Her body, their rules

Of the 11 commissions rolled out by the interim government as part of its ambitious state reform blueprint, it was the Women’s Affairs Reform Commission that drew my immediate attention. With 433 recommendations collated under 15 thematic areas, the commission set its sights on tearing down the deeply rooted structures of gender discrimination. Let’s be honest: every single point holds water. Some will, hopefully, may come into practice, despite the protests and accompanying pressure against the recommendations suggesting they may never see the light of day.

Government reform aside, change is not top-down. It is also individual. If we want to move the needle for women, we need to start by truly feeling the weight of their everyday struggles. When we scan a 400-point list, it reads like yet another bureaucratic report: lifeless and abstract. But when we zoom in – when we dissect just one issue, chew on it, hold it up to the light – we begin to feel. When we feel, we care. When we care, we act. One problem at a time, one story at a time, our outlook begins to shift. Perhaps – just perhaps – real change can begin, not in reports or conference rooms, but in our collective conscience.

I want to put the spotlight on one such issue that countless Bangladeshi women face. When we talk about “freedom,” what are we really talking about? Is it the freedom to choose your clothes, your career, your life’s path? For some, it is financial freedom. For others, it is the courage to speak without fearing backlash. But for far too many women in Bangladesh, freedom begins with something even more fundamental: the right to make decisions about their own bodies and their health. Heartbreakingly, even in 2025, this most basic autonomy is still up for debate.

As an urban woman, I once believed freedom was about breaking glass ceilings and shattering stereotypes. But my perspective shifted dramatically after working in urban slums and rural communities. As a woman working in the development sector, I discovered a harsh truth: women’s lack of autonomy over their physical wellbeing is one of the most pervasive and overlooked injustices of our time. Whether it is accessing healthcare, making reproductive choices or even seeking treatment for life-threatening illnesses, women are often at the mercy of the men in their lives. This is not just a rural phenomenon – it is a systemic issue that cuts across geography, class and culture.

Invisible chains of decision-making

In Bangladesh, a woman’s health is rarely her own business. From the moment she wakes up to the moment she sleeps, her choices are dictated by her husband, father or in-laws. Need to see a doctor? Ask your husband. Feeling unwell? Suppress it – because revealing your pain might inconvenience others. Even for something as personal as sexual and reproductive health (SRH), women often need permission to seek care. If they do manage to visit a healthcare facility, the experience is often so dehumanising that they think twice before returning.

Let me tell you about a recurring scene from my experience. A woman in a village or rural town is battling severe abdominal pain. She knows something is wrong, but her husband dismisses her symptoms as “normal” or “just stress”. When the pain becomes unbearable, she finally convinces him to let her visit the local government health centre. There, she is met with long queues, dismissive staff, and a lack of essential medicines. If she is lucky, she might get a referral to a private clinic – but that requires money, which her husband controls. In the end, she returns home, untreated, her condition left to worsen by the day.

I have seen this pattern repeated across the country. Women are denied access to basic healthcare because they lack the financial and psychological independence to make decisions for themselves. When it comes to mental health, the situation is even bleaker. Seeking therapy or counselling is seen as a luxury, reserved for the privileged few. For the rest, suffering in silence is the only option.

Myth of male expertise

One of the most infuriating aspects of this issue is the assumption that men know what is best for women’s bodies. During my work, I met men who proudly declared that the government’s cervical cancer vaccination programme was a Western conspiracy to sterilise Bangladeshi women. They had convinced their entire social circle to keep their wives and daughters away from the vaccine. Their ignorance wasn’t just laughable – it was dangerous. 

Cervical cancer is one of the leading causes of death among women in Bangladesh. While the exact figures vary, estimates indicate around 8,000 to 17,000 new cases and 5,000 to 10,000 deaths each year, making it the second most common cancer type among women in the country. Yet, men are dictating healthcare decisions pertaining to it based on sheer misinformation.

This is not just about ignorance, not least since the ignorance would not have any bearing if women had agency. It is about power. In our society, endorsed and emboldened by our governments, men hold the authority to decide whether a woman lives or dies, whether she gets treatment or suffers in silence. This power dynamic extends to every aspect of women’s health, from contraception to childbirth to abortion.

Contraception conundrum

When women have multiple options – pills, implants, IUDs – men have exactly two: condoms and vasectomy. Yet, it is women who bear the brunt of family planning. I have lost count of the number of women I have met who suffer from the side effects of oral contraceptives because their husbands refuse to use condoms. When these contraceptives fail – as they often do – it is the woman who pays the price.

I remember one particularly heartbreaking case. A young woman in her early twenties had undergone three at-home abortions using illegal MRM kits. Each time, she bled for weeks, enduring unimaginable pain and trauma. When I asked her why she didn’t seek medical help, she simply said, “My husband didn’t think it was necessary.” Then there is the issue of vasectomy. While women are expected to undergo permanent sterilisation, men rarely consider it an option for a reversible procedure. In one bizarre case, a young rickshaw-puller underwent a vasectomy in exchange for 2,000 taka (about $20). His wife, who had been married to him for just a month, was devastated. Her dream of becoming a mother was shattered, and she had no say in the matter.

Now, imagine the reverse. What if a newly married woman decided to undergo permanent sterilisation without consulting her husband? The backlash would be swift and severe. She would likely be abandoned, if not abused. But when men make these decisions, it is seen as their right – because they are the ones who earn the money or control it even when she is earning it.

The nutrition gap

The inequality extends beyond healthcare to something as basic as nutrition. In rural Bangladesh, women are often the last to eat and the first to sacrifice. I have seen mothers save fruits, eggs, and other nutritious food for their children and husbands while depriving themselves. The result? Severe anaemia and malnutrition are rampant among these women. This is not just a cultural issue; it is an economic one. When men control the household income, they decide what is on the table. All too often, women’s nutritional needs are an afterthought.

What is the solution?

The quick answer is to acknowledge and “feel” the issue. Then it extends to economic empowerment and collective awareness. Women who are educated and financially independent are more likely to make decisions about their own health and wellbeing. They are more likely to seek medical care, use contraception, and ensure their children are vaccinated.

But economic empowerment isn’t just about earning money; it is about changing mindsets. It is about challenging the deeply ingrained belief that men know best. It is about creating a society where women’s health is seen as a priority, not an afterthought.

This won’t happen overnight. It requires systemic change – from improving the quality of public healthcare to promoting gender equality in education and employment. But most importantly, it requires a shift in how we think about freedom.

For some, true freedom is about breaking barriers or achieving milestones. However, it can start with having the autonomy to make decisions as basic as about your own body and life. Until every woman has that freedom, our work is far from done.●

Khadeza Akter is a humanitarian and public health professional.