MY BODY IS MY OWN

CLAIMING THE RIGHT TO AUTONOMY AND SELF-DETERMINATION

State of World Population 2021
This report was developed under the auspicesof the UNFPA Division for Communications
and Strategic Partnerships.
EDITOR-IN-CHIEF
Arthur Erken
EDITORIAL TEAM
Editor: Richard Kollodge
Features editor: Rebecca Zerzan
Creative direction: Katie Madonia
Digital edition managers: Katie Madonia,
Rebecca Zerzan
Digital edition adviser: Hanno Ranck
RESEARCH ADVISER
Nahid Toubia
UNFPA TECHNICAL ADVISERS
Satvika Chalasani
Nafissatou Diop
Emilie Filmer-Wilson
Mengjia Liang
Leyla Sharafi

ACKNOWLEDGEMENTS
Illustrations were based on original photography by Joel Koko (page 65);
George Koranteng (page 108); Bushra Noor (page 16); Kingsley OseiAbrah on Unsplash (page 9); Mikey Struik on Unsplash (page 114).
UNFPA thanks the following people for sharing glimpses of theirlives and work for this report: Anonymous “virginity inspector,”
South Africa; Ayim, Kyrgyzstan; Dr. Mozhgan Azami, Afghanistan;
Enkhjargal Banzragch, Mongolia; Dr. Wafaa Benjamin Basta, Egypt;
Víctor Cazorla, Peru; Daniyar, Kyrgyzstan; Dr. Mouna Farhoud,
Syria; Isabel Fulda, Mexico; Dr. Caitríona Henchion, Ireland; Josefina(not a real name), Mexico; Liana, Indonesia; Lizzie Kiama, Kenya;
Olga Lourenço, Angola; José Manuel Ramírez Navas, El Salvador;
Monika, North Macedonia; Leidy Londono, USA; Dr. Ahmed Ben
Nasr, Tunisia; Chief Msingaphansi, South Africa; Sarojini Nadimpally,
India; Dr. Nuriye Ortayli, Turkey; Dipika Paul, Bangladesh; Dr. Sima
Samar, Afghanistan; Jay Silverman, USA; Dr. Suraya Sobhrang,
Afghanistan; Maeve Taylor, Ireland; Alexander Armando Morales
Tecún, Guatemala; Romeo Alejandro Méndez Zúñiga, Guatemala.
Chief of the UNFPA Media and Communications Branch, Selinde
Dulckeit, provided invaluable insights to the draft, and Gunilla Backman
and Jo Sauvarin from the UNFPA Asia and the Pacific Regional Officesupported research and commented on drafts.

COVER ARTWORK
Rebeka Artim

UNFPA colleagues and others around the world supported thedevelopment of feature stories and other content or provided
technical guidance: Samir Aldarabi, Iliza Azyei, Lindsay Barnes,
Dr. Shinetugs Bayanbileg, Esther Bayliss, Shobhana Boyle, Warren Bright,
Ikena Carreira, Cholpona Egeshova, Jens-Hagen Eschenbaecher,
Usenabasi Esiet, Rose Marie Gad, Irene Hofstetter, Matt Jackson,
Kinda Katranji, Daisy Leoncio, Guadalupe Natareno, Ziyanda Ngoma,
Claudia Martínez, Subhadra Menon, Rebecca Moudio, Rachel Moynihan,
Jasmine Uysal, Dalia Rabie, Zaeem Abdul Rahman, Patrick Rose,
Mindy Roseman, Alvaro Serrano, Ramz Shalbak, Avani Singh, Irena
Spirkovska, Walter Sotomayor, Sabrina Morales Tezagüic, Nahid Toubia,
Sujata Tuladhar, Roy Wadia, Irene Wangui, Asti Setiawati Widihastuti,
Renato Zeballos.

COMMISSIONED ORIGINAL ARTWORK
Rebeka Artim
Kaisei Nanke
Hülya ÖzdemirTyler Spangler
Naomi Vona

The editors are grateful to the Population and Development Branch of
UNFPA for aggregated regional data in the indicators section of this reportand for overall data guidance. Source data for the report’s indicators were
provided by the Population Division of the United Nations Department of
Economic and Social Affairs, the United Nations Educational, Scientific andCultural Organization and the World Health Organization.

RESEARCHERS AND WRITERS
Daniel Baker
Alice Behrendt
Stephanie Baric
Marieke Devillé
Laura Ferguson
Gretchen Luchsinger
Mindy Roseman

Publication and web interactive design and production: Prographics, Inc.

MAPS AND DESIGNATIONS
The designations employed and the presentation of material inmaps do not imply the expression of any opinion whatsoever on thepart of UNFPA concerning the legal status of any country, territory,
city or area or its authorities, or concerning the delimitation of its
frontiers or boundaries.
© UNFPA 2021

Ensuring rights and choices for all since 1969

MY
BODY
IS MY
OWN

CLAIMING THE RIGHTTO AUTONOMY AND
SELF-DETERMINATION

CONTENTSOUR AUTONOMY, OUR LIVES
A woman’s power to control her own body is linked to how muchcontrol she has in other spheres of her life 7

THREE DIMENSIONS OF AUTONOMY
Measuring the power to make decisions about health care,
contraception and sex 17

WHEN DECISIONSARE MADE BY OTHERS
The denial of bodily autonomy and integrity
takes many forms 33

MY BODY, MY RIGHTSInternational treaties and declarations provide
foundations for the right to bodily autonomy
and integrity 55

LAWS THAT EMPOWERLAWS THAT CONTROL
A look at how laws and regulations
impact bodily autonomy 85

THE POWER TO SAY YES
THE RIGHT TO SAY NO
Achieving bodily autonomy depends on genderequality and expanding choices and opportunities
for women, girls and excluded groups 109

Artwork by Rebeka ArtimFOREWORD
My body is my own.
How many women and girls canfreely make that claim?
Each of us has a right to bodily
autonomy and should therefore havethe power to make our own choices
about our bodies, and to have thosechoices supported by everyone aroundus, and by our societies at large.
Yet, millions of people are denied theirright to say no to sex. Or yes to the
choice of a partner in marriage or to
the right moment to have a child. Manyare denied this right because of race,
sex, sexual orientation, age or ability.
Their bodies do not belong to them.
Depriving women and girls of bodily
autonomy is wrong. It causes andreinforces inequalities and violence, all ofwhich arise from gender discrimination.
By contrast, when women and girls canmake the most fundamental choices about
their bodies, they not only gain in terms of
autonomy, but also through advances inhealth and education, income and safety.
These add up to a world of greater justiceand human well-being, which benefits us all.
At UNFPA, we stand with women andgirls in claiming their rights and choices,
throughout their lives. Since 1994, ourprogrammes have been guided by the

Artwork by Naomi Vona

4

International Conference on Population
and Development Programme of Action,
which made the empowerment andautonomy of women a basis for global
action for sustainable economic andsocial progress. UNFPA also stands
with countless others who are often
excluded from making autonomous
decisions about their bodies: people ofdiverse sexual orientations and gender
identities, persons with disabilities,
and ethnic and racial minorities.
The family planning programmes wesupport both increase the availability ofcontraceptives and dismantle barriers
to services, thus empowering women
to govern their own bodies. In 2019,
for example, UNFPA procured morethan 128 million cycles of the pilland doses of emergency and longacting reversible contraception.
We support programmes that promote
men’s equitable involvement in parenting
and encourage them to be better
communicators with their spouses inmatters of sexual and reproductive
health, helping to clear the way for
women to make decisions about theirown sexual and reproductive health.
The UNFPA Maternal Health Thematic
Fund is helping make life-saving services
more accessible and affordable bytraining midwives and deploying themto underserved areas, and our joint
programmes with UNICEF are helping

end child marriage, a practice that
denies girls’ autonomy, and eliminating
the harmful practice of female genital
mutilation, a violation of bodily integrity.
In 2019, at the Nairobi Summiton ICPD25, nations, civil society,development institutions and others
called for the protection of the rightto bodily autonomy and integrity,
building on international commitmentsin the 2030 Agenda for Sustainable
Development. Further momentum hascome in 2021 from the Generation
Equality Forum, which is building on
the singular achievements of the 1995
Fourth World Conference on Women
to reach gender equality by 2030.
Through our leadership in the new
Generation Equality Action Coalition
on Bodily Autonomy and Sexual andReproductive Health and Rights, andthrough this edition of the State of World
Population, UNFPA is highlighting whybodily autonomy is a universal right thatmust be upheld. The report reveals how
serious many of the shortfalls in bodily
autonomy are; many have worsened
under the pressures of the COVID-19
pandemic. Right now, for instance, record
numbers of women and girls are at riskof gender-based violence and harmful
practices such as early marriage.
The report also outlines solutions thatare already at hand, while making thepoint that success requires much morethan a disconnected series of projects
or services, as important as these may
be. Real, sustained progress largely
depends on uprooting gender inequality
and all forms of discrimination, andtransforming the social and economic
structures that maintain them.
In this, men must become allies. Many
more must commit to stepping awayfrom patterns of privilege and dominancethat profoundly undercut bodily
autonomy, and move towards ways ofliving that are more fair and harmonious,
benefiting us all. And all of us musttake action to challenge discrimination
wherever and whenever we encounterit. Complacency equals complicity.
Our communities and countries canflourish only when every individual has
the power to make decisions about theirbodies and to chart their own futures.
Let us therefore claim the right for eachindividual to make decisions about
their body and enjoy the freedomof informed choices. All of us want
this. All of us should have it. It is at
the core of our humanity, and weshould never lose sight of just how
much depends on it—for everyone.
Dr. Natalia Kanem
United Nations Under-Secretary-Generaland Executive Director of UNFPA,
the United Nations sexual andreproductive health agency

STAT E OF WOR L D POPUL AT I ON 2 02 1

5

Artwork by Rebeka ArtimOUR AUTONOMY

OUR LIVES

A woman’s power to control her own bodyis linked to how much control she has in otherspheres of her life
We have the inherent right to choose
what we do with our body, to ensure its
protection and care, to pursue its expression.
The quality of our lives depends on it.
In fact, our lives themselves depend on it.
The right to the autonomy of our bodies
means that we have the power and agency
to make choices, without fear of violence or
having someone else decide for us. It means
being able to decide whether, when or withwhom to have sex. It means making your own
decisions about when or whether you want
to become pregnant. It means the freedom
to go to a doctor whenever you need one.
Saying no, saying yes, saying this is my choice
for my body—this is the foundation of anempowered and dignified life. We can realize

who we are, fully. We do not have to shrink to fit
choices that are not ours, to be in any way “lessthan”. Further, since claiming bodily autonomy
is fundamental to the enjoyment of all otherhuman rights, such as the right to health or
the right to live free from violence, institutions
in our societies are obligated to extend all the
support and resources required for us to carry out
our choices in a meaningful way (PWN, n.d.).
Intertwined with bodily autonomy is theright to bodily integrity, where people canlive free from physical acts to which they do
not consent. While many women and girls
in the world today have the power to makeautonomous decisions about their own bodies,many more still face constraints, some withdevastating consequences to their health,well-being and potential in life.

STAT E OF WOR L D POPUL AT I ON 2 02 1

7

My body, but not my choice
For many people, but especially womenand girls, life is fraught with losses tobodily integrity and autonomy linked
to a lack of agency in making their own
decisions. These losses manifest when a lackof contraceptive choices leads to unplanned
pregnancy. They result from terrible
bargains where unwanted sex is exchanged
for a home and food. They run throughviolations such as female genital mutilationand child marriage. They arise whenpeople with diverse sexual orientations andgender identities cannot walk down a street
without fearing assault or humiliation.
They leave people with disabilities strippedof their rights to self-determination, to be
free from violence and to enjoy a safe andsatisfying sexual life.

WOMEN
ENJOY JUST75%

of thelegal rights
OF MEN8

Our autonomy, our lives

There are many dimensions to the forces thatprevent women and adolescent girls fromenjoying bodily autonomy and integrity.
But a root cause is gender discrimination,
which reflects and sustains patriarchal systemsof power and spawns gender inequality anddisempowerment.
Where there are gender-discriminatory social
norms, women’s and girls’ bodies can be subject
to choices made not by them, but by others,
from intimate partners to legislatures. Whencontrol rests elsewhere, autonomy remains
perpetually out of reach. While genderdiscriminatory norms are by themselves harmful,they become even more so when they arecompounded by other forms of discrimination,
based on race, sexual orientation, age ordisability, among other issues.
Discriminatory norms are perpetuated by thecommunity and can be reinforced by political,
economic, legal and social institutions, suchas schools and the media, and even by healthservices, including those that provide sexual andreproductive health care. These services may, forexample, undermine autonomy by being poor
in quality and constrained in meeting all of theneeds of women and adolescent girls.
Despite constitutional guarantees of genderequality in many countries, worldwide, on
average, women enjoy just 75 per cent of
the legal rights of men (United Nations
Secretary-General, 2020). Women and girls
in many instances lack the power to contest
these disparities because of still low levels ofparticipation in political and other forms ofdecision-making. Economic marginalization
can detract from a woman’s financial

independence, which in turn can weaken
her authority to make autonomous decisions
about sex, health care and contraception.
The hardships brought on by the COVID-19
pandemic have only made matters worse.
For some women and girls, the impact ofgender inequality is amplified by multiple
sources of discrimination based on age,
race, ethnicity, sexual orientation, disability
or even geography. When diverse types of
discrimination intersect, they leave womenand girls even more at risk of not realizing
bodily autonomy, not enjoying their rights,
and even further away from gender equality.
No country in the world today can claim tohave achieved gender equality in its totality. If it
had, there would be no violence against womenand girls, no pay gaps, no leadership gaps, nounfair burden of unpaid care work, no lack ofquality and comprehensive reproductive healthservices, and no lack of bodily autonomy.

Voice, choice and agency
Sexual and reproductive health and rights
have direct bearing on bodily autonomy
and integrity for women and girls, with the
body the locus of all sexual and reproductivefunctions and choices. These choices
are subject to powerful, discriminatory
subjugations of the rights of women andgirls. It is here where their bodies are all too
often bartered, bought and sold.
From a perspective of patriarchy, control ofsexual and reproductive choices effectively
becomes control in many other areas oflife. A woman who cannot define whether,

Artwork by Rebeka Artim

when or how many children to have, orchoose to stay in school instead of marrying
at a young age, or who accepts domestic
violence as her fate, stands little chance ofgaining empowerment in the workforce orcommunity decision-making or anywhere else.
She essentially loses rights not just in one partof her life, but in many or even every part.
Interests in sustaining patterns like these canbe deeply entrenched in how societies andeconomies function. In some parts of the world,for instance, bride price, where a man offers
money, property or other assets to essentially“purchase” a wife, is a critically importanteconomic mechanism for exchanging power
and wealth (Shetty, 2007).
When women and adolescent girls have morechoice in sexual and reproductive healthcare, multiple positive health outcomes
result, including greater understandingof how to prevent HIV, and a greater
likelihood of having the number of prenatal
visits recommended by the World HealthOrganization as well as giving birth with thehelp of a doctor, nurse or midwife.
Failures to uphold bodily autonomy thus
result first and foremost in profoundlosses for individual women and girls.
But they also add up to broader deficits,
potentially depressing economic productivity,
undercutting valuable skills, and imposing
extra costs for health-care and judicial services,
including for responding to violence against
women and girls (UN Women, 2013).
A mixture of low levels of bodily autonomy
and the losses in human capacity associatedwith it can undermine social stability andresilience, leaving societies less equipped
to confront and recover from crises andchallenges, such as the COVID-19 pandemic.
In recent years, countries around the world
have started prioritizing access to sexual andreproductive health care as an important means
to advance gender equality (UN ECOSOC,
2019). Gains align with the 1994 Programmeof Action of the landmark International
Conference on Population and Development,

10

Our autonomy, our lives

the ICPD, the most comprehensive global
endorsement of reproductive rights. The
Programme of Action set forth a series ofmeasures to achieve universal sexual andreproductive health and drew attention to
women’s and girls’ limited power to make theirown decisions not just about their bodies, but
in all aspects of their lives.
Further, in 2015, most countries endorsed the2030 Agenda for Sustainable Development,
where gender equality is the fifth of 17
Sustainable Development Goals. The
gender equality goal contains a series oftargets, including one affirming the ICPD
Programme of Action, by calling for universal
access to sexual and reproductive health andreproductive rights. But the 2030 Agenda also
takes a critical step further. For the first timein an international framework, it requires
measuring progress towards universal accessthrough two indicators: one that looks beyond
the provision of services and focuses onwhether girls and women can actually maketheir own decisions in terms of having sex,
using contraception and seeking reproductive
health care, and one that tracks laws andregulations that enable or impede full andequal access to care and information.
Information so far from 57 countries showsthat only about half of adolescent girls andwomen can make their own decisions that
underpin bodily autonomy and integrity
as measured by these two indicators. The
share drops as low as about one in 10 insome countries. Strikingly, once the choices
are broken down, more women can makedecisions around contraceptive use, which
could be seen as offering benefits to men, butfewer can say no to sex, where male privilege
works in the opposite direction.

New alliances standbehind bodily autonomy

These indicators, which are the focus of thisreport, capture only a few dimensions ofautonomous decision-making in sexual andreproductive health and only for women and girls
aged 15 to 49 years who are married or partnered.
The issue of bodily autonomy, however, also
relates to a range of other issues, including
abortion, age of consent, surrogacy, sex workand more, and is a concern for other groups too,such as women and girls who are not married,
LGBTI communities, persons with disabilities
and any other community marginalized or
discriminated against because of race, ethnicity,
wealth, disability or place of residence.

In 2019, the Nairobi Summit marked thetwenty-fifth anniversary of the ICPD. It wasa moment to reflect on how much moreneeds to be done to realize women’s bodily
autonomy and integrity. While the use ofmodern contraception has more than doubled
since 1994, 217 million women worldwide
still have unmet contraceptive needs, forinstance. Rates of female genital mutilation
have declined among girls in countries where
the practice is common. The share of girls
who are child brides has dropped (Pantuliano,2020). Yet as many as 4 million girls were still
subjected to female genital mutilation andan estimated 12 million were still married as
children in 2020, and that number is likely
undercounted.

Because bodily autonomy and integrity
influence so many aspects of health aswell as a decent, dignified life, progressin realizing them will lead not just toachieving sexual and reproductive healthand the fifth Sustainable Development
Goal on gender equality, but many of theother Sustainable Development Goals
too, including those related to promoting
health, reducing inequalities and ending
poverty. For example, if the discriminatory
gender gap in lifetime earned income wereclosed, it would generate an astounding$172 trillion in human capital wealth andhelp lift millions of people out of poverty(United Nations Secretary-General, 2020).
Rapid progress must be made now, however,given there is just one “Decade of Action” before
the 2030 endpoint of the global goals, when all
women and girls should have full power to makechoices in their lives.

At the Nairobi Summit, governments andothers committed to accelerating action inclosing gaps, striving for three zeros by 2030:
zero maternal mortality, zero unmet need forcontraception and zero sexual and genderbased violence and harmful practices. Implicit
in all three is the full realization of bodily
autonomy for all women and girls.
In 2020, another milestone was the twentyfifth anniversary of the 1995 United Nations
Fourth World Conference on Women. The
conference agreed on the Beijing Declaration
and Platform for Action, which refers to theempowerment and autonomy of women as
essential to sustainable development. For theanniversary, a United Nations “Generation
Equality” campaign has brought together
young and seasoned advocates to celebrate

STAT E OF WOR L D POPUL AT I ON 2 02 1

11

Your body:an owner’s manual
Few parents or community

supported programmeshow it may actually help

leaders object when a student

providing life skills anddelay adolescents’ sexualbrings home a chemistry or

comprehensive sexuality

debut (UNESCO, 2016).

calculus textbook. Yet lessons

education to youth in Angola.

in comprehensive sexuality“Almost nothing is said about

Lourenço explained that,

education—accurate, age-comprehensive sexual andbecause she lacked accurate

appropriate information about

reproductive health because

information at a young age,

one’s own body, sexual andof our taboos and prejudices.”

she actually felt pressured toreproductive health, and humanengage in sexual relationships

rights—are widely considered

Opponents of comprehensive

before she was ready, attaboo. Many schools do notsexuality education oftenage 15. “My friends alreadyteach the subject, or provide

contend that it promotes

had their boyfriends. They

only incomplete information.

sexual activity, yet studies

already had sexually active

This leaves students bothshow that this is incorrect.

lives. They made fun of me

ill-prepared for the changes

Rather, evidence indicates thatfor being the ‘virgin of thetheir bodies are undergoing

this education, when provided

group’,” she said. “In a way,

and ill-equipped to protect

to international standards,

this psychologically affected

themselves from harm.

improves young people’sme... I think that, in a way, it

knowledge and constitutes

violated my bodily autonomy.”“We are in a constant strugglea crucial and cost-effective

to include this topic in thestrategy for preventing

Dipika Paul, a longtime

school curriculum,” said

unintended pregnancy andsexual and reproductive

Olga Lourenço, a coordinatorsexually transmitted infections,health researcher and an

for Project CAJ, a UNFPA-

including HIV. Some studies

adviser at Ipas in Dhaka,Bangladesh, has seen the“They need toknow how theirbodies work.”

12

Our autonomy, our lives

consequences of poor accessto sexuality education in her
own community. “When I
was a student, I was in classseven, and there was just one
chapter—on menstruation,”she recalled. “The teacher

Olga Lourenço is used to facing resistance when providing comprehensive sexuality education, but she is undeterred.
Original artwork by Naomi Vona; photo © UNFPA/C. Cesar.

also did not feel comfortable

and misinformation. Boys

using contraception because

teaching that section to us.”and men, in particular, “haveof the belief that “an IUD

knowledge gaps, they have

travels anywhere around

Without comprehensive

misconceptions,” Paul said,in the body… they thinksexuality education, young

explaining that she has seen

they can feel pain from anpeople are vulnerable to myths

men forbid their wives from

IUD. This is not true.”

STAT E OF WOR L D POPUL AT I ON 2 02 1

13

Students who receive

locked herself up and couldn’t

are increasingly calling for thiscomprehensive sexuality

speak with anyone for fear

information to frame violence

education are not onlyof being expelled from theprevention as the responsibility

empowered to make healthierhome and ending up on theof potential perpetrators,

sexual choices, but they

street,” Lourenço described.

rather than the responsibility

are also better equipped

Mentors were able to secureof victims and survivors

to seek help when needed.

services for both girls, but(Schneider and Hirsch, 2020).

“The information I share

Lourenço is haunted by what

can significantly change amight have been: “If we did“They need to know what

person’s life,” said Lourenço.

not intervene, what would

their rights and duties are inbecome of these girls?”

a society first,” Lourenço said,

She recalled one girl who, while

explaining that this is thereceiving sexuality education

Comprehensive sexuality

foundation of comprehensive

through a mentorshipeducation can also play a rolesexuality education as she

programme, revealed she had ain preventing gender-basedteaches it. “Then they needchronic wound on her breast—

violence. When taught toto know how their bodies

something she regarded asinternational standards, thework so that they can makean embarrassment but not an

lessons include messages

decisions for themselves

emergency. Another young

about human rights, genderand not let others makewoman disclosed that she was

equality and respectfuldecisions for them.”

living with an uncle who had

relationships (UNESCO andsexually abused her. “The girlothers, 2018). And experts

achievements to date and to demand that thenext generation be the one where promises
to realize gender equality are finally kept. Six
action coalitions have formed, including one
co-led by UNFPA on bodily autonomy andsexual and reproductive health, which is taking
up issues such as how health-care and otherservices can more closely support the choicesthat women themselves say they want.

14

Our autonomy, our lives

Ramped-up activism offers inspiration, but
it is unfolding against a worrying backdrop,with the COVID-19 pandemic convulsing
the world, and current economic growthmodels leading to extreme and destabilizing
inequalities. Pushback against gender equality
has grown, leading to new restrictions on
sexual and reproductive health and rights
and thus threatening progress towards bodily

autonomy for women and girls worldwide.
For example, there have been attempts toremove comprehensive sexuality educationfrom school curricula (UN ECOSOC, 2019).
And there is mounting evidence that criticalsexual and reproductive health services havebeen deemed “less essential” and have suffereda diversion of capacity and funding during the
response to COVID-19 (Pantuliano, 2020).
Surmounting these issues will not be easy. Yet,
to some extent, bodily autonomy and integrity
can unify action for gender equality, just as
they often unify the opposition to it. Now is
the moment for making a powerful, potentiallytransformative case for asserting what bodily
autonomy and integrity really mean in practice,
and what is really required to achieve them.
In broad terms, we already know that achieving
bodily autonomy and integrity for women andgirls depends on realizing gender equality on all
fronts, and that sexual and reproductive healthand reproductive rights are among the mostimportant entry points. Progress here can,in turn, build on and support other efforts
to empower women in the economy anddecision-making, and to guarantee access tojustice. Much depends on overturning genderand other discriminatory norms to prevent
bias from operating in the first place.
Diverse constituencies are collectively
galvanizing momentum for change. The
Generation Equality campaign, for example,
is forging new alliances among genderequality activists, between disabilities, genderand health advocates, and with LGBTI groups
and organizations of persons with disabilities.
To look at bodily autonomy and imagine
what it could and should mean is to see avastly different future for human beings.
A different path starts with rights and leads
to choices, allowing people to care for andlove their bodies and their lives as they see fit.

Artwork by Kaisei Nanke

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15

Artwork by Hülya Özdemir

THREE DIMENSIONSOF AUTONOMY
Measuring the power to make decisions about
health care, contraception and sex
The power to make decisions about sexuality
and reproduction is fundamental to women’s
empowerment overall.
A woman who has control over her body is more
likely to be empowered in other spheres of herlife. A woman—or adolescent girl—with little
bodily autonomy is less likely to have control
over her home life, her health and her future,and less likely to enjoy her rights.
But what exactly is bodily autonomy? And how
does one determine whether one has it? Is it
something that can be measured?
The notion of autonomy in the context of
women’s empowerment emerged in the 1970s
and was later taken up by the sexual andreproductive health and rights movement.
In 1994, at the International Conference on
Population and Development or ICPD, theterm appeared in the pathbreaking Programmeof Action, which acknowledged that “the goalof the empowerment and autonomy of womenand the improvement of their political, social,economic and health status is a highly important
end in itself and is essential for the achievementof sustainable development”.
Since then, the word “bodily” has been joinedwith “autonomy” to create a term with a broadand sometimes ambiguous meaning. It is used
today by advocates, activists and human rights
experts surrounding issues related to sexuality,
health, reproductive rights, sexual orientation,
gender identity, transactional sex, surrogacy,
disability status, abortion and more.
The term gained further prominence in 2019,
when governments, civil society organizations,academics and members of the private sector
came together for the Nairobi Summit on
ICPD25, where they pledged to finally achieve
all the goals set out in the ICPD Programme

STAT E OF WOR L D POPUL AT I ON 2 02 1

17

of Action. Many of the delegates adopted thevoluntary Nairobi Statement, which cited theneed “to protect and ensure all individuals’
right to bodily integrity, autonomy andreproductive rights, and to provide access toessential services in support of these rights”.
While the term has become part of thevernacular of the feminist and sexual andreproductive health and rights movements,
it continues to elude simple definition andeasy measurement. However, when the
United Nations adopted its transformative
2030 Agenda for Sustainable Development
and the accompanying 17 Sustainable
Development Goals, it established indicators
to help governments track progress towards
achieving the goals and their related targets,
such as target 5.6, the achievement of sexualand reproductive health and reproductive
rights for all. Two indicators have been
identified to measure progress in this area.
The first, indicator 5.6.1, aims to measure
the proportion of women aged 15 to 49 years
who make their own informed decisions
regarding sexual relations, contraceptive
use and reproductive health care. The
second indicator, 5.6.2, tracks the numberof countries with laws and regulations thatguarantee full and equal access to women andmen aged 15 years and older to sexual andreproductive health care, information andeducation.
Indicator 5.6.1 is based on responses toquestions posed to women aged 15 to 49 years
in Demographic and Health Surveys, or DHS,
in 57 countries:

18

Three dimensions of autonomy• Who usually makes decisions about healthcare for yourself?
• Who usually makes the decision on whether
or not you should use contraception?
• Can you say no to your husband or
partner if you do not want to have sexualintercourse?
Only women who say they make theirown decisions in all three of these areas are
considered to have autonomy in reproductive
health decision-making and to be empowered
to exercise their reproductive rights.
DHS surveys rely on standard questionnairesthat yield nationally representative dataon marriage, fertility, mortality, familyplanning, reproductive health, childhealth, nutrition and HIV/AIDS. The
DHS programme is implemented by ICF
International and funded by the UnitedStates Agency for International Developmentwith contributions from internationalorganizations such as UNFPA.
The formulation of indicator 5.6.1 marks thefirst time that an international framework
measures sexual and reproductive health—andbodily autonomy—in ways that look beyond
access to services and explores the extent towhich girls and women are able to make theirown choices. UNFPA, the United Nations
sexual and reproductive health agency, is
responsible for managing the data includedin this indicator, as well as indicator 5.6.2,
covered in chapter 5 of this report.

A look at the numbers

picture of the state of bodily autonomy for millions
of women and girls: only 55 per cent of girls andwomen are able to make their own decisions in all
three dimensions of bodily autonomy.

Complete data on all three dimensions of
indicator 5.6.1 are available only for 57
countries, most of which are in sub-SaharanAfrica. However, future international surveys,
such as UNICEF’s Multiple Indicator Cluster
Surveys, as well as regional survey programmessuch as the Generations and Gender Survey, areexpected to yield data for more countries overthe next few years.

That means that little more than one in two
women and girls has the power to decide whether
and when to seek health care, including sexualand reproductive health services, whether to use
contraception and whether and when to have sex
with their partner or husband (Figure 1).

While data currently cover only about one in fourof the world’s countries, they paint an alarming

Percentages vary across regions. For example, while
76 per cent of adolescent girls and women in

FIGURE 1 

Proportion of women aged 15 to 49 years who make their own decisions
regarding sexual and reproductive health and rights (including deciding
on their own health care; deciding on the use of contraception; and cansay no to sex), by SDG region, most recent data 2007–2018
All three dimensionsof indicator 5.6.1

Power to say noto sexPower to decideon contraception

Power to decideon health care

100
94 92

91

80
75

91 91

86
75

76

92

87

74

90

70

70

60

89

40

43

91

88
79

71

64

64
53

48

86

79

75

71

59

55

94

59
51

38

36

Western Africa(13)

Middle Africa
(7)

20

0

World (57)

Eastern Asia
andSouth-eastern
Asia (5)Latin America
and Caribbean(7)

Central Asia
and Southern
Asia (5)Sub-SaharanAfrica (36)Southern Africa(4)Eastern Africa(12)Notes: The number of countries with comparable survey data included in the regional aggregations is presented in parentheses.
Source: United Nations Population Fund, global databases, 2020. Based on the Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys(MICS) and other national surveys conducted in the 2007–2018 period.

STAT E OF WOR L D POPUL AT I ON 2 02 1

19

Eastern and South-eastern Asia and Latin America
and the Caribbean make autonomous decisions in
all three dimensions of indicator 5.6.1, this figure
is less than 50 per cent in sub-Saharan Africa andCentral and Southern Asia.
Regional aggregates mask substantial differences
across countries (Figure 2). In sub-Saharan Africa,
for example, where about 50 per cent of womenmake autonomous decisions, there are three
countries, Mali, Niger and Senegal, where lessthan 10 per cent do.
In other regions, differences between countries areless pronounced but are nevertheless noteworthy.
For example, the percentages of women who
make autonomous decisions acrossall three dimensions of indicator
5.6.1 range from 33 per centto 77 per cent in Central andSouthern Asia, from 40 per
cent to 81 per cent in Easternand South-eastern Asia,and from 59 per centto 87 per cent in Latin America and the
Caribbean.
The data also show inconsistencies across thethree dimensions: a high percentage in one
dimension does not automatically mean highpercentages in others. In Mali, for example,
77 per cent of women take independent or
joint decisions on contraceptive use, but only
22 per cent are able to do the same in seeking
health care. In Ethiopia, 53 per cent of womenare able to say no to sex, but 94 per cent can
independently or jointly make decisions about
contraception. Such discrepancies help explain
lower overall composite indicators in somecountries: a woman is counted only when
she reports autonomous choices in all
three dimensions. A woman who
decides autonomously to use
contraception but is unable tosay no to sex to her husband,for example, would not be
included in the 5.6.1 overallcomposite indicator.

Artwork by Rebeka ArtimFIGURE 2

Proportion of women aged 15 to 49 years who make their own decisions
regarding health care, contraception and sex with their husbands orpartners, most recent data by country, 2007–2018
All three dimensionsof indicator 5.6.1

Power to say noto sex69
Albania
62
Angola66
Armenia
36
Benin
20
Burkina Faso
44
Burundi76
Cambodia38
Cameroon, Republic of
27
Chad
21
Comoros
31
Congo, Democratic Republic of the27
Congo, Republic of the25
Côte d'Ivoire
77
Dominican Republic
87
Ecuador49
Eswatini
45
Ethiopia
48
Gabon
41
Gambia52
Ghana
65
Guatemala29
Guinea71
Guyana59
Haiti
70
Honduras
61
Jordan56
Kenya
77
Kyrgyzstan
61
Lesotho67
Liberia74
Madagascar
47
Malawi
58
Maldives
Mali 863
Mongolia
49
Mozambique
68
Myanmar71
Namibia48
Nepal
Niger 746
Nigeria
40
Pakistan
79
Panama81
Philippines
70
Rwanda46
São Tomé and Príncipe
Senegal 7
40
Sierra Leone
65
South Africa
33
Tajikistan
47
Tanzania, United Republic of
40
Timor-Leste
30
Togo
62
Uganda81
Ukraine47
Zambia60
Zimbabwe
0

20

40

60

80

Power to decideon contraception
84
85

84
90
89
90
91
94
89
89
81

75
62
62
63
93
89
63
47

74
53
86
64
72
89
55
83
80
94
69
77
85
71
92
88
70
71
31
80
67
81
94
91
35
70
64
95
88
83
79
19
79
75
60
76
44
75
87
86
71
72
20

40

97
55
32
72
91
48
47
47
47
41
43

85
87
82
92
92
89
94
90
84
90
91
85
90
93
88
93
89
95
93
89
93
93
93
77
84
85
98
83
85
77
90
94
89
94
98
78
85
82
89
83
89
94
84
93
95
83
93

93
95

0

93
77

71
74
71
67

100

Power to decideon health care

60

80

100

0

20

40

60

80

100

88
100
72
85
60
71
82
77
61
92
78
84
94
81
94
91
83
90
70
88
22
85
77
85
91
59
21
68
58
94
97
84
69
31
60
95
54
66
94
47
75
98
76
87
0

20

40

60

80

100

Source: United Nations Population Fund, global databases, 2020. Based on the Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS)
and other national surveys conducted in the 2007–2018 period.

STAT E OF WOR L D POPUL AT I ON 2 02 1

21

What are the trends?
An analysis of trends in 22 low- and middleincome countries that have had at least twoconsecutive DHS surveys that asked women
about the three dimensions of bodily autonomy
shows that investments in programmes orservices in one dimension do not necessarily
lead to positive changes in the others. In fact,
the trends in responses to the three standard
questions for indicator 5.6.1 often move in
different directions (Figure 3).
In Ghana, for example, massive investments havebeen made to improve maternal health throughincreased affordability, quality and reach ofservices, combined with community-outreachprogrammes to promote these services. As aresult, the percentage of women able to maketheir own decisions regarding their own healthcare has risen continuously. At the same time,
the percentage of women who make their own
decisions about contraception has levelled off,
and the percentage of women who are able tosay no to sex has seen a considerable decrease.
A similar situation has occurred in Benin, where
the percentage of women who are able to makeautonomous decisions about contraception andhealth care has shown little change in the past
10 years. Women’s power to say no to sex, on
the other hand, has decreased by 20 per centover that same period (UNFPA, 2019).
Among the 22 countries, only Uganda and
Rwanda have shown consistent positive
trends in the percentage of women who makeautonomous decisions in all three dimensionsof indicator 5.6.1. Data show that Uganda had
the largest increase: 12.3 per cent. The positivechange can be attributed to a conducive

22

Three dimensions of autonomy

legal and policy environment (including
the abolition of user fees for maternal andunder-5 child health services) combinedwith community-outreach approaches
aiming at tackling gender inequality norms(UNFPA, 2019).
Figure 3 shows that overall indicator
percentages can mask simultaneous negativeand positive trends within a country. Positive
trends are more common in responses to thequestion about autonomous decisions on
seeking health care. Negative trends, however,are more common in responses to the question
about having the power to say no to sex. In
fact, women in more than half the countries
with at least two data points lost groundbetween 2005 and 2018 in their power to say
no to sex. It is difficult to pinpoint the exact
cause of this negative trend or the apparent
lack of progress. However, one study suggeststhat a combination of factors may be at play
(UNFPA, 2019):• Persistent taboos about sex and sexuality thatare reinforced by social norms and attitudes,
leaving women and adolescent girls little
opportunity to negotiate openly about sex
with their partners or husbands.
• Patriarchal systems that perpetuate unequal
power dynamics in relationships, where malesexual demands are placed above those of
women. Studies show that in Azerbaijan,
Rwanda and Mexico, some women agree toforfeit their right to say no to sex in exchange
for greater autonomy in other spheres of
their lives, such as in making decisions forthe household or deciding whether or whento venture outside the home.

FIGURE 3

Change in the percentage of women who report making autonomous
decisions in the three components of indicator 5.6.1 in West Africa
All three dimensionsof indicator 5.6.1

Power to say noto sexBENIN

Power to decideon contraception

Power to decideon health care

GHANA

MALI

100

100

100

50

50

50

2006

2017

2008

NIGER

2014

2006

NIGERIASENEGAL

100

100

100

50

50

50

2006

2012

2008

• Qualitative research indicates that women may
also comply with men’s sexual demands as atrade-off to achieve more independence in theireconomic and personal endeavours. Such tradeoffs have been reported in countries as diverse
as Azerbaijan, Mexico, Niger and Nigeria(UNFPA, 2019).

The indicator’s limitations
Indicator 5.6.1 is a picture of women’s bodily
autonomy painted with a broad brush andthus reveals few subtleties about the forces
behind positive or negative trends. Data on
women’s use of contraception, for example,

2012

2013

2010

2017

only reflect women who were married or incohabiting unions and who were actuallyusing contraception at the time survey data
were collected. Also, the question used to elicit
responses about decisions to access health caredoes not specifically refer to reproductive healthcare. And all three questions are asked only ofgirls and women aged 15 to 49, thus leaving out
younger adolescents and women aged 50 or older.
Another limitation is that the data related tocontraception and health care reflect both joint
and individual choices. A woman may say, forexample, that the decision to use contraception
was made jointly with her husband or partner.

STAT E OF WOR L D POPUL AT I ON 2 02 1

23

But there are likely instances where a “joint”
decision was actually an individual one, madeby the woman but overruled by her husband.
Furthermore, women whose husbands forbid
them from using contraception may still use it
covertly, but this type of situation is not reflectedin the indicator on making autonomous decisions
about contraception. Quantitative surveys suggestthat between 4 per cent and 29 per cent of
women who use contraception do so without
their husbands’ or partners’ knowledge. While

covert contraceptive use is an individual choice,women generally describe the experience as
negative and disempowering (UNFPA, 2019).

An ecological modelof bodily autonomy
A range of social and economic factors influencea woman’s decision-making in the three
dimensions of indicator 5.6.1 (Figure 4).

FIGURE 4

Determinants of women’s decision-making power

COMMUNITYINDIVIDUAL
POWER
KNOWLEDGE ON SEXUAL AND
REPRODUCTIVE HEALTH AND
RIGHTS, HEALTH EXPERIENCEAND AGENCY

GENDER NORMS,
STIGMA, BELIEFSHEALTH SYSTEMSPROXIMITY, COST,QUALITY OF CARE,PROVIDER BIAS

INTERPERSONALPOSITION OF PARTNER,
COMMUNICATION,
EXTENDED FAMILYSOCIOECONOMICEDUCATION, WEALTH,MEDIA ACCESS, RURAL/URBAN

Artwork by Hülya ÖzdemirSocioeconomic circumstances

contraception and health care. A woman
who has less education than her husband
or partner is more likely to be subjected
to sexual violence than a woman whose
education level is more or less equal tothat of her husband (UNFPA, 2019).
Meanwhile, girls and women in the twolower wealth quintiles are also more likely
to have experienced unwanted sexual
relations (Figure 6).

