Top Ten Barriers to Sexual and Reproductive Health Care in the Developing World

Every day in the world's poorest countries, women cross their fingers. They cross their fingers that when they reach the clinic—5 miles away—it will be open. They cross their fingers, hoping that the clinic will be staffed by a health care provider who can answer their questions about family planning truthfully and without bias.

Will their finger-crossing work? Will the clinic have their preferred method of contraception? Will their partners be supportive? Will they be allowed to space their next pregnancy so that they can provide their other children with good food and keep them in school—or perhaps go back to school themselves?

Too often, women are forced to rely on luck. Facing extreme barriers to sexual and reproductive health care, they can only wish for health. They shouldn't have to.

At Pathfinder, we assess obstacles and figure out solutions through our myriad projects every day. Here are the top ten barriers we see most frequently—and a snapshot of what we're doing to break them down.

1. Gender inequality

Women often can't access reproductive health care because of systemic gender inequality. For instance, a woman in desperate need of emergency obstetric care, may have to have her husband's permission to go to a clinic.

What we're doing to break it:
Pathfinder programs focus on engaging communities to collaboratively reflect and discuss these inequalities—what they mean for women's health—and work on changes within communities. Small changes can have resounding positive effects.

2. Stock outs

For many reasons, including supply chain issues, poor planning, or lack of funding, clinics often run out of contraceptives.

What we're doing to break it:
Pathfinder works with providers, clinic managers, and government officials to anticipate needs, improve supply chains, and ensure availability of contraceptives.

3. Lack of funding

Global reproductive health is significantly underfunded. More than 200 million women want, but lack access to contraceptives. As government budgets become tighter, international funding is even more at risk.

What we're doing to break it:
Through education initiatives and outreach to key decision-makers, Pathfinder advocates and champions the importance of reproductive health funding.

4. Lack of skilled service providers

In many areas, the number of service providers like doctors, nurses, and midwives is limited, and those that exist are often undertrained.

What we're doing to break it:
Pathfinder focuses on training providers so that their skills and knowledge are improved. In addition, Pathfinder partners with Health Ministries and local organizations to improve supportive supervision and address provider retention.

5. Distance to health service point

In rural communities, health centers, clinics, and hospitals can be far away or too difficult to reach.

What we're doing to break it:
By working with community-based health workers, peer educators, and other local outreach channels, Pathfinder brings services to the community. When a community-based health worker is trained in providing comprehensive counseling and contraceptives, it saves the client from traveling long distances and using limited financial resources to access the care they need.

6. Misinformation in communities

Whether it's about side effects of contraceptives (like they accumulate in your stomach) or the transmission of HIV, myths and misinformation about reproductive health can take many forms.

What we're doing to break it:
Through community outreach, peer education, and informative media (ie, radio broadcasts) Pathfinder strives to bring accurate information about sexual and reproductive health into communities and help communities take ownership of this knowledge.

7. Opportunity costs

For some women, the time needed to go to a clinic, or travel to a hospital means losing out on other valuable time working in the field, traveling to market, or preparing food for their children.

What we're doing to break it:
Pathfinder addresses opportunity costs by bringing services to her doorstep in some cases or at least bringing it to more accessible venues (a closer health post for instance). This ensures women can receive the services they need without giving up other valued time investments.

8. Service provider bias

Just because a nurse is trained in providing a service, does not mean he/she provides it without bias. This can take the form of refusing to discuss contraceptive use with adolescents, for instance, or turning away a woman who is seeking abortion counseling.

What we're doing to break it:
Partnering with local trainers, Pathfinder leads training that helps providers evaluate their own values and understand the needs of those they are serving. The goal in all of these is to reduce stigma and discrimination and ensure that all clients are treated with dignity and receive comprehensive services that address their needs.

9. Legislative and legal barriers

Restrictive laws and policies can have a real—and sometimes devastating—impact on the people Pathfinder serves. This is particularly challenging in relation to safe abortion services.

What we're doing to break it:
Pathfinder strongly supports the rights of all people to control their reproductive lives. Pathfinder works to support local efforts to improve policies overseas, and educates decision-makers in shaping legislation that will protect the reproductive rights of all people both in the US and abroad.

10. Cultural norms and traditions

In some cultures women can only seek services from another women; yet, female providers are limited. In others, religious leaders resist the idea of sexual and reproductive health services, such as contraception.

What we're doing to break it:
Pathfinder works within the cultural context of a country � striving not to change culture, but rather to collaborate with cultural and religious leaders to ensure that women, men, and young people have the ability to live healthy lives. Pathfinder's approach to working with religious leaders to promote healthy timing and spacing of pregnancy is one example of this collaboration.

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