Lack of Choice Jeopardizes
Women’s Health and Lives
 |
| Kadiatu Samu, who has had no prenatal
care and whose child was stillborn, is examined by a maternity ward nurse in Bo, Sierra
Leone. From 13 pregnancies, she has five surviving children. Sierra Leone has one of the
world’s highest maternal mortality rates, 1,800 deaths per 100,000 births. Worldwide,
there has been little progress in reducing the risk of childbirth. |
Despite progress, far too many women are still denied education, contraception and
decent health care, and "violence against women is endemic in all countries,"
according to the newly released The State of World Population 1999 report, which
says that hundreds of millions of women continue to suffer needlessly from gender-based
violence, unwanted pregnancies, unsafe abortions and ill-health.
Five years ago at the International Conference on Population and Development (ICPD) in
Cairo, governments agreed that citizens should be entitled to basic reproductive rights
including the right to make free choices about the number, timing and spacing of children;
the right to attain the highest standard of sexual and reproductive health; and freedom
from sexual violence and coercion. Advancing gender equality, eliminating violence against
women and ensuring women’s ability to control their own fertility were acknowledged
as cornerstones of population and development policies.
Many countries are working to improve reproductive health services and are training
staff to provide better information, wider choices and client-centred care. But the need
for universal access to education and quality reproductive health care is as pressing as
ever. The benefits of education for girls and women are well documented, yet in developing
countries, girls are two thirds of the 130 million children not attending school.
Education also leads to postponing childbirth, and having fewer and healthier children.
Although contraceptive use has increased, there are still 350 million women in
developing countries who do not have access to a range of safe and effective family
planning methods. Up to half of the nearly 175 mil-lion pregnancies each year are unwanted
or ill-timed, the report by the United Nations Population Fund (UNFPA) says. Furthermore,
there are no trained childbirth specialists present at almost half of all births in
developing countries, putting the lives of mothers and babies in jeopardy.
Every minute more than one woman dies from problems related to childbirth and
pregnancy. Less than 1 per cent of the deaths occur in developed nations. Of the estimated
585,000 women who die each year, the majority could be saved. "It has been hard to
secure the necessary resources or policy priority to reduce maternal mortality despite
well-known and widely available techniques and universal agreement that it should be a
priority," the report says.
One study found that where mothers’ death rates were very high, the risk could be
reduced by as much as 80 per cent by providing care during pregnancy, information about
warning signs and services to provide emergency obstetric care during childbirth.
In addition to deaths, complications arising in pregnancy and childbirth can have
long-lasting effects. It is estimated that at least 7 million women suffer serious health
problems and as many as 50 million suffer some health consequences after childbirth each
year.
In many developing countries, girls often marry and begin childbearing at an early age,
sometimes before reaching full maturity, increasing the risk of pregnancy-related death or
injury and jeopardizing their children’s chances of survival. The ICPD stressed that
married and unmarried adolescents should have access to reproductive health information
and services including family planning.
Another significant factor is unsafe abortion, which claims the lives of some 70,000
women annually. The ICPD agreed that unsafe abortion should be addressed as a major public
health concern. At the United Nations General Assembly’s 1999 fifth-year review of
the Cairo Conference, governments agreed that where abortion is legal, countries should
train and equip health service providers and take other measures to insure that abortion
is safe and accessible.
Studies and experience show that the best way to reduce levels of abortion is to
prevent unwanted pregnancy by making family planning services more accessible. In the
Central Asian countries of Kazakhstan, Uzbekistan and the Kyrgyz Republic, better
availability of services and information has increased the use of modern contraception by
30-50 per cent since 1990, and abortion rates have declined by half.
Reducing the incidence of sexually transmitted diseases (STDs) is another priority.
There are over 330 million new cases of STDs each year. And even though women are more at
risk than men—for biological and social reasons—decisions affecting sexual
health are reserved for men in many societies, the report says. In some countries, women
are not allowed to get contraception without the consent of their husbands.
