Bearing Children: Not Always a Woman's Choice

Jordanian woman

Updated Version 

Many women throughout the rural deserts of Jordan do not control the timing of their own pregnancies, according to a recent survey.

Women regularly discuss family planning with their husbands, yet only 54 percent said they had a choice in the frequency of child births, the Integration Health and Empowerment of Women in the South Region Project reported last month.

"Women in the south region of Jordan...need to be empowered in terms of [their] ability to make the appropriate decision and consider their health as priority," the study said.

While population and reproductive health initiatives have helped lower high fertility rates across much of the Arab world, the Jordan survey suggests that progress is still needed for rural women to gain full control of their reproductive health. Population experts consider this a key to slowing global population growth.

The Middle East and North Africa region is home to some of the world's higher population growth rates, on average. Whereas some 432 million people inhabited the region in 2007, the Population Reference Bureau (PRB) projects a population of about 692 million in 2050.

The study, which the Japanese International Cooperation Agency commissioned, surveyed 807 women in the spring of 2008. The survey found that 46 percent of women "never" choose when to get pregnant, and nearly one-third do not make decisions related to their use of contraceptives.

Relatively few studies have focused on family planning autonomy, especially among Arab women. Yet the findings appear higher than average for Jordan, according to Cari Jo Clark, a public health researcher at the University of Minnesota.

Clark has researched gender-based violence in Bosnia, Kosovo, and most recently Jordan as a Fulbright fellow. In a study published last year in Studies in Family Planning, roughly 20 percent of Jordanian women whom Clark surveyed at reproductive health clinics nationwide acknowledged that their husband or another family member intervened in family planning decisions.

"In the city they have much more access to contraceptive options, but that doesn't mean they'll make decisions on their own," Clark said. "They need their husband's permission for the most part, unless they do it secretly, which could be very dangerous."

Family members mostly intervene through non-violent disapproval, Clark's study said. But in Jordan, like in many Arab countries and beyond, women rarely report abuses in order to uphold family and personal reputations. "Women are not flapping their lips about things that will get them into lots and lots of trouble," Clark said. 

In the south region study, about 16 percent chose not to respond to marital abuse questions. Among those who responded, 20 percent reported physical abuse. "A woman who is abused physically is most likely abused psychologically, socially and economically," the study said.

The Jordanian government began advocating longer intervals between births in 1991. Ever since, the proportion of married women using contraception increased from 27 percent to 41 percent, and the average number of children per woman fell from 5.6 to 3.2, according to the United Nations Population Fund (UNFPA) 2008 report, State of World Population.

The success in Jordan reflects improvements across the Arab world. An average woman gave birth to seven children in 1950, then the highest regional fertility rate in the world. The rate now stands at 3.3 children per woman. An average rate of about 2.1 children per woman eventually stabilizes a population, absent net migration, according to demographers.

Many experts consider slowing population growth as an essential component of solutions to global climate change, resource depletion, and environmental degradation. The chair of the United Kingdom's Sustainable Development Commission, for example, now recommends that parents be limited to two children for reasons of global sustainability.  

But limits on parenthood are rarely popular. Other experts, such as University of California at Berkeley family planning specialists Malcolm Potts and Martha Campbell, argue that women are likely to have two or fewer children wherever a variety of contraceptive methods and safe abortion services are allowed.

Yet domestic violence remains ignored in many discussions about population and reproductive health. Countries such as Jordan may have to engage the issue, however, to lower fertility rates further. "It's very difficult to control your own fertility when you're not in control of aspects of your life," Clark said.

The survey also suggested that Jordan spend additional resources on extending reproductive health care services into the country's remote, rural regions. Without satellite-access to television programming, many of the surveyed women would be even less informed on family planning options, the survey found.

A PRB study found that 38 percent of pregnancies are unintended in Jordan, meaning the mother did not want a child or mistimed the pregnancy. The problem is common in many regions of the world - roughly one-third of pregnancies are unintended throughout developing countries worldwide, according to the Guttmacher Institute, a U.S. reproductive health research organization.

Countries across the Middle East, and worldwide, may soon receive additional healthcare funds to extend their population programs.

U.S. President Barack Obama last month reversed a U.S. Agency for International Development (USAID) ban on funding family planning programs abroad that perform abortion or inform women about the service, conditions that former President George W. Bush established in 2001.

Obama is also expected to restore funding for the UNFPA if Congress provides the funding as anticipated. The annual allotment, some $21.5 million or more for contraception and other reproductive health services, was eliminated by the Bush administration in 2002 due to suspicions that the funds supported abortions.

"This represents a tremendous statement about the administration's commitment to reproductive health...and [it] will also have an enormous impact on women's health and lives," said Angel Foster, director of the Middle East and North Africa Program at Ibis Reproductive Health, a U.S.-based nonprofit that attempts to spread access to contraceptives worldwide. 

In addition, the Bill & Melinda Gates Foundation announced last month that it would increase support for global healthcare and development assistance. The foundation will spend $3.8 billion in 2009, or 7 percent of its total assets - a 2 percent increase despite a 20 percent decrease in assets last year due largely to the global financial crisis.

If more funding is allocated to disease eradication, global population planning initiatives would benefit by reducing the number of children that impoverished parents desire, Bill Gates explained in his first annual letter.

"Parents choose to have enough kids to give them a high chance that several will survive to support them as they grow old," Gates wrote. "As the number of kids who survive to adulthood goes up, parents can achieve this goal without having as many children."

If true across cultures, no region may exemplify the trend more than the Middle East. About 186 infants died per 1,000 births before antibiotics and vaccines arrived there in the 1950s. A considerably reduced mortality rate has coincided with the region's falling fertility rate, with 44 infants now dying per 1,000 births, the UNFPA reports.

Ben Block is a staff writer with the Worldwatch Institute. He can be reached at

For permission to reprint this article, please contact Julia Tier at

Correction: The original version of this story inaccurately reported Dr. Clark's comments, stating that she considered the south Jordan study's findings, "consistent with observations across Jordan." In fact, Dr. Clark considers the findings "higher than average for the rest of Jordan."