What are the WHO’s priorities? Young women in the shadow of the pharmaceutical lobby

The World Health Organization (WHO) has published the WHO guideline on preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income countries¹. These guidelines replace the previous document, which had been in force since 2011.  

The WHO’s diagnoses are generally accurate, and it is difficult to dispute the importance of the issues raised in the document. However, the solutions proposed by the WHO raise doubts, as they can largely be summed up in two words: contraception and abortion. This approach to the issue is not only a shortcut, but above all a superficial measure that not only fails to eliminate the sources of the current problems but also creates new ones. When reading the WHO Guidelines, the question naturally arises as to whether the actual well-being of teenagers in low- and middle-income countries is more important to this organization than the profits of pharmaceutical companies in high-income countries. 

Accurate diagnoses 

The guidelines were developed as a result of the WHO’s recognition that teenage pregnancy is a global public health problem. Young motherhood has a wide-ranging impact on the health, education, and future opportunities of teenagers.  

It is difficult to disagree with the WHO’s basic diagnosis that teenagers are generally too young to become mothers for a number of reasons.  

As the WHO points out, teenagers who give birth are at greater risk of maternal and infant mortality than more mature women. In addition, early pregnancies can limit teenagers’ choices, narrowing their educational and economic prospects. These limitations often perpetuate cycles of poverty and inequality. This state of affairs is a logical consequence of early and often unplanned pregnancy. 

Problem 1: Teenage pregnancies 

The WHO also points out that in many parts of the world, adolescents—both married and unmarried—do not have access to the information and resources necessary to make informed decisions about their sexual and reproductive health (SRH). This leaves them vulnerable to early pregnancy and unprepared to cope with the physical, emotional, and social changes that follow.  

It is also difficult to argue with the WHO on this point. However, the way the issue is framed clearly indicates the direction the WHO is heading in: the solution is to provide access to contraception, including the ‘morning-after pill’ and ‘safe’ abortion, which, according to the WHO, simply means legal abortion. The WHO guidelines contain no recommendations for education, encouragement of sexual abstinence, or promotion of stable, formalized relationships (marriage), which are much better suited to physical, emotional, and social needs, including by providing security and conditions for making informed decisions.  

Problem 2: Child marriage 

As the WHO emphasizes, child marriage, which is still common in some regions, further exacerbates the above-mentioned risks. Marriage before the age of 18 increases the likelihood of early and repeated pregnancies, contributes to poor mental health, and can lead to early school dropout, further limiting life choices. It is impossible to disagree with the WHO, although it is worth emphasizing that eliminating the practice of child marriage (which mainly affects girls) is important not only because of its health consequences. Child marriage violates a number of provisions of the Convention on the Rights of the Child² and per se excludes awareness and voluntary decision-making about entering into marriage.  

Controversial solutions 

Although the document presented by the WHO is comprehensive and rich in interesting data, the proposed solutions (recommendations) can hardly be described as anything other than clichéd and only partially addressing the problem.  

In particular, the WHO does not provide any groundbreaking solutions to the problem of teenage pregnancy. However, groundbreaking solutions are not necessary, as there are a number of approaches, particularly education, that can successfully reduce teenage pregnancies without risking the mental and physical health of girls. 

Contraception as a panacea 

All WHO recommendations related to the prevention of teenage pregnancy focus on “increasing access to, uptake of, and continued use of contraception among adolescents.”  

The WHO recommends, among other things, the “implementation of gender-transformative behavior change interventions with adolescents to strengthen their ability to make decisions about their contraceptive use” (recommendation 2.1a (WHO, 2025, p. xii)).  

The approach to this topic is very interesting, because the very assumption that it is worthwhile to influence the behavior of teenagers by increasing their ability to make decisions seems to be a highly desirable direction. Reliable, age-appropriate education on biology, sexual development, and reproduction is an absolute prerequisite for further informed decisions, including those related to sexual initiation. The problem is that WHO recommendation 2.1.a does not call for educational measures in these areas. The WHO clearly states that it is essential for adolescents to have “the ability to make decisions about contraceptive use.” Everything else is treated as irrelevant, and the use of contraception is both the goal and the solution to the problem, even though we know very well that the use of contraception encourages behavior that can result in unwanted pregnancy—when contraception fails.  

Recommendation 2.1b is a logical consequence of the above, as it includes the implementation of interventions that will change social norms so that they support decisions about the use, access, and continued use of contraception by adolescents. In short, the WHO wants to prevent teenage pregnancies by convincing societies that contraception is an essential part of sexual intercourse – although it no longer considers the stability of a relationship, trust in a partner, or sexual, emotional, and social maturity to be necessary for starting sexual intercourse. It follows that the WHO’s goal is – at least ostensibly – to prevent pregnancy (thereby boosting the pharmaceutical industry and disregarding the negative effects of some forms of contraception on the health of girls and women), rather than to delay the onset of sexual activity among teenagers. 

This corresponds to further recommendations (recommendation 2.2 (WHO, 2025, p. xiii)): availability of injectable contraception (for self-administration), availability of oral contraceptive pills without a prescription, and availability of ‘emergency contraception,’ i.e., ‘morning-after pills’ (which may have early abortifacient effects) without a prescription for all who wish to use them. 

