The 2024 State of World Population report by the UNFPA reveals that nearly half of women worldwide are still denied the ability to make decisions about their own bodies, particularly when it comes to Sexual and Reproductive Health and Rights (SRHR). This lack of agency has far-reaching consequences, not just for women’s health, but for their ability to access education, participate in the workforce, and lead fulfilling lives. The denial of bodily autonomy is not just a personal issue—it’s a societal one. Without control over their own bodies, women are denied the fundamental freedoms and dignity that allow them to thrive in every aspect of life.

This blog post is an interview between Shubhangi Thakur, a researcher and writer based in Delhi, India, focusing on health, gender, and education, and Avni Amin.

Avni Amin works at the WHO’s Department of Sexual and Reproductive Health and Research on violence against women. Her primary focus is to support countries – Ministries of Health – in the translation and uptake of WHO’s normative guidelines and tools to strengthen health systems response to violence against women. She has led the development of clinical guidelines for responding to child and adolescent sexual abuse, the RESPECT prevention framework, and is a lead author of the WHO global plan of action on strengthening health systems response to addressing interpersonal violence, in particular againstwomen and girls and against children. Avni is a passionate feminist scientist with a fierce commitment to gender equality and women’s health.

ST: What do you think are the most ethically challenging aspects of Sexual and Reproductive Health and Rights (SRHR), and how do you approach resolving them?

AA: One of the most challenging aspects of Sexual and Reproductive Health and Rights is the widespread resistance and opposition to the idea that women and girls should have control over their own bodies, their sexuality, and their fertility. [Society believes that] they should be the ones deciding whether to have children, not to have children, with whom to have children, when to have children, when to have sex, whether to have sex or not. Yet, this very idea that women and girls should decide for themselves is fiercely opposed by so many in society.

Obviously, you know there is a generation of social norms that play into this idea that women and girls should not control their bodies. It’s the government who decides, it’s the family who decides, it’s the husband who decides, it’s the mother in law who decides, it’s the boyfriend who decides—everyone but the woman decides for her body.

This, I believe, is perhaps the ethical crux of the most contentious aspects of SRHR—the idea that it [decision-making] should actually be driven by women and girls themselves. Because it’s their bodies, and they have the rights and choices [to determine what happens to them]. This fundamental principle makes many people uncomfortable.

ST: How do you see the intersection of support for human rights and gender equality with the reluctance to endorse women’s autonomy over their own bodies? How do you navigate these contradictions with stakeholders who advocate for human rights and gender equality on paper but not for sexual rights?

AA: The rhetoric surrounding gender equality is attractive, but the reality of implementing that rhetoric is challenging. There are some aspects of gender equality that I call “motherhood and apple pie issues”—they’re more palatable to people, while others are less so. For instance, people generally agree that “girls should be educated” as a fundamental aspect of gender equality. However, when you introduce the idea that girls should also receive sexuality education in schools—education that enables them to understand their bodies, choose when to marry, with whom to marry, and whether or not to engage in sexual activity—then resistance emerges. Up until a certain point, they can agree, but then when it gets to something as fundamental as bodily autonomy, the response often becomes a firm, “No, no.”

I think this resistance stems from a lack of understanding of what gender equality and human rights truly mean. Many people think it’s about promoting agreeable ideas that can be publicly supported, like ensuring girls attend school or enter traditionally female-dominated professions such as teaching and nursing. These are the nice things that women and girls can do, and that are acceptable [but they only scratch the surface]. Beneath this superficial support lies significant opposition to genuinely empowering women and girls to have agency over their lives. As long as women and girls operate within the comfort zone established by men and society, it’s acceptable; but the moment they step outside those boundaries, resistance intensifies.

ST: How do we then bring about a change in this narrative and advocate for a broader understanding of SRHR?

AA: One [key approach] is to be explicit in our definition of gender equality. If you are [advocating] for gender equality, you need to call it out clearly that it doesn’t just mean that you are supporting motherhood and apple pie issues. Yes, it’s important that girls should have access to education, and yes, mothers should survive childbirth. However, true gender equality means fundamentally believing, not just saying you believe it but ensuring through action, that you are responsible and accountable for women and girls to have a say over their bodies and lives. Only they should have it. Nobody else should have it. I think that’s being conceptually clear about where we are going with gender equality.

