Fifty years ago, on May 9, 1960, something happened in the U.S. that changed women's lives forever: the US Food and Drug Administration approved a revolutionary contraceptive technology, known now simply as "the pill".
For women of my generation the birth control pill represented nothing less than freedom and autonomy. Not only were the days of sweating out a late period gone; we could recognise and enjoy our sexuality, and our independence, without fearing that our lives would come to a crashing halt because of an unintended pregnancy. Since it was developed, an estimated 200 million women have been liberated by the pill. Sadly another two million women, most of them in the developing world, are still not using modern contraception, including the pill, to plan and space their pregnancies.
Another medical breakthrough occurred in the 20th century: Penicillin. Like the pill, it saves lives and changed the world. But while penicillin was universally accepted and embraced, the pill remains scarce in some parts of the world. In others, it is controversial. That's because it is about gender and women's self-determination, as a recent editorial in the British medical journal, 'The Lancet', pointed out. "The pill promised for the first time that women could decide whether and when to have a child, and the timing and spacing of their children. Practically overnight, women could decide the size of their families, pursue an education, have a career, take pleasure in their sexuality without fear of becoming pregnant, and enjoy improved health," wrote Cecile Richards of Planned Parenthood Federation of America.
Birth control has always been a dicey issue in the U.S. It took until 1965 for the Supreme Court to legalise the use of birth control by married couples in Connecticut. Birth control for unmarried women wasn't legalised until a 1972 Supreme Court decision. Another battle has been federal funding for low-income women to have access to safe and effective family planning. President Nixon signed the first federal family planning programme into law in 1970 but it took several decades longer to get private insurers to cover the cost of prescription contraception. By 2004, most employer-based insurance plans did that, but coverage is still not universal.
These medieval battles continue as advocates fight to ensure that contraception is covered as preventive care for women in the health-care reform law signed by President Obama. Efforts are ongoing to make sure pharmacies stock contraception and fill prescriptions for it, even if a pharmacist thinks it's immoral. The question we need to ask is this: Why can't we trust women to decide how they want to manage their fertility? Why are we so fearful of how they might decide to live their lives? Why is female sexuality so threatening?
Those questions are even more profound when considered in the context of real women's real lives, here and around the world. They also segue with another dicey topic: Abortion. At the recent Women Deliver conference in Washington, DC, the largest ever to address issues of maternal health globally, abortion was a key topic as parliamentarians, politicians, and practitioners discussed putting a human face on women's health needs and taking a human rights approach to improving services and outcomes. While some countries have liberalised their laws, abortion remains highly restricted in many others, particularly in Sub-Saharan Africa and Latin America. And while the Guttmacher Institute, a respected research organization based in new york which supports abortion rights, reports a drop in the number of documented abortions worldwide, they note that the estimated number of unsafe abortions has changed little.
We don't often hear the stories of women and girls who can't get the pill or other contraceptives, and who must resort to unsafe abortion. Yet, it causes 13 per cent of maternal deaths worldwide. Most of these deaths - 70,000 a year - occur among the poorest women in the poorest countries - hardly a reason to dismiss them. Every year 19 million women and girls risk their lives by having an unsafe abortion; over 8 million of them require medical treatment for often life-threatening complications. Five million never get the help they need. As one advocate at the Women Deliver conference noted, "Women shouldn't have to harm themselves to get the help they need."
It's important to remember that adolescents - young women who should have their whole lives before them - are part of the tragedy of inadequate contraception or safe abortion services. Every year there are more than six million unplanned pregnancies in girls worldwide. These pregnancies account for more than two million unsafe abortions in the developing world each year. Even though many of these young women are married at an early age, adolescents are subject to unintended pregnancies that occur before their bodies are sufficiently mature for childbearing.
"For young women ... to benefit from longer schooling, gain productive experience in the labour market before marriage and childbearing, and develop a readiness for parenthood, they need access to the contraceptive and reproductive health services that will enable then to protect their health and avoid unintended pregnancies," the International Planned Parenthood Federation says.
Fifty years ago a simple pill helped make that possible. Providing safe abortions may also be necessary. Who among us should deny any woman or young girl her human right to health-related decision-making, her lifelong dignity, and in many cases, her release from untimely death?