‘Morning-after’ pills 

The ‘morning-after’ pills promoted by the WHO are in fact drugs that can pose a serious risk to the health of the woman or girl taking them and to the potentially developing child, as they can actually be taken up to several days after intercourse. Even given the WHO’s well-known position on the promotion of contraception, including ‘emergency contraception,’ it is surprising that the WHO does not recognize in its recommendations the risks associated with the use of such pills without medical supervision—both in terms of the appropriateness of taking them on a one-time basis and in terms of their impact on the health of women who take them regularly. 

It is worth recalling the position of the Presidium of the Polish Supreme Pharmaceutical Council, which clearly stated that the “frequent use of these tablets [containing the active substance ulipristal acetate – OI note] causes hormonal disorders and menstrual cycle irregularities. This is a major interference with the hormonal system, which, with frequent use, may consequently cause problems with becoming pregnant and later even accelerate menopause. The effects of ulipristal acetate on the fetus are also unknown if embryo implantation occurs after taking a pill that inhibits or delays ovulation.”³

This opinion is confirmed by the ellaOne Summary of Product Characteristics⁴ and studies presented by the European Medicines Agency⁵. 

Studies from 2009 confirm⁶ that ellaOne may prevent the further development of a child who is in the early stages of development at the time of administration, and studies published in 2017 show an indisputable link between the use of a single ellaOne tablet and significant changes in the expression of genes important for the proper functioning of the uterine lining, which determines its susceptibility to implantation⁷. This means that there is a high probability of significant difficulties in embryo implantation, which is a prerequisite for the further development of the child. This was indicated in the original leaflet for this product from 2009, but in 2010, the new leaflet omitted the passage indicating the possible negative effect of this preparation on embryo implantation. However, the validity of the original wording of the leaflet is confirmed by the content of the registration documentation, according to which one of the mechanisms of action of ulipristal acetate is to delay endometrial maturation, which may inhibit the implantation process⁸. 

However, there is no reference to the above issues in the WHO guidelines. The WHO focuses on ensuring that, “depending on the woman’s preference and anticipated use,” even a year’s supply of such pills is available. Maximum access to pills and a flexible refill system so that women can easily obtain pills in the quantity and at the time they need them (recommendation 2.2 (WHO, 2025, p. xiii)) are the WHO’s recipe for preventing teenage pregnancies. 

‘Safe’ abortion 

The negative effects of pregnancy are to be reduced, among other things, by preventing ‘unsafe abortion’ and improving access to high-quality health services for mothers (Guidelines, p. 4 – Objectives of the guidelines).  

What does the World Health Organization consider to be a ‘safe abortion’? According to the WHO, it is sufficient for abortion to be legal, so that it takes place under controlled medical conditions, which reduces the risk of complications and deaths. However, the issue is not so clear-cut, as even legal abortion carries risks to women’s physical and mental health, as confirmed by research⁹. This thesis is also contradicted by data on maternal mortality. Eurostat statistics on maternal mortality in European Union countries clearly show that Poland, with some of Europe’s strictest abortion laws, has one of the lowest maternal mortality rates in the European Union (1.1 deaths per 100,000 live births in 2018)¹⁰. This shows that high-quality healthcare, not the legalization of abortion, is key to reducing perinatal mortality. 

Education for responsibility 

The WHO guidelines indicate as an example of good practice that “political, governmental, religious, traditional and other influential leaders should be mobilized to support the access to, uptake of, and continued use of contraception among adolescents” (Good practice statement 2.1 (WHO, 2025, p. xiv)). 

Contraception, encouraged throughout the WHO document, appears to be a miracle cure for everything, and ultimately it is difficult not to get the impression that the WHO guidelines must be the result of powerful lobbying by the companies responsible for its presence on the market and reaping huge profits from it.  

It is futile to look for recommendations in the WHO guidelines that are less favorable to the pharmaceutical industry, such as education, encouragement of sexual abstinence, and promotion of stable, formalized relationships (marriage), which are much better suited to physical, emotional and social needs, including by providing security and conditions for making informed decisions, which would result in a reduction in the number of unplanned and early pregnancies. The role of such “soft” sex education (model A) has been successfully fulfilled for years in Poland, among other countries, by family life education classes.  

In contrast, countries that use a permissive model of sex education (model C), such as Sweden, Denmark, and Germany, have higher rates of teenage pregnancy compared to countries where model A education, based on teaching responsibility and family values, is dominant, as in Poland.  

In Sweden, where type C sex education has been compulsory since the 1950s, the pregnancy rate among girls aged 15-19 was 5.7 per 1,000 girls in 2018, while in Poland it was 3.2 per 1,000 in the same period. Eurostat data indicate that in countries with permissive sex education, the teenage pregnancy rate is on average 30-40% higher than in countries using the Type A education model¹¹.  

Furthermore, research conducted by the Guttmacher Institute in 2017 showed that in countries with intensive type C sex education, there are more abortions among teenagers¹², which may be linked to the greater availability of contraceptives promoted under this model, but without sufficient emphasis on responsibility. 

