Op-Ed: Andrea M Wojnor, Country Director, UNFPA Bhutan

Nearly half of all pregnancies worldwide, totaling about 121 million each year, are unintended, according to UNFPA’s State of World Population 2022 report. Moreover, over 60 per cent of unintended pregnancies end in abortion, with an estimated 45 per cent of all abortions being unsafe, and accounting for between 5 and 13 per cent of all maternal deaths recorded. In addition, nearly a quarter of all women are unable to decline sex and make decisions about their own health.

With the continued growth in global population, the absolute number of unintended pregnancies is expected to keep rising. And the profound consequences of unintended pregnancies for women, girls, societies, and global health will continue to grow.

The most basic and most life-altering reproductive choice — whether to become pregnant - is no choice at all if the fundamental human right to make informed decisions about one’s own body and health and to decide whether, when and how many children to have is not available.

Every country is facing the consequences of the silent crisis of unintended pregnancy. In Bhutan, a study of about 500 pregnant women on “Prevalence, Determinants and Outcomes of Unplanned Pregnancy and Perspectives on Termination of Pregnancy among Women in Nganglam, Bhutan” (Choden et al., 2015) revealed that for one in every five, the pregnancy was unintended and the circumstances around each diverse

Lhamo (name changed) was unaware of contraceptives when she got pregnant at the age of 19. The medication she took to ease her physical discomfort resulted in a miscarriage and weeklong hospitalization.

18- year-old Pema (name changed) became pregnant during the first year of her B. Ed program. The stress she faced from this unplanned pregnancy was three-fold—impact on her studies, life outcomes for her and her child, and intimate partner violence.

25- year- old Eden (name changed), a working and breastfeeding mother, was alarmed that in less than a year after giving birth to her first child, she was pregnant again. This increased her struggles that she was already juggling between the responsibilities of childcare and career.

The impacts of unintended pregnancy are clearly wide-ranging and life-long. When a woman is unable to complete her education, participate in the workforce, and has poor health outcomes, the snowball effects can be manifold. In fact, the costs are tremendous—not just at an individual level, but also to societies, health systems, and overall economy.

There are various factors which increase the likelihood of unintended pregnancies such as lack of knowledge about sexual and reproductive health, non-use of contraception, and sexual assault and reproductive coercion. Shame, stigma, fear, poverty, gender inequality and many other factors undermine women and girls’ ability to exercise choice, to seek and obtain contraceptives, to negotiate condom use with a partner, to speak aloud and pursue their desires and ambitions.

The unseen crisis of unintended pregnancies portrays an alarming picture of the state of neglect of women’s reproductive freedom and its impact on the achievement of the 2030 Sustainable Development Goals. Many interventions aimed at reducing unintended pregnancy are themselves core development goals such as gender equality, poverty reduction, and improved maternal health. Addressing unintended pregnancies will also contribute to the achievement of national development goals, including Bhutan’s.

If we truly desire sustainable development, we must galvanize our efforts to create a world where the vast majority of pregnancies are planned, welcomed and wanted. Policy makers, community leaders and individuals must work together to empower women and girls so that they are able to make autonomous decisions about sex, contraception and motherhood. Indeed, we must foster societies that recognize the full value of women and girls to create the conditions for transformative change.

Today, thanks to the availability of quality sexual and reproductive health care and services, Pema has successfully completed her degree and Eden is adamant that her daughter learns about comprehensive sexuality education in order to make her own choices. The continued return on these health investments pushed the needle in the right direction for Bhutan and for the world.