A woman’s level of educational attainmentis a key factor in determining how much
power she has to say no to sex but it
also correlates with her power to makeher own decisions about contraception
and health care (Figures 5a and 5b).
The education level of her partneris also positively associated withher participation in decisions about

FIGURE 5A

More decision-making power linked to higher levels of education
Decision-making on women’s own health care, by women’s level of education, select countries, per cent
No education  

Primary  

Secondary  

Higher  Tajikistan 2017
Gabon 2012
Burkina Faso 2010
Côte d'Ivoire 2012
Zambia 2014
Burundi 2017
Cameroon, Republic of 2011
Mali 2018
Tanzania, United Republic of 2010
Guatemala 2015
Mozambique 2011
Nigeria 2013
Congo, Democratic Republic of the 2014
Malawi 2016
Honduras 2012
Eswatini 2007
Maldives 2017
Gambia 2013
Angola 2016
Chad 2015
Togo 2014
Kenya 2014
Pakistan 2018
Uganda 2016
Nepal 2016
Senegal 2017
Namibia 2013
Rwanda 2015
Ghana 2014
Zimbabwe 2015
Liberia 2013
0

20

40

60

80

100

STAT E OF WOR L D POPUL AT I ON 2 02 1

25

Interpersonal relations

responsibility for reproductive health but at thesame time deny them decision-making power.

Relationships and communication withhusbands or partners as well as with extended
family members influence a woman’s ability tomake autonomous decisions.
Men, as heads of households, often hold all
the power and make many of the decisions,
including those related to sexual andreproductive health issues, even though theseissues are often perceived as “women’s matters”.
Gender norms typically assign women the sole

Communication is a positive predictor forjoint or autonomous decision-making. Couples
who regularly communicate about matters of
sexual and reproductive health are more likely
to make decisions jointly about contraception
and reproductive health care. The opinions ofextended family members, particularly mothersin-law, also play an important role in thesedecisions (UNFPA, 2019).

FIGURE 5B

More decision-making power linked to higher levels of education
Say no to sex, by women’s level of education, select countries, per cent
No education  

Primary  

Secondary  

Higher  Tajikistan 2017
Mozambique 2011
Guinea 2018
Burkina Faso 2010
Pakistan 2018
Ethiopia 2016
Jordan 2018
Mali 2018
Gambia 2013
Côte d'Ivoire 2012
Guatemala 2015
Malawi 2016
Myanmar 2016
Comoros 2012
Timor-Leste, Democratic Republic of 2016
Eswatini 2007
Cameroon, Republic of 2011
Nigeria 2013
Ghana 2014
Burundi 2017
Togo 2014
Angola 2016
Zimbabwe 2015
Sierra Leone 2013
Kenya 2014
Tanzania, United Republic of 2010
Congo, Democratic Republic of the 2014
Guyana 2009
Armenia 2016
Lesotho 2014
Albania 2018
Kyrgyzstan 2012
026

Three dimensions of autonomy

20

40

60

80

100

The role of the community
In certain communities, the notion of bodily
autonomy may be seen as incompatible withlocal norms and values. Communities maypressure women to bear children and may
generally perpetuate views that women should
be submissive and passive in sexual relations.
At the same time, community norms canoften dissuade women from discussing mattersof sexual and reproductive health with men,making it difficult, if not impossible, for women
to negotiate sexual relations, contraceptive use

and reproductive health care. Studies in ninecountries have shown that some men reportbeliefs of entitlement to dominate women, withclear expressions of unequal power relations(e.g., Habibov and others, 2017; Fahmida andDoneys, 2013; Hattori and DeRose, 2008).
Adolescent girls face further barriers to
information and services because of norms
that discourage sexual activity out of
wedlock. At the same time, norms in somecommunities may permit or even encourage

FIGURE 6

Greater power to say no to sex in higher wealth quintiles
Say no to sex, by household wealth, select countries, per cent
Poorest  

Poorer  Middle  Richer  Richest  

Guatemala 2015
Albania 2018
Angola 2016
Armenia 2016
Jordan 2018
Eswatini 2007
Togo 2014
Mozambique 2011
Lesotho 2014
Pakistan 2018
Maldives 2017
Gambia 2013
Tajikistan 2017
Burkina Faso 2010
Chad 2015
Benin 2018
Congo, Republic of the 2012
Guinea 2018
Ethiopia 2016
Timor-Leste, Democratic Republic of 2016
Comoros 2012
Mali 2018
0

20

40

60

80

100

STAT E OF WOR L D POPUL AT I ON 2 02 1

27

Healing bodies,
minds, spirits
Health-care providers haveproduction, and production ismake their own decisions

a unique responsibility insynonymous with quantity,”

about when to have sex

affirming and safeguarding

he said. “We’re forgettingwith their partner… Male

the bodily autonomy of theirabout quality in the care wechauvinism prevails,” he said.

patients. “My advice for any

give to our patients.” There

Women patients often feel

health worker would be to haveare also cultural barriers, heunable to speak candidly

empathy,” said Víctor Cazorla,

added. “Many colleagues,

about issues pertaining toa male midwife working inmany people, have gone totheir sexual health, and they

the Andes mountains ofrural areas without knowing

can be shy about expressing

Peru. He has spent more

Quechua, the mother tongue

their discomfort about

than two decades workingof the communities there,”

gynaecological procedures,with indigenous communities

leading to misunderstandings

particularly with malein Ayacucho Region, andand even discrimination.

health providers, he noted.

challenges that threaten the

At the same time, many

These factors, together, arewell-being and autonomy ofpatients are not sensitized toa dangerous combination:

the most vulnerable patients.

their sexual and reproductive

doctors are left struggling

he knows all too well therights. “Among the general

to understand the needs“The work system for healthpopulation, maybe 80 toand boundaries of theirworkers often revolves around

90 per cent, I dare say, cannot

patients, and patients are“Do they consent?... If they are
not prepared psychologically,
we must respect their choice.”28

Three dimensions of autonomy

Medical personnel at a health centre in the Ayacucho Region of Peru. Midwife Victor Cazorla is fifth from the left. Original artwork by Naomi Vona;
photo © UNFPA/A. Castañeda.

left without the words or tools

women are ignorant of theirconsider that talking about

to advocate for themselves.

sexual, physical and generalthese topics harms theirrights,” said Mouna Farhoud,dignity and their reputation.”

Such concerns are all the morea gynaecologist in Damascus

harrowing when health workers

who specializes in treating

Dr. Farhoud says even healthtend to survivors of sexualsurvivors. “Even the educatedprofessionals hold views thatand gender-based violence.

women are exposed to violence

undermine the health and rights“In Syria, more than half ofand unable to address it. Theyof their patients. She recalled

STAT E OF WOR L D POPUL AT I ON 2 02 1

29

teaching a course to health“I make it clear that this ishealthy relationships are also

providers on treating sexual

a medical procedure to finddiscussed during individual

assault survivors: “There wereout if there are infections,and family counselling

many objections from thewounds, bleeding, bruises orsessions. These efforts are

participants... There was athings that help document themaking a difference, he said,denial and lack of recognitioncase. Do they consent? Even

especially among younger

about the existence ofwhen people realize that thepeople. But the burden of

sexual assault cases.”

goal is for documentation,

providing this information falls

if they are not preparedheavily on health providers.

Doctors must communicate

psychologically, we must

“I am the only midwife, fornon-judgmentally with theirrespect their choice. Maybe

example, working on a shift

patients, and recognize

this time we are not able toat the health centre and I

when their patients are

examine her, but next time wehave to stay there to attend

uncomfortable or when they

will be able to do so after she

to patients who arrive withmay have experienced

feels respected and valued.”

emergencies.” He says there

abuse. Sometimes, thisis a need for more healthmeans being a detective,

Cazorla added that showing

resources, including staff,

Dr. Farhoud explained. “Maybe

respect for one’s cultureso that they can do more

the patient’s symptoms areis paramount. But what iscommunity education, suchnot commensurate withmost important, he says,

as targeted programmes

her complaint. Her way

is empowering patientsfor men and boys.

of walking, her look, herthemselves to becomewords, her companion, thedefenders of their own bodies

Dr. Farhoud echoes thephysical examination—all

and autonomy. “We teachcall for support. Her

these come together to flagthem to expect respect,organization also holds

that there is a problem.”that nobody has a right toawareness sessions for the

touch their bodies: not me,

community. But she wants

And health workers must

not their aunts, not their

to see more education

know when to back away.

fathers, not their mothers, notand accountability among“It is your right to refuse.

staff, not police, nobody.”

health staff, as well. They

When I examine the patient,30

have a special duty of care,such as a gynaecologicalHe and his colleagues

as sexual and reproductive

exam, I explain its importance,

conduct education sessions

health service providers, toespecially for people who

for the community, andrespect and empower their

have been subjected to sexualissues such as rights, self-

patients. “We have sworn aassault,” Dr. Farhoud said.

esteem, sexual health andprofessional oath,” she said.

Three dimensions of autonomy

adolescent girls to engage in transactionalsex as a way to support their households or
to cover the costs of their own education.
As these girls typically come from poorer
households, they have little power to say noto sex. Whether married or unmarried, they
may have limited power to negotiate the useof condoms (November and Sandall, 2018;
Moore and others, 2007). Married girls,
however, may also face family and communalpressure to demonstrate their fertility, andexperience coerced sex and opposition to theirusing contraception (Woog and Kågesten, 2017).

Barriers in the health system
Decisions about contraception andreproductive health care are sometimes
impeded by the distance to clinics
and facilities, especially in rural areas.
Other impediments include the absenceof adolescent- and youth-responsive
services, shortages of preferred methodsof contraception, poor-quality or poorly
managed services, services that are staffedby judgmental providers and lack of privacy.
In contrast, services that have convenient
opening hours and employ health workers
who have positive attitudes towards theirclients and respect their privacy help
empower women and adolescent girls to makeautonomous decisions. Readily available andaccurate contraceptive information, especiallywhen provided in a respectful, private andfriendly environment, also has a positive
impact. Studies have shown that familyplanning services that are provided throughcommunity health workers lead to increased
use of contraception, especially when services
include family planning information andeducation for men (UNFPA, 2019).

Bodily autonomy still only
a distant possibility for many
That only 55 per cent of women have thepower to make their own decisions about
their bodies should be a wake-up call togovernments, policymakers and development
institutions. In Mali, Niger and Senegal,
more than 90 per cent of women are deprivedof their bodily autonomy.
The data for indicator 5.6.1 provide insights
into the challenges women face in claiming
their right to bodily autonomy. But a deeper
analysis of the data is needed to understandthe scope and nature of the obstacles faced bygroups such as women who are not married
or in a union, persons with disabilities or
ethnic and racial minorities.
What is clear from the data is that in
57 countries—and likely every other country
in the world—women are not fully in controlof their bodies.

STAT E OF WOR L D POPUL AT I ON 2 02 1

31

Artwork by Rebeka Artim

WHEN DECISIONS ARE

MADE BY OTHERS
The denial of bodily autonomy and integrity
takes many forms
The feminist slogan “the personal is political” hasbeen rallying women around the cause of bodily
autonomy since the 1960s. Activists before andsince have argued that if women and girls lackthe power—or agency—to realize their rights to
self-determination and autonomy, they are also
unable to control other aspects of their lives.

Despite international agreements anddeclarations about the importance of autonomy
in women’s health and overall empowerment,
untold millions of women and girls around theworld today still lack the power to make theirown decisions about health care, contraception
and sex with their husbands or partners.

Agency means having the power to make choices
and decisions on one’s own behalf. In matters ofsex, sexuality and reproduction, agency can mean
having the power to decide freely whether, whenor with whom to have sex and whether, when or
how often to become pregnant. Without agency,
a person can never have autonomy.

Often these decisions are made or influenced byothers, whether partners, families, societies oreven the government, and that means womenand girls are denied their bodily autonomy.

According to the Positive Women’s Network,when women have full bodily autonomy, notonly are they empowered to make decisions
about their health and future—without coercion
or control by others—they also have the supportand resources needed to meaningfully carry out
these decisions.

Although there are many impediments to bodily
autonomy, gender inequality is perhaps the mostinsidious and pervasive one. More than 160 years
ago, American suffragist Lucy Stone wrote, “It isvery little to me to have the right to vote, to own
property, etc., if I may not keep my body, andits uses, in my absolute right. Not one wife ina thousand can do that now, and so long as she
suffers this bondage, all other rights will not help
her to her true position” (Hasday, 2000).

STAT E OF WOR L D POPUL AT I ON 2 02 1

33

Gender inequality
deters autonomous
decision-making
Gender-unequal norms and attitudes lead topower imbalances in relationships that restrict
women’s decisions, particularly when it comesto saying no to sex. Patriarchal beliefs oftentranslate into expectations that women defer totheir husbands or partners in all aspects of theirlives, including their sex lives. These expectations
may not only mean that a woman should always
engage in sex whenever her husband wants
it, but also that she should not initiate sex or
openly express her desires. At the same time,
women may be expected to avoid conflict, thus
reinforcing unequal power dynamics. Women
may also refrain from saying no to sex out of fearof verbal abuse, withdrawal of financial support,
divorce, or even beatings and rape.
Research has shown that girls and women areoften unaware that they have the right to say
no. One study in India, for example, showed

Research has
shown that girls
and women areoften unawarethat they have theright to say no
34

When decisions are made by others

that newly married women were less likely
to refer to their first sex as forced or “against
their will” because sex was expected within
marriage. The notion of consent was irrelevant
because sex, even if it was forced, was thought
to be a marital duty and therefore not a matterof consent (UNFPA, 2019).
Gender-unequal norms and attitudes canundermine a woman’s power to make her own
decisions about contraception. For example,
in a number of countries included in indicator
5.6.1, husbands, especially in rural areas,
want more children than their wives do andconsider it their right to make the decision
about family size and about whether or whencontraception should be used. Unequal power
dynamics in relationships constitute yet
another barrier for women who want to have
conversations with their husbands or partners
about contraception. Furthermore, even raising
the topic of contraception may be perceived
by men as an admission to extramarital
relationships and can lead to conflicts
resulting in violence, separation or divorce(UNFPA, 2019). The nexus between genderinequality and denial of bodily autonomy hasa real impact on the lives of women and girls
everywhere, every day. Attitudes and norms
that subordinate a woman’s or girl’s wellbeing, needs and rights to those of a man or
boy take away her power—her agency—andresearch has verified that this can have negative
consequences that can last a lifetime andcarry from one generation to the next (vanEerdewijk and others, 2017; O’Neil and others,2014). This dynamic can play out in many
ways, some more egregious than others, but
it is particularly evident in marital laws andpractices that subordinate women to men.

Persons with disabilities at greater riskof rape and coerced sex
Girls and young women with disabilities
are more likely to experience violence thaneither their male peers with disabilities or
girls and young women without disabilities(UNFPA and others, 2018). Girls and boys
with disabilities are nearly three times
more likely to be subjected to sexual
violence, with girls at the greatest risk.
Consent is crucial when any person
engages in sexual activity, but it plays
an even bigger and potentially more
complicated role when someone has adisability, according to RAINN (the Rape,
Abuse and Incest National Network),an anti-sexual violence organization in
the United States (RAINN, 2020).

Research on levels of sexual assault against
persons with disabilities shows elevated levels
when compared to people without disabilities. In
the United States, for example, the U.S. Departmentof Justice found that girls and women withdisabilities suffer violent crime, including sexualassault and rape, at a rate of 32.8 women per 1,000
each year, compared to 11.4 women per 1,000 for
women who do not have disabilities (Harrell, 2017).
In the United States, an advocacy group, DisabledWorld, reported that an estimated 80 per cent of
women and 30 per cent of men with intellectual
disabilities are forced at some point into someform of non-consensual sex but only 3 per centof such sexual abuses involving people with
developmental disabilities are ever reported.
Women with a disability were far more likely tohave a history of undesired sex with, or marital
rape by, an intimate partner. One study foundthat 54 per cent of boys who are deaf have beensexually abused in comparison to 10 per cent ofboys who are hearing (Disabled World, 2012).
Insofar as societies do not equip persons
with disabilities with the means to control
whether, when or with whom to have sex
and whether, when or how often to become
pregnant, they are denying large numbers ofpeople of their right to bodily autonomy.

Artwork by Kaisei Nanke

STAT E OF WOR L D POPUL AT I ON 2 02 1

35

lifelong subordinate relationships before they
achieve the legal capacity to make decisions
that affect their entire lives. The most recent
estimates indicate that there are 650 million
women alive today who were married before
the age of 18, and every year another 12 million
girls are married before they become adults(UNFPA, 2020; UNICEF, 2020).

Artwork by Tyler Spangler

Forced and child marriage
The most obvious marital practices that deny a
woman agency are marriages where she cannot
make a free and informed choice about her
own partner: forced and child marriage. Forced
marriage is any marriage in which one or both ofthe partners enter into it “without full, free andinformed consent”. Child marriage, a subset offorced marriage, is any marriage where at least
one of the parties is under the age of 18 andhas therefore not reached the age when she or
he can express full, free and informed consent(OHCHR, 2020). Both forms of marriage
violate an individual’s rights, including rights
associated with bodily autonomy and integrity.
These marriages are rooted in patriarchal
attitudes and deny women and girls autonomy ingeneral, and their power to make decisions about
health care, contraception and sex in particular.
Child marriage is a form of gender-based
violence. It is also a powerful constraint on theagency of women and girls, forcing them into

36

When decisions are made by others

Even though all but one of the world’s countries
has ratified the Convention on the Rights of
the Child, many countries still allow marriage
under the age of 18, sometimes with theconsent of a parent, guardian, judge or othergovernmental official.
But even where child marriage is prohibitedby law, it continues in practice. Many suchmarriages take place through traditional or
religious ceremonies and are never registeredwith civil authorities. In some parts of the world,
cohabitation where one or both partners areminors is also common. With continued highrates of child marriage in South Asia and subSaharan Africa and parts of Latin America andthe Caribbean, it is projected that by 2030, in
the absence of high-impact interventions, there
could be as many as an additional 120 million
women and girls who will have been married by
the age of 18 (UNFPA, 2020; UNICEF, 2020).
Forced marriages are driven by institutionalized
patriarchal practices, including paymentof dowry or bride price, bride kidnapping,marriage of widows to in-laws, or “widow
inheritance”, and marriage of rape survivors
to their assaulters. Through these practices,brides become a commodity, or property,
to be owned, bought, sold or traded, withno regard for their rights or autonomy.

Through dowries, the bride’s family pays, incash or in kind, the groom’s family to “take her
off their hands”. Dowries ostensibly provide
for the welfare of the bride but a closer lookreveals a system that is “as ugly and corrosive towomen’s rights as child marriage, female genital
mutilation, and systems of male guardianship”(McCarthy, 2017).
In almost all cases, the dowry practice directly
or indirectly oppresses women, often leading toabuse and violence and maintaining a system ofgender inequality. It encourages child marriage
because families pay smaller dowries for younger
brides. It also results in violence: about 8,000
dowry deaths, where women are killed because
families are not paid the expected dowry, arerecorded each year in India alone, according tothat country’s National Crimes Statistics Bureau(Dhillon, 2018).
Bride price is the opposite of dowry: a girl or
woman is “bought” by the groom’s family to
become a wife for their son. The practice iscommon in some parts of Africa where “a bride
price is the conditional exchange of property,
usually cows or money, from the groom to theparents of the bride in return for marriage”(Turner, 2009). It relegates the woman to thestatus of property and supports the notion thata man has purchased his wife’s reproductive andproductive capacity as well as, most importantly,
her obedience. The payment of a price can givethe man licence to use violence against his wife
to make her obey (Thiara, 2011).
Moreover, the bride price must be refunded if
a man decides to divorce or separate from his
wife: “this practice hangs like a threat over herhead and that of her parents, ensuring the wife’scompliance” (Turner, 2009). The tradition ofrefunding the bride price is especially problematic
because it means that if a woman or her family
cannot afford to repay it, then she can be trappedin an abusive relationship with no recourse. Bride
price also takes place in other parts of the world,
including some Pacific Island countries.
There are other, less common, traditional
patriarchal marriage customs that take away
female autonomy. In some parts of the world, forexample, there is a tradition of bride kidnapping:
physically removing a girl or woman to take her
to the home of a man who wants to marry her.
According to a 2016 UNFPA study in Kyrgyzstan,
the tradition of bride kidnapping persists,
despite being illegal. Under the custom, a man
may abduct a woman or girl from her home or
school or work and take her to his family’s home,where she is usually forced to write a letter asking
consent from her family. The letter is accompanied
by a bride price payment from the groom’s family.
Fewer than one in 10 such “proposals” is turned
down by the woman’s or girl’s family. The UNFPA
study found that almost one fifth of marriages
in Kyrgyzstan follow the traditional practice of“kidnapping”, and an estimated one quarter of
those are without the bride’s “consent” (UNFPAin the Kyrgyz Republic, 2016).
Another still-practised tradition is that of widow
inheritance, whereby a woman whose husband
has died is forced to marry a relative of thedeceased, usually a brother. Traditionally, thiswas seen as a means of providing protection for
the woman and her children and of keeping
the woman in her husband’s family, especiallyafter dowry had been paid. But the widow does
not give her consent and often ends up in a
relationship she did not want or ask for.

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37

Marital practices that
subordinate women andundermine health
The more pernicious of the female-subordinating
marital practices, which violate a woman’s right tobodily autonomy, have also been shown to havenegative consequences for sexual and reproductive
health. Widow inheritance, for example, requires awoman to engage in sexual relations with the man
who “inherits” her, regardless of how many sexual
partners he may have had in the past, increasing
the risk of HIV transmission (Mabumba andothers, 2007). A study in the Bondo district of
Kenya found that 56.3 per cent of widows had
been “inherited” through a traditional ceremony.
Among those women, the ones who had taken
part in a sexual ritual known as “widow cleansing”
were found to be more likely to be infected withHIV (Agot and others, 2010). Widow cleansing
is a ritualized dissolution of the bond of thespirit of a dead man with his wife, through her
submission to sexual intercourse with one of his
living relatives.
Child marriage has countless deleterious effects
on a girl’s sexual and reproductive health andbodily autonomy. Forced sex and early andfrequent pregnancies are closely linked to highmaternal and infant morbidity and mortality
rates, as well as poor mental health. In low- andmiddle-income countries, complications frompregnancy and childbirth are the leading causeof death among girls aged 15 to 19 years, andadolescent mothers face much higher rates ofcomplications during pregnancy and childbirth,with higher rates of stillbirths and newborn
deaths, than mothers just a few years older, 20 to
24 years (WHO, 2020).

38

When decisions are made by others

Girls and women who are subjected to childand forced marriage are often denied theirright to make decisions about, or lack accurate
information about, their sexual and reproductive
health. A large-scale study in India, for example,
documented negative reproductive healthconsequences of child marriages: young women
who had married at the age of 18 or older weremore likely than those who had married before
the age of 18 to have been involved in planningtheir marriage, to refuse to tolerate domestic
violence, to have used contraceptives to delay
their first pregnancy and to have had their firstbirth in a health facility. They were less likely
than women who had married early to haveexperienced physical violence or sexual violencein their marriage or to have had a miscarriage or
stillbirth (Santhya and others, 2010).
Another study in Nepal found that a
combination of pressure to give birth soonafter marriage, limited autonomy, and little
knowledge about reproductive health issues
make young married girls vulnerable to high-risk
pregnancies (Maharjan and others, 2019).
Besides the violation to bodily autonomy, childmarriage impinges on other human rights, such as
the right to education. Differential education rates
between genders is one of the major impediments
to full gender equality and the empowerment of
women and girls, and child marriage and earlychildbearing are significant obstacles to ensuring
educational, employment and other economic
opportunities for girls and young women.
An extensive World Bank study undertook
to test whether women worldwide who had
married as children had less decision-making
power in the marriage, with specific questions

Slavery: the ultimate violationof the right to autonomy
People who are enslaved have no power tomake any decisions about their bodies or lives.
An estimated 40 million people are in someform of modern slavery (United Nations, n.d.).

Although modern slavery is not definedin law, it is an umbrella term covering
practices such as forced labour, debt
bondage, forced marriage and humantrafficking. It refers to situations of
exploitation that a person cannot refuseor leave because of threats, violence,
coercion, deception or abuse of power.
There are more than five victims of modern
slavery for every 1,000 people in theworld. One in four victims is a child. Morethan seven in 10 victims are female.
Embedded in Sustainable Development
Goal 8—to achieve inclusive economic
growth and decent work by 2030—is atarget to eradicate forced labour and end
modern slavery and human trafficking.
Victims are often the most vulnerable inour societies: those suffering multiple
forms of discrimination—women, children,indigenous peoples, people of African
descent and persons with disabilities, United
Nations Deputy Secretary-General Amina J.
Mohammed said in 2020. “Modern slavery isa blight in our world that we must eradicate,”
she added, calling modern slavery andhuman trafficking “international crimes withsignificant costs to society and economy”.

Artwork by Kaisei Nanke

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39

Able to choose
In 1999, Lizzie Kiama wasredefining what it means, she

And then there are thecommuting to work in

explained. Kiama went onhorror stories.

Mombasa, Kenya, when her

to found This Ability Trust,minibus collided, head-on, into

a social enterprise focusing“I have heard stories of women

another vehicle. “I was seatedon the rights of persons

who would rather give birthin the front,” she remembered.

with disabilities, throughat home than face nurses or“The accident resulted in me

which she has observed

midwives who question why,becoming disabled.” But it

the many ways people

in their disabled condition,

would be 11 years before shewith disabilities are denied

they would be having children

fully accepted this new reality.

agency, particularly when it

or getting pregnant,” Kiama

comes to their sexual andsaid. “Society, in general,

reproductive health and rights.

has associated persons“I did not identify as aperson with a disability forwith disabilities, women ina long time,” Kiama said.

Those with visual or hearing

particular, as being asexual...

“That’s because there wasdisabilities seldom have

Simple things like legal

always a very negative

access to interpreters or Braillecapacity, bodily autonomy, theconnotation that surrounded

when seeking health services,

right to decision-making are

the word ‘disabled’.”she said, and persons withnot considered the norm.”

caregivers face reduced privacy
The turning point wasand confidentiality. Many

Women and girls withbecoming a mother andpersons with disabilities lackdisabilities face high rates

deciding she would improveaccessible transport options,of gender-based violence

the world for her children. For

and many health facilities lackin Kenya (Salome andher, that meant identifying as

the infrastructure, equipment

others, 2013). But too often,a person with a disability—andand trained staff to serve them.

in response, their bodily
autonomy is further violated,
Kiama said. “You find in somecases girls with disabilities“Families collude withmedical professionals
to sterilize them.”

40

When decisions are made by others

whose families collude withmedical professionals tosterilize them as a means of‘protecting them’, because
they are constant victimsof sexual violence,” sheexplained. “Nothing happens
to the perpetrators.”Lizzie Kiama is a champion for the rights of persons with disabilities. Original artwork by Naomi Vona; image courtesy of Lizzie Kiama.

But these issues are in no way

In Mongolia, for example,

consent from the women’s

unique to Kenya alone. People

there have been reports ofguardians, according towith disabilities confront

health workers performing

Enkhjargal Banzragch, a social

serious obstacles to sexual andabortions on women withworker at the Mongolian

reproductive health decision-

disabilities without consulting

National Wheelchair Users

making almost everywhere.

them. Instead, the doctors seek

Association. One study by the

STAT E OF WOR L D POPUL AT I ON 2 02 1

41

Association found 22 per centwas happening. “She said,“But how do we deal withof persons with disabilities‘No, I trust my doctor.’”the actual practices?”

members or health-care

Still, there are reasons

For that, experts agree,

providers to use contraception.

for hope.

attitudes must also change.

have been forced by family“Women with disabilities have
Refusing contraception“Looking at policies anda right to fall in love, have a

can have consequences.

the legal framework frombaby, get services and have

Women with intellectual

an advocacy point of view,a life,” Azyei emphasized.

disabilities are often

there has been progress,”

denied their allowances or

Kiama said, citing Kenya’s

Persons with disabilities

extension of their disability

2003 disability act, themust be protected fromstatus if they have notcountry’s constitution, thesexual abuse, but thesereceived required doses ofratification of international

protections must support—

injectable contraceptives,

conventions on disability

rather than undermine—Banzragch explained.

rights, and increasingly

their bodily autonomy. And

accessible building standards.

they must be empowered

Individuals with disabilities

to claim their rights.

and their caregivers may be

Mongolia, too, has seen

given little to no explanation,

progress. During a 2015

“As persons with disabilities,

says UNFPA Assistantreview of Mongolia’s humanwe imagine that we need

Representative in Mongolia

rights records, reproductive

to have our hands held

Iliza Azyei, who worked

health violations against

and to ask for permission,”with activists and the healthpersons with disabilities

Kiama said. But she sees

ministry to raise these issues.

were brought to light. Thechange in the younger

Government “made immediate

generation of persons withShe recalled the story of one

revisions in the healthdisabilities. “We’re seeing

girl: “As soon as she turned

ministerial order to provide

more young women taking

16, the public health doctor

sexual and reproductive healthup space and using social

came to her house and they

services to women, including

media for advocacy. They

started providing quarterly

disabled women,” Azyei said.

are advocating for sexual

injectable contraceptives.”

42

and reproductive rights

Azyei asked the girl’s mother

Policy-level change isin different ways, andif they had questioned whatjust one step, she added.

that’s incredible to see.”

When decisions are made by othersabout seeking reproductive health services
and use of contraception. The study foundthat, in the case of both contraceptive use anddecision-making power, the variable with themost impact was years of education. What
the study validated was that child marriage
did have an effect on reproductive health anddecision-making power mostly through its
indirect impact on educational attainment(Wodon and others, 2017). The shortening offormal education for girl brides has economic
implications for them and society, but it
also has a real impact on their sexual andreproductive health and their ability to exercise
their agency and make autonomous decisions.

Humanitarian crises
negatively impact women’sbodily autonomy
Evidence from humanitarian crises aroundthe world shows that a breakdown of family,social and legal networks increases the risk ofsexual violence as well as fuelling widespread
perceptions that the “honour” of girls andwomen, and therefore their families, is in danger.
This fear of “damage” to family honour may
underpin families’ decisions to marry girls at an
early age, resulting in higher numbers of forced
and child marriages. Fear of sexual violenceagainst women and girls has been found to bea leading cause for families to flee their homes
in emergencies—and an incentive to marry off
their daughters at a young age in the belief thatmarriage will protect them (UN HRC, 2019).
Within countries with high prevalence rates
of child marriage, girls who are displaced
or impacted by crisis are some of the mostvulnerable. Niger, for example, has the highest
child marriage prevalence rate in the world(76 per cent of girls are married before 18),
but the rates in regions with large numbers of
persons receiving humanitarian assistance areeven higher—up to 89 per cent in Maradi. In
another example, an Oxfam report found 70 per
cent of girls in a northern town in Sudan were
married before the age of 18 after an outbreakof fighting in the region, much higher than
the national average (UN HRC, 2019).
Conflict and post-conflict settings are
particularly conducive to gender-based violence,
including forced and child marriage, because ofsuch factors as the breakdown of the rule of law
and security, changes in traditional gender rolesand constraints on the freedom of women andgirls, cultures of impunity, loss of economic andsocial capital, and even extremist ideologies thatencourage the abduction of women and girls into
armed groups (Swaine and others, 2019).
In the case of these extreme ideologies, inrecent years armed non-state actors haveenforced a social order that perceives womenand girls as either tools of their movements
or as threats. In some cases, girls and women
have been forced to marry members of thesegroups to serve as sex slaves. For example,
beginning in 2014, Yazidi girls and womenin Iraq were forced to marry members ofIslamic State in Iraq and the Levant (ISIL).
ISIL in the Syrian Arab Republic, Boko Haramin Nigeria and Cameroon and Al-Shabaab in
Somalia abducted girls and women to be raped,
sold and forced into marriage. The ideological
exploitation of child and forced marriage has
been reported in the Central African Republic,

STAT E OF WOR L D POPUL AT I ON 2 02 1

43

Libya, Mali and Somalia, while armed andorganized crime groups in Malaysia and Nigeria
have been reported to use child and forced
marriage as a cover for sexual exploitation andhuman trafficking (UN HRC, 2019).
While there is ample evidence that gender-based
violence increases in conflict and displacement
settings, there is less evidence about how crises
impact women’s decision-making capacity insexual relations. Although crises often lead toa deterioration of public services, there is also
evidence to suggest that women’s agency inaccessing health care and using contraception canactually be enhanced in such times. One reason
for this is the diminished influence of genderunequal community norms in crisis-affected
settings, which allow greater latitude in making
autonomous decisions.
In crisis-affected countries such as Eritrea andLiberia, the progressive dissolution of community
norms enabled some women to have not only
more autonomy, but also greater freedom ofspeech and decision-making authority at thehousehold level. This phenomenon has also
been seen in places affected by natural disasters,such as droughts, where more women chose touse contraception. Another reason why some
women have more power to make decisions about
health care is that contraceptive informationand services are often readily available in refugee
camps (UNFPA, 2019). However, during andafter crises, gender inequality and discrimination
can also compound the challenges women andgirls face in securing their bodily autonomy andintegrity. As a result, many endure increased
insecurity, restricted mobility, gender-based
violence and harmful practices, including
female genital mutilation (ICRC, 2020).

44

When decisions are made by others

Programmes to end or prevent female
genital mutilation are often left out ofhumanitarian response plans. During theinitial phases of the COVID-19 pandemic,
for example, most countries where female
genital mutilation is prevalent did notprioritize the elimination of the practice intheir national humanitarian response plans(UNFPA and UNICEF, 2020). Yet, several
assessments indicated an increased risk ofgirls undergoing the practice: a UNFPA
assessment in Somalia showed that 31 percent of community members who wereinterviewed said they believed there had
been an increase in this harmful practicesince the pandemic began (UNFPA,
2020a). A survey by Save the Children in
September 2020 in the Dadaab refugee
camp in Kenya explored the impact of
COVID-19 and found that 75 per cent ofchild-protection workers reported a 20 per
cent increase in female genital mutilation(Save the Children, 2020).
In countries such as Ethiopia, Kenya,
Nigeria and Sudan, girls are also reportedly
at an increased risk of undergoing female
genital mutilation as a precursor to marriage,
suggesting a negative coping strategy
associated with economic fallout and school
closures (UNFPA and UNICEF, 2020).
According to estimates by UNFPA, thepandemic may result in 2 million casesof female genital mutilation that would
otherwise have been averted, or a one
third reduction in progress towards
Sustainable Development Goal target 5.3
to eliminate female genital mutilation by
2030 (UNFPA, 2020b).

“Honour killings”:
an extreme denial ofbodily autonomy
Honour killings occur in communities where
the “honour” of the family is considered
to be more important than the life of theperson, usually a woman, who violates
certain so-called norms or codes (Gibbs andothers, 2019).
Rationalizations for honour killings haveincluded separation from a spouse who
paid a bride price, refusing to enter into
an arranged marriage, entering into a
relationship with a person from a different
religion, ethnic group or caste, engaging
in premarital or extramarital sex, being thevictim of rape or assault, or being identified
as gay (Selby, 2016).
Although both men and women can commit
or be victims of honour killings, the “codeof honour” has different standards for men
and women, including stricter standards ofchastity for women and a perceived duty formen to commit violent acts to secure theirhonour or that of their family. In all cases,
the honour code is part of the patriarchalsocial system that subjugates women tomen. The result is that honour killings are
disproportionately violence against women.
Although it is not possible to know the true
number of these killings, it is estimated that
there are approximately 5,000 such murders
every year, of which most take place in the
Middle East and South Asia (Gibbs andothers, 2019). It is important to note thatan estimated 58 per cent of female victims

Artwork by Tyler Spangler

of murder were killed by an intimate partner ormember of their own family, amounting to 137
women every day (WHO, 2013). This has been
exacerbated by the COVID-19 pandemic—andviolence against women has been deemed the“shadow pandemic”.

STAT E OF WOR L D POPUL AT I ON 2 02 1

45

Threatened by awoman’s sexuality
Culture, tradition and religion

caused by the practice, which

obstetrician and gynaecologist

are among the most commonly

can include haemorrhage,in Egypt, convince parents tocited motivations for performing

sepsis, future childbirth

reject the practice. Clearlyfemale genital mutilation. Yet

complications and even death.

articulating harms, like inability

curtailed sexual desire is almost

Emphasis on the physicalto experience orgasm, pain

universally understood to beconsequences is more easily

during intercourse, and aversion

an outcome of the practicereceived in conservative

to sex due to post-traumaticand, in fact, it is also a key

communities, where discussing

stress disorder, has been an

motivator. Many proponents offemale sexuality is often

effective deterrent, especiallyfemale genital mutilation havetaboo. But a sole focus on“if the mother had a very badargued that unbridled female

physical harms may risk

experience while undergoing

sexuality is somehow a threat

inadvertently leading to thefemale genital mutilation whento chastity, honour and virtue

medicalization of the practice,

she was young or had troubles(Berg and Denison, 2013).

or the practice of alternativein her marital life because of thetypes of cutting, rather thancircumcision,” Dr. Basta said.

Frank conversations about

its abandonment altogether

female sexuality, bodily integrity(Powell and Yussuf, 2021).

She speaks with ease about
the social and psychologicaland bodily autonomy may
offer an unexpected antidote

Broadening theserepercussions women canto the practice, experts say.

conversations to include anexperience. “This may affect herhonest accounting of themental health, social well-being

Efforts to end female genital

sexual harms caused by female

and her relation with her partner,

mutilation have historically

genital mutilation has helped

which may affect deeply theunderscored the physical harms

Wafaa Benjamin Basta, anconcept of the family itself.”
One reason Dr. Basta is able to“Minds are changing,
especially for the
new generations.”
46

When decisions are made by others

have these forthright discussions
is her role as a physician. “Thereis this bond between the patient
and the doctor,” she said. But
even more critical is the growing
acceptance of women’s rights
and empowerment in Egypt.

Female genital mutilation is not simply a health issue. It is a sexuality issue. Original artwork by Naomi Vona; photo by Hana Lopez on Unsplash.

“Minds are changing, especiallyto rethink the practice ofcommunity and practitioner.

for the new generations.”

female genital mutilation.

