Reproductive Health & Development

1. Reproductive Health & Development Women’s Edition Seminar 11/12/2012 Nancy Yinger

2. Presentation Outline • Review current thinking about reproductive health (RH) • Look at some basic RH data • Assess links between RH & development

3. 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.”

4. 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

5. 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 .

6. 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

7. Something to think about Three questions: • How has the RH landscape changed since 1994? • Is reproductive health a sensitive topic in your countries? • What role do global conferences play in policy change in your countries?

8. Figure 3 Map of Maternal Mortality, Worldwide Source: The Lancet 2010; 375:1609-1623 (DOI:10.1016/S0140-6736(10)60518-1)

9. 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

10. Something to think about Maternal mortality has finally made it on the world health agenda Three questions: • Why did it take so long? • Does a global focus on maternal health address women’s major RH issues?

11. 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 Map of HIV Prevalence, Worldwide 2005 Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

12. Adults with HIV Who are Women 2005 Percent Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.

13. HIV prevention works • New HIV infections are declining in many countries • In 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 decline • Several 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

14. Something to think about HIV/AIDS receives the vast majority of health-related foreign assistance. Two questions: • Is that level of funding justified? • Is HIV/AIDS programming working well in your countries?

15. Trends in Childbearing, By Region Average number of children per woman Source: United Nations, World Population Prospects: The 2004 Revision, 2005.

16. Diverging Trends in Fertility Reduction Average Number of Children per Woman Change has been slower in SSA Why was change so dramatic in Iran? Source: United Nations, World Population Prospects: The 2008 Revision (medium scenario), 2009.

17. Rising Family Planning Use, Developing Countries, 1960 to Early 2000s Percent of Married Women 15 to 49 Using a Family Planning Method Source: Population Reference Bureau, Family Planning Worldwide 2002; and 2009 World Population Data Sheet.

18. Modern Contraceptive Use, Developing Countries Percent of Married Women 15 to 49 Using Modern Methods, Around 2005 Source: Population Reference Bureau, 2009 World Population Data Sheet.

19. 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.

20. Disparities Within Countries in Contraceptive Use Married Women 15 to 49 Using a Modern Method, by Wealth Category Percent Source: ORC Macro, Demographic and Health Surveys.

21. 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.

22. Something to think about Fertility is going down and family planning use is going up Two questions: • Do governments still need to support family planning programs? • In your countries what are the biggest challenges: health system, knowledge, social norms, disparities?

23. 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.

24. 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.

25. Pregnancy Outcomes Worldwide 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.

26. Something to think about Abortion remains controversial Two questions: • In each of your countries, is abortion a difficult topic you write about? • If abortion is illegal, does the health system still provide post-abortion care and counseling?

27. 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

28. 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

29. Early Marriage Persists in the Poorest Regions of the World Source: UNICEF, childinfo.org

30. 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.

31. www.respond-project.org