Overview: Latin America and the Caribbean

Poverty and inequity continue to be key issues in Latin America and the Caribbean. The region faces the greatest socio-economic inequalities in the world, and changes in the distribution of income during the period between 1990 and 2002 have been minimal. This partly explains why many countries are lagging behind in their efforts to meet the poverty reduction targets laid out in the Millennium Development Goals (MDGs) for 2015. The region is also lagging behind in progress toward meeting the MDGs in the areas of HIV prevention and maternal mortality.

Some 222 million people (42.9 per cent) in the region are poor, with 96 million (18.1 per cent) living in extreme poverty. The determinants of poverty are manifold, and poverty reduction strategies need to intervene on several fronts simultaneously. However, a situational analysis of the region shows that the unmet need for reproductive health services is key. When women are capable of exercising control over their fertility, households are able to realize their desired family size and have the number of children they can comfortably support and nurture. Among poor women in the region, the gap between actual fertility and desired fertility is widest. In rural areas of Peru, for example, contraceptive prevalence of modern methods is only 33 per cent, and the gap between desired and observed fertility is 1.4 children. This pattern repeats itself in many countries of the region, especially among indigenous groups, people of African descent and rural women.

Equal access to quality reproductive health services can make a substantial contribution to reducing poverty and providing social services more equitably and efficiently. More equitable access - paid for, for instance, through targeted insurance schemes based on tax earnings - could eliminate the barrier of out-of-pocket expenses that keeps many poor households from receiving treatment for obstetric complications and sexually transmitted infections, including HIV. Equally important, investments in prevention of reproductive health problems could result in public savings, decrease case loads, and release millions from the burden of poor reproductive health.

Since the 1980s, the region has witnessed 'the construction of citizenship' - the progressive incorporation of social groups into a socio-political setting in which their human rights become actual entitlements. Progress has been most significant in the area of civic and political rights. During the 1980s and 1990s, relatively dynamic political competition emerged among different actors, including the growing civil society. However, progress in the arena of economic, social and cultural rights has been less impressive, as evidenced by the rigidity in income distribution and the limited progress on poverty-reduction targets. Social statistic indicators often mask wide disparities among groups. For instance, even though literacy rates region-wide show considerable improvement, 38 per cent of indigenous women in Bolivia are illiterate, as are 59 per cent of indigenous women of Guatemala.

Despite evidence that socio-economic inequality has achieved greater priority in national and international decision-making, the specific issue of reproductive rights does not always garner comparable attention in social policies and programmes. Within certain politically powerful groups, there is a reluctance to deal with these issues as if they were rights - or even as public health issues. Much of the legislation on reproductive health and rights that has been debated in the region has been strongly contested. Some equate access for young people to reproductive health services - or to sexuality education - with promoting early and irresponsible sexual activity. However, with adolescent fertility rates still high and HIV prevalence rising among young people in many of the countries of the region, the need to address these issues is clear and demands sincere and open dialogue with young people about sexuality, reproductive health and gender.

The cultural and ideological factors that influence the policy environment and determine whether reproductive rights can be securely anchored in the social policy arena are compounded by debates regarding social investment priorities. Some poverty reduction programmes overlook reproductive health care. Likewise, basic insurance schemes - as in the case of Bolivia - often cover child and maternal health, but rarely do they integrate these services into a holistic package that includes family planning, voluntary testing and counselling or adolescent reproductive health services.

The region as a whole is moving into a phase of its demographic transition that could be used to overcome poverty - if appropriate investments and policies in place. By the year 2025, the region will have the possibility of realizing a demographic 'bonus' as the number of people in their most productive years (between 15 and 65) will outnumber older and younger dependents. It is a time in which the population structure favours savings and investments. The realization of reproductive rights will enable these people to control their fertility, giving them more options in life, including greater economic productivity and the possibility to save and invest. Other political, social and economic variables will come into play as well, including education, governance and employment, among others. Nevertheless, ensuring reproductive rights is a prerequisite for taking advantage of this potential demographic bonus.

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