Changes have taken place in the last few decades. The percentage of couples using some form of modern contraceptive has skyrocketed, from 15 per cent in 1960 to nearly 60 per cent across the developing world, and 70 per cent elsewhere. And women’s ability, at long last, to control their fertility is changing power relations between the sexes.

But women still carry a much heavier–and largely avoidable–burden of poor health related to reproduction and sexuality.

Poor Women, Poor Health

Poor women who lack adequate food, basic health care, or modern contraception suffer grave consequences. A woman who is malnourished and in poor health runs much greater risks in sexual contacts and childbearing, and she usually is forced to suffer from illness and complications of pregnancy without proper treatment. Many such women die. The major categories of illness and mortality of poor women relating to reproductive health are:

Malnutrition, anaemia: In many families, girls and women are last in line for food. Malnutrition contributes more than any other single factor to disease and injury worldwide. Anaemia, one consequence of malnutrition, is the third leading cause of disease among women in developing countries, accounting for even more of the disease burden than war.

Complications of pregnancy: More than 585,000 women die each year from causes related to pregnancy. For each death, at least 13 women suffer from other threats to their health. And nearly all maternal deaths are in developing countries: an African woman is 500 times more likely to die of these causes than her counterpart in one of the Scandinavian countries.

Obstructed labour, haemorrhage, and post-partum infection are the chief threats to the health of poor mothers. Obstructed labour is often due to the youth of the mother: the undeveloped pelvis is too small. Other mothers’ growth is stunted by malnutrition. These women suffer hours of terrible pain in labour, and can haemorrhage or become infected. Some are permanently crippled.

Sexually transmitted diseases: There are an estimated 333 million new cases of STDs every year. Worldwide, the number of women afflicted by these is five times the number of men. Almost two thirds of infertility cases are caused by STDs. And fully 50 per cent of HIV infections are to young people aged 15-24. For girls and young women, intercourse is much likelier to lead to infection. The practices of "dry sex" and female genital mutilation place them at even greater risk of injury and infection.

STDs cause pregnancy-related complications, sepsis, spontaneous abortions, premature births, stillbirths, and congenital infections. Thirty-five per cent of post-partum illness is attributed to sexually transmitted diseases. The human papilloma virus is a cause of cervical cancer, the second most common cancer in the world.

HIV/AIDS: There are now 22.6 million people living with HIV/AIDS. So far, 6.4 million have died. According to UNAIDS estimates, there were over 3.1 million new HIV infections in 1996 alone–more than 8,500 a day. The majority of newly infected adults are just 15 to 24 years old.

Worldwide, 75 to 85 per cent of HIV infections in adults were transmitted through sex without condoms. Heterosexual intercourse accounts for more than 70 per cent of all adult HIV infections. Mother-to-child transmission accounts for more than 90 per cent of all infections in infants and children. Over 85 per cent of these children are in sub-Saharan Africa.

Unsafe abortion: About 70,000 women die each year from unsafe abortion, and a much larger number suffer from infection, injury, and trauma. Victims of unsafe abortions fill hospital wards. The ICPD called on all governments to reduce the impact of unsafe abortion by increasing access to family planning, providing services to manage the consequences of abortion, and assuring that legal abortions are performed safely. Better contraceptive services for all would greatly reduce abortions: in Bolivia, for example, only 7 per cent of women hospitalized for abortion complications had ever used contraception, yet 77 per cent said that they wanted to do so.

Female genital mutilation: Female genital mutilation (FGM) is a traditional practice with horrific effects on the health of girls and women. The International Conference on Population and Development and the Fourth World Conference on Women condemned FGM as a violation of human rights.

It is estimated that over 120 million living women have endured some form of genital mutilation, and at least 2 million girls per year are at risk of mutilation. Pain, injury, infections, loss of all sexual feeling, pain in intercourse and childbirth are just some of the complications of these cruel procedures.

The custom of female genital mutilation shows a desire to control and limit women’s sexual experience and reinforce established gender roles. Such practices are often defended, not only by men but also by women who have undergone the procedure, as being central to their religion or cultural identity, and many resist and resent those who oppose the practice. But a WHO/UNICEF/UNFPA joint statement stresses that societies can "give up harmful practices without giving up meaningful aspects of their culture".

Efforts to eliminate female genital mutilation are gaining ground. In Uganda, a culturally sensitive initiative known as REACH (Reproductive, Educative, and Community Health) was launched in January 1996. REACH has actively sought to educate local leaders, policy makers, health professionals, parents, and adolescents on the need to do away with the practice. It stresses that a community’s cultural values are different from cultural practices, and that the latter can change. The programme reports that the number of girls and women undergoing FGM in western Uganda declined by 36 per cent between 1994 and 1996.

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