Still, she has seen great

As fears of female sexuality

Dr. Basta says her

is hopeful about the future,diminish, and sexual

observations are limited toboth for ending female genital

well-being is increasingly

the confidential conversations

mutilation and for promoting

considered within the frame

she is able to have with her

women’s sexual health andof psychological and social

patients, and that comfort

well-being. “There’s no shame

health, it becomes easierwith these topics will vary by

to talk about that,” she said.

progress in recent years, andSTAT E OF WOR L D POPUL AT I ON 2 02 1

47

Marital rape and“marry-your-rapist” laws
It is clear that the data points chosen forindicator 5.6.1 are inexact measures for all theways that the agency of women is attenuatedby patriarchal marital structures, but there is adirect relation in the case of one component:
can a woman say no to her husband or partner
if she does not want sexual intercourse?
Whatever the interpersonal dynamics inside amarriage, it is the case that in some countries
the law permits the husband to have sexualintercourse whether the wife wants it or not,and there are countries where a man who rapes
a woman can escape penalties if he marries her
against her will.
Whether a woman has been forced into amarriage or entered into it freely, traditional
patriarchal norms have held that once amarriage has taken place a man “owns” hiswife’s body and can use it for sex whenever hewants. It is only within the last few decadesthat “marital rape” has been recognized asa concept and as constituting an egregious
human rights violation. The victims of marital
rape are subject to the manifold harms sufferedby all rape survivors: psychological damage
as well as the physical injuries associatedwith forced sex, unintended pregnancies,
miscarriages and sexually transmitted
infections (Yllö and Torres, 2016).
This human rights violation has important
reproductive health consequences. The
risk of HIV and other sexually transmitted
infections is increased because of forced
vaginal penetration and abrasion, whichfacilitates entry of the virus into the body48

When decisions are made by others(Jewkes and others, 2011). Women
experiencing abuse in marriage are oneand-a-half to three times more likely to test
positive for HIV and two to four times more
likely to report another sexually transmitted
infection (WHO, 2015).
The various practices that enforce male
control and violate the bodily autonomy
rights of women are interrelated. Studies
have found a strong correlation, for example,
between marital rape and child marriage: a2011 study found that most cases of marital
rape in Uganda were committed against 15to 19-year-old girls whose older husbands
had paid a bride price to obtain their wives(Hague and others, 2011).
Forty-three countries do not have any
legislation that addresses the issue of marital
rape. Even in countries that recognize theconcept, the penalties for non-consensual sex
within marriage may be significantly lower
than in other cases. Likening marriage toa “get-out-of-jail-free card”, a 2020 study
found that among the 54 Commonwealthcountries 35 still apply some form of marital
exemption to criminal sexual offences(Richardson, 2020).
In some countries and territories,
marriage may be considered a legal“cure” for rape by allowing perpetrators
to marry their victims and thereby avoid
any penalties for their crime. Laws
allow men convicted of rape to havethe verdict overturned if they marry the
women they have assaulted in Algeria,
Angola, Bahrain, Bolivia, Cameroon,
Dominican Republic, Equatorial

Guinea, Eritrea, Gaza, Iraq, Kuwait, Libya,
Philippines, the Russian Federation, Serbia,
Syria, Tajikistan, Thailand, Tonga and
Venezuela (Equality Now, 2020).
In 2017, the NGO Equality Now
undertook an extensive review of “marryyour-rapist” laws. It found, for example,
that in Iraq, if the perpetrator marries
the victim, any legal action against
him becomes void, and any ongoinginvestigation or legal case is discontinued.
If a sentence has already been handed down,
it is reversed and not carried out, but it canbe reinstated if there is divorce within three
years. In Kuwait, if the perpetrator legallymarries his victim with the permission ofher guardian and the guardian requests
that he not be punished, the perpetrator
is set free. In Russia, if the perpetrator has
reached 18 years of age and has committed
statutory rape with a minor below 16, heis exempt from punishment if he marries
the victim. In Serbia, “cohabiting witha minor” is prohibited; however, “if amarriage is concluded, prosecution shall not
be undertaken and if undertaken it shall be
discontinued”. In Thailand, marriage can beconsidered as a settlement for statutory rape
if the offender is over 18 and the victim isover 15 years old, if she “consented” to theoffence and if the court grants permission
for marriage (Equality Now, 2017).
Marriage laws and practices that subordinate
women and deny them agency are widespreadand difficult to root out. However, they are
far from the only ways in which patriarchal
structures reinforce male dominance andcircumscribe female sexuality.

Female genital mutilation
Female genital mutilation comprises allprocedures that involve partial or total removalof the external female genitalia, or other injury
to the female genital organs for non-medical
reasons (WHO, 2020a).
Female genital mutilation is a violation of
women’s and girls’ human rights and an extreme
form of discrimination and violence directed
exclusively at girls and women. It is also a partof wider patriarchal practices, rooted in genderinequality and aimed at controlling women’s andgirls’ sexuality, their bodies and their sexual andreproductive rights.
The practice denies women and girls their rights
to: physical and mental integrity; freedom fromviolence; the highest attainable standard ofhealth; freedom from gender discrimination; andfreedom from torture and cruel, inhuman anddegrading treatment, among others. Yet, morethan 200 million girls and women live with theconsequences of female genital mutilation, andat least 4 million girls are at risk of undergoing
the practice each year (UNFPA, 2020c;
UNICEF, 2020a).
Female genital mutilation deprives womenand girls of their right to make autonomous
decisions about an intervention that has a lasting
effect on their bodies and infringes on theirautonomy and control over their lives. Female
genital mutilation is a deprivation of capabilities,
affecting the ability of women and girls toachieve full functioning in the world because of
the physical, sexual and emotional consequencesof the practice. These consequences, in turn,
may adversely affect their individual well-being,

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49

Putting the unity
in community
Daniyar realized he wasunique. In fact, advocatesadvocacy groups that are atransgender at age 7, but

and researchers have long

driving force for change.

believed for years that he wasobserved the creative andalone. “When I was 15 or 16,

collective ways people comeThat is happening in

I was very depressed. I wastogether to reclaim their

Kyrgyzstan, said Ayim, a

not accepting myself… I didn’t

bodily autonomy when it is24-year-old transgenderknow that there were LGBTI

threatened. LGBTI people

woman. She, too, felt isolated

communities or organizations

have created safe spaces forfor years before findingin Kyrgyzstan.” It was noteach other in even the mostacceptance and solidarity

until someone tipped him off

restrictive settings aroundin the LGBTI community. “I

about a local LGBTI groupthe world. And there arewould wear my mom’s skirts.

that he felt equipped to takeother examples. Sex workers

My mom would make funcontrol over his body and life.

come together to shareof me and scold me at the“I understood that this is myinformation about violent

same time… When I started

environment,” he said. “Before

clients. Women help eachmy studies at a university,that, I felt I was not living inother conceal contraceptives,

I understood that I needed

my own body. But I learned

escape abusive partners,

to disclose who I am. If I

about transgender people, andor terminate unwanted

disguised it all my life, I

started reading about it, andpregnancies in countries

would be trapped. In 2016,

then I started my transition.”where abortion is hard toI started actively getting

access or illegal. When andacquainted with people from

Daniyar, now 23, knows

where possible, these informal

the LGBTI community.”

this experience is far fromnetworks tend to formalize into

“We have common problems
and we know how to
support each other.”50

When decisions are made by others

Ayim says she felt isolated before finding the LGBTI community. Original artwork by Naomi Vona; image courtesy of Ayim.

Today, both Daniyar and Ayim

housing assistance andpeople are especially vulnerable,

are LGBTI activists. They work

access to health information

they say, with high rates ofwith a local non-governmental

and care. This support isunemployment in part because

organization, Kyrgyz Indigo,critical in a country where

they cannot update their

to provide services to LGBTILGBTI people face frequentidentification documents topeople in need, including

discrimination. Transgenderreflect their gender identity.

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51

“The latest amendments

we know how to support

the pandemic to meetin the law prohibit people

each other,” explained

the increased need forfrom changing their

Ayim. “We stick with each

emergency housing.

passports to correct theirother.” And expressing

gender,” said Daniyar.

one’s authentic gender

Their experiences

There are also very

identity is non-negotiable,

hold lessons forfew medical specialists

they say. It is a matter ofother marginalized

helping transgender

life or death. If transgendercommunities working topeople transition, making

people were forced to

advocate for their rights

the process extremely

hide completely, “I thinkand bodily autonomy,

costly. “Many sacrifice

there would be many

they say. Firstly, “there

their nutrition or do notsuicides,” said Daniyar.

is a need to empower

sleep [to work aroundOr they would “leave

the community and tothe clock], so they can

Kyrgyzstan and become

increase visibility,” Ayim

save money for surgery

a refugee, because living

noted. Acceptance of

to correct their bodies.”

in a body that is not yours

LGBTI issues within

is terrible,” added Ayim.

the country is greatest

There is always a threat

52

in Bishkek, the capital,of violence looming

Circumstances for

thanks to the presence ofover them. Both Daniyar

the community haveactivist groups and efforts

and Ayim have been

worsened under thethere, she explained.

threatened, and they

COVID-19 pandemic,

have friends who havewith job losses leaving

But advocates must

been assaulted. “Theremany homeless,also be prepared forare many stories likehungry or unable toopposition, and they

this,” Daniyar said. “Theyafford medication.

must protect themselves:beat up or take the

Kyrgyz Indigo has“You need to be ready for

person somewhere, tobeen delivering foodany reactions and movethe mountains, outsideand essential supplies,

with no fear,” Ayim said.

of the city… beat themincluding soap, toilet“When you fully devotealmost to death or maybe

paper and sanitary

yourself to activism, toto death and leave

napkins, to those insuch work, you burn out.”them in a wasteland.”need. It is helping ensure

And most important, she

continued access tosaid, is trust: “The main

Despite these risks, theyhormone therapy forthing is to trust yourself,

are motivated by antransgender people andtrust your power… Do

intimate understanding

antiretrovirals for people

not be afraid of anyone.

of the struggles in theirliving with HIV. And it

Because there is you,community. “We have

has been operating three

there is us, and together

common problems andshelters throughout

we can all go further.”

When decisions are made by others

including opportunities for sexual satisfaction
and for choice in matters of reproduction(Nussbaum, 2000).

No gender equality without
control over one’s own body

While families and communities cite cultural,religious and social reasons for practising female
genital mutilation, justifications centre on theneed to reduce women’s sexual desire (Gamal
and others, 2018). Female genital mutilation is
directly linked to gendered power relations andsocial control over women’s bodies and sexuality,
and to the status of women and girls in a given
society and their level of empowerment or
agency (Toubia and Sharief, 2003).

Forced and child marriage, marital rape andfemale genital mutilation are some of the more
stark examples of the relationship between
gender-unequal norms and the erosion of awoman’s or girl’s power to make autonomous
decisions in life. Assaults on this power comefrom many other directions as well, ranging
from legal and economic systems that deny
women financial independence, to patrilineal
inheritance traditions and education systems
that fail to impart knowledge to girls about
their bodies and rights.

Women living in communities that practise
female genital mutilation are subject to a strong
patriarchal social and economic regime withvery few options for choices in livelihood, whichleaves them little opportunity for negotiating alimited amount of power (Toubia and Sharief,
2003). The lack of choice over their own lives
means that having their daughters undergo
female genital mutilation, and complying withother social norms, especially those linked tosexuality and the economics of reproduction,is an essential requirement for “silent power
negotiations” (Toubia and Sharief, 2003).
Women may protect and practise female genital
mutilation because they use it as a power-gaining
tool (MIGS, 2015). Women may even foregoautonomy over their body in exchange forsocial inclusion, economic survival (marriage)and other freedoms (MIGS, 2015; Toubia andSharief, 2003).

Breaking through the many economic,
social and institutional barriers to full gender
equity and equality is complex and difficult,but any achievements that are made areof little consequence unless they provide
the most fundamental right: the right tocontrol one’s own body. This has become
globally recognized through the Sustainable
Development Goals, which acknowledge
that Goal 5 to achieve gender equality andthe empowerment of all women and girls
has to include universal access to sexual andreproductive health and reproductive rights.
And one of the measurements of achievement
is the proportion of women who maketheir own informed decisions about sexualand reproductive choices—in other words,
the extent to which women control theirown bodies.

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53

Artwork by Hülya ÖzdemirMY BODYMY RIGHTS
International treaties and declarations
provide foundations for the right to bodily
autonomy and integrity
Do people have rights to make decisions about
their own health care, including reproductive
health care? Do these rights include making
choices about contraception? Does a woman
have a right to say no—or yes—to sex, when she
wants and with whom she wants?
According to international human rights law, theanswer to these questions is an emphatic “yes”.
Even though bodily autonomy is a foundation
upon which human rights are built, it is rarely
articulated as a right in and of itself (UNGeneral Assembly, 2007). Rather, bodily
autonomy underpins or is subsumed in a
number of rights that are spelled out in treaties
and international agreements.

Bodily autonomy in the context of sexual andreproductive matters encompasses rights thatenable individuals to make informed choices
and decisions regarding their sexual andreproductive health needs, and to do so free fromdiscrimination, coercion and violence. Theserights were first articulated in the Programme of
Action of the 1994 International Conference on
Population and Development (ICPD), and the
Platform for Action of the 1995 Fourth World
Conference on Women (United Nations, 1995;
UNFPA, 1994).
Depending on the treaty or agreement,“autonomy” in matters related to sexuality andreproductive health and decision-making may
encompass access to comprehensive sexuality

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55

education, contraceptive information andservices, maternal health care, infertility
treatment, gender-affirming interventions,such as hormonal and surgical treatment, andcomprehensive abortion care. Autonomy also
touches on matters of civil status, ranging frommarriage and divorce to the legal capacity tomake decisions about one’s own body and thepower to express one’s gender identity.

cruel, inhuman and degrading treatment,or as a right to dignity and privacy, or in
the right to health as expressed in manynational constitutions (Viens, 2020).

Rights to bodily autonomy are aligned withrights to bodily integrity, which are tied
physically to liberty and security of the person,
and to freedom from torture and cruel,inhuman or degrading treatment, as well as
the inviolability of one’s self: body and mind.
In the context of reproduction and sexuality,
violations of bodily integrity include practices
such as female genital mutilation, virginity
testing and punitive anal examinations, as wellas rape, including rape by a spouse or partner,and other forms of gender-based violence.

Human rights law robustly affirms
the right to information and means
to make decisions about childbearing.
Article 16.1(e) of the Convention on the
Elimination of All Forms of Discrimination
against Women, commonly known as
the Women’s Convention, requires States
Parties to uphold women’s rights “to decide
freely and responsibly on the number andspacing of their children and to have accessto the information, education and means toenable them to exercise these rights” (UNGeneral Assembly, 1979).

Rights related to bodily autonomy andintegrity enable individuals to make their own
decisions in the realms of reproduction andsexuality. States affirm and regulate these rights
through policies and laws that define “legal
capacity” or determine the age of consent
for sex, marriage or accessing services suchas contraception.
Autonomy rights are interdependent andmutually supporting, regardless of how they
are expressed, whether as a “right to respect
for… physical and mental integrity” (European
Union, 2012, Article 3(1)), as “rights to life,
physical and mental integrity, liberty andsecurity of the person” (UN General Assembly,
2007a, Article 7(1)), as freedom from torture,56

My body, my rights

Bodily autonomy
and reproductive
decision-making

The Convention on the Rights of Persons
with Disabilities, known as the Disabilities
Convention, specifies that the right tomake decisions about the number andspacing of children applies to persons
with disabilities (UN General Assembly,2007). The right to decide on the number
and spacing of children is mirrored in the
African Charter on Human and Peoples’
Rights, in its Protocol on the Rights of
Women in Africa, the “Maputo Protocol”(African Union, 2003). Similar language
is also found in the ICPD Programmeof Action and the Beijing Declaration
and Platform for Action of the FourthWorld Conference on Women.

Human rights and the United Nations treaty system
Human rights are basic guarantees, which theinternational community recognizes and promises
to uphold. These rights cover civil, political, social,economic and cultural matters and establish what
governments can and cannot do, as well as what
they should do for all of us without discrimination.
Everyone, regardless of sex, gender, race, ethnic
origin, religion, nationality, language, disability, placeof residence or any other status, has these rights.

Observations, which suggest certain actions
countries should take to better meet their
human rights obligations. They may also issue
General Comments or Recommendations to help
governments understand their treaty obligations
and provide authoritative interpretation as tothe meaning of treaties. In certain cases, treaty
bodies can act like courts and issue opinions thatare meant to settle disputes and points of law.

Human rights are often expressed and guaranteedby law, in the forms of treaties, customaryinternational law, general principles and othersources of international law (OHCHR, n.d.).

Another important source of human rights norms
comes from political consensus agreements,
such as the ICPD Programme of Action and the
Platform for Action of the 1995 Fourth World
Conference on Women. These agreements,
together with the United Nations Sustainable
Development Goals, establish global policies
and targets for the realization of rights,
including sexual and reproductive rights.

Human rights treaties are overseen by the United
Nations through treaty-monitoring committees,
known as treaty bodies, which ensure that States
Parties honour their commitments under eachtreaty. For example, the United Nations Committee
on the Elimination of Discrimination against
Women monitors progress for women made incountries that are States Parties to the 1979
Convention on the Elimination of All Formsof Discrimination against Women. The
Committee also makes recommendations
on issues to which it believes the States
Parties should devote more attention.
Similar bodies have been establishedto monitor progress in meeting
obligations to other treaties, such as theConvention on the Rights of the Child.
Treaty bodies may issue non-binding
recommendations, or Concluding

Artwork by Kaisei Nanke

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57

First, do no harm
Virginity testing violates

and García-Moreno, 2017).

virginity tests but also forced

individuals’ human rights andAnd yet many of its defenders

anal exams, which involve

dignity, the United Nations

invoke feminist language tothe insertion of fingers or

has resoundingly asserted.

argue for its continuation.

objects into the anus of a man

When performed withoutor transgender woman withconsent, it constitutes torture

A virginity test, also known

the purported objective ofand a form of sexual violence.

as a hymen exam or “two-finding “proof” of homosexual

It is also scientifically useless,finger” test, typically involves

conduct. Forced anal tests

and a violation of medical

an examination of thehave been reported throughout

ethics (WHO and others,

hymen, a thin tissue often,

the Arab States and East and2018). Yet it persists inbut not always, present inSouthern Africa regions, yetevery region of the world;

the vagina. The test relies

they are “medically worthless”

its continued practice hason the assumption thatand “amount to torture or

recently made headlines in thephysical characteristics of

ill-treatment”, said the 2018

United Kingdom, for instance,

the hymen or vagina canreport of an independent expert

where a bill is under review

demonstrate whether ato the United Nations Humanto ban the practice. Virginity

woman or girl has engaged in

Rights Council (UN HRC, 2018).

tests are used to enforce

vaginal intercourse—a belief

or encourage abstinence

overwhelmingly discredited by

Virginity tests, as well as

among unmarried women

medical studies. Unscientificforced anal exams, areand girls, with justifications

examinations to “prove” orphysically invasive, painful

ranging from the preservation“disprove” intercourse onlyand stigmatizing. Surayaof their “purity” and family

reinforce harmful social norms

Sobhrang, a medical doctor“honour” to the prevention

and must be banned, medical

and former human rights

of HIV transmission andand human rights experts

commissioner in Afghanistan,adolescent pregnancy (Olson

assert. These include not only

says the tests used to be“This is a violation ofhuman rights and it’sagainst human dignity”

58

My body, my rights

Suraya Sobhrang describes how medical and legal personnel perpetuated nonconsensual virginity testing in Afghanistan. Original artwork by Naomi Vona;
photo © UNFPA/A. Mohaqqeq.

ordered punitively after any

Examination conditions were

women… One woman told

perceived transgression, suchoften neither sanitary norme, ‘I feel that the second

as sitting next to a member

private, and women could

time, somebody raped me.’”of the opposite sex. “Allbe forced to undergo thethis was a ‘moral crime’,”test repeatedly, she said.

Women could be imprisoned

Dr. Sobhrang described.

“This was traumatizing thesefor failing a virginity test.

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59

“Some women did self-

and realities: in places without

into having sexual relations

immolation after this testing,”

scientifically sound medical

and abuse by ‘iintsizwa’

Dr. Sobhrang recalled. Others

procedures, such as DNA[older men], especially girls

were killed by their families.

testing, virginity testing offers

in grades 10, 11 and 12,”one of the few ways survivors

said Chief Msingaphansi of

Dr. Sobhrang and her

can submit evidence to support

Umzimkhulu in KwaZulu-

colleagues helped to ban

an allegation of rape. “ForNatal. He suggests the tests,

nonconsensual virginity tests

the victim, the hymen test

largely performed by womenin Afghanistan in 2018. Today,

is a tool through which toelders, emphasize the culturalvirginity tests can only beseek justice and fight backvalue on abstinence, thereby

performed in Afghanistan

against social and traditional

encouraging girls to rejectwhen there is a court order

blame,” Dr. Azami said.

peer pressure and delay sexualand consent of the patient—activity. Chief Msingaphansi

though enforcement of thisThe test, if its results arecouches the ritual in therule remains a concern,

favourable, can also help

language of empowerment:

especially in rural areas. And

women avoid violence in“Following the tests, the girls

both doctors and patients canplaces where a perceived loss

are made aware of their rights,”

still face consequences if theyof virginity can be a deathhe said, adding that they

decline the test. Mozhgansentence. “On a marriage

learn to identify exploitative

Azami, a forensic medicine

night, a white cloth or paper

relationships. Yet these tests

specialist in Kabul, recalled

is given to the couple thatare often nonconsensual,

one girl who refused twice,

should be coloured red by themaking them illegal. “Thedespite a court order: “Theblood of the hymen after theparents decide,” acknowledged

third time, the court sent her

marriage is consummated,”a “virginity inspector”

back to us saying that if the

Dr. Azami added. If “thefrom uMgungundlovu

doctors do not perform theman doesn’t see the signs ofand uThukela districts.

test this time, they will bevirginity, the virginity test willplaced under investigation.

be performed... based on the

Despite these justifications,

Therefore, after two hours

request of the girl,” typically inthe test contributes to theof talking to the girl, we

the hope that her hymen will

erroneous belief that a

convinced her to do the test.”

show an indication of tearing.

woman’s virtue is dependent

Dr. Azami agrees that virginity

In some communities, suchit perpetuates a flawed

tests, particularly when

as in South Africa’s KwaZulu-

understanding of humanperformed under duress, canNatal Province, virginity

anatomy. Lending credibility“hurt them psychologically”.

testing is also seen by someto the test will inevitably

Yet she defends the test in

as protection from adolescentlead to harm, Dr. Sobhrang

some instances, if performed

pregnancy, HIV and otherstressed. “The hymen,

confidentially, with dignity andharms (UN HRC, 2016). “It issome women don’t havefull informed consent. Thosebelieved that virginity testingone. And sometimes theviews are shaped by real fears

will prevent girls being coerced

structure is very elastic.

on her sexual history, and60

My body, my rights

I saw one woman who had her
first baby and at the delivery,
she still had a hymen. So it
does not assure that a girlhas not had intercourse.”
Someone who reports a rape
could be found to still have ahymen, and the complainant
could be being jailed formaking false accusations
while the perpetrator goes
free, the doctor explained.
And virginity tests are not a
substitute for post-rape medical
examinations, which assess
and treat physical trauma
without requiring the insertionof anything into the vagina(WHO and others, 2018).
“This is a violation of humanrights and it’s against humandignity,” said Sima Samar, a
medical doctor and former
state minister for humanrights in Afghanistan, who
also championed the ban on
nonconsensual virginity tests.
“It requires education in the
public, to everyone, particularly
to the youth. Secondly, I think
it is required to educate police,
to educate the prosecutor, toeducate the medical doctors.”
Most importantly, individuals
must be emboldened to know
and claim their bodily autonomy,
Dr. Samar added. “How manyof them know their rights?”

Bodily autonomy
and health
Deciding for oneself, seeking and receiving
information, and accessing services forreproductive and sexual matters areunderstood and included in the right tohealth, according to the United Nations
Committee on Economic, Social andCultural Rights (UN CESCR, 2016).
At the same time, enjoying sexual andreproductive health is “indispensable to[women’s] autonomy” and “intimately
linked to civil and political rights
underpinning the physical and mental
integrity of individuals and theirautonomy” (UN CESCR, 2016, para. 34).
The rights “to make free and responsible
decisions and choices, free of violence,
coercion and discrimination regarding
matters concerning one’s body and sexualand reproductive health”, and to have“unhindered access to a whole rangeof health facilities, goods, services andinformation” are therefore two sides of thesame coin (UN CESCR, 2016, para. 5).
According to the United Nations
Committee on the Elimination ofDiscrimination against Women,
health services must create an enabling
environment where people can exercise
their autonomous choices and Statesshould “[r]equire all health services tobe consistent with the human rights ofwomen, including the rights to autonomy,
privacy, confidentiality, informed consent
and choice” (UN CEDAW, 1999).

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Bodily autonomy
and privacy

Rights andinfertility
treatment
Access to infertility treatment is part ofreproductive health care and includes
techniques such as in vitro fertilization (ZegersHochschild and others, 2009). International
human rights require all reproductive andsexual health-care services to be available andaccessible on the basis of non-discriminationand equality. Various treaty bodies haveconcluded that where in vitro fertilization
is available within a State, it must not be
unduly restricted, or offered in such a way
as to violate other human rights (UN CESCR
2019; UN CCPR, 2016; UN CEDAW, 2015).

Being able to make decisions about privateand family life are additional aspects ofrights to bodily autonomy. For example, thePolitical Rights Covenant provides that “No
one shall be subjected to arbitrary or unlawfulinterference with his privacy, family, home orcorrespondence, nor to unlawful attacks on hishonour and reputation” (UN General Assembly,
1966, Article 17(1)).
Similar formulations of the right to privacy
are also included in other international andregional human rights treaties, notably theChildren’s Convention (UN General Assembly,
1989, Article 16), the American Convention
on Human Rights (OAS, 1969, Article 11),the European Convention on Human Rights(Council of Europe, 1950, Article 8), the African
Charter on the Rights and Welfare of the Child(African Union, 1990, Article 10) and theASEAN Human Rights Declaration (ASEAN,
2012, Article 21).
The European Court of Human Rights andInter-American Court of Human Rights haveinterpreted their treaties in a similar way,emphasizing that “the notion of personalautonomy is an important principle underlying
the interpretation of its [Article 8 privacy]
guarantees” (ECtHR, 2002).
In the United States more than a century ago,
Samuel Warren and Louis Brandeis articulated
a right to privacy as the “right to be left alone”(Warren and Brandeis, 1890). Since then,privacy has gained a much broader definitionin the United States and elsewhere and applies

Artwork by Kaisei Nanke

62

My body, my rights

Abortion and bodily integrity and autonomy
United Nations treaty bodies, the committees
that monitor governments’ application of their
human rights obligations, have called on States
to reform abortion laws to protect women’sbodily integrity and autonomy. According
to the United Nations Committee on Civil
and Political Rights, for example, laws must
permit women the choice to end pregnancies
that endanger their lives (UN CCPR, 2019).

The ICPD Programme of Action is a foundational
document that has guided the work of UNFPA
since 1994. It stresses that measures or changes
related to abortion within the health system arematters left to national legislative process. The
Programme of Action also affirms that whereabortion is legal, it should always be safe; and,in all cases, women should be provided quality
care for the consequences of abortion.

Laws that compel women against their wishes tocontinue non-viable pregnancies, or impel themto travel outside their countries to terminate
such pregnancies, or those which endanger
their lives, violate a range of recognized humanrights (UN CCPR, 2017). States must also ensurethat where their laws permit women to elect anabortion, no barriers are erected to impede themin exercising their choice (UN CCPR, 2011, 2005).

Meanwhile, international, regional and national
human rights bodies and courts increasingly
recommend ensuring that even where access is
restrictive, women’s health and lives should bepromoted and protected. Moreover, they direct
States to decriminalize abortion—both for the
women who seek services and the health-carepractitioners who provide services—thereby reducing
the stigma and discrimination that they might face.

Artwork by Kaisei Nanke

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to decisions about sexual and reproductive
health, including contraceptive informationand services, access to abortion, infertility
treatments, sexual relations, sexual orientationand gender identity. International, regional andnational courts have found that rights to privacy

prohibit governmental interference with private,consensual sexual and reproductive behaviour
between adults (UN CCPR, 1994). The UnitedStates Supreme Court based its decision in
Roe v. Wade on such a right to privacy.

Legalized same-sex relationships mean greater
autonomy for previously excluded groups
Mirroring laws that discriminate against people,
particularly women, within marriage or coerce theminto unwanted marriage, there are widespread legal
restrictions on sexual relations between consenting
adults of the same sex, as well as restrictions on
same-sex partners contracting a legal marriage.
In recent years, the Office of the High Commissioner
for Human Rights of the United Nations andother international organizations concerned withhuman rights have recognized that LGBTI persons’autonomy rights are violated through discriminatory
laws and actions. The 2015 report of the HighCommissioner for Human Rights stated forthrightly:“States that criminalize consensual homosexual acts
are in breach of international human rights law sincethese laws, by their mere existence, violate the rights
to privacy and non-discrimination” (OHCHR, 2015).
In a groundbreaking address at a ministerial
meeting of the United Nations General Assemblyin 2017, the High Commissioner for Human
Rights said: “But the premise for dialogue must
be clear: not whether to end these abuses, but
how. LGBTI people are full members of the humanfamily. They are not lesser than the rest of us;
they are equal—and, as such, they are entitledto enjoy the same rights as everyone else.” The
High Commissioner called on all governments to64

My body, my rights

allow individuals to love whom they choose and toenjoy the same rights as others (OHCHR, 2017).
In this statement the High Commissioner was
acknowledging that such a change in laws andattitudes concerning our understanding of bodily
autonomy would have a liberating effect on theestimated 300 million people worldwide who
identify as LGBTI (Patterson and D’Augelli, 2012).
However, the High Commissioner acknowledgedthat not only was progress slow, it was regressing
due to political agendas that cater to prejudice
and bigotry. In fact, there are 69 countries in
the world today where consensual same-sex
sexual relations are illegal (ILGA World, 2020).
Along with the human rights implications of suchlaws, discrimination against LGBTI people has
important implications in many other spheres, suchas health. The Independent Expert on protection
against violence and discrimination based on
sexual orientation and gender identity of the United
Nations Office of the High Commissioner for
Human Rights has found that such laws “hinder
the ability of relevant government departments andother actors involved in health responses”, in, forexample, the response to HIV and AIDS. A recent
report pointed out that punitive legal environments,

Artwork by Kaisei Nanke

combined with stigma, discrimination and highlevels of violence, placed gay men and other men
who have sex with men at high risk of HIV infection
because they are driven underground out of fearof prosecution or other negative consequences.
As a result, they do not receive appropriate healtheducation, and are reluctant to seek health-careservices, testing and treatment (UN HRC, 2018).
An important part of achieving full equality under
the law is the ability of LGBTI individuals to form
unions with the same legal standing as that of
opposite sex unions: “The United Nations andregional human rights bodies… have urged States
to provide legal recognition of same-sex couples
and their children and ensure that same-sex
couples are not discriminated against compared
to different-sex couples… It is up to the State todetermine the form of recognition, but whatever
form is chosen, there should be no difference intreatment between same-sex and different-sex
couples” (United Nations, 2016). This recognition
is far from being achieved throughout the world.
But things are changing. In 1989, same-sex registeredpartnerships became a reality in Denmark. Twoyears later, the Netherlands legalized same-sex
marriage. Since then, the legal right of same-sex
partners to marry and establish families has also
been recognized in Argentina, Austria, Belgium,
Brazil, Canada, Colombia, Ecuador, Finland, France,
Germany, Greenland, Iceland, Ireland, Luxembourg,
Malta, New Zealand, Norway, Portugal, South
Africa, Spain, Sweden, Taiwan Province of China,
the United Kingdom, the United States of America
and Uruguay (World Population Review, 2020).

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65

Going to labour:the job of a surrogate
Josefina remembers making the

not had any children before.

She still had her mobile phone

choice to become a surrogate.

I remember thinking ‘where

and was able to surreptitiously“Part of it was for the money,

am I?’” A few months into her

contact the intended parents

but what really moved me waspregnancy, she, along with twoof the baby, something she

having the power to make realor three other surrogates andhad been expressly forbidden

the dream of many womensome of their children, wereto do. “I found the parentsof having a baby,” she said.

taken to a dilapidated housethrough Facebook,” sheWhat she did not anticipate

with no water, electricity or

said. “They were very nice

was how poorly run—and

food—and then locked inside.

to me and supportive.” They

abusive—the surrogacy
agency would turn out to be.

moved to another surrogacy
The situation was only

agency, bringing Josefina

temporary. But Josefina (notwith them. “I continued the“I thought there would be otherher real name), who lives inprocess in a safer place,

women like me: confident in

Mexico, said she suddenly

where I felt more confident.”

their decision, with a minimum

started worrying that theof one child, just like thepregnancy wasn’t actually

Yet even after that perilous

requirements established.

for the purpose of being aexperience, Josefina says she

But the place where I arrived

surrogate. “A lot of ideas camenever doubted her decision.

wasn’t like that. There were ato my mind such as child“I was sure that I wanted to

lot of young women who had

trafficking or organ trafficking.”

have the baby. I don’t regret it.

“I saw this opportunity of helping
others get something they reallydesired: a baby.”

66

My body, my rights

Policymakers seldom consider the perspectives of surrogates when crafting surrogacy laws, experts say. Original artwork by Naomi Vona;
photo by Alexander Krivitskiyz on Unsplash.

It was an adventure,” she said.

The issue of surrogacy has

questions about the rights and“Once I met the parents, I waslong been considered ethically

responsibilities of surrogates

pleased with the process.”and legally fraught. Highly

and intended parents, as

publicized lawsuits and custody

well as the rights of the baby

She would even consider

battles in the United States,

produced by the surrogacy

doing it again.

India and elsewhere have raisedarrangement (Nadimpally

STAT E OF WOR L D POPUL AT I ON 2 02 1

67

and others, 2016). Laws varyintense cultural pressureprohibitions, “the practicewidely across and within

to become mothers whilestill goes on, but now in an

countries. Some ban surrogacy;same-sex couples or single

underground and unsafe way.”some ban commercial,parents are often barred fromalso called compensated,

commissioning surrogates

Josefina bore many of thesesurrogacy but allow so-called

because they fail to meetconsequences. “When I was

altruistic surrogacy; some

accepted norms of parenthood.

with the first agency, we

permit both; and others

And surrogates may be

didn’t even have a contract.

have no specific surrogacy

criticized for betraying the

A contract would have given

laws at all (UCLS, 2019).

perceived sacred bond between

me safety that everything

a woman and the fetus shewould be okay.” She believes

Where compensatedcarries. Josefina kept her

the restrictions are only

surrogacy is permitted, asurrogacy arrangement quiet

pushing surrogacy further into

lucrative industry often

for just this reason. “It’s athe shadows, where unethicalemerges, comprising assisted

taboo. A lot of people getagencies can thrive without

reproductive technology clinics,

scared when they hear about

regulation and surrogatesmedical tour operators, law

it, so I decided not to tellthemselves are penalized.

firms, recruiters and others.

that many people. Actually,“If it was legal, people

Countries with lower costs

a lot of people from my own

would feel safer,” she said.

can become sought-after

family don’t know,” she said.

destinations for commissioning

68

Rather than bans, there mustparents. Yet, in such places,“Stigma has grown a lot in the

be more nuanced policies

surrogacy is often one of thelast 10 years,” said Isabel Fulda,that account for the input and

few well-paying opportunities

Deputy Director of Grupo deperspectives of those affected,

available to economicallyInformación en Reproducción

said Sarojini Nadimpally, amarginalized women, creating

Elegida, a reproductive justicefounding member of the Samathe potential for exploitation.

organization in Mexico,

Resource Group for Women

Brokers and agencies may

which has advocated on

and Health in India and expert

control the exchange ofbehalf of both surrogateson the social and legal issues

money and information as

and commissioning parents.

surrounding surrogacy. “Havewell as the provision of health

Surrogacy laws vary acrossthe surrogates and infertilecare. Surrogates may be left

Mexico, but have generally

couples been involved in theunderpaid, underinformed

grown more restrictive inpolicy formulations? Wereand medically underserved

recent years. “Even if thethey asked what they want in(Nadimpally and others, 2016).

initial intentions of reform are

the policy or in the legislation?

good, and intended for better

How accessible will these legal

The highly gendered nature

protection of every party, it

provisions be for surrogates?”of surrogacy and motherhood

has unfortunate consequences,also creates vulnerabilities onespecially for surrogate

Not only are surrogates’

both sides of the agreement.

women,” she said. In places

experiences neglected in theInfertile women may facethat have implemented strict

crafting of legislation, but

My body, my rights

stigmas and punitive rules havemade it harder for them to raise
their voices. “The more politicalthe issue becomes, the morethey are silenced,” Fulda said. In
place of surrogates’ real stories,
a caricature has emerged, inwhich compensated surrogatesare depicted as victims while
altruistic surrogates “are often
portrayed as angels who arewilling to breed for nine months,
and expose themselves topossible risks just for the love
their hearts carry. It becomes
unbelievable to think they would
want money for it,” Fulda said.
The distinction between
compensated and altruistic
surrogacy doesn’t make sense
to Josefina. For her, being asurrogate was both a job anda gift. She did not resort toEven in cases of alleged harmful sexual
behaviour, the European Court of Human Rights
directs governments to carefully balance theState’s interests against an individual’s autonomy
interests and right to engage in private,consensual sexual activity (ECtHR, 1997).
Privacy, especially as it relates to family life, iscapacious enough to encompass all manners
of decision-making related to sexuality andreproduction, embracing “the right to respect for
both the decisions to become and not to becomea parent” (ECtHR, 2010, 2007). The privacy
jurisprudence of the European Court of Human
Rights is most developed; abortion as well as
medically assisted reproduction for heterosexualand same-sex couples and individuals (including
surrogacy, both compensated and altruistic) havebeen interpreted under the private and family
life protections of Article 8 of the European
Convention for the Protection of Human Rights
and Fundamental Freedoms (Roseman, 2020).

it because of poverty: “Myeconomic situation at that time
was not really that bad. My
choice was made because I
wanted to do something different
with my life and to do something
positive for someone else... I ama mother as well, and I know theNon-discriminationand gender equality
Enjoying autonomy and having the capacity
to make decisions free from discrimination are
central to human rights.

happiness a child can bring.”

Being free from discrimination and enjoying
equal treatment means that States may not
make any distinction in law or policy on
the basis of characteristics such as sex, age,
race, ethnicity, gender expression, religion,
nationality, marital status, health or disabilities(UN CESCR, 2009). Discrimination based onsex, for example, would include distinctions
made “not only on physiological characteristics

STAT E OF WOR L D POPUL AT I ON 2 02 1

69

but also the social construction of genderstereotypes, prejudices and expected roles” (UN
CESCR, 2009, para. 20). Unequal access byadolescents to sexual and reproductive healthinformation and services is an example of agebased discrimination (UN CESCR, 2009).
States must respect individuals’ bodily autonomy
and integrity irrespective of social context.
According to a human rights working group on
the issue of discrimination against women in law
and in practice, “The right of a woman or girl to
make autonomous decisions about her own bodyand reproductive functions is at the very core ofher fundamental right to equality and privacy”(UN Working Group on Discrimination Against
Women in Law and Practice, 2017).
Women and girls have often been denied rights
to make their own decisions because of socialand cultural stereotyped beliefs or attitudes
that assign more value to the opinion of men
and parents. International human rights law
views these beliefs and attitudes as gender-basedstereotypes associated with harmful practices,
including female genital mutilation, maritaland “curative” rape (against individuals basedon their sexual orientation or gender identity),
child marriage, forced marriage and forcedchildbearing.
These beliefs and attitudes have also resulted
in exclusion from comprehensive sexuality
education, denial of contraceptive informationand services, and forced abortion, as well
as violence against people of diverse sexual
orientation and gender identities (UN CEDAWand UN CRC, 2014). These coercive and violent

Unequal accessby adolescents... is an example
of age-based
discrimination

Artwork by Hülya Özdemirpractices are all predicated on social beliefs
that privilege heteronormativity and seek tocontrol and subordinate women’s sexual andreproductive capacities.
States have a duty “to modify the socialand cultural patterns of conduct of men
and women, with a view to achieving theelimination of prejudices and customary andall other practices which are based on the ideaof the inferiority or the superiority of either ofthe sexes or on stereotyped roles for men andwomen” (OAS, 1994, Article 8(b); UN General
Assembly, 1979, Article 5(a)).
Governments can, and sometimes must,
treat people differently; however, there must
be a legitimate justification for the disparate

Transactional sex and surrogacy
What are the limits for exercising bodily autonomy in sexuality
and reproduction? According to human rights principles, personal
choices that do no harm to others should be permitted. But does
the exchange of money do no harm? Should an individual be able
to be financially compensated for sexual acts or reproductive
services? There is great variability in national laws andregulations regarding sex work, prostitution, gamete provision andgestational surrogacy. Some governments see these exchanges
as inherently exploitative and criminalize them. Others viewsex work and gestational surrogacy as legitimate livelihoods orforms of labour (UN HRC, 2018a; UN General Assembly, 2010).
Human rights law does not provide definitive answers,
although rights-based arguments have been invoked
to support both prohibition and legalization.
For example, the UNAIDS Global Commission on HIV/AIDS
and the Law has recommended decriminalizing sex work,
while the Human Rights Council has recommended thatin cases of compensated surrogacy the human rights ofall parties involved must be considered and respected
appropriately in law (UN HRC, 2019a; UNDP, 2012).

Artwork by Kaisei Nanke

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71

Legal capacity and age of consent
The Office of the High Commissioner for Human
Rights defines legal capacity as “the capacityand power to exercise rights and undertake
obligations by way of one’s own conduct,i.e., without assistance or representation bya third party” (OHCHR, 2005). Recognition inlaw of having “capacity” means a person cangive or withhold consent to sexual activity,
health services, marriage and more.

