|When the World Denies its Women|
When the World Denies its Women:
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The 1994 International Conference on Population and Development (ICPD) set historic, ambitious, but achievable goals to ensure access to reproductive health care and protect the reproductive rights of all women. Over a decade later, policy-makers are falling far short of the actions required. In nearly every country at least some women, usually the poorest and most marginalized, still lack the basic reproductive health care that would enable every woman to determine whether and when to have a
From the onset of adolescence to the end of childbearing—over three decades of every woman’s life—reproductive health is central to her own well-being and livelihood as well as that of her family. Governments and development professionals in all sectors recognize that the Millennium Development Goals (MDGs) are only achievable if ICPD’s vision is fully realized. Failure to mobilize support, resources and the services, supplies and basic information that are needed not only has serious consequences for women themselves but also significantly undermines social and economic stability and growth.
We face a crisis in women’s health. Among women of reproductive age, one-third of illness and early death is due to problems associated with pregnancy, STIs and HIV.1 Some 137 million women, mostly in developing countries, still are not using contraception despite an expressed desire not to have a child.2 Worldwide, four in 10 pregnancies are unintended, and more than half of these pregnancies end in an induced abortion.3 An estimated 60 percent of women giving birth in developing countries will do so outside of a formal health facility. 4 This year alone, 529,000 women will die of complications of pregnancy, birth or an unsafe abortion,5 and millions more will suffer serious, long-lasting health problems. There will be 340 million new cases of curable STIs and the health consequences for women will be much greater than for men.6 Half of the 40 million people currently living with HIV/AIDS are female, up from 41 percent in 1997 and 35 percent in 1985.7
What can be done? A new report from the Millennium Project8 documents that while “population assistance” has increased in recent years, higher resource flows to HIV/AIDS prevention, care and treatment make up the lion’s share of the increase. One result is that, “family planning has received less and less attention since the ICPD, and its funding as a share of total population assistance dropped from 55 percent in 1995 to 11 percent in 2003.” Moreover, even the very substantial resources now allocated to HIV/AIDS are inadequate to address the pandemic.9
Bold, practical steps are needed to build on what is working and re-envision what will best ensure sexual and reproductive health and gender equity. Commitments made by 179 nations at the ICPD, point the way forward and are as relevant today as they were in 1994.
First, accelerate and reorient efforts to strengthen health systems. As many developing countries work to provide basic health care to those most in need, it is clear that women and children suffer disproportionately and have the most to gain from planned improvements. As leaders aim for efficiency, equity and effectiveness of their health systems, it is essential to capitalize on and further develop the strengths and accomplishments of reproductive health programs, where the majority of women and children receive preventive services and care. Quality and accessibility of reproductive health care, including HIV/AIDS testing and treatment, must be a high priority in efforts to strengthen health systems.
“Stovepipe” funding and programs to eradicate and treat a single disease—such as HIV/AIDS—weaken rather than strengthen health systems which are the sine qua non of lasting, sustainable solutions to today’s health challenges, including sexual and reproductive health and rights.
Second, shift funding priorities. It is imperative that we recognize the impact of deficiencies and inefficiency in current resource flows. Whereas STIs and HIV/AIDS result in 5.8 percent of the total burden of disease and receive 23.6 percent of development assistance for health, AIDS and population, poor maternal health and perinatal conditions represents 8.3 percent of the total burden of disease and only receive 16 percent of development assistance.10
A more rational and equitable approach to funding would adjust these percentages and encourage comprehensive care. The outcomes would be healthier pregnancies, prevention of HIV, gender equality and the overall health and economic prosperity of women and their families. Strengthening the reproductive health services women use, including secure commodity flows and HIV/AIDS capabilities, is the best way to reduce the disproportionate burden that girls and women suffer from HIV/AIDS and other STIs. It is the only way to minimize maternal mortality and morbidity. The United States, in particular, must play a stronger role in this effort. Greater investment in HIV prevention—beyond abstinence—is essential to decreasing the rate of new infections
Third, move beyond a clinical perspective. Women’s ability to control their fertility and protect their health is firmly rooted in gender equality, which is far from assured in most of the world. Young women and men not only require basic information on and a fuller understanding of sexual and reproductive health, but the communications skills and broader perspective needed to develop relationships of mutual respect and shared goals. Too many girls and young women are forced into early marriage and childbearing by parents or partners.
Impediments to services—requiring a husband’s consent or excluding unmarried women—can and must be overcome. Stigma and discrimination against people living with HIV/AIDS still keep too many from essential services, including testing, and hinder the ability of some to make their own decisions regarding pregnancy and childbearing.
Finally, include women and civil society in decision-making. Gender often determines who has access to health services; how decisions are made at the family, community and sector levels; and how resources are allocated. Evidence suggests that the best way to address this problem is to ensure that women, women’s organizations, and other civil society actors play a central role in both the design and implementation of reproductive health services and programs.
The visionary goals of the ICPD and the MDGs are achievable and world leaders at the recently concluded G8 Summit agreed to some of what is needed when they set out priorities for fighting HIV/AIDS.12 However, to achieve them fully will require the revisions in policy outlined here to fully meet the needs of women to protect their health and control their fertility and ensure sexual and reproductive health for all.
Originally published in Global HealthLink, a publication of the Global Health Council. Reprinted with permission.