• the Constant Growth Scenario assumes that developing countries meet the Cairo targets while donor resources continue their current below-target rate of growth;

• the Intermediate Growth Scenario assumes that international assistance will grow 20 per cent slower than in the first scenario; and

• the Low Growth Scenario assumes that developing countries fall short of the target while donors continue their current rate of growth.

The most optimistic or "constant growth" scenario still registers a $2.1 billion deficit in resources by the year 2000 compared to ICPD targets. Table 1 summarizes these three scenarios.

By the year 2000 there will be 1.35 billion women between 15 and 45. Of these, 950 million are expected to be married or in steady relationships. By 2000, if reproductive health and family planning information and services are provided in line with the ICPD goals, 610-640 million of these couples would be using some form of contraception.

More Potential Family Planning Users
Without Contraception

Assuming the least grave of UNFPA’s three scenarios, the smallest shortfall in resources, 97 million additional individuals and couples who would have chosen contraception will not be able to do so. Under the Intermediate Growth Scenario the figure is 130 million and with the Low Growth Scenario 170 million.

Under the first of the three scenarios, the number of couples having access to and using reproductive health and family planning services would be 16 per cent lower than if Cairo resource goals are not met. The Intermediate Growth Scenario would mean a shortfall of 21 per cent, and the worst case 30 per cent. One effect will be that more people will use less effective traditional contraceptive methods: others will use no method at all.

More Unwanted Pregnancies

With inadequate contraceptive coverage, the number of unintended pregnancies will rise—by 130 million for the period 1995-2000 under the least grave scenario, climbing to 230 million under the worst case.

 For the women concerned, unintended pregnancies can have serious life and health consequences; at the least they mean additional costs in lost work time and perinatal care. For their countries, the consequences of unintended births are additional investments in health, education, housing and employment—or perhaps just more additions to the ranks of the poor and hopeless.

More Abortions

Many of these unintended pregnancies will not come to term. If resources fall short, the number of abortions will increase dramatically—from 50 million extra abortions to more than 90 million over the period 1995-2000, depending on the resource scenario.

Besides the negative health and other effects on millions of women, the costs to overburdened health systems from unsafe abortions will escalate. Complications from unsafe abortions are among the leading causes of hospitalization for women of reproductive age in developing countries.

More Unwanted Births

Depending on the resources scenario, there are likely to be somewhere between 60 million and 110 million additional unwanted births between 1995 and 2000.

These extra births imply significant burdens in terms of health risks to the mother at time of delivery, additional demands on health care services, and a general erosion of resources available to poor families.

More Deaths and Injuries
Resulting from Pregnancy

Depending on the resources scenario, there will be between 300,000 and 540,000 total extra maternal deaths between 1995 and 2000, that is, between 100,000 to 180,000 annually by the year 2000. Lack of resources would also make it more difficult to improve emergency obstetric care, antenatal care and the proportion of births attended by a trained health professional.

Maternal morbidity will increase dramatically. Shortfalls in resources could result in 3.8 million to 7 million additional cases of life-threatening complications and illnesses related to unwanted pregnancies. In the year 2000 alone, the number of women affected would range from 1.3 million to 2.3 million.

Increased Infant and Child Mortality

Currently, around 125 million children are born in developing countries every year. More than 7.5 million die before reaching their first birthday, and another 3.2 million before reaching five years of age. If Cairo resource targets are not met, these rates will rise sharply, depending on the resources scenario. Between 1995 and 2000, even under the most optimistic of the three scenarios, an additional 3.6 million infants and 1.3 million children will die.

Under the Intermediate Growth Scenario, the combined number of infant and child deaths rises to 6.4 million and to almost 9 million with the Low Growth Scenario. These additional infant and child deaths will be a direct consequence of the enormous increase in unintended pregnancies noted earlier.

Effects of Shortfalls
on Services and Infrastructure

Limited resources will hold back efforts to improve the quality and coverage of reproductive health services—the range of contraceptive methods available, the technical competence of staff, and the quality of information and communication programmes, for example.

Current resource shortfalls have already harmed service delivery. In Tanzania, for instance, three-quarters of all health centres and hospitals surveyed did not have a speculum, nearly one-third lacked disposable gloves and 22 per cent and 15 per cent, respectively, did not even have a stethoscope.

The broader effects are even more ominous. In Nicaragua, one of the poorest countries in Latin America, population is growing by 3 per cent a year, with mounting debt and an increasing number of rural and urban poor. Nicaragua must find the resources to train an extra 3,000 teachers over the next five years and build facilities to accommodate another 30,000 students. By 2040, unless population growth is slowed considerably, the country will need to educate an additional 9,000 doctors, 20,000 nurses and build 2,000 new health posts. By contrast, the cost of guaranteeing every citizen access to appropriate family planning services has been estimated at no more than $20 per person per year.