The Summit conference is coming up. In just a few days time Tory, our lovely GHU coordinator, and myself will be flying to Chicago to hear and discuss all about global health. Whitman is one of eight schools who get the opportunity to present original research, and we’ll be presenting it to 120 people total. If you are not one of those 120 people but want to hear all about our research, this is for you.
We were focusing on the issue of birth control and contraceptive use within our partner community. As part of our fundraising we provide birth control, in various forms, to around 150 women. However, even though we’ve made condoms available, the women exclusively use pills or injections. In a lot of these cases, the women won’t tell their husbands that they’re even using birth control. We wanted to know about the various stigmas that might prevent acceptance of contraceptives in our partner community and compare that to how birth control and contraceptives are used in our own community. We compiled data from last years GROW interns, interviewed BWU, surveyed our own community, and researched background information so as to view the issue holistically.
Some nation-wide statistics say 33% of couples in Burma use birth control, while 72% use it in Thailand. We brainstormed factors that might affect birth control use and came up with marriage age, frequency of abortions, urban versus rural settings, traditional beliefs, religions beliefs, and lack of education, specifically focusing on reproductive health, pregnancy prevention, and STD prevention. Though the average marriage age is early twenties, it is legal to marry as young as fourteen. In this community the purpose of marriage is predominantly to have children. Abortion is a traditional method of birth spacing, and home abortions are common, but use very unsafe techniques including home remedies, alcohol, inserting sticks and other objects into the uterus, and severe pelvic pummeling. These can create life-threatening complications.
Contraception is more prevalent in urban areas than rural areas (32.3% and 10.3% respectively). Many ethnic minority leaders hold the position that condoms promote promiscuity and 12-13 year olds, despite being a few years away from marriage, are too young to know about and use condoms. In fact, there is very little education on sexuality, reproductive health, or STDs. The sex education that exists focuses on maternal health once a woman is already pregnant. 1/3 respondents to a survey in 2002 said that unmarried youth should receive education on pregnancy prevention. We expected religion would play a big role in the lack of sex education, however the predominantly Buddhist culture is not pro-family to in the same degree as many other religions. Though they believe it is wrong to kill for any reason, preventing conception with condoms would be preferable to stopping the development of a fertilized egg with an abortion or even plan-b “morning after” pills.
In an interview conducted with BWU it became clearer that religion was not a barrier to contraceptive use. The lack of contraceptives is driven by a social stigma that builds off of hegemonic gender roles. Without any standardized form of sex education, couples do not know how much control women should have over their bodies. They also do not necessarily know how reproduction works and how birth control/contraceptives factor into it. We categorized the social stigma into three categories: reputation loss, marital stress, and lack of education.
“If [a] single woman used birth control that woman is not a good woman… That woman will not get respect by other people and [will receive] gossip by the community.”
“People criticize… that she is blocking the new generation… [she] doesn’t not want to take care of the babies, and will never get the happiness of marriage lives.”
“Many men do not want to use condom because they felt that they did not get close enough with their partner… [using condoms] makes their trust decline.”
“Some men feel that using condoms is having shower with wearing raincoat.”
“[Women are told] …they will get uterus cancers and a lot of negative effects as they could not access the right information.”
To look at contraceptive use in our own community we started looking at national averages. The condom is the most common form of birth control, used by 68% of sexually active women. However 1/3 teens do not receive education on contraceptive, and 1/5 of them receive abstinence only education. Unlike in our partner community, the lack of sex education is driven by religion. The religious breakdown in Walla Walla is 29% Catholic, 27% Seventh Day Adventist, 8% LDS (Mormon), 5% Assemblies of God, and 31% other. Many of these religions believe children are a blessing and they having varying degrees of official stances on birth control and contraception. The Catholic Church opposes all contraception. The LDS Church doesn’t forbid it, however they strongly advocate having children. Seventh Day Adventists oppose abortion but endorse “appropriate methods of birth control,” echoing a sentiment with our partner community, that prevention of fertilization is better than termination of a pregnancy.
We sent a survey around to our college and various organizations in Walla Walla, including a women’s shelter. The majority of the responses were from Whitman, and it should be noted that Whitman is isolated from the general Walla Walla community. 93.7% of people surveyed have received formalized sex education and 66.5% are sexually active. We found a discrepancy when 91.1% said birth control and contraceptives were both partner’s responsibility, but only 86.2% said they were comfortable talking to their partner about these issues. More people are comfortable with the idea of being open about birth control than they are in practice. Interestingly, the 13.8% not comfortable talking to their partner about birth control and the 8.3% who thought birth control and contraceptives weren’t their partner’s responsibility, were all female. Another interesting statistic was that only 56.5% said they felt comfortable talking to their immediate family. Family planning is not a “family” discussion. Religion was also surprisingly absent in the discussion. 97.3% said religion has no factor in the decision to use or not to use birth control. The people unaffected by religion identified with many religions, including Catholic, Unitarian, unspecified Christian, Jewish, agnostic, and atheist. The 2.7% who said religion did factor into their decision identified as Catholic, Unitarian, Mormon, unspecified Christian, Sikh, and atheist.
Barriers to contraceptive and birth control use appear in our partner community in Mae Sot and in our community in Walla Walla. However, barriers in the US are driven by religious influences, while barriers in Burma are driven by gendered social stigmas. Both communities have access to the resources, however the culture at Whitman and Walla Walla has more education. With the prevalence of sex education in our community, people have a more thorough understanding of reproductive systems and how birth control and contraceptives work. They are more comfortable talking about sex to others and more likely to share responsibility and talk about family planning. Promoting sex education to men and women with BWU will help people understand reproductive issues and give them the skills to make informed decisions related to family planning. There is a link between birth control and human rights. The social stigmas, lack of education, and gender-based hegemonies prevent open use of birth control in Mae Sot. BWU empowers women by providing access to the supplies and the education to make their own choices for their bodies.
Thanks to Tory D, Nicole H, Ali H, Alex H, Rachel P, Joel P, Kate R, and many others for helping me bring this research project together! xx