The second crucial aspect is to embed this fundamental notion of what bodily autonomy means very early in childhood for both boys and girls. It’s essential that sexuality education—even if not explicitly named as such—teaches core principles of respect, consent, choice, and bodily autonomy, regardless of what it’s called. Children should learn that “My body is mine; your body is yours.” They need to understand the principle that “I don’t touch yours without permission; you don’t touch mine without permission. You don’t get to have a say over what I do with my body and my choices, and I don’t get to do the same to you.” You really [need to] embed those as fundamental values in children because that’s where norm-setting and socialization starts, right?

We also need to ensure that parents understand clearly that sexuality education isn’t just about teaching kids how to have sex. Instead, it is about teaching kids how to have healthy, respectful relationships based on choice, consent, and empowerment. This should really start young in schools. How many of us actually received this kind of education [in our own schooling]? Probably very few. I would say don’t be hung up on names (laughs); just focus on the substance of what you are teaching and the fact that you are providing kids with valuable life skills.

ST: Your paper on analyzing power structures as a foundation for SRHR research was quite insightful. Could you elaborate on how these power structures reinforce stigma, and the ways in which SRH research can help challenge and reshape these prevailing narratives?

AA: At its core, having control and choice over one’s own body is about power. And the fact that others want to have a say over it is about someone asserting control over your fundamental rights. There’s no other area in life as driven by these power dynamics as sexual and reproductive health.

If someone has diabetes or hypertension, everyone is on eye to eye that they should get the necessary treatment. But the moment someone wants to use contraception, access abortion, or use mifepristone to abort, everyone feels entitled to weigh in: “You shouldn’t do this,” “You should have a child now,” or even “It must be a male child.”

If a woman gives birth to a child, [it doesn’t stop there]. People will say, “You should breastfeed,” “’You’re not holding the child properly,” or “You’re not feeding them right.” There’s this incessant—truly INCESSANT—policing of women’s lives and bodies. [And make no mistake], it’s all about power (pauses). It’s entirely about power.

You know, if a woman wears something like a sleeveless dress at night, people say, “Of course, that’s inviting rape or sexual attack.” That’s how policing power and control over women manifests. We don’t teach men that they’re not supposed to be doing this. [Women’s lives need to be restricted, while men’s behavior goes unchecked.] That’s power. That is entirely about exercising power because it’s based on this double standard we have in society—women’s bodies and lives need to be controlled, restricted, and circumscribed. Their choices, mobility, and freedoms need to be curtailed, so they don’t go haywire.

And that is fundamentally the issue with SRH. I think very few people would contest the idea that women shouldn’t receive treatment for cardiovascular diseases (laughs in amusement), but the minute you say women should have access to SRH information or knowledge about how fertility can be regulated, everyone starts getting nervous.

ST: Do you think SRH is seen through this narrow clinical lens, focusing primarily on the statistics of death rates? I mean, it’s so much more complex than that, right?

AA: Yes, some people view maternal health too narrowly, focusing only on maternal mortality. What they don’t realize is that the best way to prevent maternal deaths is to empower women to avoid pregnancy until they’re ready. This can only happen when women have the choice: either to avoid sex or to use effective contraception when they choose to have it. I often tell people, “If you truly want to reduce maternal deaths, then empower them to have children when they are ready, not when you want them to.”

Many who focus on preventing maternal deaths don’t understand that it’s about more than just clinical interventions. Preventing deaths fundamentally involves empowering women with bodily autonomy and choices. If we did that, we’d see fewer maternal deaths.

[For instance], why do more women in India die from maternal causes than in Switzerland? There are countless reasons, but a major one is that in Switzerland, very few girls are having children at 14 or 15—very few do. They have access to contraception, sexuality education, and the freedom to make informed choices. They’re going to school, getting employed, and choosing to delay childbearing until they’re ready—physically, emotionally, and in every other way. And, of course, they have [access to quality health] services when they do decide to have children.

