SWOP Report 2021 - Measure

How do we measure bodily autonomy?

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We don't yet have good measurements, but we know that loss of bodily autonomy is rampant around the world.

The world is beginning to create measurements. The international community has agreed to monitor two indicators—part of the Sustainable Development Goals (SDG)—measuring decision-making and laws on reproductive health care and information. But even these are just a starting point.

They need to know how their bodies work.

Only

55%

of women

are able to make their own decisions

Decision-making power

SDG Indicator 5.6.1 looks at three questions posed to women:

  • Who usually makes decisions about health care for yourself?

  • Who usually makes the decision on whether or not you should use contraception?

  • Can you say no to your husband or partner if you do not want to have sexual intercourse?

Only women who make their own decisions in all three of these areas are considered to have autonomy in reproductive health decision-making and to be empowered to exercise their reproductive rights.

These data are only available in about one in four countries, but they paint an alarming picture: only 55 per cent of girls and women are able to make their own decisions in all three dimensions of bodily autonomy.

Laws that empower

SDG Indicator 5.6.2 looks at laws and regulations that guarantee full and equal access to women and men to sexual and reproductive health care, information and education. It covers:

Maternity care

About

71%

of countries

have laws guaranteeing access to overall "maternity care"*

  • Maternity care

  • Life-saving commodities

  • Abortion

  • Post-abortion care

*Out of 79 countries reporting complete data

Contraception and family planning

About

75%

of countries

have laws to ensure full, equal access to contraception*

  • Contraception

  • Consent for contraceptive services

  • Emergency contraception

*Out of 104 countries reporting complete data

Comprehensive sexuality education and information

About

56%

of countries

have laws and policies supporting comprehensive sexuality education*

  • Comprehensive sexuality education law

  • Comprehensive sexuality education curriculum

*Out of 98 countries reporting complete data

Sexual health and well-being

About

80%

of countries

have laws supporting sexual health and well-being*

  • HIV testing and counselling

  • HIV treatment and care

  • Confidentiality of health status for men and women living with HIV

  • HPV vaccine

*Out of 101 countries reporting complete data

The indicator measures whether a supportive law exists and whether there are restrictions, such as age limitations or spousal permission requirements.

About

71%

of countries

have laws guaranteeing access to overall "maternity care"*

  • Maternity care

  • Life-saving commodities

  • Abortion

  • Post-abortion care

*Out of 79 countries reporting complete data

Not enough measured

These measurements are critical, but they offer only a glimpse into the bodily self-determination of people around the world.

The first indicator, 5.6.1, has data from only 57 countries. The questions, too, were asked of only a subset of women, such as those in cohabiting relationships or those of reproductive age. Therefore, it cannot provide a complete picture of women’s reproductive decision-making.

The second indicator, 5.6.2, is also limited. The presence of laws or regulations does not always mean those rules are implemented or enforced. Additionally, the indicator does not cover laws governing other important matters, such as rape within marriage, self-determination in gender identity, genital surgeries in the case of intersex infants and same-sex sexual activity.

In addition, there are many bodily autonomy issues that remain hotly contested, which are unresolved by human rights agreements and international law, such as voluntary sex work, surrogacy and abortion. Because these issues are frequently driven underground, they are often poorly understood by researchers and lawmakers alike.

Artwork

  1. Thumbnail Hülya Özdemir
  2. Thumbnail Kaisei Nanke
  3. Thumbnail Rebeka Artim
  4. Thumbnail Tyler Spangler
  5. Thumbnail Tyler Spangler
  6. Thumbnail Kaisei Nanke
  7. Thumbnail Kaisei Nanke
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Your body: an owner’s manual

Olga Lourenço is used to facing resistance when providing comprehensive sexuality education, but she is undeterred.
Original artwork by Naomi Vona; photo © UNFPA/C. Cesar.

Few parents or community leaders object when a student brings home a chemistry or calculus textbook. Yet lessons in comprehensive sexuality education—accurate, age-appropriate information about one’s own body, sexual and reproductive health, and human rights—are widely considered taboo. Many schools do not teach the subject, or provide only incomplete information. This leaves students both ill-prepared for the changes their bodies are undergoing and ill-equipped to protect themselves from harm.

“We are in a constant struggle to include this topic in the school curriculum,” said Olga Lourenço, a coordinator for Project CAJ, a UNFPA-supported programme providing life skills and comprehensive sexuality education to youth in Angola. “Almost nothing is said about comprehensive sexual and reproductive health because of our taboos and prejudices.”

Opponents of comprehensive sexuality education often contend that it promotes sexual activity, yet studies show that this is incorrect. Rather, evidence indicates that this education, when provided to international standards, improves young people’s knowledge and constitutes a crucial and cost-effective strategy for preventing unintended pregnancy and sexually transmitted infections, including HIV. Some studies show it may actually help delay adolescents’ sexual debut (UNESCO, 2016).

Lourenço explained that, because she lacked accurate information at a young age, she actually felt pressured to engage in sexual relationships before she was ready, at age 15. “My friends already had their boyfriends. They already had sexually active lives. They made fun of me for being the ‘virgin of the group’,” she said. “In a way, this psychologically affected me... I think that, in a way, it violated my bodily autonomy.”

Dipika Paul, a longtime sexual and reproductive health researcher and an adviser at Ipas in Dhaka, Bangladesh, has seen the consequences of poor access to sexuality education in her own community. “When I was a student, I was in class seven, and there was just one chapter—on menstruation,” she recalled. “The teacher also did not feel comfortable teaching that section to us.”

Without comprehensive sexuality education, young people are vulnerable to myths and misinformation. Boys and men, in particular, “have knowledge gaps, they have misconceptions,” Paul said, explaining that she has seen men forbid their wives from using contraception because of the belief that “an IUD travels anywhere around in the body… they think they can feel pain from an IUD. This is not true.”

Students who receive comprehensive sexuality education are not only empowered to make healthier sexual choices, but they are also better equipped to seek help when needed. “The information I share can significantly change a person’s life,” said Lourenço.

She recalled one girl who, while receiving sexuality education through a mentorship programme, revealed she had a chronic wound on her breast—something she regarded as an embarrassment but not an emergency. Another young woman disclosed that she was living with an uncle who had sexually abused her. “The girl locked herself up and couldn’t speak with anyone for fear of being expelled from the home and ending up on the street,” Lourenço described. Mentors were able to secure services for both girls, but Lourenço is haunted by what might have been: “If we did not intervene, what would become of these girls?”

Comprehensive sexuality education can also play a role in preventing gender-based violence. When taught to international standards, the lessons include messages about human rights, gender equality and respectful relationships (UNESCO and others, 2018). And experts are increasingly calling for this information to frame violence prevention as the responsibility of potential perpetrators, rather than the responsibility of victims and survivors (Schneider and Hirsch, 2020).

“They need to know what their rights and duties are in a society first,” Lourenço said, explaining that this is the foundation of comprehensive sexuality education as she teaches it. “Then they need to know how their bodies work so that they can make decisions for themselves and not let others make decisions for them.”

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