A legacy of deeming women, children andpersons living with disabilities “incompetent”
to make decisions for themselves or in need ofprotection from exploitation is what international
human rights redress. For example, the Women’s
Convention directs that “States Parties shallaccord to women, in civil matters, a legal capacity
identical to that of men” and they shall have “thesame opportunities to exercise that capacity”(UN General Assembly, 1979, Article 15(2)).
Given the history of discrimination faced by
women with disabilities, the Convention on the
Rights of Persons with Disabilities emphasized
the importance of legal capacity for autonomous
decision-making by women with disabilities: “Allwomen with disabilities must be able to exercise
their legal capacity by taking their own decisions,with support when desired, with regard to medical
and/or therapeutic treatment, including by taking
their own decisions on retaining their fertility andreproductive autonomy… Restricting or removing
legal capacity can facilitate forced interventions,such as sterilization, abortion, contraception, female
genital mutilation, surgery or treatment performed onintersex children without their informed consent andforced detention in institutions” (UN CRPD, 2016).
Another way of understanding legal capacity
is “age of consent”. Minimum ages of consent
vary among and sometimes within nations byactivity and sometimes by sex (although thisis considered incompatible with human rights
standards). The Children’s Convention directs
States to recognize the evolving capacities ofchildren, specifically adolescents, with regard
to consent to sexual activity as well as accessto sexual and reproductive health services andArtwork by Kaisei Nanke72

My body, my rights

information. The Committee on the Rights of
the Child urges governments to put supportive
laws and policies in place so that “children,
parents and health workers have adequate
rights-based guidance on consent, assent andconfidentiality” (UN CRC, 2013). These policies
include providing confidential counsellingto children, without the need for parental
or guardian consent, as well as conferring
presumptive legal competency for adolescents
to seek and obtain sexual and reproductive
health services, commodities and information(UN CRC, 2016). According to the Committee
on the Rights of the Child, governments
should avoid criminalizing consensual,
non-exploitative sexual activity among
adolescents of similar ages (UN CRC, 2016).
The right to marry and found a family isrecognized in both the Universal Declaration of
Human Rights, Article 16 (UN General Assembly,1948), and the Political Covenant, Article 23,
specifying that “no marriage shall be enteredinto without the free and full consent of theintending spouses” (UN General Assembly,1966). Any marriage entered into without
such consent is forced and is always a humanrights violation. The Women’s Convention
clearly states that child betrothal and marriage
is legally null and void and directs Statesto establish minimum ages for consent
to marriage (UN General Assembly, 1979,
Article 16(2)). In keeping with the principle ofevolving capacities, most nations, following theChildren’s Convention, establish a minimum ageof consent to marriage at 18, although in somesettings the minimum age varies, dependingon the sex of the individual (Pew ResearchCenter, 2016). In over half of the world’s
nations, parental consent can override any
age-related minimum (Arthur and others, 2018).

treatment, balancing all the respective rights(Clapham, 2015). The general principle of“best interests” in the Children’s Convention
is an illustration of this approach. Whileparents and guardians make decisions onbehalf of their children, children have a rightto participate meaningfully in decisions that
affect them, with no clear line delimiting
an appropriate age (Coyne and Harder,
2011). As children’s capacities evolve, theChildren’s Convention expects parents toinclude them and eventually cede final
control over such decisions to them when
they are mature. One example of respecting
children’s evolving capacities is in the shift
in thinking about intersex infants. In thepast, it was widely accepted that surgery
should be performed immediately to assign
the genitalia to one sex or the other. That
attitude has largely been replaced by one of
waiting for the children to make their own
choice about surgery (Reis, 2019; Zillén andothers, 2017). Without intersex children’s
meaningful consent, such surgeries havebeen labelled violations of bodily integrity,
tantamount to torture (UN HRC, 2016a).
Similarly, the categorical denial of thesexual and reproductive desires andchoices of persons living with physicalor developmental disabilities evidenced
by giving authority to parents, guardians
and institutions, or “substituted decisionmaking”, has been transformed into thestandard of “supported decision-making”,
where every effort is made to educate andascertain the person’s will and enable themto execute it (UN CRPD, 2018, 2014).

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73

Bodily integrity
As a general principle, rights related to bodily
integrity prevent the State or third parties from
intruding on someone’s physical body withoutobtaining free and informed consent.
The foundation for the notion of informed
consent in relation to bodily integrity flows
from Article 7 of the Political Convention: “No
one shall be subjected to torture or to cruel,inhuman or degrading treatment or punishment.
In particular, no one shall be subjected without
his free consent to medical or scientificexperimentation” (UN General Assembly, 1966).
This idea has been echoed in internationaland regional human rights treaties, including
the Disability Rights Convention, Article 15(UN General Assembly, 2007); the Children’s

Rights tobodily autonomy
and integrity
are formallyrecognized underinternational
human rights law
74

My body, my rights

Convention, Article 37(a) (UN General
Assembly, 1989); and the Convention
against Torture and Other Cruel, Inhumanor Degrading Treatment or Punishment(UN General Assembly, 1984).
Bodily integrity has been interpreted by the
Human Rights Committee as protected by theright to liberty and security of the person in
the Political Convention (UN HRC, 2014)
and by Article 7 of the Political Convention,
which protects all individuals from cruel,inhuman or degrading treatment.
Rights to bodily integrity are formallyrecognized in human rights instruments. The
Disabilities Rights Convention, for example,
notes that “Every person with disabilities has
a right to respect for his or her physical andmental integrity on an equal basis with others”(UN General Assembly, 2007, Article 17).
A number of regional human rights treaties
recognize bodily integrity outright or as partof the right to humane treatment, for example,
the African Union Banjul Charter (African
Union, 1981, Article 4); the African Union
Maputo Protocol (African Union, 2003,
Article 4(1)); and the American Convention
on Human Rights (OAS, 1969, Article 5(1)).
An array of sexual and reproductive healthand rights matters have been adjudicated byregional human rights courts. For example,
the Inter-American Court of Human Rights
has found violations of the right to bodily
integrity in cases of forced nudity and vaginal
inspections (IACtHR, 2006), threats of rapeand sexually transmissible infection (IACtHR,
2014) and a wide range of other forms ofsexual violence (IACtHR, 2013, 2010).

Obligations of States Parties
Rights to bodily autonomy and integrity
are formally recognized under international
human rights laws and address a range ofreproductive and sexual health and rights
matters. But how do these rights translate
into what governments can, cannot or must
do for the people and populations they serve?
Governments primarily observe their
human rights duties through legislation,
policy and budgetary appropriation; someactions can be taken immediately andothers may be taken progressively over timeso that rights are respected, protected andfulfilled (UN CESCR, 2016; Gruskin andTarantola, 2002).

Remove barriers to individual
decision-making
Respecting the rights to bodily autonomy
and integrity requires governments to ensurethat their laws, policies and programmes
do not infringe on individuals’ ability tomake decisions about their reproductive
and sexual lives. This means removing
barriers that interfere with access tocomprehensive sexual and reproductive
health services, goods, education andinformation (UN CESCR, 2016).
Laws, policies and programming musttake into account the differing needs andvulnerabilities of women, children, LGBTI
communities, migrants, racial and ethnic
minorities and people in rural areas, andensure that measures to protect one groupdo not infringe on others along the way(UN CESCR, 2000).

According to the United Nations Committee
on Civil and Political Rights, criminal laws
related to contraception, comprehensive
sexuality education, abortion and accessing
information about sexual and reproductive
health violate rights to bodily autonomy andintegrity (UN CCPR, 2019; UN CESCR,
2016). Laws that require third-party
authorization or consent (taking account of
the evolving capacities of children) also violate
rights (UN CEDAW, 1999).
Human rights treaty bodies have criticizedStates that have permitted third parties,
whether parents, spouses or others, toobstruct individuals from making decisions
about their own bodies and reproductive
and sexual lives (UN CCPR, 2005).
Human rights treaties and agreements directgovernments not to interfere with “adultconsensual sexual activity in private” or toenact criminal laws against same-sex sexual
activity among adults in “private” (UN CCPR,
1994, para. 8.2). Furthermore, laws that“criminalize” abortion, non-disclosure of HIV
status and transgender identity or expression
run afoul of bodily autonomy and integrity
rights (UN CESCR, 2016, para. 40).
The United Nations Committee on
Economic, Social and Cultural Rights statesthat laws and policies can fulfil a government’s
human rights obligations provided they areenabling and guarantee all individuals accessto affordable, safe and effective contraceptives
and comprehensive sexuality education,liberalize restrictive abortion laws, guarantee
women and girls access to safe abortion
services and quality post-abortion care, andSTAT E OF WOR L D POPUL AT I ON 2 02 1

75

“Conversion therapy”“Conversion therapy” aims to change sexual
orientation and gender identities that do notconform to heteronormative social and cultural
expectations. It employs methods such as “correctiverape”, aversion therapy, chemical castration andhormonal treatments, and even exorcism.

para. 59). He detailed the psychological andphysical pain and suffering conversion therapy
causes and noted that treaty bodies havefound these practices to violate the rights toequality and non-discrimination, health andfreedom from torture and ill-treatment.

In 2020, the Independent Expert on protection
against violence and discrimination based on sexual
orientation and gender identity published a reporton practices of so-called conversion therapy.
In it, he observed that all such practices share“the specific aim of interfering in [an individual’s]
personal integrity and autonomy” (UN HRC, 2020,

The Independent Expert recommended
that States ban the practice of conversion
therapy and take affirmative measures
to protect bodily autonomy and integrity
through interventions including eliminatingprejudice and discrimination against
LGBTI communities (UN HRC, 2020).

Artwork by Kaisei Nanke76

My body, my rights

respect women’s right to make autonomous
decisions about their sexual and reproductive
health (UN CESCR, 2016).

Uphold adolescents’ rights
Having accurate information about one’s own
body and health and understanding what itmeans is indispensable to exercising bodily
autonomy (UN CESCR, 2016). This means
ensuring that adolescents have such access“regardless of their marital status and whether
their parents or guardians consent, withrespect for their privacy and confidentiality”(UN CESCR, 2016, para. 44).
Some States have criminalized child marriage
and sex under the age of 18, in the interestof protecting vulnerable populations from
exploitation or harm (Khosla and others,2017). But human rights advocates are
generally sceptical about criminal prohibitions,despite their symbolic importance, because
they disproportionately affect communities
that are already marginalized and comparatively
disempowered, and have few alternatives.
Advocates instead recommend redressing theconditions that render such individuals andcommunities vulnerable to exploitation in
the first place, such as providing economic
opportunities for young women (Miller andRoseman, 2019).

Establish systems to redressrights violations
Protecting rights to bodily autonomy andintegrity requires a functioning system toredress rights violations. The United Nations
Committee on Economic, Social and Cultural
Rights in 2016 called on governments to put
into place laws, policies and programmes that

accurate
information about
one’s own bodyand health... isindispensable toexercising bodily
autonomy“prevent, address and remediate violationsof the right of all individuals to autonomous
decision-making on matters regarding theirsexual and reproductive health, free fromviolence, coercion and discrimination”(UN CESCR, 2016).
In addition to removing requirements forthird-party authorization to access services andinformation, the Committee called for ending
health-care professionals’ “conscientious
objection” to the provision of services and forrequiring referrals to providers “capable of andwilling to provide the services being sought”(UN CESCR, 2016, para. 43).
Laws that are aligned with human rights
guarantee equal protection for all individuals
aiming to exercise their rights to bodily
autonomy and integrity. But all around the

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77

The languageof violation
In her years as a survivors’

survivors to hospitals andhealth, whether or not

advocate in the United States,

provided hotline counselling.

they consented to a sexual

Leidy Londono has grown

She now works as an educator

encounter. Without the words

accustomed to the language

and programme manager

to identify this experience,of shock, fear and shame thatat Planned Parenthood inthey often express confusion

people use when grappling

Washington, DC. “It canand self-recrimination.

with the aftermath of sexual

take a lot of different forms.

Londono recalled one youngassault. And she has listened

There are explicit attempts toperson who discovered thatto people struggle to put into

impregnate a partner against

their partner had secretly

words one particular form of

their own wishes. It could be

removed a condom during

sexual violation, a phenomenon

about controlling the outcomes

consensual sex—a practicethat is pervasive yet poorly

of a pregnancy, coercing aknown as stealthing. “At

understood, even by thosepartner to have unprotected

first they were like, ‘Am I

who experience or perpetratesex, interfering either explicitly

just exaggerating this?’”it: reproductive coercion.

or implicitly with birth control“It involves behaviours that amethods, or lying or deceit

The concept of reproductive

around birth control methods.”

coercion is relatively new,partner or someone uses towith most studies on themaintain power and control

Survivors lack a common

topic taking place in the lastin a relationship that arelanguage to describe the20 years, often in the Unitedconnected to reproductive

specific violation felt whenStates, where the prevalence

health,” explained Londono,

they are denied ownershipof reproductive coercion is

who has accompaniedof their fertility or sexualestimated at 15 to 25 per“There’s a universal involved here,
and it is male entitlement tocontrol female partners.”

78

My body, my rights

Leidy Londono has worked in person, over the phone and via online chat to provide support and information to survivors of sexual assault.
Original artwork by Naomi Vona; photo © UNFPA/R. Zerzan.

cent (Park and others, 2016).

require husbands’ permission

with the term reproductive

But recent inquiries show

before a woman can use

coercion. Rather, she andthat it is widespread globally,family planning, for example.

health workers and advocates

perpetrated not only by

spoke more generally about

partners but even by families

Dipika Paul has worked for“barriers in family planning”.

and community members

decades as a researcher in(Grace and Fleming, 2016). It

sexual and reproductive healthToday, Paul is an expert in the

may even be abetted by healthin Bangladesh, yet even she

topic. As an adviser at Ipas insystems, via policies thatsays she was not familiar

Dhaka, she sees many forms of

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79

reproductive coercion. “WithJay Silverman, a professor at

Silverman explained, “I also

husbands... it can start with

the University of California,

believe human beings innately

telling them, ‘do not use any

San Diego School of Medicine,resist against being controlled…

contraception’, then women

began his career working

There are many different

will follow their husband’swith men and boys who had

coping strategies that women

opinion. And it also ranges toperpetrated intimate partnerin communities around thesevere violence. Sometimes

violence. He has since studied

world have developed to copehusbands withhold food or

reproductive coercion inwith reproductive coercion,

money if she wants to continue

Bangladesh, India, Kenya, Niger

including women supporting

using contraception,” Paul said.

and the United States. Even

women. That is something that

Often this pressure is related

though reproductive coercion

is just happening organically,

to “husbands’ or other family

may sometimes be carried out

everywhere. It always has,

members’ desire for moreby female family members, thewhether it be a neighbour orchildren or desire for sons”.

violation is rooted in genderfemale family member hiding

Forced use of contraception

inequality, Silverman said.

your pills for you or helping

and forced abortion are
also seen, she added.

you get to a clinic.” Where“There’s a universal involved

clinics give out pamphlets

here,” he explained, “and it isabout reproductive coercion,

These coercive acts are notmale entitlement to control

partner violence and how towidely regarded as forms offemale partners… On someseek help, women often “takeviolence because reproductionlevel, that sense that men

handfuls” so they can share themay be seen as a family

do have, that entitlement to

information with other women.

decision. “In-laws, they playthat control, is somethinga big role,” Paul said. This isthat’s ubiquitous in, I think,

Much of the burden ofparticularly true for younger

most of our societies.”

addressing reproductive

and underage wives; thecoercion falls to service

median age of marriage is 16,

Silverman and his colleagues,

providers, who often face aaccording to a Demographic

including Ipas in Bangladesh,

double bind: they must strike aand Health Survey from 2018.

are piloting tools to help healthbalance between engaging men“It is difficult for young women

workers identify reproductive

in reproductive health matters

to take decisions alone.”coercion, such as questions

without ceding full decision-

about partner attitudes andmaking power to them. “TheAnd yet there is a clear link

behaviour. Once coercion is

ideal of male engagement

between reproductive coercion

acknowledged, women canin sexual and reproductive

and violence. Paul estimates

reassert bodily autonomy by,health and maternal and child

that, in a study she is currently

for example, selecting family

health internationally has

conducting, about three inplanning methods that arebecome a priority,” Silverman

five women who said they

undetectable by a partner.

said. Male involvement

had experienced reproductive

80

has been associated withcoercion also experienced

Even as women lack theincreased family planningsexual or physical violence

language to describe

and contraceptive use andfrom their husbands.

reproductive coercion,

improved maternal and child

My body, my rights

health outcomes (Kriel andothers, 2019; Assaf and Davis,2018). But when men wish tocontrol the reproductive choicesof their partner, “involving men
is obviously detrimental”.
And men—indeed, peopleof all genders and sexual
orientations—can also be victimsof reproductive coercion. “Anyone
can experience reproductive
coercion,” said Londono.
“Women in marginalized
communities experience levelsof violence at disproportionate
rates, and that includes
reproductive coercion… but that
doesn’t negate the fact that I
have talked to young boys andyoung men—men in general—
who are trying to identify theirown experiences and put it intowords and contextualize it.”
Fluency in the language ofreproductive coercion is needed,
particularly among policymakers.
“When our laws and our policies
are vague and our language isambiguous, it doesn’t provide
for survivors,” Londono said.
And learning about bodily
autonomy is also crucial. In one
recent project, Paul said, “wetalked to women, and they chose
this terminology: ‘my body,my rights.’... They all agreed
that we need to disseminate
this among the population—that my body is mine.”world, there are examples where protections
are anything but equal. Violence anddiscrimination against people of diverse sexual
orientation or gender identities, for example, iswell-documented and has been perpetrated by
State and non-State actors (UN HRC, 2016b).
Similarly, women and girls, especially thosefacing intersectional discrimination, suchas those with disabilities or those who aremembers of ethnic or religious minorities,
face higher rates of gender-based violenceand disparities in access to justice and fairpolicing (UN CEDAW, 2015a). Impunity forsexual and gender-based violence, marital rapeand “curative rape” targeted at gender-nonconforming individuals are other egregious
examples of unequal protection under the law(UN CESCR, 2016).

Enabling everyone toexercise the rights to bodily
autonomy and integrity
Fulfilling rights to bodily autonomy andintegrity requires that governments makequality sexual and reproductive healthinformation, services and methods available
and accessible (UN CESCR, 2016, 2000).
According to United Nations treaty bodies,
this would entail services and informationthat support decisions about family formation(contraception, infertility treatment, maternal
health care, safe abortion) and about sexual
health (prevention of sexually transmitted
infections, including HIV, comprehensive
sexuality education, treatment for sexual
dysfunction, prevention of sexual violence
and care for survivors), and gender-affirmative

STAT E OF WOR L D POPUL AT I ON 2 02 1

81

The right toreproductive healthand rights in the
Programme of Action“Reproductive health is a state of complete
physical, mental and social well-being and not
merely the absence of disease or infirmity, inall matters relating to the reproductive systemand to its functions and processes. Reproductive
health therefore implies that people are able tohave a satisfying and safe sex life and that they
have the capability to reproduce and the freedom
to decide if, when and how often to do so. Implicitin this last condition are the rights of men andwomen to be informed and to have access to safe,
effective, affordable and acceptable methods offamily planning of their choice, as well as othermethods of their choice for regulation of fertility
which are not against the law, and the right of accessto appropriate health-care services that will enable
women to go safely through pregnancy and childbirthand provide couples with the best chance of having
a healthy infant. In line with the above definitionof reproductive health, reproductive health care isdefined as the constellation of methods, techniquesand services that contribute to reproductive healthand well-being by preventing and solving reproductive
health problems. It also includes sexual health, thepurpose of which is the enhancement of life andpersonal relations, and not merely counselling andcare related to reproduction and sexually transmitted
diseases.… Reproductive rights embrace certain
human rights that are already recognized in nationallaws, international human rights documents andother consensus documents. These rights rest on

the recognition of the basic right of all couples
and individuals to decide freely and responsibly
the number, spacing and timing of their children
and to have the information and means to doso, and the right to attain the highest standardof sexual and reproductive health. It also
includes their right to make decisions concerning
reproduction free of discrimination, coercion
and violence, as expressed in human rights
documents” (UNFPA, 1994). —Excerpts fromthe Programme of Action of the International
Conference on Population and Development

Artwork by Kaisei Nanke82

My body, my rights

health care (World Professional Association forTransgender Health, 2011).
Services and information, as detailed by theUnited Nations Committee on Economic,
Social and Cultural Rights, must be:• Available—in sufficient quantities;• Accessible—reachable and affordable by all;• Acceptable—sensitive to gender, culture,age and medically ethical;• Quality—meeting scientific and medical
standards of care and delivered with respect
for rights.
Having the means to exercise the rights related
to bodily autonomy and integrity throughreproductive and sexual health services is
inseparable from the recognition of those rights
in the first place. According to the United
Nations Human Rights Council, “Healthsettings must empower users as rights holders to
exercise autonomy and participate meaningfully

and actively in all matters concerning them,to make their own choices about their health,including sexual and reproductive health, andtheir treatment, with appropriate support where
needed” (UN HRC, 2017, para. 43).
International human rights to bodily autonomy
and integrity ensure that every person canmake decisions that affect their sexual andreproductive lives and have the means to do so.
This requires States to provide comprehensive,age- and culturally appropriate information
about sexuality and reproduction, as well as thequality goods and services to effectuate thosedecisions, free from discrimination, coercion
and violence.
Human rights provide the common groundupon which States build their national legal andpolicy standards to promote and protect bodily
autonomy and integrity in the context of sexualand reproductive health. But many States still
have a long way to go to ensure all people havethe power to make their own decisions about
health care, contraception and sex—and about
many other dimensions of bodily autonomy.

STAT E OF WOR L D POPUL AT I ON 2 02 1

83

Artwork by Tyler Spangler

LAWS THATEMPOWERLAWS THATCONTROL
A look at how laws and regulations
impact bodily autonomy
Every country has laws that protect or denybodily autonomy.
Laws can help support bodily autonomy by,for example, guaranteeing everyone’s accessto sexual and reproductive health services,mandating schools to provide comprehensive
sexuality education and requiring informed
consent in the provision of health care.
Governments can also use laws to control
people’s bodies by, for example, limiting
adolescents’ access to sexual and reproductive
health services and information, or forbidding

same-sex relationships. Laws that are notwell formulated or are unclear can also be
detrimental to bodily autonomy, even if
they were not intended to have that effect.
Laws in some countries still require
married women to obey their husbands,
still fall short of making domestic violencea criminal offence, still treat divorce inways giving more rights to men, andstill do not criminalize rape in marriage.
More than 30 countries restrict women’s
right to move around outside the home
(World Bank, 2020).

STAT E OF WOR L D POPUL AT I ON 2 02 1

85

National laws can also be the primary
instruments used by governments to fulfil their
obligations under international human rights
law. But to make these rights meaningful inpeople’s lives, governments must go beyond
enacting laws and take action to effect change.
The World Health Organization has called on
governments to establish supportive legislativeand regulatory frameworks that improve accessto sexual and reproductive health services andremove unnecessary restrictions that have theeffect of preventing women from enjoying theirright to bodily autonomy (WHO, 2004).
Understanding how national legal frameworks
affect bodily autonomy—where they might besupportive and where legal reform might beneeded—is a critical starting point for action.
Sometimes the law changes to reflect evolution
in public opinion; at other times, legal change
precedes changes in societal attitudes, inwhich case substantial social and behaviouralcommunication-change efforts may be required
for the law to become widely accepted and toease implementation. Once a law is enacted, its
intended impact may not be realized for years,
depending on political will or the commitment
to implement or enforce it. Policies may need to
be formulated to add operational detail to thelaw, a budget may need to be allocated, or an
accountability system may need to be created.
Even when a law is broadly supportive, it may
not benefit everyone equally. For example, many
countries have laws that guarantee access to free
antiretroviral therapy to treat HIV, but access to
it may not be universal. In Botswana, treatment
was available to citizens only, including thosein prison, but that excluded prisoners who were86

Laws that empower, laws that control

from other countries. The law changed in 2019
to expand access to all prisoners, regardless ofnationality (UNAIDS, 2019).

Conflicting laws
No single law or policy can be considered inisolation from a country’s entire legal and policy
framework. Many countries, for example, haveage-of-consent laws in relation to sexual activity
that are inconsistent with minimum-age laws
for accessing sexual and reproductive healthinformation and services (Figure 7). This meansthat adolescents may legally have sex before they
can legally access any information or services
relating to safer sex practices or contraception(Sexual Rights Initiative, 2020; Committee on
Adolescence, 2017; Dennis and others, 2009).
Where conflicting laws exist, there may be
confusion about which law takes precedence.
The confusion can sometimes affect not
only individuals but also the people who areresponsible for enforcing it.
Even in the absence of conflicting legislation,lack of clarity can remain a problem. What are
health workers required to do in cases where
they are unsure of their legal obligations or
potential criminal liabilities arising from any
given action? For example, where abortion islegal under certain circumstances, providers
may still be reluctant to provide this service forfear of being accused of breaking the law, andhealth systems’ guidelines and policies may bebased on a more conservative interpretationof the law. Post-abortion care, which 179
governments agreed at the International
Conference on Population and Development(ICPD) in 1994 should be available irrespectiveFIGURE 7

Age of consent for sex and age at which parental consent is not
required for selected services in selected countries
BelizeCroatia

Italy

Jamaica

North
Macedonia

Malaysia

Palau

PolandLegal age of marriage

18

18

18

18

18

18

No minimum
age forcitizens; 18
for others

18

Legal age of marriage with parental,
judicial or other consent

16

16

16

16

16

16

None needed
for citizens;
16 for others

16

Age of consent for sex

16*

15

14

16

14

16*

15

15

Access to abortion withoutparental consent

18

16

18

18

18

18

18

18

Access to emergency contraception
without parental consent

18

16

14

16

18

18

18

18

Access to oral contraception
without parental consent

18

18

14

16

18

18

18

18

* Applies to girls only
Source: Sexual Rights Initiative, 2020
Artwork by Tyler Spangler

When sex is work
“Knowing that I have a say“I visited one of the

Monika, in North Macedonia,

and that I’m in control ofestablished venues for sex

became a sex worker after

my own body, I really only

work and applied to work

she lost her job and got

learned those things after

there,” she said, emphasizing

divorced. She, too, is firm

becoming a sex worker,”that this was her choice.

when she says this was her

Liana explained through a“I did it independently

decision. “I was 19 or 20

translator in Indonesia.

and without force.”

years old. I was sufficiently

By now, Liana is used to

These days, Liana is theabout what I did and what I

shattering expectations; asnational coordinator of OPSI,

didn’t want.” Today—as thea middle-class university

a network that supports sex

regional coordinator of STAR,

graduate and former

workers with services including

the first sex workers collective

accountant, she does nothealth care. OPSI is supported

in the Balkans, also a UNFPA

fit the stereotype of a sex

by UNFPA. “Sex workers are

partner—she says she has

worker. “When my baby was

actually quite diverse,” sheobserved that this is the norm:

four months old, my husband

explained. “There are male

“I am most often surroundedpassed away,” she recalled.

sex workers, transgenderby sex workers who voluntarily

Her income did not stretch

sex workers, and the reasons

engage in sex work.”

far enough and, at the same

people choose to engage intime, her family’s businesssex work vary from person

Still, both Liana and Monika

was struggling and her sisterto person. The majority are

acknowledge that sex

was facing financial hardship.

seeking a source of income.”

trafficking—sexual exploitation

aware and mature to think

through force, coercion, fraud
or deception—is a serious
concern within the industry.
Their respective organizations“I learned that actually,
hey, I can control
my own body. My
body is my own.”

88

Laws that empower, laws that control

work closely with victims
and survivors, helping themto secure services and exit
sex work if they choose.
The prevalence of exploitation
and abuse has driven much of
the conversation around thelegal status of sex work. Bothproponents and opponents ofLiana advocates for the rights of sex workers in Indonesia. Original artwork by Naomi Vona; image courtesy of Liana.

decriminalization cite the needsex industry is inherently

history of childhood poverty,

to protect people from abuses.

fraught. Indeed, studies

abuse and family instability,

show that many entrants

as well as barriers to the

But for opponents of

into sex work haveformal economy, including

decriminalization, theexperienced heightenedlack of education (McCarthy

notion of consent within thevulnerablities, such as aand others, 2014). These

STAT E OF WOR L D POPUL AT I ON 2 02 1

89

conditions are seen as

even while earning decent

not legal and thinking that

undermining their freeincomes outside the sex trade.

we cannot report it and thatand informed consent.

there is nothing we can do”.

Additionally, a significant“Please don’t assume that all

proportion of sex workers—

sex workers are victims of

They want to see theestimated at between 20

trafficking. There are people

criminalization—andand 40 per cent—report

like me who choose this work

prosecution—of sexualentering sex work as

intentionally. We’re not being

violence and exploitation

children (Parcesepe andtricked,” Liana said. “When we

rather than sex work. “Violence

others, 2016), a clear

ask OPSI members whether

is not just an issue among

human rights violation.

they would want to stop sex

sex workers. It’s an issue

work if they could find otherfor all women and minority

Human rights instruments

jobs, most of the time thegroups,” Liana emphasized.

have responded to theseanswer is no.” Other jobs

vulnerabilities. The Convention

available to sex workers are

The movement to decriminalizeon the Elimination of alloften low wage, she explained,

sex work has gained ground

Forms of Discriminationand sex work offers flexibility

in recent years at the United

against Women calls for “allthat many find desirable.

Nations, with many agencies

appropriate measures, including“They can manage their own

and programmes, such as thelegislation, to suppress all

time. They can fulfil their

World Health Organization

forms of traffic in women andobligations in society, and theyand UNAIDS, embracing

exploitation of prostitution of

can feel closer to their kids.”

it as an effective means to

women”. And the Protocols of90

prevent HIV transmission andthe United Nations Convention

Sex work, or aspects of it

end discrimination against

against Transnational(such as facilitation), is illegal

vulnerable populations (WHO,Organized Crime include “thein the majority of countries,

2014; UNAIDS, 2012).

giving or receiving of payments

according to the Global

or benefits to achieve the

Network of Sex Work Projects.

At the same time, the Unitedconsent of a person having

Liana and Monika say such

Nations is stepping up efforts

control over another person forlaws only drive the profession

to eliminate sexual exploitation

the purpose of exploitation”

underground, where sex

and abuse. Concerns overwithin the definition ofworkers have a harder time

peacekeepers and humanitarian

trafficking in persons.

screening out violent clients.

workers entering exploitative

Criminalization also leaves

relationships with sex

But many sex worker advocatessex workers vulnerable toworkers and vulnerable andsay the focus on vulnerability

arrest and fearful of reporting

marginalized individuals haveactually strips away their safety

abusers, they assert. Some

prompted the institution toand autonomy. Both Liana

police also harass and abusestrengthen the enforcement ofand Monika say they freely

sex workers, Monika said,

rules that prohibit staff fromchose to continue sex work“knowing that sex work is

exchanging money, goods or

Laws that empower, laws that control

services for sex, even in countries
where sex work is legal. These
positions—that decriminalization
will help safeguard the healthand rights of sex workers, andalso that staff members must
not purchase sex, even wherelegal—are not contradictory,
say United Nations officials.
“UN personnel must notparticipate in any activity that
could even potentially result insexual exploitation. This is not a
judgment on voluntary sex workby consenting, informed adults,
but we must acknowledge thereality that legality alone does
not ensure that participationin sex work is voluntary,” said
Eva Bolkart, who coordinates
UNFPA’s efforts to prevent
sexual exploitation and abuse.
Monika and Liana agree thatlegality alone is not enough. For
them, decriminalization mustcome alongside destigmatization.
Until sex workers are afforded
the respect and dignity of normal
citizens, they will continue tobe forced to operate in the
shadows, where abuses can be
hidden. “We are parents. We
are someone’s children. We
have families,” Monika said.
“There is no need for anyone totreat us differently from others
because of the choice of our
profession. Sex work is work.”of the legal status of abortion, is still lacking inmany places and is sometimes denied by healthworkers who fear prosecution or stigmatization
for providing services to someone who has had
an illegal abortion.

Structural obstacles
At the structural level, adequate budgets are
critical to ensuring a law’s effectiveness. Mexico,
for example, enacted a law requiring that
contraceptives be available to all, regardless ofage or marital status. Nevertheless, fertility rates
remained high among adolescents, especiallythose from the poorest households. A numberof civil society organizations looked at budgets
for, and spending on, sexual and reproductive
health services at federal and state levels andidentified bottlenecks and inefficiencies inmaking funds available to local programmes. The
analysis led to better earmarking of funds so theyreached poorer communities, where the needfor contraceptive information and services foradolescents had not been fully met (Rajan, n.d.).
Ensuring that health systems have the capacity
to fully implement a law may require actions
ranging from creating medical guidelines
on the provision of services, to training
health workers on the law’s content and its
implications for their work, strengthening
logistics and procurement systems to ensure
uninterrupted access to appropriate drugs
and equipment, ensuring that information
systems can capture data on service uptake,quality and impact, adjusting health financing
mechanisms to promote the affordability ofservices and monitoring the acceptability andquality of services being provided.

STAT E OF WOR L D POPUL AT I ON 2 02 1

91

Societal factors, including religion and gendernorms, can influence the extent to which laws
are implemented or enforced. For example, insocieties where sex before marriage is considered
unacceptable, laws allowing adolescents toaccess contraception may not translate into useof contraception if the stigma associated withteenage sex is too great.
Even where supportive laws exist, otherconcerns may impact people’s ability to protect
their bodily autonomy or access appropriate
health services. People may face immediatechallenges such as hunger, poverty or difficult
living situations. Services may be unaffordable,
childcare may be unavailable, or a husband or
relative may interfere with decisions about healthcare or contraception.
Structural factors that perpetuate or exacerbate
poverty, impede access to education or
employment, and lead to discrimination basedon race, ethnicity, sexual orientation or gender
identity must be understood and addressed bypolicymakers because they can interfere with
the intended benefits of supportive laws forcertain groups. For example, even in countries
where sexual and reproductive health services
are available to all under the law, health-careproviders may nevertheless deny access topeople living with HIV, sex workers, men
who have sex with men or transgender people(UNAIDS, 2017).
Furthermore, individuals may not be aware ofa law or may find it an abstraction far removed
from their daily lives.
Laws and policies can empower women to
make their own decisions and can play an

92

Laws that empower, laws that control

important role in ensuring accountability,
including in health care for diverse populations,by guaranteeing access to justice, redress andreparation mechanisms for people whose humanrights are violated (WHO, 2015).

Indicator 5.6.2 tracks
supportive laws andlegal barriers
To help governments track progress towards
target 5.6 of the Sustainable Development
Goals—to ensure universal sexual andreproductive health and reproductive rights
in line with the ICPD Programme of Action
and the Beijing Platform for Action—the
United Nations developed indicator 5.6.2.
This indicator is an assessment of “the extent
to which countries have laws and regulations
that guarantee full and equal access to womenand men aged 15 years and older to sexualand reproductive health care, information andeducation” (UNFPA, 2020d).
Guided by international human rights law,international consensus documents andhuman rights standards, this composite
indicator seeks to assess the legal environment
related to sexual and reproductive health andrights. It covers four broad topics: maternity
care, contraception and family planning,
comprehensive sexuality education andinformation, and sexual health and wellbeing (Figure 8). Each of the 13 components
within these four topics addresses areas thatare susceptible to regulation by law. For eachof the components, data are collected on theexistence of legal enablers (supportive laws andregulations) and legal barriers. Such barriers

encompass restrictions to supportive laws
and regulations—for example, requirements
for third-party authorization that compel
individuals to obtain consent from a parent,
spouse, judge or medical committee to accesscertain health service.

All aspects of this indicator are relevant tobodily autonomy.
Within each of these components, theindicator assesses whether a supportive
law exists and whether there are potential

FIGURE 8

The four topics and 13 components tracked by indicator 5.6.2

MATERNITY CARECONTRACEPTIONAND
FAMILY PLANNING• Maternity care
• Life‐saving commodities• Abortion• Post‐abortion care

• Contraception• Consent for contraceptive
services• Emergency contraception

INDICATOR

5.6.2

The existence of laws,
regulations or policies thatguarantee full and equal accessto women and men aged
15 years and older to sexualand reproductive health care,information and education

COMPREHENSIVESEXUALITYEDUCATION• Comprehensive sexuality
education law• Comprehensive sexuality
education curriculum

SEXUAL HEALTH
ANDWELL-BEING• HIV testing and counselling• HIV treatment and care
• Confidentiality of healthstatus formen and women
living with HIV• HPV vaccine

STAT E OF WOR L D POPUL AT I ON 2 02 1

93

restrictions, such as limitations according
to age or a requirement for spousal
permission. It also assesses whether there
are plural legal systems—those that are
traditional, customary or determined byreligion—that exist alongside nationallaw and that can restrict the applicabilityof national law for certain populationgroups (UNDESA, 2018).
Thus indicator 5.6.2 capturesinformation on the existence of a
supportive law and also on some
additional factors that might impedethat law’s positive impact. Data on allof these aspects are used to calculate avalue for each country for each of the 13
components, which are then aggregatedup to the four broad topics and then toan overall value (Figures 9 and 10).

94

Guaranteeing sexualand reproductive
health and rights
Data for indicator 5.6.2 and its individualcomponents are reported by 107 national
governments, including national statistics
authorities and line ministries. There are,however, only 75 countries with complete
data for the overall indicator.
Within the overall indicator, each of the four
sections has a different number of reporting
countries: 79 countries for maternity care,
104 countries for contraception and familyplanning, 98 countries for comprehensive
sexuality education and 101 countries for sexual
health and well-being.

The indicator is a percentage scale up
to 100, indicating a country’s status andprogress in the existence of national laws
and regulations to guarantee full andequal sexual and reproductive health andrights. Indicator 5.6.2 measures only theexistence of laws and regulations; it does
not measure their implementation.

In the 75 countries reporting complete data, on
average, 73 per cent of the laws and regulations
needed to guarantee full and equal access tosexual and reproductive health and rights werereported to be in place. However, 20 per cent of
the countries that have enabling laws also haveplural legal systems, which suggests that not
everyone in those countries benefits from theenabling laws.

Among all countries that reported data
for this indicator, the five countries withthe highest overall value for indicator
5.6.2 are Sweden (100), Uruguay (99),
Cambodia (98), Finland (98) and theNetherlands (98). The five countries withthe lowest values are South Sudan (16),Trinidad and Tobago (32), Libya (33),
Iraq (39) and Belize (42).

