Reproductive Health & DevelopmentWomen’s Edition Seminar

11/12/2012

Nancy Yinger

Presentation Outline

Review current thinking about reproductive health (RH)

Look at some basic RH data

Assess links between RH & development

1994 ICPD Definition of RH

ICPD emphasized sexual & reproductive health & rights within a broad development framework.

“Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes.”

For RH, National Sovereignty Trumps Rights

Universal power of rights language not as strong for reproductive health

Strong link between reproduction & social norms makes reproductive rights more controversial

ICPD’s rights-based approach had less impact than hoped for

The Bad News: Reproductive Health & Rights Still Politicized

Interviewees for Hewlett Foundation project on RH & rights and CGD project on new head for UNFPA said – No consensus on the definition or indicators of

reproductive health.

– Consensus unlikely; Efforts to achieve consensus may

result only in acrimonious debate. – UNFPA decided not to hold another global conference

to renew ICPD– Population and RH ignored at Rio +20 Conference on

Sustainable Development– RH & rights an issue in the US election .

News Flash: Efforts to Revitalizing Family Planning

July 11, 2012: Family Planning Summit

An initiative of DFID and The Bill and Melinda Gates Foundation; 150 senior officials from around the world.

Goal to reach 120 million more women with voluntary family planning by 2010; Financial commitments of $2.6 billion

Focus on FP technologies, especially long acting methods.

http://www.who.int/pmnch/media/news/2012/20120627_family_planning_summit/en/index2.html

Something to think about

Three questions:

1. How has the RH landscape changed since 1994?

2. Is reproductive health a sensitive topic in your countries?

3. What role do global conferences play in policy change in your countries?

Figure 3

Source: The Lancet 2010; 375:1609-1623 (DOI:10.1016/S0140-6736(10)60518-1)

Map of Maternal Mortality, Worldwide

New maternal mortality data

In 2008, there were 342,900 maternal deaths worldwide, down from 526,300 in 1980.

More than 50% of all maternal deaths were in only six countries (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo).

HIV impacts maternal mortality: In the absence of HIV, there would have been 281,500 maternal deaths worldwide in 2008.

Source: lancet

Something to think about

Maternal mortality has finally made it on the world health agenda

Three questions:

1. Why did it take so long?

2. Does a global focus on maternal health address women’s major RH issues?

Map of HIV Prevalence, Worldwide 2005

Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

Adults Ages 15-49 with HIV

15.01% - 34.0%

5.01% - 15.0%

1.01% - 5.0%

0.51% - 1.0%

0.0% - 0.5%

Not available

Adults with HIV Who are Women

48

59

53

48

30

30

28

28

28

26

World

Sub-Saharan Africa

Caribbean

North Africa/Middle East

Latin America

South/Southeast Asia

East Asia

Eastern Europe/Central Asia

Western and Central Europe

North America

Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

2005Percent

HIV prevention works

New HIV infections are declining in many countriesIn 33 countries, HIV incidence has fallen by more than 25% between 2001 and 2009. – Twenty-two of these countries are in sub-Saharan

Africa. The biggest epidemics in sub-Saharan Africa—Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe—have either stabilized or are showing signs of declineSeveral regions and countries do not fit the overall trend. In seven countries, five of them in Eastern Europe and Central Asia, HIV incidence increased by more than 25% between 2001 and 2009.

Source: UNAIDS 2009 annual report

Something to think about

HIV/AIDS receives the vast majority of health-related foreign assistance.

Two questions:

1. Is that level of funding justified?

2. Is HIV/AIDS programming working well in your countries?

Average number of children per woman

4.9

6.8

5.7 5.6

2.42.7

5

2.5 2.6

1.6

World Africa Asia Latin Americaand the

Caribbean

More DevelopedCountries

1965-1970 2000-2005

Source: United Nations, World Population Prospects: The 2004 Revision, 2005.

Trends in Childbearing, By Region

Source: United Nations, World Population Prospects: The 2008 Revision (medium scenario), 2009.

Diverging Trends in Fertility Reduction

8.7

7.16.4

5.75.3 5.35.3

6.4

1.8

2.9 2.82.2

Yemen Uganda Iran Egypt India Indonesia

1970-1975 2005-2010

Average Number of Children per Woman

Change has been slower in SSA

Why was change so dramatic in Iran?

Rising Family Planning Use, Developing Countries, 1960 to Early 2000s

Percent of Married Women 15 to 49 Using a Family Planning Method

9

24

38

53

61

1960 1970 1980 1990 Early 2000s

Source: Population Reference Bureau, Family Planning Worldwide 2002; and 2009 World Population Data Sheet.

