The 1st June promises to be an historic day for advancing sexual and reproductive health rights in Burkina Faso. From that day onwards, the government has committed to provide free family planning services, including contraceptives and medical consultations. This is a long overdue but very positive decision which Amnesty International has been calling for some time. However, for it to really work and truly contribute to the better protection of women and girl's rights it will need to be backed up by a country-wide awareness campaign combined with a scaling up of health care facilities.
In 2016, Amnesty International published a report on access to contraception and early and forced marriages in Burkina Faso. Women and girls interviewed for the report, particularly those who lived in rural areas highlighted a number of factors which prevented them from accessing sexual and reproductive health care and services. These include cost; intimidation and stigma; the inability to make their own decisions which were often taken on their behalf by other family members; lack of information and comprehensive sexual education; and the lack of readily accessible facilities where information, services and goods are available.
Nearly all the 375+ women and girls who shared their experiences with our researchers said that they often suffered verbal abuse or physical violence when they raised the issue of contraception with their partners. Many women said that such conversations were forced upon them as they had to ask for money from their partners to buy contraceptive products due to the lack of control over their own financial resources.
Burkina Faso has some of the highest rates of early and forced marriage in the world. Once married, it is expected that the couple will have children as soon as possible. At the same time Burkina Faso also has one of the lowest contraceptive prevalence rates (19% in 2014) and one of the highest maternal mortality in the world. Worldwide, death during childbirth is the second biggest cause of death for girls aged 15-19. For this age group and younger, there are also higher risks of life-threatening and life-changing physical injuries, such as obstetric fistula, where a tear forms between the vagina and the rectum.
The cost of contraception was frequently cited as a barrier by women we interviewed. Cost often influences decisions about which method to use, meaning that women and girls do not necessarily choose the one that they would prefer but rather the cheapest, or the one available at the nearest clinic to get to, or through the most discreet means. The lack of financial resources leads to inconsistent use of contraception, elevating the risk of unwanted and sometimes high-risk pregnancies.
In this context, the government's promise of providing free of cost family planning services could be a lifeline to many girls and women in the country. However, welcome and important as this is, in order to make family planning services truly accessible and to protect the rights of girls and women, the government will need to go much further.
Access to contraception must go hand in hand with a widespread public information and awareness raising campaign. Many women and girls told us that the first time they had heard about contraception was after giving birth to a child. Many of them, particularly those living in rural areas, said they had not attended school, or only for short periods, and had not received community outreach information or education on sexual and reproductive health. Lack of reliable and scientific information can lead to myths, misinformation and rumours that undermine contraceptive use.
This is illustrated by the fact that a number of men interviewed by Amnesty International put forward varying myths as reasons to oppose the use of contraception; these included the belief it would make their wives unfaithful, that it could result in them having twins, or that it could make them unable to have children at all. In the words of Binta (name changed): "I had my first child at 16. I had no knowledge of contraception until I had my fourth child. There is less than one year of age difference between my children. First my husband was opposed to me using contraception, he said if it made me sick, he would not be responsible. If I had known about contraception before, I would have spaced the births, because now I have trouble taking care of all my children. My husband said that if I took contraception, he would reject me. But when he realized that we have many children, and we do not have the means to support them, he agreed."
Along with an awareness raising campaign, the government must also ensure that the free of cost contraceptive products and medical consultations must reach women in both urban and rural areas. Women and girls often have to travel long distances, sometimes 15 kms, to get to health care facilities where sexual and reproductive information, services and goods are provided. Such facilities are sparsely spread out in rural areas and transport is often unreliable and expensive. This is particularly acute for women and young girls who do not have their own money and must rely on their husbands or families. Although the authorities have increased the number of health facilities around the country during recent few years, there remain enormous disparities between urban and rural areas.
The government of Burkina Faso has taken noteworthy steps towards upholding sexual and reproductive rights of women and girls as it is obliged to do under international law. As 1 June draws closer, we hope that the government keeps its promise of providing free of cost family planning services and also goes much further to ensure that these services are truly and equally accessible to all girls and women no matter where they live, and that other barriers to accessing contraception such as the lack of information on contraception are removed through the implementation of a nationwide comprehensive awareness raising campaign.