About 80 per cent of the countries with datareport having laws to protect or support sexual
health and well-being. About 75 per centreport having laws and regulations needed toguarantee full and equal access to contraception.
About 71 per cent have laws guaranteeing
access to overall “maternity care”, which could
include maternal health services and supplies,
abortion or post-abortion care, and 56 per centLaws that empower, laws that control

FIGURE 9

Indicator 5.6.2 combined value (per cent) for 13 sexual and reproductive
health components, by country
54

Afghanistan

82

Albania

87

87

91

98

Cambodia
77

Chad

75

89
57
45
100

Sweden75

92

Switzerland

65

77

Syrian Arab Republic

39

83

Korea, Democratic People's Republic of73

Kyrgyzstan

Ukraine88

United Kingdom

92
99

Uruguay96

Lao People's Democratic Republic

54

Viet Nam

70

Latvia32

Trinidad and Tobago

63

Kazakhstan

73

Togo

83

Japan

63

Yemen

33

40

60

80

91

Zambia88

Lithuania
20

16

Suriname

70

0

95

Sudan

54

Haiti

65

Sri Lanka

93

Guyana86

South Sudan

83

Georgia81
54

South Africa

58

Guinea-Bissau

75

Sierra Leone

98

Finland

Gambia60

Serbia83

Gabon

Palestine*

São Tomé and Príncipe

44

El Salvador

65Saint Vincent and the Grenadines

90

Denmark

94

Pakistan

Philippines

70

Czechia98

New Zealand

53

63

48

Netherlands

97

Côte d'Ivoire

96

Namibia
Nepal

Colombia

62

82

Myanmar

Central African Republic

Costa Rica

94

Mozambique

64

Burundi52

Montenegro

72

Burkina Faso

Libya

73

Mauritius

Benin

Iraq

62

Mauritania

42

Greece90

Malta

Belarus

Egypt

79

Mali

44

Congo, Republic of the45

Maldives

Armenia

Belize81

Malaysia

66

AngolaBarbados

76

Malawi

100

0

20

40

60

80

100

*On 29 November 2012, the United Nations General Assembly passed Resolution 67/19, which accorded Palestine “non-member observer State status in the United Nations...”STAT E OF WOR L D POPUL AT I ON 2 02 1

95

FIGURE 10

Extent to which countries have laws and regulations that guarantee full and equal
access to women and men aged 15 years and older to sexual and reproductive healthcare, information and education (values expressed as percentages)
Maternity CareContraceptive Services

Sexuality Education

HIV and HPV

HPV
VaccineCategory
Average

Overallvalue
for allcategories,
SDG
indicator
5.6.2

100

0

75

54

100

0

70

82

100

100

0

75

66

100

100

100

0

75

–

100

80

100

100

0

70

87

0

0

100

100

100

0

75

–

100

88

94

40

40

75

0

39

–

0

0

0

80

80

100

0

65

44

100

100

100

100

100

100

75

0

69

87

100

100

100

100

100

100

100

100

100

100

–

0

0

0

0

100

50

60

80

100

0

60

42

80

100

50

77

100

100

100

100

100

100

100

100

91

–

80

100

100

93

100

88

94

40

80

100

100

80

–

69

80

0

75

52

100

50

75

60

100

100

100

90

72

79

40

0

75

38

0

100

50

100

100

100

0

75

64

100

94

100

100

100

100

100

100

100

100

100

100

100

100

98

25

100

79

100

100

100

100

0

0

0

–

–

–

0

–

–

100

0

100

75

60

100

50

70

100

88

94

100

100

100

0

75

77

100

100

75

100

94

100

100

100

100

0

0

0

100

100

100

0

75

75

China

100

62

–

100

–

100

100

100

100

–

–

–

100

100

100

0

75

–

Colombia

100

92

75

100

92

100

100

100

100

100

100

100

100

100

100

100

100

97

Congo, Democratic
Republic of the

100

92

–

100

–

80

100

75

85

–

–

–

100

100

100

0

75

–

Congo, Rep of

100

100

-25

0

44

100

100

75

92

0

0

0

60

80

100

0

60

53

Costa Rica

100

77

25

0

50

100

100

0

67

0

0

0

100

100

100

100

100

62

Côte d'Ivoire

100

100

25

0

56

100

100

100

100

0

0

0

100

100

100

0

75

63

Czechia

100

15

100

100

79

0

0

0

0

100

100

100

100

100

100

100

100

70

Denmark

100

100

50

100

88

80

100

75

85

100

100

100

80

80

100

100

90

90

Egypt

100

54

-50

100

51

60

0

50

37

0

0

0

80

80

100

0

65

44

Maternity
Care

Life Saving
Commodities

Afghanistan

100

Albania

100

AngolaAbortion

Category
Average

Contraceptive
Services

92

0

100

73

60

0

50

37

0

0

0

100

100

77

50

100

82

80

100

75

85

100

100

100

80

100

100

62

0

100

65

100

100

100

100

0

0

0

100

Antigua andBarbuda

–

85

0

100

–

0

100

0

33

0

0

0

Armenia

75

100

100

100

94

80

100

100

93

100

100

Australia

100

–

0

100

–

80

100

100

93

0

Bangladesh

0

85

–

100

–

0

0

0

0

Barbados

100

77

75

0

63

60

0

0

20

Belarus

100

85

75

100

90

100

100

100

Belgium

–

–

100

0

–

100

100

Belize

0

100

0

100

50

0

Benin

100

100

50

100

88

Botswana

100

92

–

0

Burkina Faso

75

100

0

100

Burundi

75

92

50

100

Cambodia

100

100

75

Cameroon, Rep of

100

92

Central African
Republic

100

Chad

96

Laws that empower, laws that control

ContraceptiveConsent

Sexuality Sexuality
HIV
HIV
Emergency
Education EducationCounselling Treatment
HIV
ContraCategory Curriculum Curriculum Category and Test and Care Confidenception
Average
Laws
TopicsAverage
Services
Servicestiality

Post–
Abortion
Care

Maternity CareEl Salvador
Equatorial Guinea

Maternity
Care

Life Saving
Commodities

100

100

Contraceptive Services

Sexuality Education

HIV and HPV

Abortion

Post–
Abortion
Care

Category
Average

Contraceptive
Services

ContraceptiveConsent

Sexuality Sexuality
HIV
HIV
Emergency
Education EducationCounselling Treatment
HIV
ContraCategory Curriculum Curriculum Category and Test and Care Confidenception
Average
Laws
TopicsAverage
Services
Servicestiality

-25

100

69

100

100

100

100

100

100

100

100

100

100

HPV
VaccineCategory
Average

Overallvalue
for allcategories,
SDG
indicator
5.6.2

0

75

83

–

100

–

–

–

–

–

–

–

0

0

0

100

100

100

0

75

–

Finland

100

100

75

100

94

100

100

100

100

100

100

100

100

100

100

100

100

98

Gabon

100

100

0

100

75

40

0

25

22

100

100

100

40

100

50

0

48

58

Gambia

100

100

25

100

81

100

100

100

100

100

100

100

40

20

100

100

65

83

Georgia

100

85

75

100

90

100

100

100

100

100

88

94

80

80

100

100

90

93

Germany

100

46

50

75

68

80

100

75

85

–

–

–

100

100

100

100

100

–

Greece

100

62

75

0

59

100

0

0

33

0

0

0

80

80

100

100

90

54

Guatemala

100

85

–

0

–

80

100

75

85

100

100

100

80

80

100

0

65

–

Guinea

100

100

–

100

–

100

100

100

100

–

100

–

100

100

100

0

75

–

Guinea-Bissau

100

100

100

0

75

80

100

75

85

0

100

50

80

80

100

0

65

70

Guyana

100

92

75

100

92

60

100

50

70

100

100

100

60

60

75

0

49

75

Haiti

100

92

0

100

73

80

100

75

85

0

0

0

100

100

100

0

75

65

Honduras

50

–

-25

0

–

80

100

0

60

0

0

0

100

100

100

0

75

–

India

–

85

75

–

–

100

100

100

100

0

0

0

60

100

100

–

–

–

Iran, Islamic Rep of

100

100

0

–

–

100

100

100

100

0

0

0

100

100

100

0

75

–

Iraq

75

77

0

0

38

80

0

0

27

0

0

0

80

100

100

0

70

39

Japan

100

85

0

0

46

100

100

100

100

100

100

100

100

100

100

100

100

83

Kazakhstan

75

69

75

100

80

100

100

0

67

0

0

0

100

100

100

0

75

63

Korea, Democratic
People’s Republic of

75

77

100

100

88

100

100

100

100

100

25

63

100

100

100

0

75

83

Kyrgyzstan

100

92

50

50

73

60

100

50

70

100

88

94

60

100

100

0

65

73

Lao People's
Democratic
Republic

100

100

50

100

88

100

100

100

100

100

100

100

100

100

100

100

100

96

Latvia

100

31

75

0

51

0

100

0

33

100

100

100

100

100

100

100

100

70

Liberia

100

92

–

100

–

80

100

75

85

0

0

0

100

100

100

0

75

–

Libya

75

77

-25

0

32

0

0

0

0

0

0

0

100

100

100

0

75

33

Lithuania

100

92

75

100

92

80

100

75

85

100

100

100

60

60

100

100

80

88

Malawi

25

100

-50

75

38

80

100

100

93

100

100

100

80

80

100

100

90

76

Malaysia

75

77

-25

75

50

80

100

75

85

100

100

100

100

100

100

100

100

81

Maldives

0

92

25

0

29

0

0

0

0

100

63

81

100

100

100

0

75

45

Mali

100

100

50

100

88

80

100

100

93

0

0

0

100

100

100

100

100

79

Malta

100

100

-25

100

69

100

100

100

100

100

100

100

100

100

100

100

100

90

Mauritania

50

85

-25

0

27

100

100

100

100

0

0

0

100

100

100

100

100

62

Mauritius

100

85

50

100

84

60

100

50

70

0

0

0

100

100

100

100

100

73

STAT E OF WOR L D POPUL AT I ON 2 02 1

97

Maternity CareContraceptive Services

Sexuality Education

HIV and HPV

Abortion

Post–
Abortion
Care

Category
Average

Contraceptive
Services

ContraceptiveConsent

Sexuality Sexuality
HIV
HIV
Emergency
Education EducationCounselling Treatment
HIV
ContraCategory Curriculum Curriculum Category and Test and Care Confidenception
Average
Laws
TopicsAverage
Services
Servicestiality

HPV
VaccineCategory
Average

Overallvalue
for allcategories,
SDG
indicator
5.6.2

–

–

0

–

100

100

100

100

100

88

94

–

–

–

100

–

–

75

100

75

100

88

100

100

0

67

100

–

–

80

80

75

100

84

–

Montenegro

75

100

75

75

81

60

0

50

37

0

0

0

80

80

75

0

59

52

Mozambique

100

92

25

100

79

100

100

100

100

100

100

100

100

100

100

100

100

94

Myanmar

100

92

-25

100

67

100

100

100

100

100

100

100

100

100

100

0

75

82

Namibia

100

100

50

100

88

100

100

100

100

100

100

100

100

100

100

100

100

96

Nepal

100

77

50

100

82

100

100

0

67

0

0

0

0

0

100

0

25

48

Netherlands

100

100

75

100

94

100

100

100

100

100

100

100

100

100

100

100

100

98

New Zealand

100

100

25

100

81

100

100

100

100

100

100

100

100

100

100

100

100

94

Niger

100

100

–

100

–

100

100

100

100

100

100

100

80

100

100

100

95

–

Nigeria

–

100

75

0

–

100

100

100

100

100

100

100

100

100

100

100

100

–

Pakistan

100

92

-50

100

61

100

100

100

100

0

0

0

100

100

100

0

75

65

Palestine*

100

77

-50

100

57

80

100

75

85

0

0

0

100

100

100

0

75

60

Peru

100

–

–

100

–

80

100

100

93

100

100

100

100

100

100

100

100

–

Philippines

100

77

-25

100

63

60

100

0

53

100

100

100

80

80

100

100

90

75

Romania

–

–

–

–

–

–

–

–

–

0

0

0

–

–

–

–

–

–

Russian Federation

100

77

–

100

–

100

100

100

100

0

0

0

100

100

100

0

75

–

Saint Lucia

100

92

–

100

–

60

100

50

70

100

100

100

80

80

75

100

84

–

Saint Vincent and
the Grenadines

100

62

25

100

72

80

100

100

93

100

100

100

80

100

100

0

70

81

São Tomé and
Príncipe

0

100

0

100

50

0

0

0

0

100

0

50

100

100

100

100

100

54

Saudi Arabia

75

–

–

–

–

100

100

100

100

–

–

–

100

100

100

0

75

–

Senegal

25

92

–

100

–

40

0

25

22

0

0

0

40

80

75

–

–

–

Serbia

100

92

25

100

79

100

100

100

100

100

0

50

100

100

100

100

100

86

Sierra Leone

100

100

50

0

63

100

100

100

100

0

0

0

100

100

100

0

75

65

Slovenia

100

54

–

100

–

100

100

100

100

–

–

–

100

100

100

100

100

–

Somalia

0

85

–

100

–

0

0

0

0

0

0

0

100

100

100

0

75

–

South Africa

100

100

75

100

94

80

100

75

85

100

100

100

100

100

100

100

100

95

South Sudan

0

100

0

0

25

20

0

0

7

0

88

44

0

0

0

0

0

16

Sri Lanka

100

77

-25

100

63

100

100

100

100

100

100

100

100

100

100

100

100

89

Sudan

100

85

25

100

77

60

0

75

45

0

0

0

100

100

100

0

75

57

Suriname

100

62

0

0

40

60

0

0

20

0

0

0

80

80

100

100

90

45

Sweden

100

100

100

100

100

100

100

100

100

100

100

100

100

100

100

100

100

100

Switzerland

100

100

0

100

75

100

100

100

100

100

100

100

100

100

100

100

100

92

Syrian Arab
Republic

100

85

-50

100

59

80

100

100

93

100

88

94

100

100

100

0

75

77

Maternity
Care

Life Saving
Commodities

Mexico100

Moldova,
Republic of98

Laws that empower, laws that control

Maternity CareContraceptive Services

Sexuality Education

HIV and HPV

Abortion

Post–
Abortion
Care

Category
Average

Contraceptive
Services

ContraceptiveConsent

Sexuality Sexuality
HIV
HIV
Emergency
Education EducationCounselling Treatment
HIV
ContraCategory Curriculum Curriculum Category and Test and Care Confidenception
Average
Laws
TopicsAverage
Services
Servicestiality

HPV
VaccineCategory
Average

Overallvalue
for allcategories,
SDG
indicator
5.6.2

100

–

100

–

100

100

100

100

100

100

100

100

100

100

100

100

–

100

100

50

100

88

100

100

100

100

0

0

0

100

100

100

0

75

73

Trinidad andTobago

25

85

0

25

34

0

0

0

0

100

100

100

40

40

0

0

20

32

Tunisia

100

100

–

100

–

100

–

–

–

0

0

0

0

0

75

0

19

–

Turkey

100

100

0

100

75

80

100

75

85

–

–

–

80

100

100

0

70

–

Ukraine

100

69

75

100

86

100

100

100

100

100

100

100

100

100

100

0

75

88

United Kingdom

100

100

0

100

75

100

100

100

100

100

100

100

100

100

100

100

100

92

Uruguay

100

85

100

100

96

100

100

100

100

100

100

100

100

100

100

100

100

99

Uzbekistan

100

69

75

–

–

100

100

0

67

–

–

–

–

–

–

0

–

–

Viet Nam

50

77

25

0

38

80

0

75

52

0

100

50

100

100

100

0

75

54

Yemen

25

100

0

100

56

100

100

100

100

0

0

0

100

100

100

0

75

63

Zambia

100

100

50

100

88

60

100

75

78

100

100

100

100

100

100

100

100

91

Maternity
Care

Life Saving
Commodities

Tanzania, United
Republic of

100

Togo

Source: UNFPA, global databases, 2020. Based on official responses to the United Nations 12th Inquiry among Governments on Population and Development.
Negative values reflect the existence of more legal restrictions than supportive laws. This may mean, for example, that a country or territory has restrictions on abortion,such as requiring a husband’s consent for a married woman to access abortion, and that it criminalizes obtaining an abortion.
“–” signifies missing data
*On 29 November 2012, the United Nations General Assembly passed Resolution 67/19, which accorded Palestine “non-member observer State status in the United Nations...”say they have laws supporting comprehensive
sexuality education.
Analysis of the overall values for indicator 5.6.2
reveals that countries of any income level can
perform either well or poorly. Countries of any
income level can create a supportive legal andregulatory environment (Figure 11).

Sexual health and well-being
In the context of HIV, almost all countries
reported laws and regulations that guarantee
access to voluntary HIV counselling and testing
services, treatment and care, and protection ofprivacy. But in some of these countries, plural
legal systems may impede access, and some haveage restrictions or require third-party consent.
A little more than 50 per cent of the reporting
countries have laws or regulations in place
to guarantee adolescent girls’ access to theHPV vaccine. A recent review of experience
introducing HPV vaccines in 45 low- andmiddle-income countries showed that successdepended above all on securing political will
and financing, but also required solid planning,social mobilization and clear communications(Howard and others, 2017).

STAT E OF WOR L D POPUL AT I ON 2 02 1

99

Contraception and family planning
Ninety-one per cent of 104 countries reported
having laws and regulations that guarantee accessto contraceptive services, but in a number ofthese countries access depends on a minimum
age, third-party authorization or marital status.

and informed consent of individuals before
receiving contraceptive services, includingsterilization, 9 per cent of these countries
reported plural legal systems that contradictthese laws.

Maternity care
In 12 per cent of 104 countries where laws
protect access to contraceptive services, plural
legal systems contradict the enabling laws
and regulations. Although 87 per cent ofreporting countries reported having laws
and regulations that ensure full, free

The maternity care dimension of indicator 5.6.2
covers four components: laws that guarantee
access to maternity care services, life-saving
medicines and supplies, or “commodities”,
abortion and post-abortion care. Data on eachof these are explored below.
Ninety-five per cent of 79 countries reported
having laws and regulations to guarantee accessto maternity care. However, access to services
in some of these countries depends on marital
status, age or authorization by a third party,
such as a parent or spouse.
Only 44 per cent of these countries
reported that their national essential
medicines list included all 13 of
the commodities deemed by theUnited Nations Commission
on Life-Saving Commodities
for Women and Children
to be “life-saving” acrossreproductive, maternal,
newborn and child health.

Artwork by Tyler Spangler

FIGURE 11

Overall values for indicator 5.6.2 showing that the existence of supportive
sexual and reproductive health laws and regulations does not depend on acountry’s income level (values expressed as percentages)
HIGH-INCOME COUNTRIESUPPER-MIDDLE-INCOME COUNTRIES

Sweden100

Uruguay99

Finland98

Netherlands

98

New Zealand94

Switzerland

92

United Kingdom

92

Malta

90

Denmark

90

Lithuania

88

Japan

83

Mauritius

73

Czechia70

Latvia70

Greece54

Barbados

44

Trinidad and Tobago

32
0

20

40

60

80

Colombia
NamibiaSouth Africa
Georgia
Armenia
BelarusSerbiaAlbania
MalaysiaSaint Vincent and the Grenadines
GuyanaKazakhstan
Costa Rica
Gabon
Montenegro
Suriname
Maldives
Belize
Iraq
Libya

100

LOWER-MIDDLE-INCOME COUNTRIES
98

Mozambique

96

Korea, Democratic People's Republic ofZambia

91

Benin

91

Sri Lanka

89

Ukraine88

El Salvador

83

Myanmar82
75
73

Angola66

Pakistan

65

Côte d'Ivoire

63

Mauritania

62

Viet Nam

54

São Tomé and Príncipe

54

Congo, Republic of the

53

100

94
83
83

Syrian Arab Republic

77

Central African Republic

77

Malawi

76

Chad

75

Togo

73

Burkina Faso

72

Guinea-Bissau

70

Sierra Leone

65

Haiti

65

Burundi

64

Yemen

63

Sudan

48

Afghanistan
South Sudan
60

80

79

44
40

60

Mali

Egypt
20

40

Gambia

Nepal

0

20

LOW-INCOME COUNTRIES

Cambodia

Kyrgyzstan

63
62
58
52
45
45
42
39
33
0

Lao People’s Democratic Republic

Philippines

97
96
95
93
87
87
86
82
81
81
75

80

100

57
54
16
0

20

40

60

80

100

STAT E OF WOR L D POPUL AT I ON 2 02 1

101

Laws aside: thereality of unequal
abortion access“One woman, she washad been able to come towhether a woman will be ablebrought from a remote village

the hospital… you could do

to access a safe abortion.

and she was in very severe

it under local anaesthesia,”

condition… She’d tried toshe said. Instead, her story is

Dr. Ortayli saw thisinduce an abortion by herself,”

about a reality facing women

phenomenon play out both asrecalled Nuriye Ortayli, whoand health providers arounda physician in Turkey and asworked as an obstetrician

the world: abortions happen,

a programme manager andand gynaecologist in Turkey

frequently, even in places

reproductive health adviser forin the 1980s and 1990s.

where the procedure is highly

health organizations, including“Everybody, younger residents,

restricted or illegal (Bearak

UNFPA, in Eastern Europe,

more senior people, tried forand others, 2020), and womenthe Middle East, West Africa

more than 12 hours, close to

are regularly denied access toand the Americas. “We see it

24 hours. We tried everythingsafe abortion even in places

again and again. Independent

we could. But she died.”

where it is legally permittedof the legal status of abortion(Gerdts and others, 2015).

in a country, women makeYet Dr. Ortayli’s story is

No matter the law, then, it

those decisions and they find

not about an illegal, back-is often other factors—sucha way,” she said. “Those whoalley abortion. Safe abortion

as economic resources,

are affluent, somehow they

services were legally available

distance from services ormanage to have better healthin Turkey at the time. “If shesocial norms—that determine

than others, because they“Independent of the legal status ofabortion in a country, women makethose decisions and they find a way.”102

Laws that empower, laws that control

No matter the legal status of abortion, women with means tend to find a way to access the procedure while women without resources face heightened risks.
Original artwork by Naomi Vona; photo by JESHOOTS on Unsplash.

have opportunities, they haveall circumstances in Ireland,said Caitríona Henchion, themoney, they have networks.

large numbers of women who

medical director at the Irish

Those who are disadvantaged

wanted the procedure were

Family Planning Association.

economically or socially orable to travel overseas to obtain

culturally, they suffer more.”it. “In an awful lot of cases, if

For many—even most—

women were determined to

women, the law did not

By contrast, even when abortion

have an abortion, they would

prevent abortion, but it “often

was strictly banned in almost

eventually manage to do it,”might result in a long delay in

STAT E OF WOR L D POPUL AT I ON 2 02 1

103

actually being able to get it,”explained. Still, it was “regular

do not speak English also

Dr. Henchion said. “All of theenough” to receive patients

continue to face challenges.

time that they were waiting

with heavy or prolonged

is a period of great stress andbleeding and “women who

Dr. Ortayli described a similar

anxiety… [and] there would

maybe took abortion pills at

frustration. “I had a private

have obviously been the higher

home at a more advanced

practice for seven or eightrisk attached to the procedure

gestation than either theyyears in Istanbul, and I had

that they were then having.”

thought they were, or than they

many clients coming fromshould have been if they were

the Gulf, where [abortion] isgoing to use that method.”more restricted. Of course,

Those who were unable
to obtain an abortion by

these women were womentravelling internationally wereThese circumstances were

who could afford it.” At the“a, relatively speaking, small

challenging for doctors, Dr.

same time, she knew thatgroup,” she said, “particularly

Henchion recalled. Sometimes,

vulnerable women in her

women who had either poor

patients literally begged

own country were struggling

English or who didn’t have full

for abortion information or

to receive the same level ofcitizenship and those rights

referrals she legally couldcare, whether because ofthat would go with it”—such

not provide. In the end, thedistance to services or spousalas the ability to easily leave therules seemed to create one

permission rules. “I have seen

country and return—“teenagers

outcome for people with money

men sometimes use this as a

who might’ve required

and resources, and anotherweapon towards women. For

parental consent, people

outcome for those without.

example, if a woman wants a

who didn’t have the money”That’s how I always felt,”

divorce, but she gets pregnant,to travel at all… or people

she said. She was a leadingand he doesn’t let her have an

who did not have anybody

proponent for the legalizationabortion in order to tie her up.”that they could disclose [theof abortion in Ireland, a change

pregnancy] to or nobody thatthat took place following

Still, she was glad the option

could have helped them.”a referendum in 2018.

to terminate a pregnancy

Though Dr. Henchion could

But even today, those who are

if access was uneven. She

not provide abortions at themost disadvantaged continue

remembers being bereft whentime, she could and did perform

to experience higher barriers

her patient died following thepost-abortion care, typicallyand greater risks. “There areunsafe abortion. A more senior

after women illegally obtainedsome parts of the country

physician told her it used topills to induce a medicalthat really have almost no

be worse. “He said, before theabortion. “In most cases, it isaccess in terms of providers,”

liberalization of the [abortion]safe and straightforward andDr. Henchion said. Somelaw, in the same ward, we lost

people won’t have problems

women still have to travel towomen like her, maybe two oror complications,” so only aaccess safe abortion, incurring

three of them every week.”

fraction of abortions performed

all the associated delays

this way came to the attention

and costs. Undocumented

And paradoxically, Dr. Henchionof the health system, she

immigrants and people whosays, the legalization of

was available in Turkey, even104

Laws that empower, laws that control

abortion in Ireland has given
many women one more option:
the choice to change theirminds. Before, when women
had to travel internationallyfor an abortion, they mightfeel compelled to undergo theprocedure after spending thetime and resources to arrange it.
“The pressure on them to actually
make the decision was huge…
This is your only chance either
to have it, or don’t.” But today,
she says, “you can actually give
people all of the information andgive them space and time.”
She says these changes makean even bigger difference now
during the COVID-19 pandemic.
“When you think about the[pandemic-related] limitations
on travel, we would be looking ata really, really serious situation
if we hadn’t legalized when
we did… There have been a lotof crisis pregnancies becauseof COVID, people who maybe
have lost jobs or their situations
have totally changed, and they
can still access this care.”Of the 13 commodities on this list, three
are contraceptives—female condoms,
contraceptive implants and emergency
contraception—and their inclusion on
national essential medicines lists was lower
than any of the other 10 commodities.
Ninety-three per cent of the 79 countries
reported that abortion is legal on some or
all grounds, with about 90 per cent of themallowing abortion to save a woman’s life,
about 80 per cent allowing it to preserve awoman’s physical health or in cases of fetal
impairment, and a little more than 60 per
cent allowing it in cases of rape.
The most frequently cited restriction onabortion in these countries is a requirement
for authorization by a medical professional.
This restriction may be construed as
discrimination against people who facebarriers accessing health services in generalor whose health-care providers refuse
to provide abortion because of personalor prevailing societal beliefs against thisprocedure. Medical abortion is one safe
option that does not necessarily require
the direct involvement a doctor. With
this type of abortion, counselling may beprovided by a lay person at pharmacies
where pills are dispensed, by other healthprofessionals, or through telemedicine andsafe-abortion hotlines.
Countries where women can legally accessabortion services and are provided withaccess to information and to all methods ofcontraception, have the lowest abortion rates(UN Working Group on Discrimination
Against Women in Law and Practice, 2017).

STAT E OF WOR L D POPUL AT I ON 2 02 1

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One study drawing on data from 61
countries found that in countries whereabortion is completely banned or allowed
only to save a woman’s life or her physicalhealth, only 25 per cent of abortions
were safe. In countries where abortion islegal on broader grounds nearly 90 per
cent of abortions were safe (Ganatra andothers, 2017). Abortions are consideredsafe when they are carried out by amethod recommended by the World
Health Organization that is appropriate
to the pregnancy duration, and when the
person carrying out the abortion has thenecessary skills. Such abortions can bedone using tablets (medical abortions) or
through outpatient procedures.

Indicator limitations

International declarations such as the
ICPD Programme of Action say that
post-abortion care should be universallyavailable irrespective of the legal status
of abortion. However, only about
80 per cent of the 79 countries withdata have laws or regulations that ensure
access to post-abortion care irrespectiveof the legal status of abortion. This
inconsistency between international legal
frameworks and national laws in somecountries creates gaps in services thatcan contribute to maternal mortality
and morbidity.

All of the laws and regulations assessed underindicator 5.6.2 relate only to the supply sideof health services, which paints a critical but
incomplete picture. What is also needed is adeeper understanding of the laws and manyother forces that support or diminish women’sautonomy and empowerment in general andhow those forces more directly affect thedecision-making power of the individual inmatters of sexual and reproductive health.

Comprehensive sexuality
education and information
Only 62 per cent of reporting countries
have laws, regulations or national policies
that make comprehensive sexuality
education a mandatory component of
national school curricula.

106

Laws that empower, laws that control

No single indicator can ever capture the wholestory with regard to legal and regulatoryenvironments. The complexity of theseframeworks on paper, with multiple laws andregulations impacting health outcomes anda long pathway from the existence of laws totheir full implementation, makes it impossible.
As a result, there are few clear associations
between a country’s performance on indicator
5.6.2 and relevant sexual and reproductive
health outcomes in that country. The datafrom indicator 5.6.2 provide an entry point
for deeper investigation into the strengths andweaknesses of laws and regulations as they exist
on paper, and into their implementation.

Also, indicator 5.6.2 encompasses only
a selection of the areas of health that areassociated with bodily autonomy. The
indicator does not cover laws governing
other important matters, such as rape within
marriage, self-determination in gender
identity, genital surgeries in the case ofintersex infants and same-sex sexual activity.
Other laws governing health-care service
delivery are also relevant to bodily

autonomy but are not included in indicator
5.6.2. These laws include provisions fornon-discrimination, privacy and access tojustice. For example, where people’s identities
or professions might be criminalized, suchas transgender people or sex workers, stigma
and discrimination in health facilities is often
known to be high, acting as a barrier to accessto services that can play a role in protecting
bodily autonomy (Global Commission on
HIV and the Law, 2012).

Recent legal reforms
paving way to changeCountries around the globe are enacting
laws and regulations with the intentionof guaranteeing full and equal sexual andreproductive health and rights. While theimpact of these positive changes is yet to beassessed, they are important first steps towards
ensuring bodily autonomy.
In Tunisia, for example, marital rape was once
not considered a crime. However, in 2017, theParliament passed a comprehensive genderbased violence law that included the explicit
criminalization of marital rape. The new law
also eliminated a pre-existing loophole thatallowed rapists to escape punishment if theymarried the woman (or girl) they had raped(McCormick-Cavanagh, 2017).
In Malta, the 2015 Gender Identity, Gender
Expression and Sex Characteristics Act
recognized a right to “bodily integrity andphysical autonomy” as part of the right togender identity. The law prohibits “anysex assignment treatment and/or surgicalintervention on the sex characteristics of aminor which treatment and/or intervention
can be deferred until the person to betreated can provide informed consent”(Cabral, 2015).
In Ireland in 2015, a law was passed allowing
transgender people over the age of 18 to selfdeclare their gender without the need for a
medical certificate or other interventions bystate authorities (Transgender Europe, 2015).
Ireland was the fourth country in the world,
after Denmark, Malta and Argentina, tointroduce such a law (Heidari, 2015).
And Botswana, in 2019, became the latest
country in Africa to decriminalize same-sex
sexual conduct or acts among consenting
adults, citing rights to privacy, dignity andnon-discrimination (Esterhuizen, 2019).

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107

Artwork by Rebeka Artim

THE POWER
TO SAY YES
THE RIGHT
TO SAY NO
Achieving bodily autonomy depends on genderequality and expanding choices and opportunities
for women, girls and excluded groups
Women and women’s movements have always
known, at the core, that choice is power. And
that there are no more fundamental choices thanthose related to one’s own body.
Claiming the right to make choices seems likea modern concept, but it was in 400 BC that
the Greek gynaecologist Agnodice refused toacknowledge a law banning women physicians
and depriving women of the power of choice.
Taken to court for treating patients anyway,
she won her case, and the law was revoked.

The centuries since then have echoed with thevoices of women insisting on autonomy andchoice, all the way to the women’s movementsof recent decades that have claimed “our bodies,
our choice” as a rallying cry.
Bodily autonomy involves many issues, but they
all come back to the power to make one’s own
decisions. Tracking bodily autonomy under the
Sustainable Development Goals emphasizes
three critical dimensions: the ability to makeyour own decisions on health care, contraception

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109

and sex. But many other issues influencethese decisions. Little progress will be madewithout demolishing an underlying barrier
to making choices: gender discrimination,
which is woven throughout the fabricof our societies, economies and politicalarrangements, sustained by privilege andpower still mostly held by men.
The power to make choices is so importantbecause it underpins many other rights, andbecause the benefits run in many directions.
A woman who can make her own decisions
about sex, contraception and reproductive
health is also likely to enjoy better healthoverall, own property, be gainfully employed,
have more time for leisure and avoid genderbased violence. If she chooses to havechildren, they are more likely to be healthy(UNFPA, 2020e).

The power tomake choices is so
important because
it underpins manyother rights, andbecause the benefits
run in many
directions
110

The power to say yes, the right to say no

There is no question that today womenand girls are starting to face less gender
discrimination. Gains in gender equality
and the choices available to women and girls
are evident everywhere. And yet, the goal ofequality and the power to make decisions
are far from realized. Women and girls facecontinued, blatant violations of their rights,
even more so if they are also experiencing
discrimination because of their race, age,sexual orientation, income or disability status.
Being able to make meaningful decisions
depends on both empowered individuals,
who have information and agency, and on anenvironment, from families to legal systems,
that fully upholds and respects individual
choices. These twin notions sit at the core of
the Programme of Action of the International
Conference on Population and Development(ICPD) and the Beijing Declaration andPlatform for Action. These notions arereflected as well in the 2030 Agenda for
Sustainable Development and the 2019
Nairobi Statement on ICPD25, which called
for protecting and ensuring “all individuals’
right to bodily integrity, autonomy andreproductive rights, and to provide access toessential services in support of these rights”.
Such commitments now serve as touchstones
for a new global Generation Equality campaign
mobilizing around the Beijing Platform’s
twenty-fifth anniversary and committed toachieving gender equality by 2030. Linking
people of all ages and backgrounds, who areoutspoken and passionate in calls for change,
Generation Equality has a chance to see choice
and autonomy finally, irrevocably, reaching
everyone. What is still required to get there?

Autonomy depends
on gender equality
Achieving bodily autonomy for women andgirls depends above all on achieving genderequality. While a bold goal, gender equality isalso an internationally agreed one, as the fifth
Sustainable Development Goal, and as the
purpose of the Beijing Declaration and Platform
for Action. All countries can do more to achieve
gender equality, since none is yet there.
Governments have a lead role to play in reachingthat goal. By fulfilling their obligations underhuman rights treaties, such as the Convention on
the Elimination of All Forms of Discrimination
against Women and the Convention on the
Rights of the Child, governments can alter thesocial, political, institutional and economic
structures that reinforce and thrive on genderunequal norms.
One foundational advance comes from ending
inequalities in civil services, legislatures andleadership positions, so that women’s perspectives
inform and guide policies and regulations
that affect women’s rights and choices. Somecountries have made strides in bringing more
women into elected positions, including throughthe use of quotas and other special measures.
But such shifts can have a greater impact when
they are accompanied by stronger and adequately
financed systems, institutions or “machineries”,
as they are referred to in the Beijing Platform for
Action, for promoting gender equality.
As it stands now, many national machineries forgender equality are poorly funded, or are fundedby donor countries, whose priorities may notalign with those of developing countries. And

while around three quarters of countries claimthat gender equality is central to their national
strategy for implementing the Sustainable
Development Goals, only half involve national
institutions for gender equality in formulatingthese strategies (UN ECOSOC, 2019).
An increasing number of governments, startingwith Sweden in 2014, have adopted a “feminist
foreign policy”. Such a policy, according to
the Centre for Feminist Foreign Policy, is a“multidimensional policy framework thataims to elevate women’s and marginalizedgroups’ experiences and agency….” While anencouraging development, feminist foreign
policy will only make a difference if it goesbeyond “fem-washing”, where rhetoric does
not meet reality.
One place to start might be with official
international development and humanitarianaid. In 2018, only about 4 per cent of the total
aid provided by the 30 largest donors supported
programmes with gender equality and women’s
empowerment as the primary objective.
Looking ahead, an urgent issue will likely
revolve around record levels of public debt.
Many countries are on the cusp of a new wave of
fiscal austerity, affecting, by one pre-pandemic
estimate, almost three quarters of womenand girls globally. Decisions on such austerity
measures rarely reflect alignment with genderequality. They tend to reduce public services,
wages and the overall quality of employment,
hitting poor women with particular force. Even
amid major challenges, governments can shapemonetary and fiscal policies so they protect
services essential to equality and autonomy, andpromote full employment and the creation of

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At UNFPA, realizing bodily autonomy
is everything we do
For over 50 years, UNFPA has been the leading
global champion of the right to bodily autonomy.
As the United Nations sexual and reproductive
health agency, our mission is to deliver a world
where every pregnancy is wanted, every childbirthis safe and every young person’s potential isfulfilled. Our programmes operate in more than150 countries and territories with 80 per centof the world’s population, and all programmes
in one way or another further the realization of
the rights and choices that define autonomy.
For women, girls and young people all over
the world, UNFPA provides accessible andquality health care, a variety of modern
contraceptives, accurate and empowering
information, and protection from harmful
practices such as early marriage and allother forms of gender-based violence.
We are the world’s single-largest providerof donated contraceptives to developing
countries. In 2019, these contraceptives
empowered women to make decisions that
helped avert an estimated 14 million unintended
pregnancies and 3.9 million unsafe abortions.
Our support for women’s maternal healthoptions worldwide is especially significant in
the 32 countries in five regions with the highest
rates of maternal mortality and morbidity.
In 2019, 29,000 midwives received educationand training while 2,700 midwifery tutors
upgraded their skills, expanding affordable,
quality health-care choices for women.

112

The power to say yes, the right to say no

Since early pregnancy is often a consequenceof little or no access to school, information or
health care, UNFPA helps protect and fulfil therights and choices of adolescent girls throughcomprehensive sexuality education and by
advocating for girls to complete their schooling.
Collaboration with UNICEF sustains the world’s
largest global programme to accelerate theabandonment of female genital mutilationin 17 countries where the practice is mostprevalent. Among other achievements, theprogramme has pioneered strategies to shiftsocial norms towards ending a practice that
undermines bodily integrity early in life.
Collaboration with UNICEF also sustains
programmes to eliminate child marriage by 2030.
Every year, as many as 12 million girls are subjectedto this practice, which can undermine their power
to make decisions not only about health care,
contraception and sex, but also about schooling,
livelihoods and participation in community affairs.
As one of the lead entities in the United Nationscommitted to furthering gender equality and women’s
empowerment, UNFPA acts to protect survivors ofgender-based violence, providing a combination of
essential services, including in humanitarian crises.
The realization of bodily autonomy is in somesense the measure of the role of UNFPA in
the world: it is our purpose. And only when
every woman and girl realizes it, without
exception, will our mission be complete.

decent work (UN ECOSOC, 2019), but thiswould in part require latitude in international
debt servicing, something that could be
advocated under a feminist foreign policy.

Autonomy demands
seeing the connections
This report focuses on choices and bodily
autonomy related to sexual and reproductive
health and rights, in line with some of the genderequality targets defined under the Sustainable
Development Goals. This is an important
starting point, since the power to decide inthese areas can determine decisions in manyother parts of life. Women’s choice and bodily
autonomy are compromised on many fronts,
however, and these are highly interconnected
and mutually reinforcing. Industries and entire
sectors of economies, for instance, thrive because
women do tedious, poorly paid jobs in marginal
working conditions that may undermine theirhealth and longevity. Women in many societies
suffer the indignities, if not worse, of sexual
harassment, which can define decisions about
choices to move in or even go to public spaces.
Impetus to consider the diverse elements ofautonomy and the numerous ways they intersect
comes from the new United Nations Action
Coalition on Bodily Autonomy and Sexual andReproductive Health and Rights. An integral
part of preparations for the Generation Equality
Forum to mark the twenty-fifth anniversaryof the Beijing Declaration, the coalition ischarged with putting ambitious actions on
the table to boost improvements in women’s
rights within the next five years. UNFPA is the

Artwork by Kaisei Nanke

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113

that entrench gender discrimination. Women’s
entrepreneurship programmes, for example,
while popular in many quarters and with thepotential to improve women’s economic wellbeing and ability to make choices, can only go so
far without eliminating multiple biases at work
and in social protection systems, health care,
pension schemes, access to assets and financial
services, access to markets and labour protections(UN ESCAP and UN Women, 2020).

Autonomy requires
changing norms andopening opportunities
Important advances have been in madein understanding how to alter the social
norms that keep gender and other forms of
discrimination intact. These include advocacy
and communications campaigns, and workwithin communities to raise awareness about
how everyone—women, men, boys and girls—
can benefit from gender-equal societies.

Artwork by Kaisei Nanke

United Nations agency designated as one of thecoalition’s leaders.
Overall, women and adolescents need more
options that support their choices in immediate
and practical terms, such as through equal
opportunities for high-quality education anddecent work. But even well-intentioned measures
can fall short if they do not make links andactively contribute to transforming systems

114

The power to say yes, the right to say no

The UNFPA-supported MenCare programmein Georgia may be a model that other countries
could adapt to local circumstances. It promotes
men’s involvement as equitable fathers andcaregivers in order to achieve better health andfamily well-being, and encourage men to support
gender equality. It also contributes to better
couples’ communication, consent and decisionmaking, which in turn can foster better bodily
autonomy for women and girls.
Steps like these must be combined with broader,more systemic ones that support and even
incentivize new ways of thinking. Rebalancing
the unfair burden of unpaid care work placed onwomen and girls, for instance, requires not justthat men step up and do their fair share, butthat families enjoy affordable access to essential
services that lighten the load of this kind oflabour, from quality child- and eldercare toreliable water and electricity supplies.

were in decisions related to family law or thefamily, followed by cases of gender-based
violence. This may demonstrate the challenges
courts face in advancing women’s equality inrelation to customs that are widely supported
and practised (UN Women and IDEA, 2017).

