UNFPAState of World Population 2002
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Reproductive Rights and
Sustainable Development

Photo:UNICEF/93-1969/ Giacomo Pirozzi


"Widespread poverty remains the major challenge to development efforts. Poverty is often accompanied by unemployment, malnutrition, illiteracy, low status of women, exposure to environmental risks and limited access to social and health services, including reproductive health services which, in turn, include family planning. All these factors contribute to high levels of fertility, morbidity and mortality, as well as to low economic productivity. . . "

Paragraph 3.13, Programme of Action of the International Conference on Population and Development, 1994

Reproductive behaviour and reproductive rights are closely linked to the attainment of other social rights and opportunities. The ICPD, the Social Summit and the FWCW all recognized that sustainable development is defined by, among other things, a better quality of life for all people, regardless of gender. This implies a development agenda that focuses directly on meeting the needs and hopes of individual men, women and children, now and in the future. Empowering people to escape from poverty and accelerate overall development will require the recognition and exercise of their basic rights.

Gender Equality

Women’s empowerment will be central to advancing this person-centred agenda. The development task facing many countries is too immense to allow narrowly defined gender roles to prevent half the population from contributing fully. Within the spheres where women have been allowed to participate—in many societies, primarily in domestic roles and in the informal economy—their contributions have been substantial, but under-appreciated.

Empowering people to escape from poverty and accelerate overall development will require the recognition and exercise of their basic rights.

Social, economic and political rights are not just interrelated in principle; their implementation is bound together in practice. Thus, women’s access to reproductive health services is constrained by their broader social deprivation, including the lack of resources for or priority to their health, restrictions on social participation, and limited access to information due to illiteracy.

The social empowerment of women clearly contributes to, and depends on, good reproductive health. Mobility, particularly the freedom to travel outside the home, is important in broadening access to reproductive health services including family planning. Economic security, including the right to own property and have cash savings, enables women to negotiate household spending decisions. Where women have control over purchases (either from their own earnings or in cooperation with their spouses) they invest more of their discretionary income in their children, their household and their own health needs. Shared household decision-making strengthens a family’s capacity to improve the well-being of all its members.

The successful exercise of reproductive rights strengthens families directly and indirectly. Ill health and untimely death from diseases of the reproductive system cause a significant loss of resources. Moreover, women’s lack of control over reproduction extracts additional costs. In the Philippines, the pace of childbearing has been shown to affect significantly women’s participation in the labour force; there, as elsewhere, women must work to meet basic family needs. The same study found that childbearing affects many dimensions of the quality of life in the household including available assets, conveniences, nutritional status and child well-being.1

Family planning has also been linked to lower rates of marital dissolution. Couples that discuss family matters and make decisions jointly—including decisions about family planning—are evidently better able to adapt to other shared stresses. Greater control over reproductive decisions also reduces the stresses and burdens to which the couple must adapt.

While contraceptive use may not by itself change a woman’s situation in life, her control over her fertility is often associated with greater choice in other life domains. Women’s knowledge of government and participation in the political arena, including informal local associations, are also important for the exercise of their rights, as are knowledge of marriage and inheritance laws, and the means to ensure that these laws are applied fairly.

Role of Men

Discussion of gender equality concerns both sexes. Efforts to advance women’s rights began with recognition of the need to redress the systematic exclusion of women from opportunities open to men, and to end gender-based discrimination in the distribution of resources and rewards. Early rights language, therefore, placed men’s opportunities as a standard against which women’s could be assessed. However, just as gender-defined roles have led to thwarted opportunities for many women, they have also burdened men. Recognizing, cultivating and sharing the diverse potentials of both men and women can advance the quality of life of all.

Women’s lives are usually described in terms of motherhood, while men’s lives are usually characterized as heads of household or wage-earners. Men’s role as fathers tend to be vague. Yet, men’s commitment to their children is key to the quality of family life and the prospects of the next generation.

Women’s contributions to the household economy, remunerated or not, are substantial and undervalued. On the domestic front, while women have taken on an increasing role in providing income to their families, men have not taken up their share of responsibility in family life. Responsibility for children, in particular, is still seen as belonging to the mother.

To successfully promote male involvement in the family, concerned leaders, governments, and NGOs must begin by confronting cultural barriers. They must work to educate boys and men to prepare them for a broader fathering role. Studies have found that this kind of education, combined with experience, can strengthen the bonds between fathers and children. The media can also play a role by popularizing a positive picture of relationships between fathers and children.