Whereas in India, you have high death rates among girls from maternal mortality. Many get married by 14, are pregnant by 15, and have a child by 16. Their bodies and minds aren’t prepared for motherhood. By 20, they’ve often had multiple children without adequate antenatal care, education, or access to healthcare services.

So, preventing maternal deaths isn’t just about providing [healthcare] services. It’s about fundamentally empowering girls as they grow into women. If we did that, we wouldn’t need to rely so heavily on emergency care, and we’d see fewer young girls having children before their bodies are ready.

ST: This year marks the 30th anniversary of the International Conference on Population and Development held in Cairo. Given all the progress and setbacks we’ve seen over the years, what do you think is the current state of women’s reproductive rights globally in 2024? What are the most pressing challenges and opportunities for advancement in this space today?

AA: I believe we’ve made considerable progress overall. We’ve managed to cut maternal deaths significantly—maybe not quite by half, but we’ve made substantial strides globally in preventing deaths from childbirth. There have also been notable advancements in women’s access to contraception, treatment for sexually transmitted infections, and HIV prevention. However, the biggest challenge remains that this progress has been unequal.

The highest rates of maternal mortality, unmet contraceptive needs, and STIs, including HIV, persist in the poorest countries and communities—those with the fewest resources. Education is still not universally accessible, and many individuals face discrimination based on race, ethnicity, or other aspects of their identity. This is what I call the ‘last mile problem,’ where we struggle to eliminate gaps in inequality, especially for those living in the most precarious circumstances.

Another significant concern is that, in some areas, we are witnessing a reversal of progress. While we might wish for continuous forward momentum in government and societal ideologies, sometimes they also regress. For example, we’ve seen figures like Bolsonaro in Brazil reverse previous advancements. In Argentina, recent shifts in government have also led to a setback. In India, we had a period of notable progress, but current governmental perspectives reflect a regression. The U.S. experienced a significant regression during the Trump administration, especially with the implications of the Roe v. Wade’s decision that really set things back. generationally, it set things back for American women and girls.

What’s happening is that in many countries, we see the rise of ‘’illiberal democracies.’ Leaders who fundamentally oppose women’s rights, progress, [and equality] are coming into power—not through force, but because people are voting for them. Trump was elected in the U.S., the BJP government in India, Bolsonaro in Brazil, and similar situations have occurred in Argentina. These leaders, [elected by popular vote], often end up oppressing the most marginalized and vulnerable within their societies.

This trend is on the rise. If we look back at the past 30 years, we’ve moved from the very progressive ideals of the ICPD to now seeing many of the same governments now contesting those ideals. Countries that once championed progressive actions are now reversing course because the people in these democracies are voting for leaders who retract progress.

ST: It seems that people are okay with having their sexuality framed through control, power, and shame, rather than a perspective of health and rights.

AA: Well, I think it’s not just the people, but rather those in power who benefit from maintaining control [over these issues]. And yes, people vote for leaders who oppose these ideas. But I also see a growing divide between how young men and women are voting. Many young men are leaning more conservative, feeling threatened or emasculated, and thus support leaders like Bolsonaro, Trump, and—

ST: Modi?

AA: (smiling) Yes, the Modi government. Meanwhile, young women are saying, “These politicians affect our bodies and our lives,” and are voting for more progressive leaders. There’s a big gulf happening between young men and women when it comes to voting preferences, particularly on issues of sexual and reproductive rights.

ST: Absolutely. Do you have any final thoughts on why sexual and reproductive health and rights (SRHR) are so crucial, not just for personal agency, but for broader community health?

AA: Honestly, it’s a no-brainer to me. Sexual and reproductive health is essential to everyone’s well-being because, frankly, we all have sex. Many of us will reproduce at some point in our lives….

ST: …if you want to.

AA: Exactly—if you want to. But for many, that choice isn’t always available. So, if you’re having sex, whether you want to have children or not, or you want control over your fertility, then SRHR is fundamental to your health. It’s essential whether you’re a woman or a man [non-binary, transgender, or anywhere on the gender spectrum]. So for me, not addressing sexual and reproductive health as part of general health doesn’t make sense—unless you want to pretend people are asexual, which is unrealistic.