In view of the above, it is difficult to understand why the WHO completely omits the aspect of education for responsibility and certain universal values in its recommendations. It would be entirely justified to include this aspect at least alongside the other recommendations. Unless the aim of the recommendations is not so much to reduce the number of teenage pregnancies as to increase the scale of their sexual activity—so that contraception, which is so widely promoted in the guidelines, maintains and even expands the market for pharmaceutical companies, but also, in reality, for the abortion industry. 

People vs. money  

What, then, might be the consequences of promoting contraception in complete isolation from education about responsibility and without consideration for higher values such as fidelity or respect for life? The number of pregnancies among teenagers who are taught that contraception is almost necessary for sexual intercourse will certainly fall (it has already fallen: between 2000 and 2021, the global teenage birth rate fell by 34%¹³, but the overall number of abortions and the age of sexual initiation will not decrease, nor will the level of education among young people increase, as this education will be limited to information on where to obtain and how to use contraceptives. Is this the aim of the WHO recommendations? Unfortunately, there are many indications that this is the case, which may mean that today, the official guidelines of the World Health Organization are primarily driven by the financial interests of the big pharmaceutical companies. 

The validity of this conclusion is confirmed by the way in which the WHO treated the second topic raised in the guidelines, namely child marriage. In this area, the recommendations are much more diverse and actually give grounds for believing that this problem will be eliminated or at least reduced. Encouraging girls to continue their education, strengthening their position, building their knowledge, skills, resources and social networks, removing barriers to education, expanding alternatives to marriage before the age of 18, but also adapting legal systems to human rights requirements, including women’s rights – all this adds up to a coherent, concrete plan of action that offers promising prospects for the future.  

Could this be possible because child marriages do not bring benefits to large corporations?  

Read also: Will there be a debate in Poland about leaving the WHO? Ordo Iuris presents a special report

^[1] 
WHO, WHO guideline on preventing early pregnancy and poor reproductive outcomes among adolescents in low- and middle-income countries, 2025, https://www.who.int/publications/i/item/9789240104105, (accessed: 01.07.2025).

^[2] 
Convention on the Rights of the Child adopted by the United Nations General Assembly on November 20, 1989.

^[3] 
Position No. VI/2/2015 of the Presidium of the Supreme Pharmaceutical Council of January 21, 2015 on the use of tablets containing ulipristal acetate.

^[4] 
“Very limited data are available on the health of the fetus/newborn when exposed to ulipristal acetate during pregnancy. Although no teratogenic effects have been observed, animal studies are insufficient to assess the toxic effects on reproduction.” (CHPL ellaOne, http://chpl.com.pl/data_files/Ellaone.pdf, accessed: 02.07.2025).

^[5] 
2009 European Medicines Agency report “CHMP ASSESSMENT REPORT FOR Ellaone International Nonproprietary Name: ulipristal acetate Procedure No. EMEA/H/C/001027.

^[6] 
According to the 2009 European Medicines Agency report CHMP ASSESSMENT REPORT FOR Ellaone International Nonproprietary Name: ulipristal acetate. Procedure No. EMEA/H/C/001027, “[T]he applicant proposes several different mechanisms of action of the compound in humans, […] ability to delay maturation of the endometrium likely resulting in prevention of implantation.”

^[7] 
Lira-Albarrán S, Durand M, Larrea-Schiavon MF, González L, Barrera D, Vega C, Gamboa-Domínguez A, Rangel C, Larrea F, Ulipristal acetate administration at mid-cycle changes gene expression profiling of endometrial biopsies taken during the receptive period of the human menstrual cycle, Mol Cell Endocrinol. 2017;15;447:1-11. doi: 10.1016/j.mce.2017.02.024.

^[8] 
The leaflet stated: “It is believed that [ellaOne – OI note] works by stopping the release of an egg from the ovaries and possibly also by changes in the uterus.” See the position of the Scientific Council of the Bioethics Center of the Ordo Iuris Institute for Legal Culture on the change in the availability category in Poland of the medicinal product ellaOne, June 8, 2017, https://ordoiuris.pl/informacje-prasowe/rada-naukowa-centrum-bioetyki-ordo-iuris-o-ellaone/#_ftn8, (accessed on 02.07.2025).

^[9] 
Coleman, P.K., “Abortion and mental health: quantitative synthesis and analysis of research published 1995–2009,” British Journal of Psychiatry, 2011; Reardon, D.C., “The abortion and mental health controversy: A comprehensive literature review,” 2018.

^[10] 
Eurostat, “Maternal mortality statistics,” 2018, https://ec.europa.eu/eurostat, (accessed: 01.07.2025).

^[11] 
Eurostat, “Fertility statistics – Teenage and older mothers”, https://ec.europa.eu/eurostat, (accessed: 01.07.2025).

^[12] 
Guttmacher Institute, “Adolescent Pregnancy and Its Outcomes Across Countries,” 2017, https://www.guttmacher.org/, (accessed: 01.07.2025).

^[13] 
See Guidelines, p. 7.