Men’s support for women during pregnancy and involvement in childbirth have not yet been promoted effectively despite considerable evidence of their benefits for all concerned. Indeed, some health facilities are set up in a way that prevents men who wish to be involved from getting involved. Yet, programmes in Jamaica, Cameroon and other countries have shown that men respond very well to efforts to involve them in the period after childbirth, for example, which is a critical time for them to support their partners and bond with their newborn children. Policies and programmes must be put in place that recognize the critical role of both parents in the family.

Men are frequently unaware of and insensitive to women’s reproductive and sexual health needs. In many cultures misunderstandings and myths about female sexuality and reproductive systems persist— though there are some indications of change in male attitudes towards a range of taboos and concerns, including those about menstruation and “cleanliness.” Definitions of men’s family responsibilities as primarily economic and protective can prevent them from developing nurturing and satisfying relationships with their children and spouses. Gender stereotypes can also subject men to unrealistic expectations; failure to fulfil these may result in a sense of frustration and insecurity which can foster violent or escapist behaviour.

Male socialization has perpetuated these myths, as well as attitudes about male roles, expectations about sexuality and masculinity, and a certain acceptance of domestic violence. These are increasingly being challenged, but a large minority of men still consider sexual and reproductive health matters to be women’s concerns, and as such beneath their notice.

Boys and men should learn in the family, school and community positive values and practices promoting respectful and responsible sexuality and parenthood. Men need to understand the risks women face from multiple partners, harmful traditional practices, and sexual initiation too early in life; they also need to understand and respond to the risks of pregnancy and childbirth. Women’s health, particularly in the area of reproductive and sexual health, requires the mutual concern and investment of both members of the couple.

Husband and wife communication about reproductive health including family planning has been improving over the past decades. Men often play important direct and indirect roles in family planning decisions, but still assume only a minor role in household and domestic duties, including child care. Men’s desired family size is often similar to but slightly larger than their partners’; if the balance of domestic responsibility were more equal, men’s attitudes to family size might be still closer to their partners’.

Increasing numbers of women today are working towards their own empowerment. But they cannot do it alone. Men’s support is essential: efforts to increase women’s status are unlikely to succeed without it. Because men dominate positions of power and hold the power to influence societal thinking in most parts of the world, they have a key role to play in eliminating inequalities between themselves and women. Men must come to recognize that women’s empowerment is not a threat but rather a way to improve families and societies. Societal progress can only be achieved if men promote women’s empowerment in all spheres: in the home, in reproductive decision-making, in education, in the workplace, and in the political, legislative and public policy arenas.

Promoting Education

In much of the world too little attention has been paid to the education of girls. Huge gaps persist between women’s and men’s educational achievement. Globally, nearly 600 million women remain illiterate today, compared with about 320 million men. In certain parts of the world, moreover, as many as three in four women are illiterate, and others have received no more than a negligible education. This neglect has had critical consequences for women’s well-being, for their empowerment as well as for their reproductive choices and roles.

Through empowerment, women take control of their lives. The education of girls is a key factor in improving family health, reducing infant mortality, and changing reproductive behaviour. With education comes increased confidence and self-esteem. Educated women are more likely to stand up for themselves, participate in the labour force, and seek health care for themselves and their children.

While few studies have addressed the myriad linkages among women’s education, their autonomy, and their reproductive behaviour, a recent review of literature from various disciplines and regions affirms that in almost every setting, regardless of region, culture, or level of development, well-educated women have a greater say in their lives, including their reproductive lives, and bear fewer children than do uneducated women. In almost every setting where it has been studied, the relationship is genuine and cannot be explained by the fact that educated women marry better-educated men or come from wealthier households.2

At the same time, the study cautions that a modest amount of education does not necessarily enhance women’s autonomy, improve reproductive health, or increase reproductive choices in all contexts. In settings where incomes and literacy are low and where there are wide disparities in literacy between men and women, there appear to be threshold levels of education that must be reached before changes in fertility and other aspects of reproductive behaviour can occur. The results clearly suggest that the impact of women’s education is greatest among women with more than five or six years of schooling; it is also greatest when education offers women an expanded role in family decisions and control over resources.