Autonomy depends on lawsthat enable, not constrain

Reviewing laws for gender responsivenessand alignment with human rights standards
can be a step towards removing vestigesof discrimination and inequality. In somecountries, a national human rights institution
can comprehensively advise on legal reform,
looking at discrimination in all its forms,
and across civil, political, economic, socialand cultural rights (UNFPA, 2020c). Sucha process could encourage adopting lawsthat guarantee universal access to sexualand reproductive health services without
discrimination of any kind, if these do notalready exist. It could help in removing
contradictions such as requirements forthird-party consent and constraints related tomarital status. Misalignment between the ageof consent for sexual activity and for accessing
sexual and reproductive health information andservices should be resolved, so that as soon asadolescents can legally have sex, they can accessinformation and services.

Laws may not be a panacea for correcting
deficits in choice and autonomy, but they doset standards and ensure accountability byguaranteeing recourse for when those standards
are broken. They can have the greatest impact
when they align with globally agreed humanrights principles and commitments thatcountries have made to women’s rights, genderequality and sexual and reproductive health.
In most countries, having explicit
constitutional commitments to women’s
rights and gender equality opens the door
to correcting discrimination in law andlegal practice. Yet, while 191 constitutions
now include some provisions on equality
and non-discrimination, only 24 havestand-alone provisions on women’s rights(UN ECOSOC, 2019).
Explicit constitutional provisions for
applying international treaties, such as theConvention on the Elimination of All Formsof Discrimination against Women, havebeen successful in advancing women’s rights,
providing an extra source of law to resolve
contradictions domestically. A recent review of
62 court decisions in 30 countries found themost frequent references to the Convention

Making choices must be
upheld in legal practice
Since discriminatory social norms infiltratejustice systems just as efficiently as otherinstitutions in a society, they can lead todiscriminatory outcomes, even if the letter ofthe law is correctly aligned with human rights
and gender equality. The social backdrop can

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in fact be as much of a determinant of justice as
the law itself.
Nepal, for example, has a highly patriarchal
society and acute gender disparities. To
counteract these patterns and ensure that
substantial recent legal reforms supporting
gender equality would actually be implemented,
it has proactively established strong mechanisms
for enforcement and accountability. These haveincluded a National Women’s Commission
mandated by the Constitution to regularly
investigate issues related to women and thelaw. Steps to increase the number of womenpolice officers have encompassed establishingunits of women officers in all 77 districts of thecountry. Since doing so, reporting of domestic
violence cases has increased more than eight-fold(Akhmetova and others, 2020).
There are some indications of growing judicial
recognition that patriarchal rules and practices,
whatever their source, cannot be sustainedin conflict with changing societal attitudes
and constitutional values. A number ofgender-based violence cases have seen courts
defining discrimination based on religious
or cultural grounds as unconstitutional, as
was the case with female genital mutilationin Uganda. In Pakistan, the Lahore High
Court not only rejected an argument based onreligion, but referred to Islamic principles tomaintain the sentence passed for the murderof the perpetrator’s daughter, son-in-law andgrandchild (UN Women and IDEA, 2017).
Moving in such directions requires membersof the judiciary and police not only to be fully
aware of laws designed to uphold women’s rights
and autonomy, but to be able to examine their116

The power to say yes, the right to say noown assumptions and biases, and how these
may operate as they adjudicate or report cases.
With this knowledge, judicial officials can be
encouraged to apply innovative interpretativetechniques, such as analysis that factors insocial context, and routine gender assessmentsof whether groups of women or girls would
be negatively affected by a judgment.
Women and girls also need to be aware of rights
guaranteed by the law and where they can findrecourse if these are violated. Since many issues
around bodily autonomy operate in deeply
personal realms, behind barriers reinforced bynotions of public and private spaces as well as
gender discrimination, it can be important tosupport women’s rights organizations as thevanguard for this outreach. With often better
access to women in families and communities,
they can help provide a bridge between womenand their legal rights. They can also detect
patterns of discrimination among marginalizedgroups that could potentially be rectified throughpublic interest legislation.

Choices in health care
centre on the patient
Women and girls cannot realize bodily autonomy
without access to health care, including essential
sexual and reproductive health services. Twentysix years ago, the Beijing Declaration, thepolitical statement accompanying the Platform
for Action, recognized that “the right of all
women to control all aspects of their health, inparticular their own fertility, is basic to theirempowerment”. More recently, the Sustainable
Development Goals set the first global goal forachieving universal health coverage, defined asArtwork by Hülya Özdemir

all people accessing the essential health services
they need, without being exposed to financial
hardship (Hogan and others, 2017).

and using sound data to adapt services and social
protection to different population groups as well
as needs across the life cycle.

Universal health coverage depends on prioritizingcare in national development planning,developing effective health systems, providing
adequate budgetary allocations, and generating

But given the ways in which gender
discrimination operates, including in healthsystems, universal health coverage that supports
bodily autonomy must go beyond the notion

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that it is enough to provide services based solely
on narrow definitions of medical needs, without
attention to gender dynamics that influence
those needs as well as health-seeking behaviour.
As the Beijing Platform for Action noted,“Women’s health is also affected by gender bias
in the health system and by the provision of
inadequate and inappropriate medical services
to women.” Similar issues apply to people
with disabilities and those with diverse sexual
orientations and gender identities, and others.
While much attention has been paid towhether health services are technically soundand affordable, there is often less emphasis on
acceptability, safety and empowerment fromthe perspective of women and girls as users.
Tolerance or acceptance of discriminatory
norms can quickly lead health-care providers
to put aside the notions of informed consent
and patient autonomy, which require themto support and educate patients to makechoices, without making decisions for them(Bernstein, 2018). Outcomes may include thedenial of services, such as a refusal to provide
contraceptives or safe abortion or post-abortion
care to unmarried girls and women, even wherethat is not against the formal law, as well asobstetric violence, defined as experiencing, inpregnancy or childbirth, mistreatment or being
forced into procedures against one’s will, at thehands of medical personnel.
A number of options can help correct biases inhealth care. Medical guidelines can stipulate how
services should be provided in line with the law;training can make health-care workers aware oflegal statutes so they can work in line with them.
Specific gender-sensitivity training for healthcare providers could include developing skills to

118

The power to say yes, the right to say nounderstand, probe and respond to the barriers
to choice faced by some patients. Regularmonitoring for compliance with principles of
non-discrimination and quality of care could
include patient monitoring, such as throughsimple text message surveys.
Services that support choice and autonomy
offer multiple options for contraception, ensurethat if women prefer a female doctor they will
be able to find one, and provide channels tocommunicate with health-care providers in avariety of languages. Posting a patient bill ofrights emphasizing dignity, rights and choices
in hospitals and health-care service centres, with
provisions to communicate this information to
women who are illiterate or have a disability,
sets a tone that services are grounded in whatpatients want and decide. Service relevanceis also key, underscoring the importance ofprioritizing health-care interventions that
respond to demand from patients, starting witha strong focus on groups with the highest unmet
need for sexual and reproductive health care or
low service use. Also needed is an environmentthat enables sexual and reproductive healthworkers, the majority of whom are women,
to do their jobs with professionalism andcompassion.
Encouraging service use and the exercise of
choice also depends on basic elements of quality
health care, such as proximity, convenient
operating hours and affordability. Services must
guarantee privacy and employ health workers
with positive attitudes and full respect for theirclients. Providing family planning services
through community health workers who sharecorrect information and help educate men has
been shown to increase uptake of contraceptives

(UNFPA, 2019). Community-level advocacy ofthe health benefits of sexual and reproductive
health information and services for unmarriedadolescents can diminish stigma and foster use.
Uganda’s “SASA!” programme, backed by
UNFPA, uses multiple forums to catalyse
community-led changes in norms andbehaviours that perpetuate gender inequality,
violence and increased HIV vulnerability among
women. Health workers, local authorities andactivists start with a critical analysis of power andinequalities, and then introduce concepts learned
through community conversations, door-to-door
discussions, film shows, soap opera groups andother events. The programme has significantly
decreased social acceptance of intimate partner
violence, and increased agreement that a woman
can refuse sex. Rates of physical intimate partner
violence among women in communities withthe programme have fallen by up to 52 per cent(Starmann and others, 2017; Kyegombe andothers, 2014).
Midwives offer potentially unique opportunities
as primary caregivers for pregnant women
all over the world. They also provide a hostof other services essential to realizing sexualand reproductive health and rights, fromcounselling on family planning to screening fornutrition and cervical cancer. In their practices,midwives, almost all of whom are women, canmodel and shift norms around what choice
and bodily autonomy can mean, especially ifthey themselves are skilled and empowered.
Since they may have a clearer sense of theissues that other women face around bodily
autonomy, health-care systems should encouragechannels where they can share knowledge
that supports more gender-responsive service

delivery. Midwifery also requires continued
and scaled-up investment in cultivating,deploying and retaining skilled practitioners.
All health-care systems need to respond to theways in which gender discrimination intersects
with other forms of exclusion to undermineautonomy and choice. If left unrecognized,
this can result in services that are inappropriate
or not available or are even based on blatantrights violations. This danger has been realized,
for instance, by many indigenous women andwomen with disabilities, who have been subject
to practices such as forced sterilization. To
rectify disempowerment and discrimination, theUnited Nations Inter-Agency Support Groupon Indigenous Issues has emphasized several
measures to ensure indigenous peoples fully
realize their sexual and reproductive healthand rights, including through their active
engagement in designing culturally appropriate
health policies and programmes. This has
increased access among indigenous women,
girls and youth to critical services for sexualand reproductive health, HIV prevention andgender-based violence, especially in rural andunderserved areas (UN IASG, 2014).

Autonomy requires
information
Realizing bodily autonomy depends on theability not just to make choices, but to makeinformed choices, grounded in a careful
weighing of facts and options. Women withmore education are more likely to maketheir own decisions about contraception
and health care, and to be able to say no tosex. With less education than her husband

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or partner, a woman is more likely to facesexual violence. Further, a correlation exists
between women and girls with more accessto mass media and using contraception
and seeking health care (UNFPA, 2019).
Among 75 countries with data on laws
and regulations supporting sexual andreproductive health, fewer than two
thirds have statutes or policies making
comprehensive sexuality education mandatory
in national school curricula. Such education
is age-appropriate, based on a clearly defined
curriculum, aligned with human rights andgender equality, and culturally relevant.
It is ideally available in and out of school(UNESCO and others, 2018).
The United Nations Educational, Scientificand Cultural Organization stresses that
evidence-based comprehensive sexuality
education from early childhood encourages
greater autonomy and safety during young
adulthood without leading to earlier sexual
activity (UNESCO, 2009). Comprehensive
courses can support more respectful
relationships and more autonomous decisions
about sexuality late in life (Marí-Ytarte andothers, 2020).
Since much information on sex andreproduction can come from health-careproviders, they need to be attuned to offering
it respectfully and without judgment, andaccounting for different needs based on age,ability or socioeconomic standing. This isparticularly necessary for adolescents and othergroups who have been traditionally overlookedor marginalized in access to sexuality education.
Providers should be prepared to counter myths

120

The power to say yes, the right to say nothat circulate and undermine the ability tomake informed choices. One novel approachbeing pursued by UNFPA in Colombia and thePhilippines is to “scrape” Twitter conversations
to identify common myths about issues fromcontraception to sexually transmitted infections.
This information can then be used to shapesexuality education and health-care programmes.
Reinforcing empowering messages around choice
could operate in education more broadly byencouraging girls to pursue diverse fields of study,
unfettered by gender norms around what “girls
should do”. Making such a choice is empoweringin and of itself, and could lead to further
empowerment and autonomy as girls cross into
potentially more lucrative and rewarding jobs.
Much of the current gender pay gap is explainedby labour market segregation that shunts women
into lower-paying jobs. A mere 3 per cent ofstudents joining information and communication
technology courses across the globe are women,
for instance (United Nations, n.d.a).

Autonomy demands
defending the defenders
of women’s empowerment
and rights
Women’s movements have long advocatedand defended the right to choice and bodily
autonomy, often with minimal resources.
The same is true for organizations of LGBTI
people, indigenous peoples, youth and people
with disabilities. Today, however, space forthem to operate is increasingly under pressure,and there is evidence of backtracking on
hard-won gains. More vocal and organizedopposition to gender equality and women’s
rights activism has emerged around theworld, including by religious and conservative
groups, populist and nationalist groups,
men’s rights groups and anti-gender ideology
movements (Roggeband and Krizsán, 2020).
Women politicians, journalists, activists
and human rights defenders have been
increasingly subject to harassment, violence
and cyberbullying. Between 2014 and 2018,
the Special Rapporteur on Human Rights
Defenders issued 181 communications to
60 States on women human rights defenders.
Documented attacks have included defamation
campaigns; physical or sexual violence,
torture, killings and forced disappearances;
threats to and attacks on family members,
or by family members, because of theiractivities; and attacks against their collectives
and movements (UN ECOSOC, 2019).
Decisive action should counter and prevent
such violations. Some countries have passed
specific laws criminalizing violence against
women in politics and public life, often
under pressure from women’s activists, as in
Costa Rica, Ecuador, Mexico and Peru. The
Organization of American States in 2017
issued its Inter-American Model Law on thePrevention, Punishment and Eradication ofViolence against Women in Political Life.
Since the fear of violence is a major deterrent
to women taking more public roles in many
places, adopting and implementing measures
like these could reshape the conditions underwhich women can participate, lead and makechoices. Complementary actions might include
advocacy campaigns and work with media
and schools to eliminate gender stereotypes.

Political parties should be encouraged
to recognize women’s political value andrights, and move beyond lip service andtokenism (O’Neil and Domingo, 2016).
Women’s groups and movements arehighly diverse, with enormous stores ofknowledge about the issues women face inrealizing autonomy and rights. But fromgrass-roots service providers to women’s
professional associations, they are notalways well connected. Sustained supportand resources to systematically bring them
together could advance organizing aroundcommon problems (O’Neil and Domingo,2016) and presenting a more unified,powerful response to regressive forces.

Women politicians,
journalists,
activists andhuman rights
defenders have been
increasingly subject
to harassment,
violence andcyberbullying
STAT E OF WOR L D POPUL AT I ON 2 02 1

121

Similarly, bodily autonomy presents aunifying concern for diverse groups ofactivists, including around disability,
LGBTI rights and the rights of indigenous
communities. Linking different issues andthe intersections among them could shapea collective, influential agenda and activism
for realizing fundamental human rights
in all economic priorities, justice systems,
health and social services and safety nets.

Autonomy requires shifts
in men’s attitudes
Women can claim their rights. States canuphold them. Yet progress fundamentallydepends on men, individually and collectively,
being willing to step away from dominatingroles that privilege their power and choices atthe expense of women’s power and choices.
This is now happening, with a shift in attitudes
towards gender equality among younger men inparticular, but still has far to go.
Part of the way forward may be moremen understanding the downside of maledominance, such as risks to their own healthand that of their wives or partners, andinterpersonal conflicts. A regional survey ofEurope by the World Health Organization
found that gender equality benefits men’s
health, including through lower mortality
rates, half the chance of being depressed anda 40 per cent reduced risk of violent death(WHO Regional Office for Europe, 2018).
Adolescent boys in particular need exposure
to positive notions of masculinity, especiallyat a time of life when harmful gendernorms start to crystallize, causing long-term
harm to themselves and girls (UNFPA and
Promundo, 2016).
The #MeToo movement as well as survey data
show that one of the areas where women are
most behind in terms of choice and autonomy
is in the power to say no to sex. Notions ofrespectful, non-violent relationships are ideallymodelled to children in households fromthe beginning, but regardless, they should be
integral to comprehensive sexuality educationin school. They can feature more prominently

Artwork by Rebeka Artim

in the media and entertainment, in the ways
religion is taught, and even in workplaces interms of clear and enforced policies on sexual
harassment. Ending impunity for sexual
violence in all its forms, from single violations
to the mass crimes that occur when rape isused as a weapon of war, is also essential. In
2000, the United Nations Security Council
issued Resolution 1325, which called on parties
to armed conflict to take special measures toprotect women and girls from gender-based
violence, particularly rape and other forms ofsexual abuse, and all other forms of violencein situations of armed conflict. Since then,the Security Council has issued seven other
resolutions condemning this form of violence.
Improving women’s opportunities forlivelihoods and leadership roles in theircommunity and beyond can increase theirpower to make decisions within households
and about their bodies. Such support may
need to build in explicit work with men andcommunities, however, to ease a transition tomore progressive gender norms and limit therisk of backlash from some men who may feelthreatened by women’s gains.
Another important element is to engage menin transforming patterns of unpaid care, sothat it is not performed primarily by women,
and household dynamics in power and choice
to achieve greater equilibrium. Paternity andparental leave policies can encourage men toparticipate in caregiving, especially if leavecannot be transferred to the other parent.
These provisions are becoming more common,but still reach a limited number of families
in developing countries, particularly in theinformal workforce. Public policies could also

Gender equality
benefits men’s
health, including
through lower
mortality rates,
half the chanceof being depressed
and a 40 per centreduced risk ofviolent death
do more to encourage men to breakstereotypes and enter female-dominatedcare professions such as child- and eldercare(UN ECOSOC, 2019).
Other opportunities exist to promote genderequitable attitudes among men and adolescentboys through sexual and reproductive healthservices, where providers can share knowledge
about equitable relationships, parenting andcommunications (IPPF and UNFPA, 2017).
Community mobilization programmes canalso challenge unequal power relations anddiscriminatory social norms, building on a strong
grounding in theories of gender and power.
Initiatives involving women, men, girls and boys
together have proven more effective than thosefor men and boys alone (UN ECOSOC, 2019).

STAT E OF WOR L D POPUL AT I ON 2 02 1

123

The masculinit y trap
The lush beauty of Guatemala’s

according to Georgetownin the United States, national

central highlands hides

University’s 2019 Women,

media reported that she wasa dark reality for women

Peace and Security Index. In

known to dress inappropriately

and girls, says Alexander

fact, victims around the world

for her age. In Afghanistan, rape

Armando Morales Tecún, an

are routinely blamed for inviting

survivors may be imprisoned

indigenous youth educatorgender-based violence by being

for “morality crimes”.

and gender equality advocate

in the wrong place, wearing

in the rural department of

the wrong clothing, behaving

The blaming and shaming of

Quiché. “In many places,

the wrong way or simply being

victims rather than perpetrators

women are blamed if theyphysically developed at an

can be traced back to norms

are attacked, said to haveearly age. And such factors arethat encourage men to take

tempted or seduced theiroften considered mitigating orcontrol—not only of women’saggressors or rapists, because

exculpatory for perpetrators.

bodies but also of their families.

of the way they are dressed,

Tecún recalled asking a groupfor example, or because

In 1998, for instance, Italy’sof young men why they wantedof their way of acting.”

Supreme Court overturned theto get married. One of themrape conviction of a man whose

answered, “I want to rule my

These attitudes are not uniqueaccuser was wearing tight blue

family. Because I want someone

to Guatemala, which ranks injeans at the time of the attack.

to cook for me, someone tothe bottom third of countries

In 2010, when an 11-year-old

wash my clothes, someone

and territories on measures ofgirl was gang-raped by more

to give me children andwomen’s safety and welfare,than a dozen boys and men

someone to keep my house.”
Jay Silverman, a professor“Women are blamed
if they are attacked,
said to have temptedor seduced theiraggressors or rapists.”

124

The power to say yes, the right to say noat the University ofCalifornia, San Diego Schoolof Medicine who studies
reproductive coercion, saysthese attitudes are universal.
“Male entitlement to control
female partners often also
extends to children. The
perception of that right ismaintained by all sorts ofdifferent structures andAlexander Armando Morales Tecún educates young people about gender equality. Original artwork by Naomi Vona; photo © UNFPA/J. Serrano.

norms in communities andgender norms—which heare not in a relationship,nations across the globe.”

calls “a hegemonic model

you are not a man.”of masculinity”—can leave
But the result is not a simple

men feeling trapped, as

And women play a role inmale-versus-female dynamic,

well. “If you are not married,

perpetuating these beliefs

Tecún cautioned. Theseyou are not a man. If you

as well, he added. “Many

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125

women also reaffirm that it isis born, a good creole chicken

negative ideas because it

acceptable to beat a woman

broth is made. When a girlaffects the patriarchal malewhen she has not fulfilled her

is born, it is totally silent, as

chauvinist system,” he said.

duties, because she did not

if the event were a wake.”

wash her husband’s clothes,Zúñiga wants men and boys

because her husband’s foodAnything that undermines

to embrace new norms

was burned… It is said thatthese norms—includingthat liberate both men and

it is good that they beat you

the very concept of bodily

women from traditional

because you did not comply

autonomy—can be regarded

masculine ideals. “What ourwith satisfying your husband.”as a threat, according tosociety deserves… are new

Romeo Alejandro Méndez

masculinities, new ways of

These ideas are instilled early

Zúñiga, another indigenous

seeing manhood, ways thatand reinforced “from music,

youth educator and activist

strengthen and promote

games, images, advertising,”

in Quiché. “The few people

equality of opportunity for

Tecún said. “In the locality

who have heard of bodily

development, that enable allwhere I am from, when a boy

autonomy associate it withof us to live with dignity.”

Autonomy requires
investment
Gender discrimination poses multiple
steep barriers to women’s empowerment
and autonomy. Taking these down requires
substantial and sustained investment, in linewith principles of fairness and equity, and withparticular attention to intersecting inequalities.
Yet financing typically falls far short of what itshould be, for reasons that start with economies
structured to concentrate resources in a few
privileged hands, mostly belonging to men.
Substantial and sustained investments in
integrated social protection, health and126

The power to say yes, the right to say no

education services could address the multiple
risks and vulnerabilities that women andgirls face throughout their lives, and build in
empowerment and autonomy by putting acentral emphasis on sexual and reproductive
health and rights (UN ECOSOC, 2019). Suchapproaches have never been more important
than in COVID-19 recovery plans, with poor
and increasingly desperate families struggling
to cope with the economic downturn by, forexample, marrying off their daughters.
National gender equality action plans andinstitutions for gender equality need adequate
resources, as many remain chronicallyunderfunded and unable to fulfil theirmandates (UN ECOSOC, 2019). So do
women’s civil society organizations, which
are often on the front lines of protecting
women’s autonomy and rights. They provide
many of the services to assist survivors ofgender-based violence, for instance, yetwere significantly underfunded even before
the COVID-19 pandemic. While the needfor such services rose dramatically during
the crisis, funding in many cases did not.
In the Asia and the Pacific region, 12 percent of civil society organizations working
on eliminating violence against womencompletely suspended their services as aresult, and 71 per cent are only partiallyoperational (UN ESCAP and UN Women,2020). Smaller groups doing pioneering work
and with a dedicated women’s rights agenda
tend to be among those most often missed byinternational aid and other donors.
The price tag for ending preventable maternal
deaths, covering all unmet needs for familyplanning and stopping gender-based violence
worldwide by 2030 will total $264 billion,
according to a joint study by UNFPA andJohns Hopkins University, in collaboration
with Victoria University, the University ofWashington and Avenir Health. Achieving
these goals would contribute to women’sbodily autonomy (UNFPA, 2020f ).

Autonomy means
measurement
The Sustainable Development Goals represent
an advance in calling for the measurement ofprogress on gender equality, including whether
women and adolescent girls can make choices

about their bodies. Yet gaps in data broken
down by gender remain large. Gender data
may not be collected, or if they are, may
not be used or shared. Inconsistencies incollection prevent essential analysis of how
trends move over time.
This lack of information on what is actually
taking place in the lives of women and girls
automatically diminishes the possibility ofdeveloping services and policies that mosteffectively support gender equality andautonomy. It can be a driver of discrimination
where issues like gender-based violence andunpaid care work remain invisible, uncounted
and unaddressed.
Only an estimated 13 per cent of countries
have a dedicated budget to collect and analyse
gender statistics. For the 54 gender-specificindicators in the Sustainable Development
Goals, regular data are produced for only
22 per cent worldwide (UN Women, 2018).
Major shortfalls exist in data on women over
reproductive age; digital literacy among girls;
and gender and the environment, among
others (Data2x, 2020).
Women’s informed decision-making ispoorly measured, and data are missing or not
regularly produced on women’s use of healthservices as well as on laws guaranteeing fulland equal access to sexual and reproductive
health care. Also missed are intersectional
needs, especially for women and adolescent
girls in humanitarian crises, LGBTI
individuals and women with disabilities.
Health data for adolescents are not always sexdisaggregated, and data on socially excluded
girls are particularly scarce (Data2x, 2020a).

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127

Data systems need to be strategically designed
to capture the common experiences ofwomen and girls, while being nuanced
enough to reflect their diversity (Data2x,2020). Such systems need to be systematicand comprehensive, and should apply humanrights principles to prevent marginalizationand discrimination, a direction that should
be set through national policy.
Another priority is to avoid compartmentalizing
gender within certain issues or areas of work,
which is happening even now under the
Sustainable Development Goals, where six of
17 goals are dubbed “gender-blind”, meaningthat they make no mention of gender eventhough achievement of the goal will require
addressing some aspects of gender inequality(UN Women, 2018). More questions
reflecting broader dimensions of choice
and bodily autonomy could be includedin national surveys. Measurement also falls
short in capturing links across the global
goals (Data2x, 2020), a problem reflected
as well in the “sectoral” divisions of manynational statistical systems.
Bolstering investment in gender data requiresa fully funded national gender action plan
covering all sources of data and statistics, andguided by measurable milestones. Work withnational statistics offices could start by clearly
demonstrating the value of collecting genderdata and addressing sex differentials within
important administrative data such as civil
registration and vital statistics, building onsome momentum now evident on the issue(Pryor, 2020).

128

The power to say yes, the right to say no

A world of rights,
choices, autonomy
Many justifications, rationalizations and theories
have been put forward to justify depriving
women and girls of their rights and choices andfor making their bodies subject to the whimsof others. But if these excuses are allowed tocontinue, virtually none of the United Nations
Sustainable Development Goals will beachieved by 2030. And that means the potential
for human, social and economic progressenvisioned by the international community inthe 2030 Agenda for Sustainable Development
would go unrealized, to everyone’s detriment.
Gender equality is a critical variable in theequation for success. So is realizing the rightsof people who identify as LGBTI, people
with disabilities, and anyone else who isdiscriminated against or denied autonomy
because of their race, ethnicity or economic
status. Everyone should have the power tomake their own decisions about health care,
contraception and sex.
Governments, all social and economic
institutions, communities, families and men
have roles in upholding women’s rights andending discrimination more broadly. All
must do a better job. The new “Generation
Equality” is here, and it won’t wait for change.
Nor should it.
Individuals alone have the right to decideand make choices about their bodies andlives. They alone have the right to say yesor no. We together can make it happen.

Artwork by Rebeka Artim

Tracking Progress Towards ICPD Goals

Sexual and Reproductive HealthMaternal
mortality
ratio (MMR)(deaths per
100,000 live
births)aRangeof MMR
uncertainty(UI 80%),lower
estimatea

Rangeof MMR
uncertainty(UI 80%),upper
estimatea

Birthsattendedby skilled
healthpersonnel,
per cent

Number of
new HIV
infections,
all ages,per 1,000
uninfected
population

Contraceptive
prevalence rate, women
aged 15–49, per centANY
METHOD
All Married
or in
union

MODERNMETHOD
All Married
or in
union

Unmet needfor familyplanning,
women aged
15–49, per centAll

Married
or in
union

Proportionof demandsatisfiedwith modern
methods, allwomen aged
15–49

Laws and regulations
that guarantee
access to sexual andreproductive healthcare, information andeducation, per centCountries,
other areas
World and territories,
regional areas

2017

2017

2017

2014–2019

2018

2021

2021

2019

World

211

199

243

81

0.24

49

63

45

57

9

11

77

73

More developed regions

12

11

13

99

–

59

71

53

62

7

9

80

84

Less developed regions

232

219

268

79

–

47

62

43

56

9

12

76

69

Least developed countries

415

396

477

61

0.58

32

42

28

37

16

20

59

71

Arab States

151

121

208

90

–

34

53

29

45

10

16

65

53

Asia and the Pacific

120

108

140

85

–

52

67

48

62

7

9

80

72

Eastern Europe and Central Asia

20

18

22

99

–

46

64

36

49

8

12

66

82

Latin America and the Caribbean

74

70

80

94

–

59

75

56

70

8

10

83

66

East and Southern Africa

391

361

463

64

–

34

43

31

39

16

21

62

75

West and Central Africa

717

606

917

55

–

20

22

17

18

17

22

46

70

2021

2021

UNFPA regions

Countries, territories, other areas

2017

2017

2017

2014 –2019

2018

2021

2019

Afghanistan

638

427

1010

59

0.02

19

26

17

23

17

24

47

54

Albania

15

8

26

–

–

31

44

4

5

12

17

10

82

Algeria

112

64

206

–

0.03

35

64

31

57

6

9

76

–

Angola

241

167

346

47

1.01

16

17

15

15

27

36

35

66

Antigua and Barbuda

42

24

69

100

–

45

64

43

61

10

13

78

–

Argentina

39

35

43

94

0.15

60

71

57

67

9

11

84

–

Armenia

26

21

32

100

0.06

39

59

21

31

8

12

44

87

Aruba

–

–

–

–

–

–

–

–

–

–

–

–

–

Australia

6

5

8

97

0.04

59

67

57

64

8

11

85

–

Austria

5

4

7

98

–

65

70

62

68

6

8

88

–

Azerbaijan

26

21

32

99

–

37

57

15

22

9

14

32

–

Bahamas

70

48

110

99

0.55

45

67

43

65

9

12

80

–

Bahrain

14

10

21

100

–

31

67

21

46

5

10

59

–

Bangladesh

173

131

234

53

0.01

55

66

48

57

9

11

75

–

Barbados

27

17

39

99

0.58

50

63

47

61

12

14

76

44

Belarus

2

1

4

100

0.22

61

70

52

58

6

8

78

87

Belgium

5

4

7

–

–

59

67

58

66

6

8

90

–

Belize

36

26

48

94

0.81

44

57

42

53

14

18

71

42

Benin

397

291

570

78

0.34

17

18

14

14

25

31

33

91

Bhutan

183

127

292

96

0.11

39

60

38

58

8

13

80

–

Bolivia (Plurinational State of)

155

113

213

72

0.13

48

67

35

49

12

16

59

–

Bosnia and Herzegovina

10

5

16

100

0.01

38

49

19

21

11

14

38

–

Botswana

144

124

170

100

4.36

57

69

56

68

8

10

86

–

Brazil

60

58

61

99

–

65

80

63

77

6

7

89

–

Brunei Darussalam

31

21

45

100

–

–

–

–

–

–

–

–

–

Bulgaria

10

6

14

100

0.05

65

79

50

57

5

7

71

–

Burkina Faso

320

220

454

80

0.12

30

34

29

33

20

24

58

72

Burundi

548

413

728

85

0.16

19

31

17

28

17

28

47

64

Cambodia

160

116

221

89

0.05

43

63

32

46

7

11

63

98

Cameroon, Republic of

529

376

790

69

1.02

27

23

22

17

16

23

51

–

Canada

10

8

14

98

–

74

82

70

77

3

5

91

–

Cape Verde

58

45

75

92

0.19

49

68

47

65

11

11

79

–

Central African Republic

829

463

1470

–

1.20

23

26

17

20

18

22

42

77

130

Indicators

2021

2021

2021

Tracking Progress Towards ICPD Goals

Sexual and Reproductive HealthMaternal
mortality
ratio (MMR)(deaths per
100,000 live
births)aCountries, territories, other areas

Range
of MMR
uncertainty(UI 80%),lower
estimatea

Rangeof MMR
uncertainty(UI 80%),upper
estimatea

Birthsattendedby skilled
healthpersonnel,
per cent

Number of
new HIV
infections,
all ages,per 1,000
uninfected
population

Contraceptive
prevalence rate, women
aged 15–49, per centANY
METHOD
All Married
or in
union

MODERNMETHOD
All Married
or in
union

Unmet needfor familyplanning,
women aged
15–49, per cent
All

2021

Married
or in
union

2021

Proportionof demandsatisfiedwith modern
methods, allwomen aged
15–49

Laws and regulations
that guarantee
access to sexual andreproductive healthcare, information andeducation, per cent

2017

2017

2017

2014–2019

2018

2021

2021

2019

Chad

1140

847

1590

24

0.44

7

8

6

7

18

24

25

75

Chile

13

11

14

100

0.27

63

77

59

71

6

8

85

–

China

29

22

35

100

–

69

85

67

83

4

3

91

–

China, Hong Kong SAR

–

–

–

–

–

48

70

45

67

8

9

81

–

China, Macao SAR

–

–

–

–

–

–

–

–

–

–

–

–

–

Colombia

83

71

98

99

0.14

64

82

60

77

6

7

87

97
–

Comoros

273

167

435

–

0.00

20

27

16

22

19

29

41

Congo, Democratic Republic of the

473

341

693

80

0.21

23

25

12

12

21

26

28

–

Congo, Republic of the

378

271

523

91

1.03

42

43

28

27

15

19

50

53

Costa Rica

27

24

31

99

0.21

55

73

53

71

9

11

84

62

Côte d'Ivoire

617

426

896

74

0.70

26

26

23

22

21

27

49

63

Croatia

8

6

11

100

0.02

51

71

36

47

7

8

63

–

Cuba

36

33

40

100

0.15

70

75

69

74

7

8

89

–

Curaçao

–

–

–

–

–

–

–

–

–

–

–

–

–

Cyprus

6

4

10

98

–

–

–

–

–

–

–

–

–

Czechia

3

2

5

100

0.05

63

85

56

76

3

4

85

70

Denmark

4

3

5

95

0.02

65

78

61

74

5

7

88

90

Djibouti

248

116

527

–

0.57

16

29

16

28

15

27

50

–

Dominica

–

–

–

100

–

–

–

–

–

–

–

–

–

Dominican Republic

95

88

102

100

0.26

57

72

55

70

9

10

84

–

Ecuador

59

53

65

96

0.13

60

81

54

73

6

6

82

–

Egypt

37

27

47

92

0.04

44

61

43

59

9

12

81

44

El Salvador

46

36

57

100

0.11

52

73

49

69

8

10

81

83

Equatorial Guinea

301

181

504

–

4.21

17

17

15

14

23

31

37

–

Eritrea

480

327

718

–

0.15

9

14

9

13

18

29

32

–

Estonia

9

5

13

99

0.23

57

65

52

58

7

11

81

–

Eswatini

437

255

792

–

8.62

54

68

53

66

10

13

83

–

Ethiopia

401

298

573

28

0.24

29

42

29

41

15

21

66

–

Fiji

34

27

43

100

–

35

51

30

44

12

16

65

–

Finland

3

2

4

100

0.04

79

82

74

78

3

5

91

98

France

8

6

9

98

0.09

65

78

63

75

4

4

91

–

French Guiana

–

–

–

–

–

–

–

–

–

–

–

–

–

French Polynesia

–

–

–

–

–

–

–

–

–

–

–

–

–

Gabon

252

165

407

–

1.01

38

37

30

27

18

24

53

58

Gambia

597

440

808

–

1.06

11

15

11

15

17

25

39

83

Georgia

25

21

29

99

0.18

32

47

24

34

13

19

52

93

Germany

7

5

9

99

0.03

61

78

60

78

5

5

91

–

Ghana

308

223

420

78

0.70

27

36

23

31

19

26

51

–

Greece

3

2

4

100

–

54

74

39

50

6

7

64

54

Grenada

25

15

39

100

–

45

64

42

59

10

13

76

–

Guadeloupe

–

–

–

–

–

46

60

41

53

11

15

73

–

Guam

–

–

–

–

–

42

66

36

56

7

10

75

–

Guatemala

95

86

104

70

0.14

42

64

36

53

9

13

70

–

Guinea

576

437

779

55

0.52

12

10

10

9

20

25

33

–

Guinea-Bissau

667

457

995

45

1.43

29

20

27

19

16

20

60

70

Guyana

169

132

215

96

0.51

34

46

32

44

17

25

63

75

STAT E OF WOR L D POPUL AT I ON 2 02 1

131

Tracking Progress Towards ICPD Goals

Sexual and Reproductive HealthMaternal
mortality
ratio (MMR)(deaths per
100,000 live
births)aRangeof MMR
uncertainty(UI 80%),lower
estimatea

Rangeof MMR
uncertainty(UI 80%),upper
estimatea

Birthsattendedby skilled
healthpersonnel,
per cent

Number of
new HIV
infections,
all ages,per 1,000
uninfected
population

Contraceptive
prevalence rate, women
aged 15–49, per centANY
METHOD
All Married
or in
union

MODERNMETHOD
All Married
or in
union

Unmet needfor familyplanning,
women aged
15–49, per centAll

Married
or in
union

Proportionof demandsatisfiedwith modern
methods, allwomen aged
15–49

Laws and regulations
that guarantee
access to sexual andreproductive healthcare, information andeducation, per centCountries, territories, other areas

2017

2017

2017

2014–2019

2018

2021

2019

Haiti

480

346

680

42

0.69

28

38

26

35

23

34

50

65

Honduras

65

55

76

74

0.09

52

76

47

67

7

9

78

–

Hungary

12

9

16

100

0.02

49

70

45

63

6

9

81

–

Iceland

4

2

6

98

0.05

–

–

–

–

–

–

–

–

India

145

117

177

81

–

43

57

39

51

9

12

74

–

Indonesia

177

127

254

95

0.17

44

62

42

59

8

11

81

–

Iran (Islamic Republic of)

16

13

20

99

0.05

58

81

46

65

4

5

75

–

Iraq

79

53

113

96

–

37

56

26

39

9

13

57

39

Ireland

5

3

7

100

0.08

66

71

63

66

6

9

88

–

Israel

3

2

4

–

0.05

39

74

30

56

5

8

68

–

Italy

2

1

2

100

0.05

59

67

48

51

7

9

73

–

Jamaica

80

67

98

100

–

42

68

40

64

9

11

78

–

Japan

5

3

6

100

0.01

48

56

41

44

12

16

68

83

Jordan

46

31

65

100

0.00

30

54

22

38

8

14

56

–

Kazakhstan

10

8

12

100

0.14

43

53

40

51

11

15

75

63

Kenya

342

253

476

62

1.02

46

64

45

62

12

14

77

–

Kiribati

92

49

158

–

–

20

26

16

21

18

26

44

–

Korea, Democratic People's Republic of

89

38

203

100

–

58

74

55

71

8

9

84

83

Korea, Republic of

11

9

13

100

–

56

81

51

73

6

5

82

–

Kuwait

12

8

17

100

0.04

41

60

34

49

9

14

67

–

Kyrgyzstan

60

50

76

100

0.09

29

41

27

39

13

18

66

73

Lao People's Democratic Republic

185

139

253

64

0.08

39

61

34

54

8

11

74

96

Latvia

19

15

26

100

0.19

61

72

54

62

6

9

81

70

Lebanon

29

22

40

–

0.02

29

62

21

46

6

12

61

–

Lesotho

544

391

788

87

7.80

53

66

52

65

11

15

81

–

Liberia

661

481

943

–

0.39

28

30

27

29

25

28

51

–

Libya

72

30

164

–

0.07

25

39

16

25

17

26

38

33

Lithuania

8

5

12

100

–

46

66

38

53

8

11

70

88

Luxembourg

5

3

8

–

0.09

–

–

–

–

–

–

–

–

Madagascar

335

229

484

46

0.24

41

50

36

44

15

16

65

–

Malawi

349

244

507

90

2.28

48

64

48

63

13

15

77

76

Malaysia

29

24

36

100

0.18

35

57

25

41

9

14

57

81

Maldives

53

35

84

100

–

15

22

12

17

22

30

33

45

Mali

562

419

784

67

0.78

18

19

17

19

21

24

45

79

Malta

6

4

11

100

–

64

85

50

66

4

3

74

90

Martinique

–

–

–

–

–

47

62

43

56

11

14

74

–

Mauritania

766

528

1140

69

0.03

12

18

11

16

18

29

35

62

Mauritius

61

46

85

100

0.70

43

67

28

43

8

10

56

73

Mexico

33

32

35

96

0.08

56

73

53

70

9

10

82

–

Micronesia (Federated States of)