Source: Population Reference Bureau, 2009 World Population Data Sheet.

Modern Contraceptive Use, Developing Countries

Percent of Married Women 15 to 49 Using Modern Methods, Around 2005

6

9

32

32

34

48

57

58

68

68

Congo, Dem. Republic

Nigeria

Pakistan

Kenya

Philippines

Bangladesh

Indonesia

Egypt

Vietnam

Colombia

11

6

5

18

20

34

29

25

23

17

11

Ghana 2003

Burkina Faso 2003

Kenya 2003

Bolivia 2003

Cameroon 2004

Mozambique 2003

Philippines 2003

Bangladesh 2004

Jordan 2002

Columbia 2005

Vietnam 2002

Unmet Need for Family Planning

Married Women 15 to 49 Not Using Family Planning Who Say They Would Prefer to Avoid a Pregnancy (Percent)

Source: DHS STATcompiler: accessed online at www.measuredhs.com/statcompiler on June 8, 2006.

2223

50

45

11

36

50

60

49

38

Bangladesh2004

Egypt 2005

Bolivia 2003

Malawi 2004

Tanzania2004/2005

Poorest Fifth Richest Fifth

Disparities Within Countries in Contraceptive Use

Married Women 15 to 49 Using a Modern Method, by Wealth CategoryPercent

Source: ORC Macro, Demographic and Health Surveys.

Population Growth and Poverty

In 56 developing countries, on average, the poorest fifth of women had a fertility rate of 6 births, compared with 3.2 births in the wealthiest fifth

Families with many children are more likely over time to become poor and less likely to recover from poverty than families with only a few children.

Children from large families are usually less well nourished and less well educated than those from smaller families.

Something to think about

Fertility is going down and family planning use is going up

Two questions:

1. Do governments still need to support family planning programs?

2. In your countries what are the biggest challenges: health system, knowledge, social norms, disparities?

Family Planning and Health

An estimated 1 million of the 11 million deaths per year of children younger than 5 years could be averted if all birth intervals of less than 2 years were avoided.One-third of maternal deaths could be prevented if women who say they would prefer to postpone or cease further childbearing had used effective contraception.

332428

2014

23

17

2737

3122

3434

23

Bolivia 2003

Columbia2005

Ghana 2003

Kenya 2003

Madagascar2003/2004

Morocco2003/2004

Philippines2003

<24 months 24-35 months

62

4542

60 58

40

60

Birth Spacing, Less Developed Countries

Births, by Interval (Percent of all births)

Source: Measure DHS STATcompiler: accessed online at www.statcompiler.com on June 2, 2006.

Pregnancy Outcomes Worldwide

Miscarriages and Stillbirths

15%

Induced Abortions

22%Live Births

63%

Abortions as a Share of Pregnancy Outcomes, Estimates for 1999

Note: The percentages are based on a 1996 UN projection of 210 million pregnancies for 1999.Source: Alan Guttmacher Institute, Sharing Responsibility: Women, Society, and Abortion Worldwide, 1999.

Something to think about

Abortion remains controversial

Two questions:

1. In each of your countries, is abortion a difficult topic you write about?

2. If abortion is illegal, does the health system still provide post-abortion care and counseling?

Development Rationale to Reduce Fertility: The Demographic Bonus

As fertility levels go down, age structures shift so that a smaller proportion of the population are in young dependent ages groups.

Income can be used for productive investment rather than expended to provide young people with food, health care and education

Evolution of Thinking about RH: New Areas to Emphasize

% of women married before the age of 18

Extent of gender-based or domestic violence

Integration of family planning, HIV, and safe motherhood services.– What are the objectives of integration and how can

those objectives be measured?

Indicators to measure stigma, discrimination and disparities

Early Marriage Persists in the Poorest Regions of the World

Source: UNICEF, childinfo.org

Achieving Good Reproductive Health

Reproductive health services need to include: Services for underserved populations, including adolescents, people in

emergency situations & men Family planning, including access to & informed, voluntary choice of

contraceptive methods. Safe motherhood, including antenatal, normal delivery, emergency

obstetric & postnatal care Postabortion care & access to safe abortion, where permitted by law. A continuum of prevention, treatment & care for HIV/AIDS & other

sexually transmitted infections. Prevention, surveillance & care for gender-based violence. Action against harmful traditional practices, such as female genital

mutilation & early and/or coerced marriage.

www.respond-project.org