Over the past few years, recognition of the neglect of women’s education has grown, both in international forums and in national agendas, with increasing commitments to investments in female education. The ICPD Programme of Action reaffirms everyone’s right to education and gives special attention to women and girls. It recognizes education as a key factor in sustainable development and women’s empowerment, and terms the eradication of illiteracy “one of the prerequisites for human development.” The ICPD called for universal access to primary education before 2015, and urged countries to take steps to keep girls and adolescents in school, in order to close the gender gap in primary and secondary education by 2005. Encouraging attention “to the quality and type of education, including recognition of traditional values,” the Programme of Action urges “countries that have achieved the goal of universal primary education . . . to extend education and training to, and facilitate access to and completion of education at, secondary school and higher levels.”

Men—as legislators, decision-makers in ministries of education, school administrators, participants in the design of educational curricula, teachers and fathers—have a critical role to play. They must make sure that girls are able to go to school, stay in school, and are taught the skills they need to succeed in the workplace and the world at large on equal terms. Men also must teach boys new ways to think about their roles and about women in this rapidly changing world.

Education can provide boys with a different interpretation of masculinity, replacing the one based on domination with one defined by shared responsibility. Education can provide girls with increased opportunities to make informed decisions for them-selves. Offer a girl education and she has the power to make choices. Offer her a nurturing environment in which to grow and she can change her society for the better. Offer her reproductive health services and she and her future children will enjoy a healthier tomorrow.

Attacking Poverty

Attacking poverty by providing economic opportunities also improves reproductive health. Realizing sexual and reproductive rights will help to end poverty. The poor are multiply disadvantaged. Lacking political influence and social visibility, they are underserved by public services, and cannot afford private services to meet their fundamental needs. Their days are often caught up in a struggle for survival. Their basic social and economic rights, including the right to reproductive and sexual health, are often restricted, and they often do not know what their rights are.

The poor are often disadvantaged in their quest for reproductive and sexual health early in life. Poor children, born to women more likely to be undernourished themselves, are more likely to be of relatively low birthweight and therefore at higher risk of ill health and death in their earliest years. Continued poor nutrition through early life can stunt growth and retard physical and mental development.

Poorer mothers tend to have more children than other women; they are frequently unaware of or unreached by contraceptive services, or are deterred by the real and perceived costs of services. Within families on the margin of subsistence, more children means greater competition for resources. Children face pressure to contribute to family resources, reducing the already limited support for their education. As families grow, daughters are often kept out of school to assist with child-rearing and household tasks. Changing conditions of life in diverse parts of the world are confronting families with situations not faced by prior generations. Research indicates that women increasingly understand that the prospects for a better life for their families depend on educating their children. Even where economic development has been slow and life conditions have not changed dramatically, people have very different views than their parents had about how their reproductive and sexual lives relate to their own and their children’s prospects for success.
3 New social norms lend community support to reproductive self-determination and the choice of small families. Where reproductive services are available, these can make a significant contribution to the alleviation of poverty.

Research around the world4 suggests that programmes that attack poverty by providing economic opportunities, also allow poor people, especially women, to exercise greater control over all aspects of their lives. One of the most important effects is on reproductive health and behaviour. For example, a study of rural villages in Bangladesh where the Grameen Bank has provided small loans to women’s groups for economic activities found all women—even those who were not participants—to have more power of decision than women in similar villages without these opportunities; as a consequence, they were also more likely to use contraception.

In societies where tradition insists on the social isolation of women, self-employment programmes can have considerable impact simply by involving women in informal social interaction with other women, including those who practise family planning. Along with increased availability of information, the result can be changes in social norms concerning fertility and contraception.

The interaction of education, employment, resource control and women’s control over reproductive decisions is complex. Research in Togo,5 for example, found that the greater a woman’s control over economic resources6 and the selection of her marital partner,7 the more likely she was to have communicated with her partner about family planning. Higher levels of discussion between spouses were associated with higher use of both traditional and modern methods of family planning. Use of modern methods was also associated with higher levels of education and urban residence.

Since 1982 UNFPA has supported more than 20 projects combining provision of reproductive health services and information with microcredit activities—in countries as diverse as India, Madagascar, Paraguay and the Sudan. These experiences confirm that the benefits of individual control over reproductive life and economic life reinforce each other. Improving livelihoods, while also ensuring access to reproductive health services and information, enhances women’s self-esteem, their confidence, their participation in political and community life, their decision-making power and their position in the family. They benefit, their families benefit, and their communities prosper.