88

40

193

–

–

–

–

–

–

–

–

–

–

Moldova, Republic of

19

15

24

100

0.25

53

64

42

50

9

12

67

–

Mongolia

45

36

56

99

0.01

41

56

37

51

13

15

70

–

Montenegro

6

3

10

99

0.08

26

26

18

15

17

22

43

52

2021

2021

2021

Morocco

70

54

91

87

0.03

43

71

37

61

7

11

74

–

Mozambique

289

206

418

73

5.25

26

28

25

27

19

22

56

94

Myanmar

250

182

351

60

0.20

33

58

33

56

8

14

78

82

132

Indicators

Tracking Progress Towards ICPD Goals

Sexual and Reproductive HealthMaternal
mortality
ratio (MMR)(deaths per
100,000 live
births)aRangeof MMR
uncertainty(UI 80%),lower
estimatea

Rangeof MMR
uncertainty(UI 80%),upper
estimatea

Birthsattendedby skilled
healthpersonnel,
per cent

Number of
new HIV
infections,
all ages,per 1,000
uninfected
population

Contraceptive
prevalence rate, women
aged 15–49, per centANY
METHOD
All Married
or in
union

MODERNMETHOD
All Married
or in
union

Unmet needfor familyplanning,
women aged
15–49, per centAll

Married
or in
union

Proportionof demandsatisfiedwith modern
methods, allwomen aged
15–49

Laws and regulations
that guarantee
access to sexual andreproductive healthcare, information andeducation, per centCountries, territories, other areas

2017

2017

2017

2014–2019

2018

2021

2019

Namibia

195

144

281

–

2.82

52

61

52

60

10

15

83

96

Nepal

186

135

267

58

0.03

43

55

38

48

17

21

63

48

Netherlands

5

4

7

–

0.03

63

73

61

71

6

7

89

98

New Caledonia

–

–

–

–

–

–

–

–

–

–

–

–

–

New Zealand

9

7

11

97

0.03

65

80

61

75

5

5

88

94

2021

2021

2021

Nicaragua

98

77

127

96

0.07

53

82

51

79

5

6

88

–

Niger

509

368

724

39

0.08

16

19

16

18

16

18

49

–

Nigeria

917

658

1320

43

0.65

17

20

13

15

15

19

41

–

North Macedonia

7

5

10

100

0.02

40

48

21

21

13

17

40

–

Norway

2

2

3

99

0.02

67

86

63

80

4

4

89

–

Oman

19

16

22

99

0.07

21

35

14

24

15

26

40

–

Pakistan

140

85

229

69

0.11

25

37

19

28

12

17

52

65

Palestine1

–

–

–

100

–

41

62

31

47

7

11

65

60

Panama

52

45

59

93

0.32

48

60

45

56

14

17

73

–

Papua New Guinea

145

67

318

56

0.26

28

38

23

32

18

25

51

–

Paraguay

84

72

96

98

0.16

58

72

54

67

8

9

82

–

Peru

88

69

110

92

0.10

55

77

42

57

5

7

70

–

Philippines

121

91

168

84

0.13

36

57

27

43

10

16

58

75

Poland

2

2

3

100

–

53

73

43

57

6

8

72

–

Portugal

8

6

11

99

0.07

61

75

52

65

7

7

78

–

Puerto Rico

21

16

29

–

–

57

82

52

74

6

5

82

–

Qatar

9

6

14

100

–

30

48

26

40

10

16

64

–

Réunion

–

–

–

–

–

49

72

48

71

9

9

83

–

Romania

19

14

25

97

0.04

55

72

45

58

5

8

75

–

Russian Federation

17

13

23

100

–

49

68

41

57

6

10

75

–

Rwanda

248

184

347

91

0.29

34

58

31

53

12

17

69

–

–

–

–

100

–

–

–

–

–

–

–

–

–

Saint Lucia

117

71

197

100

–

49

61

46

57

12

15

76

–

Saint Vincent and the Grenadines

68

44

100

99

–

50

67

48

64

10

12

80

81

Samoa

43

20

97

83

–

17

29

16

27

24

41

39

–

San Marino

–

–

–

–

–

–

–

–

–

–

–

–

–

130

73

217

93

–

36

46

33

43

21

27

59

54
–

Saint Kitts and Nevis

São Tomé and Príncipe
Saudi Arabia

17

10

30

99

–

19

30

15

24

15

25

44

Senegal

315

237

434

74

0.08

22

31

21

29

16

22

56

–

Serbia

12

9

17

98

0.02

49

56

33

30

10

13

56

86

Seychelles

53

26

109

–

–

–

–

–

–

–

–

–

–

Sierra Leone

1120

808

1620

87

0.55

28

25

27

25

20

24

57

65

Singapore

8

5

13

100

0.04

40

69

36

61

6

10

77

–

Sint Maarten

–

–

–

–

–

–

–

–

–

–

–

–

–

Slovakia

5

4

7

98

0.02

56

79

48

66

4

6

79

–

Slovenia

7

5

9

–

–

54

80

45

67

6

5

76

–

Solomon Islands

104

70

157

86

–

24

33

20

27

13

17

54

–

Somalia

829

385

1590

–

0.03

16

27

7

12

16

27

23

–

South Africa

119

96

153

97

4.94

50

58

50

57

11

14

82

95

South Sudan

1150

789

1710

–

1.56

6

8

5

7

20

30

21

16

4

3

5

–

0.07

60

63

58

62

9

13

84

–

Spain

STAT E OF WOR L D POPUL AT I ON 2 02 1

133

Tracking Progress Towards ICPD Goals

Sexual and Reproductive HealthMaternal
mortality
ratio (MMR)(deaths per
100,000 live
births)aRangeof MMR
uncertainty(UI 80%),lower
estimatea

Rangeof MMR
uncertainty(UI 80%),upper
estimatea

Birthsattendedby skilled
healthpersonnel,
per cent

Number of
new HIV
infections,
all ages,per 1,000
uninfected
population

Contraceptive
prevalence rate, women
aged 15–49, per centANY
METHOD
All Married
or in
union

MODERNMETHOD
All Married
or in
union

Unmet needfor familyplanning,
women aged
15–49, per centAll

Married
or in
union

Proportionof demandsatisfiedwith modern
methods, allwomen aged
15–49

Laws and regulations
that guarantee
access to sexual andreproductive healthcare, information andeducation, per centCountries, territories, other areas

2017

2017

2017

2014–2019

2018

2021

2019

Sri Lanka

36

31

41

100

0.01

45

67

37

55

5

7

74

89

Sudan

295

207

408

78

0.13

11

16

10

14

18

28

34

57

Suriname

120

96

144

98

0.49

33

46

33

45

15

23

68

45

Sweden

4

3

6

–

–

62

73

57

66

6

8

84

100

2021

2021

2021

Switzerland

5

3

7

–

–

72

73

68

69

4

7

89

92

Syrian Arab Republic

31

20

50

–

0.00

37

62

28

46

8

13

62

77

Tajikistan

17

10

26

95

0.09

24

32

22

29

16

22

55

–

Tanzania, United Republic of

524

399

712

64

1.41

36

44

32

39

16

20

61

–

Thailand

37

32

44

99

0.09

56

80

54

78

4

5

91

–

Timor-Leste, Democratic Republic of

142

102

192

57

–

19

32

17

29

14

24

52

–

Togo

396

270

557

69

0.70

24

26

22

24

22

31

48

73

Tonga

52

24

116

–

–

20

37

17

32

13

25

52

–

Trinidad and Tobago

67

50

90

100

–

40

49

36

45

14

20

66

32

Tunisia

43

33

54

100

0.02

30

58

26

50

7

13

69

–

Turkey

17

14

20

98

–

48

71

33

49

7

10

61

–

Turkmenistan

7

5

10

100

–

37

55

34

51

10

14

74

–

Turks and Caicos Islands

–

–

–

–

–

–

–

–

–

–

–

–

–

Tuvalu

–

–

–

–

–

–

–

–

–

–

–

–

–

Uganda

375

278

523

74

1.40

35

45

32

41

19

25

59

–

Ukraine

19

14

26

100

0.28

53

68

44

55

6

9

74

88

United Arab Emirates

3

2

5

100

–

36

51

29

41

12

17

60

–

United Kingdom

7

6

8

–

–

73

82

67

74

4

5

87

92

United States of America

19

17

21

99

–

64

76

57

67

5

6

83

–

United States Virgin Islands

–

–

–

–

–

52

75

49

70

8

8

81

–

Uruguay

17

14

21

100

0.26

57

79

55

77

6

7

87

99

Uzbekistan

29

23

37

100

0.16

49

69

46

65

6

9

83

–

Vanuatu

–

–

–

–

–

36

48

31

41

15

20

61

–

Venezuela (Bolivarian Republic of)

125

97

170

99

–

56

76

52

71

8

10

82

–

Viet Nam

43

32

61

94

0.06

59

80

50

67

4

5

79

54

Western Sahara

–

–

–

–

–

–

–

–

–

–

–

–

–

Yemen

164

109

235

–

0.04

27

43

20

31

15

24

48

63

Zambia

213

159

289

63

2.97

37

53

35

50

15

18

68

91

Zimbabwe

458

360

577

86

2.79

49

69

49

68

8

10

85

–

134

Indicators

Tracking Progress Towards ICPD Goals

Sexual and Reproductive Health
NOTES− Data not available.
a The MMR has been rounded according to the following scheme: <100, rounded tonearest 1; 100–999, rounded to nearest 1; and ≥1,000, rounded to nearest 10.
1	 On 29 November 2012, the United Nations General Assembly passed Resolution
67/19, which accorded Palestine “non-member observer State status in the
United Nations...”DEFINITIONS OF THE INDICATORS
Maternal mortality ratio: Number of maternal deaths during a given time period per
100,000 live births during the same time period. (SDG indicator 3.1.1)
Births attended by skilled health personnel: Percentage of births attended by skilled
heath personnel (doctor, nurse or midwife). (SDG indicator 3.1.2)

MAIN DATA SOURCES
Maternal mortality ratio: United Nations Maternal Mortality Estimation Interagency Group (WHO, UNICEF, UNFPA, The World Bank and the United Nations
Population Division).
Births attended by skilled health personnel: Joint global database on skilledattendance at birth, 2020, United Nations Children’s Fund (UNICEF) and World HealthOrganization (WHO). Regional aggregates calculated by UNFPA based on data fromthe joint global database.
Number of new HIV infections, all ages, per 1,000 uninfected population: UNAIDS.
Contraceptive prevalence rate: United Nations Population Division.
Contraceptive prevalence rate, modern method: United Nations Population Division.

Number of new HIV infections, all ages, per 1,000 uninfected population: Number of
new HIV infections per 1,000 person-years among the uninfected population. (SDG
indicator 3.3.1)

Unmet need for family planning: United Nations Population Division.

Contraceptive prevalence rate: Percentage of women aged 15 to 49 who are
currently using any method of contraception.

Laws and regulations that guarantee access to sexual and reproductive healthcare, information and education: UNFPA.

Proportion of demand satisfied with modern methods: United Nations Population
Division.

Contraceptive prevalence rate, modern method: Percentage of women aged 15 to 49
who are currently using any modern method of contraception.
Unmet need for family planning: Percentage of women aged 15 to 49 who want tostop or delay childbearing but are not using a method of contraception.
Proportion of demand satisfied with modern methods: Percentage of total demand
for family planning among women aged 15 to 49 that is satisfied by the use of modern
contraception. (SDG indicator 3.7.1)
Laws and regulations that guarantee access to sexual and reproductive healthcare, information and education: The extent to which countries have national laws
and regulations that guarantee full and equal access to women and men aged 15
years and older to sexual and reproductive health care, information and education.
(SDG indicator 5.6.2)

STAT E OF WOR L D POPUL AT I ON 2 02 1

135

Tracking Progress Towards ICPD Goals

Gender, Rights and Human CapitalWorld
and territories,
regional areas
Countries,
other areas

Adolescentbirth rate per
1,000 girls
aged 15–19

Childmarriageby age 18,
per cent

Femalegenitalmutilation
prevalence
among girls
aged 15–19,
per cent

Intimate
partnerviolence,
past 12months,per cent

DecisionTotal net
Gendermaking onenrolment
parity index,
sexual and rate, primary
total net
reproductive education,
enrolment
health andper cent
rate, primary
reproductive
educationrights,per cent

Total netenrolment
rate, lower
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, lower
secondaryeducation

Total netenrolment
rate, upper
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, upper
secondaryeducation2020
2003–201820192005–20192019
2004–20182018
2000–20192020
2007–201820192010–20202019
2010–20202019
2010–201920192010–201920192009–201920192009–2019

World

41

20

–

13

55

–

–

85

1.00

65

0.99

More developed regions

12

–

–

–

–

–

–

98

1.00

93

1.01

Less developed regions

45

27

–

–

54

–

–

83

1.00

62

0.99

Least developed countries

91

38

–

22

50

–

–

66

0.97

44

0.89

Arab States

48

20

55

–

–

–

–

81

0.94

60

0.91

Asia and the Pacific

23

26

–

–

59

–

–

87

1.02

63

1.03

Eastern Europe and Central Asia

27

12

–

–

75

–

–

96

0.99

85

1.00

Latin America and the Caribbean

61

25

–

–

74

–

–

93

1.00

79

1.03

East and Southern Africa

95

32

24

–

53

–

–

66

0.96

44

0.84

West and Central Africa

108

39

23

–

37

–

–

62

0.96

43

0.86

UNFPA regions

Countries, territories, other areas

2003–2018

2005–20192004–2018

2000–20192007–20182010–2020

2010–2020

2010–20192010–20192009–20192009–2019

Afghanistan

62

28

–

46

–

–

–

–

–

44

0.56

Albania

16

12

–

–

69

98

1.04

96

1.05

82

1.07

Algeria

10

3

–

–

–

100

0.99

–

–

–

–

Angola

163

30

–

26

62

82

0.78

76

0.76

18

0.71

Antigua and Barbuda

28

–

–

–

–

99

1.01

99

0.99

87

1.02

Argentina

54

–

–

–

–

100

0.99

100

1.00

90

1.10

Armenia

21

5

–

4

66

91

1.00

90

1.02

89

1.15

Aruba

26

–

–

–

–

100

1.00

–

–

–

–

Australia

10

–

–

2b

–

100

1.00

98

1.00

92

1.04

Austria

7

–

–

4c

–

100

1.00

100

1.00

90

1.01

Azerbaijan

45

11

–

10

–

92

1.03

100

1.00

100

1.00

Bahamas

29

–

–

–

–

76

1.02

71

1.02

67

1.06

Bahrain

14

–

–

–

–

98

0.99

96

1.07

87

1.14

Bangladesh

74

59

–

29

–

95

1.11

74

1.10

62

1.08

Barbados

50

29

–

–

–

99

0.98

95

1.04

95

1.05

Belarus

14

5

–

–

–

99

0.98

99

1.00

99

1.02

Belgium

6

–

–

8c

–

99

1.00

99

0.99

99

1.00

Belize

64

34

–

–

–

100

1.01

90

0.98

64

1.04

Benin

108

31

2

14

36

94

0.94

66

0.78

44

0.63

Bhutan

28

26

–

7

–

96

1.03

88

1.15

72

1.16

Bolivia (Plurinational State of)

71

20

–

27

–

93

1.00

87

0.99

79

1.00

Bosnia and Herzegovina

11

4

–

–

–

–

–

–

–

79

1.04

Botswana

50

–

–

–

–

89

1.01

–

–

–

–

Brazil

53

26

–

–

–

96

0.99

97

1.00

85

1.07

Brunei Darussalam

10

–

–

–

–

99

1.01

97

1.00

82

1.04

Bulgaria

38

–

–

9c

–

87

1.00

87

0.99

88

0.95

Burkina Faso

132

52

58

9

20

78

0.99

54

1.08

34

1.04

Burundi

58

19

–

28

44

92

1.04

66

1.08

35

1.15

Cambodia

57

19

–

9

76

91

1.00

87

0.98

–

–

Cameroon, Republic of

119

31

0.4

22

38

92

0.91

63

0.89

46

0.83

136

Indicators

Tracking Progress Towards ICPD Goals

Gender, Rights and Human CapitalCountries, territories, other areas

Adolescentbirth rate per
1,000 girls
aged 15–19

Childmarriageby age 18,
per cent

Femalegenitalmutilation
prevalence
among girls
aged 15–19,
per cent

Intimate
partnerviolence,
past 12months,per cent

DecisionTotal net
Gendermaking onenrolment
parity index,
sexual and rate, primary
total net
reproductive education,
enrolment
health andper cent
rate, primary
reproductive
educationrights,per cent

Total netenrolment
rate, lower
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, lower
secondaryeducation

Total netenrolment
rate, upper
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, upper
secondaryeducation

2003–2018

2005–20192004–2018

2000–20192007–20182010–2020

2010–2020

2010–20192010–20192009–20192009–2019

Canada

8

–

–

–

–

100

1.00

100

1.00

94

0.99

Cape Verde

80

18

–

8

–

94

0.98

87

1.01

73

1.08

Central African Republic

229

68

18

26

–

67

0.80

44

0.61

16

0.48

Chad

179

67

32

18

27

74

0.79

38

0.68

22

0.51

Chile

26

–

–

–

–

99

0.99

95

0.99

95

1.00

China

9

–

–

–

–

–

–

–

–

–

–

China, Hong Kong SAR

2

–

–

–

–

97

1.05

99

1.00

99

1.00

China, Macao SAR

3

–

–

–

–

99

0.99

98

1.02

87

1.06

Colombia

61

23

–

18

–

98

1.01

94

1.01

79

1.03

Comoros

70

32

–

5

21

82

1.00

81

1.02

50

1.07

Congo, Democratic Republic of the

138

37

–

37

31

–

–

–

–

–

–

Congo, Republic of the

111

27

–

–

27

89

1.09

–

–

–

–

Costa Rica

50

21

–

–

–

100

1.00

98

1.01

94

1.03

Côte d'Ivoire

123

27

27

22

25

95

0.93

56

0.87

42

0.74

Croatia

9

–

–

4c

–

98

1.03

99

1.02

86

1.05

Cuba

52

26

–

–

–

99

1.00

90

1.00

82

1.07

Curaçao

23

–

–

–

–

–

–

–

–

–

–

Cyprus

4

–

–

3c

–

99

1.00

100

1.00

93

0.98

Czechia

12

–

–

6c

–

100

1.01

99

1.00

97

1.00

Denmark

3

–

–

7c

–

99

1.01

99

0.99

90

1.02

Djibouti

21

5

80

–

–

67

0.96

52

1.00

34

0.95

Dominica

48

–

–

–

–

96

1.01

99

1.02

82

1.03

Dominican Republic

51

36

–

16

77

96

1.01

94

1.00

78

1.02

Ecuador

71

20

–

11

87

99

1.03

95

1.03

80

1.01

Egypt

52

17

70

14

–

99

1.01

98

1.02

77

0.98

El Salvador

74

26

–

7

–

86

1.01

83

0.99

66

0.97

Equatorial Guinea

176

30

–

44

–

45

1.02

–

–

–

–

Eritrea

76

41

69

–

–

53

0.91

64

0.88

51

0.86

Estonia

11

–

–

4c

–

98

1.00

99

1.02

99

0.99

Eswatini

87

5

–

–

49

84

0.98

97

1.00

84

0.96

Ethiopia

80

40

47

20

45

86

0.93

53

0.92

26

0.91

Fiji

23

–

–

30c

–

99

0.97

96

–

74

1.09

Finland

5

–

–

8c

–

99

1.00

100

1.00

96

0.98

France

9

–

–

7c

–

100

1.00

99

1.00

95

1.01

French Guiana

76

–

–

–

–

–

–

–

–

–

–

French Polynesia

42

–

–

–

–

–

–

–

–

–

–

Gabon

91

22

–

32

48

–

–

–

–

–

–

Gambia

86

26

75

7

40

85

1.12

69

1.03

–

–

Georgia

32

14

–

1d

–

99

1.01

100

1.00

94

1.04

Germany

6

–

–

5c

–

99

1.01

95

1.02

86

0.96

Ghana

75

21

2

19

52

99

1.01

89

1.05

72

1.00

Greece

9

–

–

8c

–

99

1.00

96

0.99

95

0.98

Grenada

36

–

–

–

–

99

1.02

97

–

97

1.00

STAT E OF WOR L D POPUL AT I ON 2 02 1

137

Tracking Progress Towards ICPD Goals

Gender, Rights and Human CapitalCountries, territories, other areas

Adolescentbirth rate per
1,000 girls
aged 15–19

Childmarriageby age 18,
per cent

Femalegenitalmutilation
prevalence
among girls
aged 15–19,
per cent

Intimate
partnerviolence,
past 12months,per cent

DecisionTotal net
Gendermaking onenrolment
parity index,
sexual and rate, primary
total net
reproductive education,
enrolment
health andper cent
rate, primary
reproductive
educationrights,per cent

Total netenrolment
rate, lower
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, lower
secondaryeducation

Total netenrolment
rate, upper
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, upper
secondaryeducation

2003–2018

2005–20192004–2018

2000–20192007–20182010–2020

2010–2020

2010–20192010–20192009–20192009–2019

Guadeloupe

16

–

–

–

–

–

–

–

–

–

–

Guam

35

–

–

–

–

–

–

–

–

–

–

Guatemala

79

30

–

9

65

89

1.01

67

0.93

41

0.90

Guinea

120

47

92

–

29

78

0.83

49

0.70

33

0.59

Guinea-Bissau

106

24

42

–

–

73

0.95

–

–

–

–

Guyana

74

30

–

–

71

98

0.96

93

1.02

70

1.11

Haiti

55

15

–

14

59

–

–

–

–

–

–

Honduras

89

34

–

11

70

87

0.97

62

1.23

44

1.11

Hungary

23

–

–

8c

–

96

1.00

97

1.00

88

1.01

Iceland

6

–

–

–

–

100

1.00

100

1.00

87

1.04

India

11

27

–

22

–

98

1.02

85

1.07

52

0.98

Indonesia

36

16

–

5d

–

94

0.95

84

1.07

77

1.01

Iran (Islamic Republic of)

33

17

–

–

–

100

1.00

95

0.97

74

0.97

Iraq

82

28

4

–

–

–

–

–

–

–

–

Ireland

7

–

–

4c

–

100

1.00

99

–

99

1.01

Israel

10

–

–

–

–

100

1.01

100

–

98

–

Italy

4

–

–

7c

–

97

1.00

98

1.00

95

1.01

Jamaica

52

8

–

9

–

83

1.00

82

1.02

76

1.04

Japan

3

–

–

–

–

–

–

–

–

–

–

Jordan

27

10

–

14

61

81

0.98

70

1.00

54

1.09

Kazakhstan

26

7

–

6c

–

99

1.02

100

–

99

–

Kenya

96

23

11

26

56

81

1.04

–

–

–

–

Kiribati

49

20

–

43

–

96

1.08

–

–

–

–

Korea, Democratic People's Republic
of

1

–

–

–

–

–

–

–

–

–

–

Korea, Republic of

1

–

–

–

–

99

1.00

97

1.00

96

0.99

Kuwait

6

–

–

–

–

83

1.22

94

1.05

82

1.03

Kyrgyzstan

34

13

–

17

77

100

0.99

98

0.99

72

1.05

Lao People's Democratic Republic

83

33

–

6

–

92

0.98

72

1.00

56

0.92

Latvia

16

–

–

7c

–

99

1.01

99

1.01

96

1.01

Lebanon

13

6

–

35

–

–

–

–

–

–

–

Lesotho

94

16

–

–

61

98

1.01

83

1.11

66

1.15

Liberia

150

36

26a

35

67

79

1.01

79

0.90

74

0.86

Libya

11

–

–

–

–

–

–

–

–

–

–

Lithuania

13

–

–

6c

–

100

1.00

100

1.00

97

1.02

Luxembourg

4

–

–

3c

–

99

0.98

96

0.98

81

1.06

Madagascar

152

40

–

–

74

98

1.05

70

1.03

36

0.97

Malawi

138

42

–

24

47

98

1.04

81

1.01

31

0.64

Malaysia

9

–

–

–

–

100

1.01

87

1.03

63

1.16

Maldives

9

2

1

6

58

98

1.03

91

–

–

–

Mali

164

54

86

21

8

59

0.90

47

0.86

25

0.74

Malta

13

–

–

5c

–

100

1.01

99

1.01

90

1.05

Martinique

17

–

–

–

–

–

–

–

–

–

–

Mauritania

84

37

63

–

–

77

1.05

72

1.08

39

1.12

138

Indicators

Tracking Progress Towards ICPD Goals

Gender, Rights and Human CapitalCountries, territories, other areas

Adolescentbirth rate per
1,000 girls
aged 15–19

Childmarriageby age 18,
per cent

Femalegenitalmutilation
prevalence
among girls
aged 15–19,
per cent

Intimate
partnerviolence,
past 12months,per cent

DecisionTotal net
Gendermaking onenrolment
parity index,
sexual and rate, primary
total net
reproductive education,
enrolment
health andper cent
rate, primary
reproductive
educationrights,per cent

Total netenrolment
rate, lower
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, lower
secondaryeducation

Total netenrolment
rate, upper
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, upper
secondaryeducation

2003–2018

2005–20192004–2018

2000–20192007–20182010–2020

2010–2020

2010–20192010–20192009–20192009–2019

Mauritius

24

–

–

–

–

99

1.03

95

1.02

79

1.10

Mexico

71

26

–

10

–

99

1.01

92

1.02

74

1.05

Micronesia (Federated States of)

44

–

–

26

–

90

0.98

87

1.06

–

–

Moldova, Republic of

21

12

–

15

–

90

0.98

84

0.98

65

1.02

Mongolia

33

12

–

15

63

99

0.99

–

–

–

–

Montenegro

10

6

–

–

–

100

1.00

92

1.01

89

1.02

Morocco

19

14

–

–

–

100

1.01

91

0.96

72

0.94

Mozambique

180

53

–

16

49

98

0.97

57

0.87

31

0.76

Myanmar

28

16

–

11

67

98

0.96

79

1.03

57

1.16

Namibia

64

7

–

20

71

98

1.03

–

–

–

–

Nepal

88

40

–

11

48

96

0.93

97

1.03

81

1.18

Netherlands

3

–

–

7c

–

100

1.01

97

1.01

100

1.00

New Caledonia

15

–

–

–

–

–

–

–

–

–

–

New Zealand

14

–

–

–

–

100

1.01

99

1.00

98

1.03

Nicaragua

92

35

–

8

–

96

1.03

88

1.03

64

1.08

Niger

154

76

1

–

7

59

0.88

35

0.79

14

0.67

Nigeria

106

43

14

14

46

66

0.84

–

–

–

–

North Macedonia

15

7

–

–

–

99

1.00

–

–

–

–

Norway

3

–

–

–

–

100

1.00

99

0.99

92

1.01

Oman

12

4

–

–

–

97

1.06

98

1.02

90

0.90

Pakistan

46

18

–

15

40

–

–

–

–

–

–

Palestine1

48

15

–

–

–

97

1.00

97

1.04

75

1.21

Panama

76

26

–

10

79

87

0.99

88

1.01

56

1.08

Papua New Guinea

68

27

–

48

–

93

0.94

86

0.89

54

0.82

Paraguay

72

22

–

8e

–

89

1.00

90

0.90

68

1.05

Peru

44

17

–

11

–

98

0.96

98

1.00

92

0.94

Philippines

39

17

–

6

81

96

0.99

89

1.07

79

1.09

Poland

11

–

–

3c

–

98

1.01

98

0.98

96

1.00

Portugal

8

–

–

6f

–

100

0.99

100

1.00

99

0.99

Puerto Rico

22

–

–

–

–

78

1.03

80

1.10

83

1.07

Qatar

9

4

–

–

–

98

1.03

95

0.92

91

0.97

Réunion

30

–

–

–

–

–

–

–

–

–

–

Romania

38

–

–

7c

–

87

1.00

91

1.00

80

1.03

Russian Federation

22

–

–

–

–

100

1.00

100

1.01

97

1.00

Rwanda

41

7

–

21

70

94

1.00

96

1.04

50

1.02

Saint Kitts and Nevis

46

–

–

–

–

99

0.98

87

0.95

96

0.99

Saint Lucia

36

24

–

–

–

98

1.03

90

0.98

79

0.99

Saint Vincent and the Grenadines

52

–

–

–

–

97

1.06

98

0.99

85

1.02

Samoa

39

11

–

22

–

99

1.02

100

–

90

1.11

San Marino

1

–

–

–

–

95

1.10

99

–

46

0.89

São Tomé and Príncipe

92

35

–

26

46

94

1.00

90

1.06

83

1.03

Saudi Arabia

9

–

–

–

–

98

0.98

99

0.98

96

0.94

Senegal

78

29

21

8

7

74

1.14

–

–

–

–

Serbia

15

3

–

–

–

98

1.00

98

1.00

88

1.03

STAT E OF WOR L D POPUL AT I ON 2 02 1

139

Tracking Progress Towards ICPD Goals

Gender, Rights and Human CapitalCountries, territories, other areas

Adolescentbirth rate per
1,000 girls
aged 15–19

Childmarriageby age 18,
per cent

Femalegenitalmutilation
prevalence
among girls
aged 15–19,
per cent

Intimate
partnerviolence,
past 12months,per cent

DecisionTotal net
Gendermaking onenrolment
parity index,
sexual and rate, primary
total net
reproductive education,
enrolment
health andper cent
rate, primary
reproductive
educationrights,per cent

Total netenrolment
rate, lower
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, lower
secondaryeducation

Total netenrolment
rate, upper
secondaryeducation,
per cent

Genderparity index,
total netenrolment
rate, upper
secondaryeducation

2003–2018

2005–20192004–2018

2000–20192007–20182010–2020

2010–2020

2010–20192010–20192009–20192009–2019

Seychelles

68

–

–

–

–

98

1.05

99

–

82

1.16

Sierra Leone

101

30

64

29

40

99

1.03

51

0.99

35

0.93

Singapore

3

–

–

–

–

100

1.00

99

0.99

100

–

Sint Maarten

–

–

–

–

–

97

1.07

–

–

–

–

Slovakia

27

–

–

8c

–

96

1.00

95

1.00

89

1.00

Slovenia

4

–

–

2c

–

100

1.00

98

1.01

98

1.01

Solomon Islands

78

21

–

42

–

96

1.01

–

–

–

–

Somalia

123

45

97

–

–

–

–

–

–

–

–

South Africa

41

4

–

11

65

89

1.02

86

1.03

79

1.02

South Sudan

158

52

–

–

–

38

0.77

44

0.72

36

0.65

Spain

7

–

–

2c

–

97

1.00

100

1.00

98

1.01

Sri Lanka

21

10

–

6g

–

99

0.99

100

1.00

84

1.06

Sudan

87

34

82

–

–

62

0.98

45

0.88

43

0.96

Suriname

57

36

–

–

–

88

1.04

85

1.09

62

1.15

Sweden

5

–

–

6c

–

100

1.00

100

1.01

99

0.99

Switzerland

2

–

–

–

–

100

1.00

99

0.99

82

0.96

Syrian Arab Republic

54

13

–

–

–

72

0.98

62

0.97

34

1.00

Tajikistan

54

9

–

19

33

99

0.99

94

0.94

61

0.74

Tanzania, United Republic of

139

31

5

30

47

87

1.04

–

–

14

0.76

Thailand

38

23

–

–

–

–

–

–

–

79

1.00

Timor-Leste, Democratic Republic of

42

15

–

35

40

95

1.04

90

1.04

76

1.07

Togo

89

25

1

13

30

97

0.98

79

0.85

43

0.64

Tonga

30

6

–

19

–

99

1.02

95

1.02

62

1.17

Trinidad and Tobago

38

11

–

7

–

99

0.99

–

–

–

–

Tunisia

4

2

–

–

–

99

1.02

–

–

–

–

Turkey

21

15

–

11

–

95

0.99

94

0.99

83

0.99

Turkmenistan

28

6

–

–

–

–

–

92

0.98

83

0.99

Turks and Caicos Islands

15

–

–

–

–

99

1.03

80

1.06

68

0.90

Tuvalu

27

10

–

25

–

85

0.96

71

0.92

50

1.57

Uganda

132

34

0.1

30

62

96

1.03

–

–

–

–

Ukraine

19

9

–

10

81

92

1.02

96

1.01

94

1.03

United Arab Emirates

5

–

–

–

–

99

0.97

99

0.99

88

0.86

United Kingdom

12

–

–

6c

–

99

1.00

100

1.00

96

1.01

United States of America

19

–

–

–

–

99

1.00

100

1.02

96

1.00

United States Virgin Islands

25

–

–

–

–

–

–

–

–

–

–

Uruguay

36

25

–

3

–

100

1.00

100

1.01

88

1.08

Uzbekistan

19

7

–

–

–

99

0.99

99

0.98

86

0.99

Vanuatu

51

21

–

44

–

–

–

–

–

–

–

Venezuela (Bolivarian Republic of)

95

–

–

–

–

90

1.00

86

1.02

77

1.12

Viet Nam

30

11

–

10

–

99

1.03

–

–

–

–

Western Sahara

–

–

–

–

–

–

–

–

–

–

–

Yemen

67

32

16

–

–

84

0.88

72

0.85

44

0.59

Zambia

135

29

–

25

47

85

1.05

–

–

–

–

Zimbabwe

78

34

–

20

60

100

1.01

98

0.95

52

0.90

140

Indicators

Tracking Progress Towards ICPD Goals

Gender, Rights and Human Capital
NOTES− Data not available.
a 	 Percentage of girls aged 15 to 19 years who are members of the Sande society.
Membership in Sande society is a proxy for female genital mutilation.
b For ever-partnered women aged 18+.
c For ever-partnered women aged 18 to 49.
d For ever-partnered women aged 15 to 64.
e For ever-partnered women aged 15 to 44.
f

For ever-partnered women aged 18 to 50.

g For ever-partnered women aged 15+.

Total net enrolment rate, lower secondary education: Total number of students of
the official age group for lower secondary education who are enrolled in any level of
education, expressed as a percentage of the corresponding population.
Gender parity index, total net enrolment rate, lower secondary education: Ratio of
female to male values of total net enrolment rate for lower secondary education.
Total net enrolment rate, upper secondary education: Total number of students of
the official age group for upper secondary education who are enrolled in any levelof education, expressed as a percentage of the corresponding population.
Gender parity index, total net enrolment rate, upper secondary education: Ratio of
female to male values of total net enrolment rate for upper secondary education.

1 O
 n 29 November 2012, the United Nations General Assembly passed Resolution
67/19, which accorded Palestine “non-member observer State status in the
United Nations...”MAIN DATA SOURCES

DEFINITIONS OF THE INDICATORS

Female genital mutilation: prevalence among girls aged 15 to 19: UNFPA.

Adolescent birth rate: Number of births per 1,000 adolescent girls aged 15 to 19.
(SDG indicator 3.7.2)

Intimate partner violence, past 12 months: UNFPA. Regional estimates generated
by Violence Against Women Inter-Agency Group on Estimation and Data (WHO, UN
Women, UNICEF, UNSD, UNODC, and UNFPA).

Child marriage by age 18: Proportion of women aged 20 to 24 years who were
married or in a union before age 18. (SDG indicator 5.3.1)
Female genital mutilation prevalence among girls aged 15–19: Proportion ofgirls aged 15 to 19 years who have undergone female genital mutilation. (SDG
indicator 5.3.2)

Adolescent birth rate: United Nations Population Division.
Child marriage by age 18: UNICEF. Regional aggregates calculated by UNFPA basedon data from UNICEF.

Decision-making on sexual and reproductive health and reproductive rights:
UNFPA. As this report went to press, updated data for this SDG indicator became
available. The updated figures are available at https://unstats.un.org/sdgs/
indicators/database/.

Intimate partner violence, past 12 months: Percentage of ever-partnered womenand girls aged 15 to 49 who have experienced physical and/or sexual partner
violence in the previous 12 months. (SDG indicator 5.2.1)

Total net enrolment rate, primary education: UNESCO Institute for Statistics (UIS).

Decision-making on sexual and reproductive health and reproductive rights:
Percentage of women aged 15-49 years who are married (or in union), who maketheir own decisions in three areas—their health care, use of contraception, andsexual intercourse with their partners. (SDG indicator 5.6.1) As this report went topress, updated data for this SDG indicator became available. The updated figures
are available at https://unstats.un.org/sdgs/indicators/database/.

Total net enrolment rate, lower secondary education: UNESCO Institute for
Statistics (UIS).

Total net enrolment rate, primary education: Total number of students of theofficial age group for primary education who are enrolled in any level of education,
expressed as a percentage of the corresponding population.

Gender parity index, total net enrolment rate, primary education: UNESCO Institutefor Statistics (UIS).

Gender parity index, total net enrolment rate, lower secondary education:
UNESCO Institute for Statistics (UIS).
Total net enrolment rate, upper secondary education: UNESCO Institutefor Statistics (UIS).
Gender parity index, total net enrolment rate, upper secondary education:
UNESCO Institute for Statistics (UIS).

Gender parity index, total net enrolment rate, primary education: Ratio of female tomale values of total net enrolment rate for primary education.

