimated at 15 to 25 per cent (Park and others, 2016). But recent inquiries show that it is widespread globally, perpetrated not only by partners but even by families and community members (Grace and Fleming, 2016). It may even be abetted by health systems, via policies that require husbands’ permission before a woman can use family planning, for example.

Dipika Paul has worked for decades as a researcher in sexual and reproductive health in Bangladesh, yet even she says she was not familiar with the term reproductive coercion. Rather, she and health workers and advocates spoke more generally about “barriers in family planning”.

Today, Paul is an expert in the topic. As an adviser at Ipas in Dhaka, she sees many forms of reproductive coercion. “With husbands... it can start with telling them, ‘do not use any contraception’, then women will follow their husband’s opinion. And it also ranges to severe violence. Sometimes husbands withhold food or money if she wants to continue using contraception,” Paul said. Often this pressure is related to “husbands’ or other family members’ desire for more children or desire for sons”. Forced use of contraception and forced abortion are also seen, she added.

These coercive acts are not widely regarded as forms of violence because reproduction may be seen as a family decision. “In-laws, they play a big role,” Paul said. This is particularly true for younger and underage wives; the median age of marriage is 16, according to a Demographic and Health Survey from 2018. “It is difficult for young women to take decisions alone.”

And yet there is a clear link between reproductive coercion and violence. Paul estimates that, in a study she is currently conducting, about three in five women who said they had experienced reproductive coercion also experienced sexual or physical violence from their husbands.

Jay Silverman, a professor at the University of California, San Diego School of Medicine, began his career working with men and boys who had perpetrated intimate partner violence. He has since studied reproductive coercion in Bangladesh, India, Kenya, Niger and the United States. Even though reproductive coercion may sometimes be carried out by female family members, the violation is rooted in gender inequality, Silverman said.

“There’s a universal involved here,” he explained, “and it is male entitlement to control female partners… On some level, that sense that men do have, that entitlement to that control, is something that’s ubiquitous in, I think, most of our societies.”

Silverman and his colleagues, including Ipas in Bangladesh, are piloting tools to help health workers identify reproductive coercion, such as questions about partner attitudes and behaviour. Once coercion is acknowledged, women can reassert bodily autonomy by, for example, selecting family planning methods that are undetectable by a partner.

Even as women lack the language to describe reproductive coercion, Silverman explained, “I also believe human beings innately resist against being controlled… There are many different coping strategies that women in communities around the world have developed to cope with reproductive coercion, including women supporting women. That is something that is just happening organically, everywhere. It always has, whether it be a neighbour or female family member hiding your pills for you or helping you get to a clinic.” Where clinics give out pamphlets about reproductive coercion, partner violence and how to seek help, women often “take handfuls” so they can share the information with other women.

Much of the burden of addressing reproductive coercion falls to service providers, who often face a double bind: they must strike a balance between engaging men in reproductive health matters without ceding full decision-making power to them. “The ideal of male engagement in sexual and reproductive health and maternal and child health internationally has become a priority,” Silverman said. Male involvement has been associated with increased family planning and contraceptive use and improved maternal and child health outcomes (Kriel and others, 2019; Assaf and Davis, 2018). But when men wish to control the reproductive choices of their partner, “involving men is obviously detrimental”.

And men—indeed, people of all genders and sexual orientations—can also be victims of reproductive coercion. “Anyone can experience reproductive coercion,” said Londono. “Women in marginalized communities experience levels of violence at disproportionate rates, and that includes reproductive coercion… but that doesn’t negate the fact that I have talked to young boys and young men—men in general—who are trying to identify their own experiences and put it into words and contextualize it.”

Fluency in the language of reproductive coercion is needed, particularly among policymakers. “When our laws and our policies are vague and our language is ambiguous, it doesn’t provide for survivors,” Londono said.

And learning about bodily autonomy is also crucial. In one recent project, Paul said, “we talked to women, and they chose this terminology: ‘my body, my rights.’... They all agreed that we need to disseminate this among the population—that my body is mine.”

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