Why Population Assistance Matters

North-South Gap Remains

Ninety-nine percent of pregnancy-related deaths still take place in developing countries. This one statistic captures the impact of poor access to contraception, lack of skilled care in pregnancy and childbirth, as well as of pregnancies that occur too early in life, too late or too often. Women in sub-Saharan Africa face a 1 in 16 lifetime risk of dying in pregnancy or childbirth; women in developed countries face a 1 in 2,800 risk.

More than 200 million women still have an unmet need for effective contraceptive methods, and the need continues to grow as the number of women and men in their childbearing years increases, and as more of them want to plan their families. Unmet need is highest in sub-Saharan Africa, where 46 percent of women at risk of unintended pregnancy are using no method of contraception. The demand for contraception is projected to increase by 40 percent by 2025.

The gap between demand and donor support for contraceptives, condoms for HIV/AIDS prevention, and other reproductive health supplies is growing. If all the male condoms in sub-Saharan Africa made available by donors were evenly distributed, each man would have just three or four per year. Yet donor funding for supplies and supply systems continues to fall. The combined cost of contraceptives and condoms for disease prevention is expected to nearly double over the next decade—from US$1.0 billion in 2003 to $1.8 billion in 2015—while delivery and related costs will rise to $9 billion. In 2002, donors funded just 30 percent of the costs of needed supplies, down from 41 percent in the early to mid-1990s. To return to 41 percent, donors would have to contribute $739 million for contraceptives and condoms in 2015.

Hundreds of millions of women still lack access to basic care in pregnancy and childbirth. While women in developed countries have almost universal access to care, one-third of pregnant women in developing countries receive no medical care whatsoever. Only half of all deliveries are attended by skilled personnel, a proportion that falls to less than one-third in the least developed countries. And the number of women of reproductive age in developing countries is increasing by more than 20 million annually.

HIV/AIDS prevention and treatment remain out of reach. An estimated 38 million people are living with HIV/AIDS, half of them women, and 5 million people were newly infected in 2003. More than three-quarters of HIV infections are transmitted sexually, while 10 percent are due to mother-to-child transmission (MTCT). Yet proven means of prevention—such as condoms, voluntary testing and counseling, and drugs to prevent MTCT—are available to less than 20 percent of people at high risk of infection. The international goal of treating 3 million people by 2005 is now even further from reach.

Reproductive Rights, Human Rights

The ICPD Programme of Action reaffirms the right to plan one’s family, first articulated in 1968. Stating that “reproductive rights embrace certain human rights that are already recognized…,” it places the right to sexual and reproductive health firmly within the concept of the right to health.

Major human rights treaties lay the foundation for the right to reproductive health. These treaties include the International Covenant on Economic, Social, and Cultural Rights adopted in 1966, which lays out the “right to health” in Article 10.2. In 1979, the Convention on the Elimination of All Forms of Discrimination Against Women included the right to health care, including information, counseling, and family planning services in Article 14.2(b) and certain other Articles. In 1989, the Convention on the Rights of the Child established the right of women to appropriate maternal health services in Article 24(2)(d).

Countries that have ratified these treaties are legally bound to protect, promote and ensure the rights identified. Donor countries that invest in sexual and reproductive health services are contributing to the exercise of the right to health.

Reproductive Health, Population, and Development are Linked

Reproductive illnesses and unintended pregnancies weaken or kill people in their most economically productive years. In sub-Saharan Africa, one-third of all disability and premature death among women is due to reproductive illnesses, including complications of unsafe abortion and HIV/AIDS. In many developing countries, women earn 40 percent to 60 percent of household income, and grow 80 percent of the food consumed. This economic contribution is lost when a woman dies in pregnancy or is unable to work due to poor reproductive health.

Deaths from HIV/AIDS are damaging prospects for economic development. In Zambia alone, more than 2,500 teachers died of AIDS in 2001, the equivalent of 1 in 16 teachers in the country. AIDS experts estimate that a country with 15 percent of its population HIV-positive could expect its gross domestic product to decline by about 1 percent annually.

Women’s ability to manage their fertility is critical to gender equality and reducing poverty. Access to reproductive health care, including contraceptive services, is crucial if women are to make their own decisions about childbearing and other aspects of their lives.

Access to reproductive health care hastens the demographic transition. The shift from short lives and large families to long lives and small families that has occurred in the developed countries and some developing countries is due in part to access to key health interventions, such as antibiotics, immunization, and contraception. The resulting lower birth rates and slower population growth are largely the consequence of women and men realizing their own childbearing intentions, but carry benefits for entire societies. Research has shown that smaller family size has a positive impact on household savings and investment, and through these, on economic growth.