Another key concern is violence against women, including rape, domestic violence, dowry
murder and "honour" killings. Although there are growing efforts to stop it,
more than half of all women will suffer some form of gender-based violence in their lives,
according to the report. To end the violence, "countries need to make a commitment to
gender equity and equality, greater participation of women in policy- and decision-making
roles, and partnership with men," the report says.
Information—and discussion—about reproductive health issues is critical and
can lead to changes in harm-ful behaviours and traditions. Each year, an estimated 2
million girls and young women are at risk of female genital mutilation (FGM), which can
cause infections, severe bleeding and even death. In Senegal, the actions of dozens of
community groups helped spur the country’s president and parliament to outlaw the
practice.
The grass-roots activism grew out of the efforts of a literacy programme for women,
built around group discussions. "It is a hard thing to admit that something you and
your ancestors had considered right all your life is in fact wrong," said one of the
elders who participated in the discussions on women’s health. One woman who lost her
job as a circumciser was persuaded to abandon the practice after months of discussion.
"When I learned that this might cause sterility and infections, I didn’t want to
be the cause of all that," she said. Altogether some 15 African countries have
outlawed FGM.
An area of increasing concern is the need for reproductive health care for refugee
women. Around the world, there are more than 22 million people who have been displaced by
war or natural disaster, the vast majority of them women and children. It has become
increasingly clear that these women need services to protect them from violence, ensure
safe pregnancy and delivery, prevent unwanted pregnancies and STDs, and deal with rape and
the complications of unsafe abortions.
Since 1995, an initiative by the Office of the United Nations High Commissioner for
Refugees and UNFPA (in collaboration with other partners) has addressed the reproductive
health needs of refugee women in Africa’s Great Lakes region. The programme trains
staff and provides equipment and supplies to address needs in family planning, assisted
childbirth, complications of unsafe abortions, sexual violence and rape, and prevention of
STDs including HIV/AIDS.
In April 1999, UNFPA provided reproductive health packages of drugs, supplies and basic
surgical equip-ment for the hundreds of thousands of refugees fleeing Kosovo to camps in
Albania. The Fund also undertook an investigation of sexual violence against Kosovar women
and uncovered "alarming accounts of abduction, rape and torture," according to
the report.
Although reproductive health services have been provided in emergencies since 1995, the
report says, "efforts are often hampered by a lack of health personnel skilled in
reproductive health information and services."
Many important advances in reproductive health have been made as the result of the
growing strength of women’s organizations and their increasing ability to forge
alliances with governments as well as other civic groups. Working together, these
alliances have been able to secure legislative change and action to improve reproductive
health, and to begin to change underlying attitudes towards gender issues.
Since the Cairo Conference, two thirds of all countries have introduced policy or legal
measures to pro-mote gender equality and the empowerment of women. Many have strengthened
laws and policies to combat gender-based violence. Many countries have acted to improve
the quality of health services.
Despite progress, the report says further action and resources are needed to enable
women to avoid unwanted sex and pregnancy, to ensure healthy babies and mothers, to reduce
gender-based violence, to improve communication about sexual and reproductive concerns,
and to increase women’s opportunities outside of the household and male participation
in the family.
The State of World Population report is published annually by UNFPA, which is
the largest multilateral provider of population assistance in the world.
—Word count: 1,364  Download PDF version
Other News Features:
Global Population Hits 6 Billion
Youth: At Risk and in Need of Information and Services
Cairo Population Plan Needs More Funding to Sustain Progress
BACK TO THE STATE OF WORLD POPULATION
1999
For more information:
United Nations Population Fund
Information and External Relations Division
220 E. 42nd Street, New York, NY 10017, U.S.A.
Tel. 212-297-5020; fax: 212-557-6416
E-mail: ryanw@unfpa.org. Web site: www.unfpa.org |