STAT E OF WOR L D POPUL AT I ON 2 02 1

141

Demographic Indicators
Countries,
other areas
World and territories,
regional areas

POPULATIONPOPULATIONCHANGE

Total populationin millions

Average annual
rate of population
change, per cent

POPULATION COMPOSITION
Population
aged 0–14,
per cent

Population
aged 10–19,
per cent

Population
aged 10–24,
per cent

FERTILITY

LIFE EXPECTANCY
Life expectancy at birth,years, 2021

Population
aged 15–64,
per cent

Population
aged 65
and older,
per cent

Total
fertility rate,
per woman2021

2015–2020

2021

2021

2021

2021

2021

2021

male

female

World

7,875

1.1

25.3

16.0

23.6

65.1

9.6

2.4

71

75

More developed regions

1,276

0.3

16.3

11.0

16.6

64.0

19.7

1.6

77

83

Less developed regions

6,599

1.3

27.0

17.0

25.0

65.4

7.6

2.5

69

74

Least developed countries

1,082

2.3

38.5

22.3

31.7

57.8

3.6

3.8

64

68

UNFPA regions
Arab States

385

1.9

33.8

19.2

27.6

61.0

5.1

3.2

70

74

4,116

0.9

23.4

15.6

23.3

67.9

8.6

2.1

71

75

Eastern Europe and Central Asia

251

0.9

23.4

14.4

21.2

66.2

10.5

2.1

71

78

Latin America and the Caribbean

656

1.0

23.7

16.0

24.2

67.2

9.2

2.0

73

79

East and Southern Africa

633

2.6

40.9

23.0

32.3

55.9

3.2

4.2

62

67

West and Central Africa

471

2.7

42.9

23.3

32.3

54.3

2.8

4.9

57

60

Countries, territories, other areas

2021

2015–2020

2021

2021

2021

2021

2021

2021

male

femaleAfghanistan

39.8

2.5

41.2

25.0

35.2

56.1

2.7

4.0

64

67

Albania

2.9

-0.1

17.1

12.2

19.8

67.7

15.2

1.6

77

80

Algeria

44.6

2.0

30.9

15.8

22.3

62.2

6.9

2.9

76

79

Angola

33.9

3.3

46.2

24.1

32.9

51.6

2.2

5.3

59

65

Antigua and Barbuda

0.1

0.9

21.7

14.0

21.6

68.6

9.7

2.0

76

78

Argentina

45.6

1.0

24.3

15.7

23.3

64.2

11.5

2.2

74

80

Armenia

3.0

0.3

20.8

12.7

18.4

66.9

12.3

1.8

72

79

Aruba1

0.1

0.5

17.3

12.8

19.8

67.5

15.1

1.9

74

79

Australia2

25.8

1.3

19.3

12.4

18.5

64.2

16.5

1.8

82

86

Austria

9.0

0.7

14.5

9.6

15.1

66.1

19.5

1.6

80

84

Azerbaijan3

10.2

1.0

23.4

13.4

20.2

69.5

7.1

2.0

71

76

Bahamas

0.4

1.0

21.3

15.9

24.3

70.7

8.0

1.7

72

76

Bahrain

1.7

4.3

18.0

11.1

17.0

79.1

2.9

1.9

77

79

Bangladesh

166.3

1.1

26.3

18.3

27.5

68.4

5.3

2.0

71

75

Barbados

0.3

0.1

16.6

12.5

19.0

66.3

17.2

1.6

78

81

Belarus

9.4

0.0

17.3

10.2

14.5

66.6

16.1

1.7

70

80

Belgium

11.6

0.5

17.0

11.4

17.0

63.5

19.6

1.7

80

84

Belize

0.4

1.9

28.8

19.2

29.0

66.1

5.2

2.2

72

78

Benin

12.5

2.7

41.7

22.9

32.1

55.0

3.3

4.6

61

64

Bhutan

0.8

1.2

24.6

17.2

26.6

69.1

6.3

1.9

72

73

Bolivia (Plurinational State of)

11.8

1.4

29.8

19.5

28.6

62.6

7.6

2.6

69

75

Bosnia and Herzegovina

3.3

-0.9

14.3

10.5

17.0

67.2

18.5

1.2

75

80

Botswana

2.4

2.1

33.0

20.1

28.7

62.3

4.7

2.8

67

73

214.0

0.8

20.5

14.4

22.3

69.6

9.9

1.7

73

80

Brunei Darussalam

0.4

1.1

21.9

14.7

22.7

72.1

6.0

1.8

75

77

Bulgaria

6.9

-0.7

14.7

10.1

14.3

63.6

21.7

1.6

72

79

Burkina Faso

21.5

2.9

44.1

24.1

33.3

53.5

2.4

5.0

62

63

Burundi

12.3

3.1

45.1

23.1

31.8

52.5

2.5

5.2

60

64

Cambodia

16.9

1.5

30.7

18.5

27.4

64.3

5.0

2.4

68

72

Cameroon, Republic of

27.2

2.6

41.8

23.3

32.4

55.5

2.7

4.4

59

61

Canada

38.1

0.9

15.8

10.5

16.6

65.7

18.6

1.5

81

85

Cape Verde

0.6

1.2

27.7

17.7

25.8

67.4

4.9

2.2

70

77

Central African Republic

4.9

1.4

43.0

26.1

36.3

54.1

2.8

4.5

52

56

Chad

16.9

3.0

46.2

24.6

33.9

51.3

2.5

5.5

53

56

Chile

19.2

1.2

19.0

13.0

20.1

68.3

12.7

1.6

78

83

Asia and the PacificBrazil142

Indicators

Demographic Indicators

Countries, territories, other areas

POPULATIONPOPULATIONCHANGE

Total populationin millions

Average annual
rate of population
change, per cent2021

POPULATION COMPOSITION
Population
aged 0–14,
per cent

Population
aged 10–19,
per cent

Population
aged 10–24,
per cent

Population
aged 15–64,
per cent

FERTILITY

LIFE EXPECTANCY

Population
aged 65
and older,
per cent

Total
fertility rate,
per woman

Life expectancy at birth,years, 2021

2015–2020

2021

2021

2021

2021

2021

2021

male

female1,444.2

0.5

17.6

7.4

17.5

70.0

12.4

1.7

75

80

China, Hong Kong SAR5

7.6

0.8

13.0

11.6

12.1

68.1

18.9

1.4

82

88

China, Macao SAR6

0.7

1.5

14.6

7.4

12.5

72.6

12.7

1.3

82

87

Colombia

51.3

1.4

21.9

15.6

24.1

68.7

9.4

1.8

75

80

Comoros

0.9

2.2

38.7

22.0

31.1

58.1

3.2

4.0

63

67

Congo, Democratic Republic of the

92.4

3.2

45.6

23.6

32.2

51.4

3.0

5.6

60

63

Congo, Republic of the

5.7

2.6

41.0

23.0

31.7

56.2

2.8

4.3

63

67

Costa Rica

5.1

1.0

20.6

13.9

21.6

68.8

10.6

1.7

78

83

Côte d'Ivoire

27.1

2.5

41.4

23.0

32.6

55.7

2.9

4.5

57

60

Croatia

4.1

-0.6

14.5

10.0

15.6

63.9

21.7

1.4

76

82

Cuba

11.3

0.0

15.7

10.9

17.0

68.1

16.2

1.6

77

81

Curaçao1

0.2

0.5

17.8

13.0

19.0

64.0

18.2

1.7

76

82

Cyprus7

1.2

0.8

16.5

11.7

19.1

68.8

14.7

1.3

79

83

Czechia

10.7

0.2

15.8

10.1

14.4

63.8

20.4

1.7

77

82

Denmark8

5.8

0.4

16.3

11.6

17.9

63.4

20.3

1.8

79

83

Djibouti

1.0

1.6

28.6

18.0

27.0

66.6

4.8

2.6

66

70

Dominica

0.1

0.2

–

–

–

–

–

–

–

–

Dominican Republic

11.0

1.1

27.2

17.7

26.2

65.1

7.8

2.3

71

78

Ecuador

17.9

1.7

27.2

17.4

26.2

65.0

7.8

2.4

75

80

Egypt

104.3

2.0

33.8

18.2

26.3

60.7

5.4

3.2

70

75

El Salvador

6.5

0.5

26.3

17.6

27.1

64.9

8.8

2.0

69

78

Equatorial Guinea

1.4

3.7

36.8

19.4

29.2

60.8

2.4

4.3

58

61

Eritrea

3.6

1.2

40.7

24.5

32.6

54.8

4.5

3.9

65

69

Estonia

1.3

0.2

16.5

10.7

14.9

62.8

20.8

1.6

75

83

Eswatini

1.2

1.0

37.0

23.7

33.4

59.0

4.0

2.9

57

66

Ethiopia

117.9

2.6

39.6

23.1

33.3

56.9

3.6

4.0

65

69

Fiji

0.9

0.6

28.9

17.7

25.6

65.1

6.0

2.7

66

70

Finland9

5.5

0.2

15.6

11.0

16.6

61.4

23.0

1.4

80

85

France10

65.4

0.3

17.5

12.1

17.8

61.4

21.1

1.8

80

86

French Guiana11

0.3

2.7

31.7

19.0

27.6

62.5

5.8

3.2

77

83

French Polynesia11

0.3

0.6

22.0

15.5

23.1

68.6

9.4

1.9

76

80

Gabon

2.3

2.7

37.4

19.2

27.1

59.1

3.5

3.8

65

69

Gambia

2.5

2.9

43.8

23.1

32.4

53.7

2.5

5.0

61

64

Georgia12

4.0

-0.2

20.3

12.1

17.8

64.2

15.6

2.0

70

78

Germany

83.9

0.5

14.0

9.4

14.8

64.0

22.0

1.6

79

84

Ghana

31.7

2.2

36.9

21.3

30.4

59.9

3.2

3.7

63

66

Greece

10.4

-0.4

13.4

10.2

15.3

63.9

22.6

1.3

80

85

Grenada

0.1

0.5

23.8

14.4

21.8

66.2

10.0

2.0

70

75

Guadeloupe11

0.4

0.0

18.2

14.2

21.5

61.9

19.9

2.1

79

86

Guam13

0.2

0.8

23.6

15.8

24.0

65.5

10.9

2.3

77

84

Guatemala

18.2

1.9

32.9

21.2

31.3

62.0

5.1

2.7

72

78

Guinea

13.5

2.8

42.7

24.2

34.1

54.3

3.0

4.5

61

63

Guinea-Bissau

2.0

2.5

41.7

22.9

32.1

55.4

2.9

4.3

57

61

Guyana

0.8

0.5

27.5

18.1

27.8

65.2

7.3

2.4

67

73

Haiti

11.5

1.3

32.1

20.4

29.7

62.6

5.3

2.8

62

67

Honduras

10.1

1.7

30.1

20.4

30.6

64.8

5.1

2.4

73

78

Hungary

9.6

-0.2

14.5

10.0

15.2

65.0

20.6

1.5

74

81

Iceland

0.3

0.7

19.2

13.2

19.5

64.8

16.1

1.7

82

85

STAT E OF WOR L D POPUL AT I ON 2 02 1

143

China4

Demographic Indicators

Countries, territories, other areas

POPULATIONPOPULATIONCHANGE

Total populationin millions

Average annual
rate of population
change, per cent2021

POPULATION COMPOSITION
Population
aged 0–14,
per cent

Population
aged 10–19,
per cent

Population
aged 10–24,
per cent

FERTILITY

LIFE EXPECTANCY
Life expectancy at birth,years, 2021

Population
aged 15–64,
per cent

Population
aged 65
and older,
per cent

Total
fertility rate,
per woman

2015–2020

2021

2021

2021

2021

2021

2021

male

female1,393.4

1.0

25.8

18.0

26.9

67.4

6.8

2.2

69

71

Indonesia

276.4

1.1

25.6

16.8

25.1

67.9

6.5

2.2

70

74

Iran (Islamic Republic of)

85.0

1.4

24.8

14.1

20.5

68.4

6.8

2.1

76

78

Iraq

41.2

2.5

37.3

21.6

31.1

59.2

3.5

3.5

69

73

Ireland

5.0

1.2

20.5

13.8

19.7

64.6

14.9

1.8

81

84

Israel

8.8

1.6

27.7

16.3

23.6

59.7

12.6

3.0

82

85

Italy

60.4

0.0

12.8

9.5

14.4

63.6

23.6

1.3

82

86

Jamaica

3.0

0.5

23.1

15.5

24.1

67.6

9.3

1.9

73

76

Japan

126.1

-0.2

12.3

8.9

13.6

59.0

28.7

1.4

82

88

Jordan

10.3

1.9

32.1

21.3

30.5

63.9

4.0

2.6

73

77

Kazakhstan

19.0

1.3

29.2

15.2

20.8

62.7

8.2

2.7

70

78

Kenya

55.0

2.3

38.0

23.6

33.4

59.4

2.6

3.3

65

70

Kiribati

0.1

1.5

35.8

20.0

28.8

59.8

4.3

3.5

65

73

Korea, Democratic People's
Republic of

25.9

0.5

19.8

13.6

21.0

70.6

9.6

1.9

69

76

Korea, Republic of

51.3

0.2

12.3

9.1

15.1

71.2

16.6

1.1

80

86

Kuwait

4.3

2.1

21.1

13.1

18.5

75.5

3.4

2.1

75

77

Kyrgyzstan

6.6

1.8

32.6

17.3

24.9

62.5

4.9

2.9

68

76

Lao People's Democratic Republic

7.4

1.5

31.6

20.0

29.3

64.0

4.4

2.5

67

70

Latvia

1.9

-1.1

16.8

10.2

13.7

62.2

21.0

1.7

71

80

Lebanon

6.8

0.9

24.5

16.3

24.8

67.6

7.9

2.0

77

81

Lesotho

2.2

0.8

32.1

19.7

29.1

62.8

5.0

3.0

52

59

Liberia

5.2

2.5

40.0

23.2

32.4

56.6

3.4

4.1

63

66

Libya

7.0

1.4

27.4

17.4

25.2

68.0

4.6

2.1

70

76

Lithuania

2.7

-1.5

15.6

9.0

13.7

63.3

21.1

1.7

71

82

Luxembourg

0.6

2.0

15.6

10.5

16.8

69.8

14.6

1.4

81

85

Madagascar

28.4

2.7

39.8

22.7

32.4

57.0

3.2

3.9

66

69

Malawi

19.6

2.7

42.5

24.7

34.4

54.8

2.7

4.0

62

68

Malaysia14

32.8

1.3

23.3

15.5

24.1

69.3

7.4

1.9

75

79

Maldives

0.5

3.4

19.8

11.3

19.3

76.4

3.8

1.8

78

81

Mali

20.9

3.0

46.7

24.8

33.7

50.8

2.5

5.6

59

61

Malta

0.4

0.4

14.4

9.3

14.7

63.8

21.8

1.5

81

85

Martinique11

0.4

-0.2

15.5

12.2

18.8

62.2

22.3

1.8

80

86

Mauritania

4.8

2.8

39.5

21.7

30.6

57.3

3.2

4.4

64

67

Mauritius15

1.3

0.2

16.4

13.4

20.7

70.6

13.0

1.4

72

79

Mexico

130.3

1.1

25.5

17.2

25.6

66.7

7.8

2.1

72

78

Micronesia (Federated States of)

0.1

1.1

31.0

19.9

29.8

64.4

4.6

2.9

66

70

Moldova, Republic of16

4.0

-0.2

15.8

10.5

16.2

71.2

13.0

1.3

68

76

Mongolia

3.3

1.8

31.2

15.8

22.4

64.3

4.5

2.8

66

75

Montenegro

0.6

0.0

18.0

12.4

18.9

65.9

16.2

1.7

75

80

Morocco

37.3

1.3

26.5

16.5

24.2

65.6

7.9

2.3

76

78

Mozambique

32.2

2.9

43.8

24.2

33.6

53.3

2.9

4.6

59

65

Myanmar

54.8

0.6

25.1

17.9

26.7

68.4

6.5

2.1

64

71

Namibia

2.6

1.9

36.7

20.8

30.2

59.7

3.6

3.2

61

67

Nepal

29.7

1.5

28.1

20.3

31.2

66.0

5.9

1.8

70

73

Netherlands17

17.2

0.2

15.5

11.3

17.2

64.0

20.5

1.7

81

84

New Caledonia11

0.3

1.0

21.7

15.0

23.2

68.3

10.0

1.9

75

81

New Zealand18

4.9

0.9

19.3

13.0

19.5

64.0

16.7

1.9

81

84

India

144

Indicators

Demographic Indicators
POPULATIONPOPULATIONCHANGEPOPULATION COMPOSITION

Total populationin millions

Average annual
rate of population
change, per centCountries, territories, other areas

2021

2015–2020

2021

2021

Nicaragua

6.7

1.3

29.1

18.6

Niger

25.1

3.8

49.5

24.4

Nigeria

211.4

2.6

43.3

North Macedonia

2.1

0.0

Norway19

5.5

Oman

Population
aged 0–14,
per cent

Population
aged 10–19,
per cent

Population
aged 10–24,
per cent

FERTILITY

LIFE EXPECTANCY
Life expectancy at birth,years, 2021

Population
aged 15–64,
per cent

Population
aged 65
and older,
per cent

Total
fertility rate,
per woman

2021

2021

2021

2021

male

female

27.3

65.0

5.9

2.3

71

78

33.1

47.9

2.6

6.6

62

64

23.2

32.0

53.9

2.8

5.2

54

56

16.2

11.1

17.2

68.9

14.9

1.5

74

78

0.8

17.1

11.9

18.3

65.1

17.8

1.7

81

85

5.2

3.6

22.9

11.1

17.1

74.5

2.6

2.7

77

81

Pakistan

225.2

2.0

34.6

20.4

29.7

61.0

4.4

3.3

67

69

Palestine20

5.2

2.4

38.0

21.8

31.4

58.8

3.3

3.4

73

76

Panama

4.4

1.7

26.2

16.7

24.8

65.0

8.8

2.4

76

82

Papua New Guinea

9.1

2.0

34.8

21.3

30.7

61.5

3.7

3.4

64

66

Paraguay

7.2

1.3

28.6

18.5

27.8

64.4

7.0

2.4

72

77

Peru

33.4

1.6

24.7

15.5

23.1

66.4

9.0

2.2

75

80

Philippines

111.0

1.4

29.5

19.4

28.6

64.7

5.7

2.5

68

76

Poland

37.8

-0.1

15.2

9.9

14.9

65.4

19.4

1.5

75

83

Portugal

10.2

-0.3

12.9

9.9

15.2

64.0

23.1

1.3

79

85

Puerto Rico13

2.8

-3.3

14.9

14.1

19.4

63.9

21.3

1.2

77

84

Qatar

2.9

2.3

13.7

8.4

16.5

84.5

1.9

1.8

79

82

Réunion11

0.9

0.7

22.0

15.3

22.6

64.8

13.2

2.2

78

84

Romania

19.1

-0.7

15.5

10.8

16.1

64.9

19.7

1.6

73

80

Russian Federation

145.9

0.1

18.5

10.8

15.3

65.5

16.0

1.8

67

78

Rwanda

13.3

2.6

39.2

22.3

31.5

57.5

3.2

3.9

67

72

Saint Kitts and Nevis

0.1

0.8

–

–

–

–

–

–

–

–

Saint Lucia

0.2

0.5

17.7

12.8

21.2

71.7

10.6

1.4

75

78

Saint Vincent and the Grenadines

0.1

0.3

21.6

15.4

23.8

68.3

10.2

1.8

71

75

Samoa

0.2

0.5

37.1

21.2

29.5

57.7

5.2

3.7

72

76

San Marino

0.0

0.4

–

–

–

–

–

–

–

–

São Tomé and Príncipe

0.2

1.9

41.3

24.7

33.5

55.6

3.1

4.2

68

73

Saudi Arabia

35.3

1.9

24.5

14.2

20.8

71.8

3.6

2.2

74

77

Senegal

17.2

2.8

42.3

23.2

32.3

54.6

3.1

4.4

66

70

Serbia21

8.7

-0.3

15.2

11.3

17.3

65.4

19.4

1.4

74

79

Seychelles

0.1

0.7

23.7

14.3

20.6

67.9

8.4

2.4

70

78

Sierra Leone

8.1

2.1

40.0

23.4

32.8

57.1

2.9

4.0

55

56

Singapore

5.9

0.9

12.4

8.4

14.8

73.3

14.3

1.2

82

86

Sint Maarten1

0.0

1.4

–

–

–

–

–

–

–

–

Slovakia

5.5

0.1

15.6

10.1

15.2

67.2

17.2

1.5

74

81

Slovenia

2.1

0.1

15.1

9.6

14.2

63.6

21.3

1.6

79

84

Solomon Islands

0.7

2.6

39.9

21.7

30.6

56.4

3.7

4.3

72

75

Somalia

16.4

2.8

46.0

24.6

34.3

51.1

2.9

5.8

56

60

South Africa

60.0

1.4

28.6

17.7

25.8

65.8

5.6

2.3

61

68

South Sudan

11.4

0.9

41.1

23.0

32.5

55.6

3.4

4.5

57

60

Spain22

46.7

0.0

14.2

10.2

15.0

65.5

20.3

1.4

81

86

Sri Lanka

21.5

0.5

23.4

15.8

22.7

64.9

11.6

2.2

74

81

Sudan

44.9

2.4

39.5

23.0

32.5

56.8

3.7

4.2

64

68

Suriname

0.6

1.0

26.4

17.3

25.6

66.3

7.3

2.3

69

75

Sweden

10.2

0.7

17.7

11.3

16.5

61.9

20.5

1.8

81

85

Switzerland

8.7

0.8

15.0

9.7

15.1

65.6

19.4

1.6

82

86

Syrian Arab Republic

18.3

-0.6

30.7

18.3

27.1

64.4

4.9

2.7

71

79

Tajikistan

9.7

2.4

37.4

19.0

27.4

59.3

3.3

3.5

69

74

STAT E OF WOR L D POPUL AT I ON 2 02 1

145

Demographic Indicators
POPULATIONPOPULATIONCHANGEPOPULATION COMPOSITION

Total populationin millions

Average annual
rate of population
change, per centCountries, territories, other areas

2021

2015–2020

2021

2021

Tanzania, United Republic of23

61.5

3.0

43.3

23.6

Thailand

70.0

0.3

16.3

12.0

Timor-Leste, Democratic Republic of

1.3

1.9

36.6

Togo

8.5

2.5

Tonga

0.1

Trinidad and Tobago

Population
aged 10–24,
per cent

Life expectancy at birth,years, 2021

Population
aged 65
and older,
per cent

Total
fertility rate,
per woman

2021

2021

2021

2021

male

female

32.5

54.0

2.7

4.7

64

68

18.7

70.2

13.5

1.5

74

81

22.8

32.7

59.1

4.3

3.8

68

72

40.3

23.1

32.2

56.8

2.9

4.1

61

63

1.0

34.4

22.1

31.5

59.7

6.0

3.4

69

73

1.4

0.4

19.8

13.4

19.4

68.3

11.9

1.7

71

76

Tunisia

11.9

1.1

24.2

14.0

20.8

66.6

9.2

2.1

75

79

Turkey

85.0

1.4

23.6

15.9

23.9

67.1

9.3

2.0

75

81

Turkmenistan

6.1

1.6

30.6

17.0

24.5

64.4

5.0

2.7

65

72

Turks and Caicos Islands

0.0

1.5

–

–

–

–

–

–

–

–

Tuvalu

0.0

1.2

–

–

–

–

–

–

–

–

Uganda

47.1

3.6

45.5

25.0

34.6

52.4

2.0

4.6

62

66

Ukraine24

43.5

-0.5

15.9

10.3

15.1

66.8

17.3

1.4

67

77

United Arab Emirates

10.0

1.3

14.9

9.1

16.5

83.7

1.4

1.4

78

80

United Kingdom25

68.2

0.6

17.6

11.4

17.3

63.5

18.8

1.7

80

83

United States of America26

332.9

0.6

18.2

12.7

19.4

64.7

17.0

1.8

76

82

United States Virgin Islands13

0.1

-0.1

18.9

13.4

19.6

59.9

21.1

2.0

78

83

Uruguay

3.5

0.4

20.2

13.6

20.9

64.5

15.3

1.9

74

82

Uzbekistan

33.9

1.6

28.7

16.4

24.4

66.2

5.0

2.4

70

74

Vanuatu

0.3

2.5

38.2

21.9

30.3

58.2

3.6

3.7

69

72

Venezuela (Bolivarian Republic of)

28.7

-1.1

26.5

18.2

25.9

65.3

8.2

2.2

68

76

Viet Nam

98.2

1.0

23.2

14.0

20.7

68.6

8.2

2.0

72

80

Western Sahara

0.6

2.5

26.9

16.5

24.8

69.5

3.6

2.3

69

73

Yemen

30.5

2.4

38.4

22.6

32.2

58.6

3.0

3.5

65

68

Zambia

18.9

2.9

43.6

24.7

34.3

54.3

2.2

4.4

61

68

Zimbabwe

15.1

1.5

41.3

24.2

33.6

55.6

3.1

3.4

60

63

Indicators

Population
aged 10–19,
per cent

LIFE EXPECTANCY

Population
aged 15–64,
per cent

146

Population
aged 0–14,
per cent

FERTILITY

Demographic Indicators

NOTES− Data not available.

DEFINITIONS OF THE INDICATORS

1 For statistical purposes, the data for Netherlands do not include this area.

Average annual rate of population change: Average exponential rate of growthof the population over a given period, based on a medium variant projection.

2 Including Christmas Island, Cocos (Keeling) Islands and Norfolk Island.
3 Including Nagorno-Karabakh.
4 For statistical purposes, the data for China do not include Hong Kong and
Macao, Special Administrative Regions (SAR) of China, or Taiwan Provinceof China.

Total population: Estimated size of national populations at mid-year.

Population aged 0–14, per cent: Proportion of the population between age 0 andage 14.
Population aged 10–19, per cent: Proportion of the population between age 10
and age 19.

5 As of 1 July 1997, Hong Kong became a Special Administrative Region (SAR) of
China. For statistical purposes, the data for China do not include this area.

Population aged 10–24, per cent: Proportion of the population between age 10
and age 24.

6 As of 20 December 1999, Macao became a Special Administrative Region (SAR)of China. For statistical purposes, the data for China do not include this area.

Population aged 15–64, per cent: Proportion of the population between age 15
and age 64.

7 Refers to the whole country.

Population aged 65 and older, per cent: Proportion of the population aged 65
and older.

8 For statistical purposes, the data for Denmark do not include Faroe Islands
or Greenland.
9 Including Åland Islands.
10 For statistical purposes, the data for France do not include French Guiana,
French Polynesia, Guadeloupe, Martinique, Mayotte, New Caledonia, Réunion,
Saint Pierre and Miquelon, Saint Barthélemy, Saint Martin (French part) or
Wallis and Futuna Islands.
11 For statistical purposes, the data for France do not include this area.
12 Including Abkhazia and South Ossetia.
13 For statistical purposes, the data for United States of America do not include
this area.
14 Including Sabah and Sarawak.
15 Including Agalega, Rodrigues and Saint Brandon.

Total fertility rate: Number of children who would be born per woman if she
lived to the end of her childbearing years and bore children at each age inaccordance with prevailing age-specific fertility rates.
Life expectancy at birth: Number of years newborn children would live if subject
to the mortality risks prevailing for the cross section of population at the time of
their birth.
MAIN DATA SOURCES
Total population: United Nations Population Division.
Average annual rate of population change: United Nations Population Division.
Population aged 0–14, per cent: UNFPA calculation based on data from
United Nations Population Division.

16 Including Transnistria.

Population aged 10–19, per cent: UNFPA calculation based on data from
United Nations Population Division.

17 For statistical purposes, the data for Netherlands do not include Aruba,
Bonaire, Sint Eustatius and Saba, Curaçao or Sint Maarten (Dutch part).

Population aged 10–24, per cent: UNFPA calculation based on data from
United Nations Population Division.

18 For statistical purposes, the data for New Zealand do not include Cook Islands,
Niue or Tokelau.

Population aged 15–64, per cent: UNFPA calculation based on data from
United Nations Population Division.

19 Including Svalbard and Jan Mayen Islands.
20 Including East Jerusalem.

Population aged 65 and older, per cent: UNFPA calculation based on data from
United Nations Population Division.

21 Including Kosovo.

Total fertility rate: United Nations Population Division.

22 Including Canary Islands, Ceuta and Melilla.

Life expectancy at birth: United Nations Population Division.

23 Including Zanzibar.
24 Refers to the territory of the country at the time of the 2001 census.
25 Refers to the United Kingdom of Great Britain and Northern Ireland.
For statistical purposes, the data for United Kingdom do not include
Anguilla, Bermuda, British Virgin Islands, Cayman Islands, Channel
Islands, Falkland Islands (Malvinas), Gibraltar, Isle of Man, Montserrat,
Saint Helena or Turks and Caicos Islands.
26 For statistical purposes, the data for United States of America do not include
American Samoa, Guam, Northern Mariana Islands, Puerto Rico or UnitedStates Virgin Islands.

STAT E OF WOR L D POPUL AT I ON 2 02 1

147

Technical notes
The statistical tables in the State of World Population 2021 include indicators that track progress toward the goals of the Framework of Actions for thefollow-up to the Programme of Action of the International Conference on Population and Development (ICPD) and the Sustainable Development Goals(SDGs) in the areas of maternal health, access to education and reproductive and sexual health. In addition, these tables include a variety of demographic
indicators. The statistical tables support UNFPA’s focus on progress and results towards delivering a world where every pregnancy is wanted, every birth issafe and every young person’s potential is fulfilled.
Different national authorities and international organizations may employ different methodologies in gathering, extrapolating or analyzing data. To
facilitate the international comparability of data, UNFPA relies on the standard methodologies employed by the main sources of data. In some instances,
therefore, the data in these tables differ from those generated by national authorities. Data presented in the tables are not comparable to the data inprevious State of World Population reports due to regional classifications updates, methodological updates and revisions of time series data.
The statistical tables draw on nationally representative household surveys such as Demographic and Health Surveys (DHS) and Multiple Indicator Cluster
Surveys (MICS), United Nations organizations estimates and inter-agency estimates. They also include the latest population estimates and projections
from World Population Prospects: The 2019 Revision, and Estimates and Projections of Family Planning Indicators 2020 (United Nations Department of Economic
and Social Affairs, Population Division). Data are accompanied by definitions, sources and notes. The statistical tables in the State of World Population 2021
generally reflect information available as of January 2021.

Tracking Progress Towards ICPD Goals
Sexual and Reproductive HealthMaternal mortality ratio (MMR), (deaths per 100,000 live births)
and range of MMR uncertainty (UI 80%), lower and upper estimates(2017).
Source: United Nations Maternal Mortality Estimation Inter-agency Group(MMEIG). This indicator presents the number of maternal deaths during
a given time period per 100,000 live births during the same time period(SDG indicator 3.1.1). The estimates are produced by the MMEIG using
data from vital registration systems, household surveys and population
censuses. UNFPA, WHO, the World Bank, UNICEF and the United
Nations Population Division are members of the MMEIG. Estimates andmethodologies are reviewed regularly by the MMEIG and other agencies
and academic institutions and are revised where necessary, as part of theongoing process of improving maternal mortality data. Estimates should
not be compared with previous inter-agency estimates.
Births attended by skilled health personnel, per cent (2014–2019).
Source: Joint global database on skilled attendance at birth, 2020, UNICEF
and WHO. Regional aggregates calculated by UNFPA based on data fromthe joint global database. Percentage of births attended by skilled healthpersonnel (doctors, nurses or midwives) is the percentage of deliveries
attended by health personnel trained in providing life-saving obstetriccare, including giving the necessary supervision, care and advice towomen during pregnancy, labour and the post-partum period; conducting
deliveries on their own; and caring for newborns (SDG indicator 3.1.2).
Traditional birth attendants, even if they receive a short training course, are
not included.
Number of new HIV infections per 1,000 uninfected population (2018).
Source: UNAIDS. Number of new HIV infections per 1,000 person-years
among the uninfected population (SDG indicator 3.3.1).

148

Indicators, Technical notes

Contraceptive prevalence rate, women aged 15–49, any method(2021).
Source: United Nations Population Division. Percentage of women aged 15
to 49 who are currently using any method of contraception. Model-based
estimates are based on data that are derived from sample survey reports.
Survey data estimate the proportion of all women of reproductive age, andmarried women (including women in consensual unions), currently using
any method of contraception.
Contraceptive prevalence rate, women aged 15–49, modern methods(2021).
Source: United Nations Population Division. Percentage of women aged
15 to 49 who are currently using any modern method of contraception.
Model-based estimates are based on data that are derived from sample
survey reports. Survey data estimate the proportion of all women of
reproductive age, and married women (including women in consensual
unions), currently using any modern methods of contraception. Modern or
clinic and supply methods include male and female sterilization, IUD, thepill, injectables, hormonal implants, condoms and female barrier methods.
Unmet need for family planning, women aged 15–49 (2021).
Source: United Nations Population Division. Percentage of women aged 15
to 49 who want to stop or delay childbearing but are not using a method ofcontraception. Model-based estimates are based on data that are derived
from sample survey reports. Women who are using a traditional methodof contraception are not considered as having an unmet need for familyplanning. All women or all married and in-union women are assumed to
be sexually active and at risk of pregnancy. The assumption of universal
exposure among all women or all married or in-union women may lead tolower estimates compared to the actual risks among the exposed. It might
be possible, in particular at low levels of contraceptive prevalence, thatwhen contraceptive prevalence increases, unmet need for family planningalso increases. Both indicators, therefore, need to be interpreted together.

Proportion of demand for family planning satisfied by any modern
methods, women aged 15–49 (2021).
Source: United Nations Population Division. Percentage of total demand
for family planning among women aged 15 to 49 that is satisfied by theuse of modern contraception (SDG indicator 3.7.1). Modern contraceptive
prevalence divided by total demand for family planning. Total demand forfamily planning is the sum of contraceptive prevalence and unmet need forfamily planning.
Laws and regulations that guarantee access to sexual and reproductive
health care, information and education (2019).
Source: UNFPA. The extent to which countries have national laws andregulations that guarantee full and equal access to women and men aged
15 years and older to sexual and reproductive health care, information andeducation (SDG indicator 5.6.2).

Gender, Rights and Human Capital
Adolescent birth rate per 1,000 girls aged 15–19 (2003–2018).
Source: United Nations Population Division. Number of births per 1,000
adolescent girls aged 15 to 19 years (SDG indicator 3.7.2). The adolescentbirth rate represents the risk of childbearing among adolescent women
aged 15 to 19 years. For civil registration, rates are subject to limitations
which depend on the completeness of birth registration, the treatment
of infants born alive but which die before registration or within the first
24 hours of life, the quality of the reported information relating to theage of the mother and the inclusion of births from previous periods.
The population estimates may suffer from limitations connected toage misreporting and coverage. For survey and census data, both thenumerator and denominator come from the same population. The main
limitations concern age misreporting, birth omissions, misreporting thedate of birth of the child and sampling variability in the case of surveys.
Child marriage by age 18, per cent (2005–2019).
Source: UNICEF. Regional aggregates calculated by UNFPA based on datafrom UNICEF. Proportion of women aged 20 to 24 years who were married
or in a union before the age of 18 (SDG indicator 5.3.1).
Female genital mutilation prevalence among girls aged 15–19, per cent(2004–2018).
Source: UNFPA. Proportion of girls aged 15 to 19 years who haveundergone female genital mutilation (SDG indicator 5.3.2).
Intimate partner violence, past 12 months, per cent (2000–2019).
Source: UNFPA. Regional and global estimates generated by Violence
Against Women Inter-Agency Group on Estimation and Data (WHO,UN Women, UNICEF, UNSD, UNODC and UNFPA). Percentage ofever-partnered women and girls aged 15 to 49 who have experienced
physical and/or sexual partner violence in the previous 12 months (SDG
indicator 5.2.1).
Decision-making on sexual and reproductive health and reproductive
rights, per cent (2007–2018).
Source: UNFPA. Percentage of women aged 15 to 49 years who aremarried (or in union), who make their own decisions on three areas—theirhealth care, use of contraception, and sexual intercourse with their partners(SDG indicator 5.6.1). As this report went to press, updated data for thisSDG indicator became available. The updated figures are available athttps://unstats.un.org/sdgs/indicators/database/.

Total net enrolment rate, primary education, per cent (2010–2020).
Source: UNESCO Institute for Statistics (UIS). Total number of students of
the official age group for primary education who are enrolled in any level of
education, expressed as a percentage of the corresponding population.
Gender parity index, total net enrolment rate, primary education(2010–2020).
Source: UNESCO Institute for Statistics (UIS). Ratio of female to malevalues of total net enrolment rate for primary education.
Total net enrolment rate, lower secondary education, per cent(2010–2019).
Source: UNESCO Institute for Statistics (UIS). Total number of studentsof the official age group for lower secondary education who areenrolled in any level of education, expressed as a percentage of thecorresponding population.
Gender parity index, total net enrolment rate, lower secondary
education (2010–2019).
Source: UNESCO Institute for Statistics (UIS). Ratio of female to malevalues of total net enrolment rate for lower secondary education.
Total net enrolment rate, upper secondary education, per cent(2009–2019).
Source: UNESCO Institute for Statistics (UIS). Total number of studentsof the official age group for upper secondary education who areenrolled in any level of education, expressed as a percentage of thecorresponding population.
Gender parity index, total net enrolment rate, upper secondary
education (2009–2019).
Source: UNESCO Institute for Statistics (UIS). Ratio of female to malevalues of total net enrolment rate for upper secondary education.

Demographic indicators
Population
Total population in millions (2021).
Source: United Nations Population Division. Estimated size of national
populations at mid-year.

Population change
Average annual rate of population change, per cent (2015–2020).
Source: United Nations Population Division. Average exponential rateof growth of the population over a given period, based on a medium
variant projection.

Population composition
Population aged 0–14, per cent (2021).
Source: UNFPA calculation based on data from the United Nations
Population Division. Proportion of the population between
age 0 and age 14.

STAT E OF WOR L D POPUL AT I ON 2 02 1

149

Population aged 10–19, per cent (2021).
Source: UNFPA calculation based on data from the United Nations
Population Division. Proportion of the population between age 10
and age 19.
Population aged 10–24, per cent (2021).
Source: UNFPA calculation based on data from the United Nations
Population Division. Proportion of the population between age
10 and age 24.
Population aged 15–64, per cent (2021).
Source: UNFPA calculation based on data from the United Nations
Population Division. Proportion of the population between age 15
and age 64.

Population aged 65 and older, per cent (2021).
Source: UNFPA calculation based on data from the United Nations
Population Division. Proportion of the population aged 65 and older.

Fertility
Total fertility rate, per woman (2021).
Source: United Nations Population Division. Number of children who
would be born per woman if she lived to the end of her childbearing
years and bore children at each age in accordance with prevailing agespecific fertility rates.

Life expectancy
Life expectancy at birth, years (2021).
Source: United Nations Population Division. Number of years newborn
children would live if subject to the mortality risks prevailing for the crosssection of population at the time of their birth.

Regional classifications
UNFPA aggregates presented at the end of the statistical tables arecalculated using data from countries and areas as classified below.
Arab States Region
Algeria; Djibouti; Egypt; Iraq; Jordan; Lebanon; Libya; Morocco; Oman;
Palestine; Somalia; Sudan; Syrian Arab Republic; Tunisia; Yemen
Asia and the Pacific Region
Afghanistan; Bangladesh; Bhutan; Cambodia; China; Cook Islands; Fiji;
India; Indonesia; Iran (Islamic Republic of); Kiribati; Korea, Democratic
People’s Republic of; Lao People’s Democratic Republic; Malaysia;
Maldives; Marshall Islands; Micronesia (Federated States of); Mongolia;
Myanmar; Nauru; Nepal; Niue; Pakistan; Palau; Papua New Guinea;
Philippines; Samoa; Solomon Islands; Sri Lanka; Thailand; Timor-Leste,
Democratic Republic of; Tokelau; Tonga; Tuvalu; Vanuatu; Viet Nam
Eastern Europe and Central Asia Region
Albania; Armenia; Azerbaijan; Belarus; Bosnia and Herzegovina; Georgia;
Kazakhstan; Kyrgyzstan; Moldova, Republic of; North Macedonia; Serbia;
Tajikistan; Turkey; Turkmenistan; Ukraine; Uzbekistan
East and Southern Africa Region
Angola; Botswana; Burundi; Comoros; Congo, Democratic Republic ofthe; Eritrea; Eswatini; Ethiopia; Kenya; Lesotho; Madagascar; Malawi;
Mauritius; Mozambique; Namibia; Rwanda; South Africa; South Sudan;
Tanzania, United Republic of; Uganda; Zambia; Zimbabwe
Latin America and the Caribbean Region
Anguilla; Antigua and Barbuda; Argentina; Aruba; Bahamas; Barbados;
Belize; Bermuda; Bolivia (Plurinational State of); Brazil; British Virgin
Islands; Cayman Islands; Chile; Colombia; Costa Rica; Cuba; Curaçao;
Dominica; Dominican Republic; Ecuador; El Salvador; Grenada;
Guatemala; Guyana; Haiti; Honduras; Jamaica; Mexico; Montserrat;
Nicaragua; Panama; Paraguay; Peru; Saint Kitts and Nevis; Saint Lucia;
Saint Vincent and the Grenadines; Sint Maarten; Suriname; Trinidad
and Tobago; Turks and Caicos Islands; Uruguay; Venezuela (Bolivarian
Republic of)150

Indicators, Technical notes

West and Central Africa Region
Benin; Burkina Faso; Cameroon, Republic of; Cape Verde; Central African
Republic; Chad; Congo, Republic of the; Côte d’Ivoire; Equatorial Guinea;
Gabon; Gambia; Ghana; Guinea; Guinea-Bissau; Liberia; Mali; Mauritania;
Niger; Nigeria; São Tomé and Príncipe; Senegal; Sierra Leone; Togo
More developed regions are intended for statistical purposes and do
not express a judgment about the stage reached by a particular country
or area in the development process, comprising UNPD regions Europe,
Northern America, Australia/New Zealand and Japan.
Less developed regions are intended for statistical purposes and do not
express a judgment about the stage reached by a particular country or
area in the development process, comprising all UNPD regions of Africa,
Asia (except Japan), Latin America and the Caribbean plus Melanesia,
Micronesia and Polynesia.
The least developed countries, as defined by the United Nations
General Assembly in its resolutions (59/209, 59/210, 60/33, 62/97,
64/L.55, 67/L.43, 64/295 and 68/18) included 47 countries (as ofDecember 2018): 33 in Africa, 9 in Asia, 4 in Oceania and 1 in Latin
America and the Caribbean­­—Afghanistan; Angola; Bangladesh; Benin;
Bhutan; Burkina Faso; Burundi; Cambodia; Central African Republic;
Chad; Comoros; Congo, Democratic Republic of the; Djibouti; Eritrea;
Ethiopia; Gambia; Guinea; Guinea-Bissau; Haiti; Kiribati; Lao People’s
Democratic Republic; Lesotho; Liberia; Madagascar; Malawi; Mali;
Mauritania; Mozambique; Myanmar; Nepal; Niger; Rwanda; São Toméand Príncipe; Senegal; Sierra Leone; Solomon Islands; Somalia; South
Sudan; Sudan; Tanzania, United Republic of; Timor-Leste, Democratic
Republic of; Togo; Tuvalu; Uganda; Vanuatu; Yemen; Zambia. These
countries are also included in the less developed regions. Further
information is available at http://unohrlls.org/about-ldcs/.

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