Transcript Document

Reproductive Health & Development
Women’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_fa
mily_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
Map of Maternal Mortality, Worldwide
Source: The Lancet 2010; 375:1609-1623 (DOI:10.1016/S0140-6736(10)60518-1)
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
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
Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.
Adults with HIV Who are Women
2005
Percent
North America
26
Western and Central Europe
28
Eastern Europe/Central Asia
28
East Asia
28
South/Southeast Asia
30
Latin America
30
North Africa/Middle East
48
Caribbean
53
Sub-Saharan Africa
World
Source: UNAIDS, 2006 Report on the Global AIDS Epidemic, 2006.
59
48
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
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?
Trends in Childbearing, By Region
Average number of children per woman
6.8
5.7
5.6
5
4.9
2.7
2.5
2.6
2.4
1.6
World
Africa
Asia
1965-1970
Latin America
and the
Caribbean
More Developed
Countries
2000-2005
Source: United Nations, World Population Prospects: The 2004 Revision, 2005.
Diverging Trends in Fertility Reduction
Average Number of Children per Woman
Change has been
slower in SSA
8.7
Why was change so
dramatic in Iran?
7.1
6.4
6.4
5.7
5.3
5.3
2.9
5.3
2.8
2.2
1.8
Yemen
Uganda
Iran
1970-1975
Egypt
India
Indonesia
2005-2010
Source: United Nations, World Population Prospects: The 2008 Revision (medium scenario), 2009.
Rising Family Planning Use, Developing
Countries, 1960 to Early 2000s
Percent of Married Women 15 to 49 Using a Family Planning Method
61
53
38
24
9
1960
1970
1980
1990
Early 2000s
Source: Population Reference Bureau, Family Planning Worldwide 2002; and 2009 World Population Data
Sheet.
Modern Contraceptive Use, Developing
Countries
Percent of Married Women 15 to 49 Using Modern Methods, Around 2005
Colombia
68
Vietnam
68
58
Egypt
Indonesia
57
48
Bangladesh
Philippines
34
Kenya
32
Pakistan
32
9
Nigeria
Congo, Dem. Republic
6
Source: Population Reference Bureau, 2009 World Population Data Sheet.
Unmet Need for Family Planning
Married Women 15 to 49 Not Using Family Planning Who Say They
Would Prefer to Avoid a Pregnancy (Percent)
Vietnam 2002
Columbia 2005
5
6
Jordan 2002
11
Bangladesh 2004
11
Philippines 2003
Mozambique 2003
Cameroon 2004
Bolivia 2003
Kenya 2003
Burkina Faso 2003
Ghana 2003
17
18
20
23
25
29
34
Source: DHS STATcompiler: accessed online at www.measuredhs.com/statcompiler on June 8, 2006.
Disparities Within Countries in Contraceptive Use
Married Women 15 to 49 Using a Modern Method, by Wealth Category
60
Percent
50
50
49
45
38
23
36
22
11
Bangladesh
2004
Egypt
2005
Bolivia
2003
Poorest Fifth
Malawi
2004
Tanzania
2004/2005
Richest Fifth
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.
Birth Spacing,
Less Developed Countries
Births, by Interval (Percent of all births)
62
34
60
42
60
58
45
37
34
40
27
22
31
23
28
20
Bolivia
2003
Columbia
2005
14
Ghana
2003
33
24
23
17
Kenya
2003
<24 months
Madagascar Morocco Philippines
2003/2004 2003/2004
2003
24-35 months
Source: Measure DHS STATcompiler: accessed online at www.statcompiler.com on June 2, 2006.
Pregnancy Outcomes Worldwide
Abortions as a Share of Pregnancy Outcomes, Estimates for 1999
Miscarriages
and Stillbirths
15%
Induced
Abortions
22%
Live Births
63%
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