For decades, the world has wrestled with the challenge of ensuring that women everywhere can access safe, effective family planning and maternal health care. While significant strides have been made—most notably, the doubling of global use of modern contraception methods since 1990—millions of women, especially in developing regions, still find themselves on the margins of these advances. Recent reports by the United Nations Population Fund (UNFPA) and Human Rights Watch (HRW) cast a stark light on the persistent barriers that undermine women’s basic rights to reproductive health, autonomy, and dignity.
According to UNFPA, as of early November 2025, nearly 224 million women worldwide, predominantly in developing countries, are not using safe and effective family planning methods. This figure stands as a sobering reminder that, despite progress, the “basic human right to choose whether to have children continues to be undermined” for far too many. The consequences are not merely statistical—they are deeply personal and often tragic, encompassing unwanted pregnancies, preventable maternal deaths, and curtailed futures for millions of young women and girls.
“Contraceptives save lives,” emphasized Diene Keita, the executive director of UNFPA, underscoring the life-or-death stakes of this issue. The unavailability of contraception, UNFPA notes, leads directly to a rise in unintended pregnancies and higher rates of maternal deaths resulting from unsafe abortions. The ripple effects extend further: increased adolescent pregnancies, school dropouts, and a heightened risk of gender-based violence. These are not isolated problems—they are deeply intertwined with cycles of poverty and marginalization that can span generations.
The economic argument for expanding access to contraception is compelling. “Every $1 spent ending unmet need for contraception yields nearly $27 in economic benefits,” Keita pointed out, highlighting the transformative potential of investing in reproductive health. These benefits accrue not just to individuals, but to entire societies, as women who can plan their families are better able to pursue education, participate in the workforce, and contribute to the economic vitality of their communities.
Yet, even as the scientific and economic case for contraception grows stronger, misinformation and stigma continue to cloud public understanding. UNFPA has identified five persistent myths that undermine confidence in modern contraceptive methods. Among them: the belief that contraception is unsafe, that it causes abortion or infertility, and that it is only appropriate for married women or those whose partners approve. The agency is unequivocal in its rebuttal. “Modern forms of contraception are among the most prescribed and well-studied medications in existence,” UNFPA states. Health risks associated with unintended pregnancy are “significantly higher” than those linked to any recommended contraception method.
Moreover, contraceptives do not cause abortion or miscarriage. Instead, they work by preventing fertilization or ovulation—stopping pregnancy before it begins. Concerns about long-term fertility are also unfounded. While some hormonal methods may temporarily delay the return of ovulation and menstruation, they do not cause permanent infertility. The agency further warns against the growing popularity of so-called "natural methods"—such as cycle tracking or daily temperature checks—on social media, noting that these are “significantly less likely to prevent pregnancy” compared to modern methods. “The most effective methods of contraception are modern methods,” UNFPA asserts.
Perhaps most crucially, the right to contraception is not contingent on relationship status or partner approval. “Every individual has the right to decide whether or not to become pregnant,” UNFPA insists. No one should ever be pressured into having unprotected sex—a form of reproductive coercion that, as the agency reiterates, constitutes abuse.
While the lack of access to contraception is a global issue, the situation in some countries is especially dire. In Sierra Leone, the problem is compounded by systemic abuses within the healthcare system itself. On November 3, 2025, Human Rights Watch released a damning 80-page report titled “No Money, No Care: Obstetric Violence in Sierra Leone.” The report documents widespread obstetric violence faced by women giving birth in public healthcare facilities, painting a grim picture of the obstacles women face even when they seek care.
HRW’s findings are based on interviews with over 50 postpartum women who suffered health complications due to delayed or denied care—often because they could not afford to pay hospital staff informal fees. This, despite a 2010 government initiative promising free health care for maternal and child health. In practice, every woman interviewed still had to pay for some part of her care in public facilities. In 15 particularly harrowing cases, women in obstetric emergencies were abandoned or had their treatment delayed because they lacked money. The speed and kindness of care, HRW found, often depended on a woman’s ability to deliver informal payments.
Obstetric violence, as defined by HRW, is a form of gender-based discrimination that can include non-consensual interventions (such as sterilization or unnecessary surgery), verbal and psychological abuse, withholding pain relief, neglect or abandonment in the delivery ward, and the denial of bodily autonomy and dignity. The report calls on the Sierra Leonean government to publicly acknowledge obstetric violence as a serious rights violation, improve regulation and oversight of healthcare providers, increase paid staffing, ensure essential medical commodities are available, and reduce reliance on out-of-pocket and informal payments.
Sierra Leone’s struggles are particularly poignant given its recent legislative reforms. The nation decriminalized abortion in 2022 and criminalized child marriage in 2024—important milestones in the fight for women’s rights. Yet, it continues to have the highest maternal mortality rate in the world, a grim statistic that underscores how legal change alone is not enough without systemic reform and genuine access to care.
The stories and statistics from UNFPA and HRW converge on a single, urgent truth: reproductive rights and safe maternal care are not luxuries, but necessities. They are foundational to women’s health, autonomy, and equality. As the world marks more than three decades of progress since 1990, the unfinished business of universal access to contraception and respectful, affordable maternal care remains a defining challenge for global health and human rights.
For millions of women, the stakes could not be higher—and the time for change is now.
