UNFPAState of World Population 2002
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HOME: STATE OF WORLD POPULATION 2002: Overview
State of World Population
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Overview
Characterizing Poverty
Macro-economics, Poverty, Population and Development
Women and Gender Inequality
Health and Poverty
HIV/AIDS and Poverty
Poverty and Education
Population, Poverty and Global Development Goals: the Way Ahead
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Overview

Introduction
Population, Development and the Millennium Development Goals
Other Key Issues
How to Meet Poverty Eradication Goals

Other Key Issues

4 THE POOR SPEAK OUT

The World Bank-supported project Voices of the Poor vividly illustrates how poor people link poverty to high fertility and gender inequality.

From Ghana: "Poor men and women across the communities visited … consider lack of money, unemployment, and having too many children as leading causes of poverty. Other causes mentioned in most communities relate to low crop yields and soil infertility, and to diseases and ill health. … [In listing] the impacts of poverty, every single community mentions poor health or premature death…. In five communities, prostitution is identified as an impact…. Poor people often speak of their large households and the added stress this can place on meager resources and social relations. In almost every [description of] the causes of poverty, women and men have included 'unplanned births', 'lack of family planning', or 'too many children'."

From Malawi: "Study participants in two urban settlements … say that some households are doing better because family planning is now more available. According to a poor woman in Chemusa, 'In the past, people were not using family planning methods and this was causing the families to have more … so that it was difficult for most households to budget properly'."

From Jamaica: "A woman … speaks for many others when she explains that a woman must have her own economic means so that 'she doesn't feel helpless'.… Many women … acknowledge their drive for financial independence and express appreciation for the greater freedom that having an income brings…. Other women advise, 'Have your own shelter and finances so you don't have to stay in an abusive relationship.' … A woman in Cassava Piece remarks, 'More women work now, so they don't have to put up with men's foolishness.' In some urban communities women mention greater freedom to choose family planning methods." See Sources

Health care reform often means decentralization, so that local services can respond to local needs. Effective reform depends on guaranteed funding-by providing more resources and better use of available funds-and central support for services that cannot be supplied locally.

Health systems focus on treatment and cure, so specific action is needed to protect preventive services like reproductive health. Partnerships with NGOs and the private sector can be productive.

Decentralized systems can pay more attention to inequities in health service delivery. Affordable service fees can be used to improve the quality of care, but the poorest cannot afford fees at any level. Fees have meant that millions of poor people, particularly women and children, forgo the care they need. Health issues are discussed in Chapter 5


HIV/AIDS Poverty, inequality and globalization combine to increase the impact of the pandemic. It is the major cause of death in Africa, where 28 million live with HIV/AIDS: all but 1.5 million of the 40 million currently infected people live in developing countries. It is spreading fastest in Eastern Europe and Central Asia, and is daily becoming a more serious threat in India and China.

In 2001 three million people died of AIDS, out of 22 million the disease has killed. AIDS deaths have left 13.4 million children without one or both parents, a third of all orphans. For the poor, this means increasingly relying on the grandparents' generation, but older people are often unable to cope. An increasing number of poor children are without any kind of family support.

POVERTY SPREADS HIV/AIDS Malaria, tuberculosis and sexually transmitted diseases that predispose to HIV infection are more common among the poor. Poor people know less about HIV/AIDS and are less able to protect themselves. Young women are especially vulnerable, and especially uninformed-in one African country nearly nine out of ten sexually active teenagers know nothing about HIV/AIDS. The impact of AIDS further impoverishes the families affected.

HIV/AIDS is a demographic, social and economic disaster. As it kills predominantly younger adults, the worst-affected countries are seeing the hollowing out of an entire generation in the productive age group, with all the attendant consequences: personal tragedy, families forced deeper into poverty, communities threatened, the social fabric weakened and now looming economic crisis.

In the worst-affected countries public servants and private sector employees are falling sick in increasing numbers. By 2020 economies could be 20-40 per cent smaller than expected because of the pandemic. Damage to public services such as education and health will drive the poor further into poverty. Health services have already moved out of the reach of many of the poorest because of fees for service and other charges. Education can provide a "social vaccine", but education and health systems are both collapsing as teachers and health workers die.

The pandemic shows no signs of slowing. Instead it is threatening to engulf the most populous countries of the world, India, China and Indonesia. Effective leadership has held back infection in countries such as Senegal, Thailand and Uganda, but many leaders at all levels have not yet confronted the pandemic. Despite many statements of support, members of the international community have not yet provided the resources poor countries need.

The disease spreads overwhelmingly by unprotected sexual contact, predominantly between men and women. About a third of infected mothers pass the disease to their children in utero. Women are more vulnerable to infection for physiological and social reasons, and sex workers are far more likely than the population at large to be infected, but the sexual behaviour of men is largely responsible for spreading the disease.

Half of all new HIV infections are among young people aged 15-24, and young women are more likely to be infected than young men their own age, reflecting their social vulnerability. Young people are ignorant of the disease and its effects, and do not know how to protect themselves against it. Many societies still do not consider this information suitable for young people, despite ample evidence that the exercise of sexual responsibility, including abstinence, depends at least in part on accurate and timely information, and that young people will use sexual information and services in a responsible manner (15).

Stopping the pandemic means stopping the spread of infection. Prevention calls for adequate information and services, which should include emphasis on abstinence outside marriage and fidelity within it. Treatment can help, but any cost is too expensive for the poorest people. There must be adequate supplies of male and female condoms, and the motivation for people to use them. At present, only one person in five has access to information and services to protect themselves against infection.

Calls for "behaviour change" alone will not motivate people to protect themselves, or enable them to do so. HIV/AIDS accompanies poverty, is spread by poverty and produces poverty in its turn. The infection spreads rapidly among people without confidence in the present or hope for the future.(16)

Effective strategies to turn back the epidemic must go beyond medicine and health care and reach into the community. They call for close consultation with the people they seek to assist(17). Strong and committed leadership that leads by example as well as exhortation is a prime necessity.

The Global Fund for AIDS, Tuberculosis and Malaria will do much to combat the pandemic, if the international community provides the required funding.

HIV/AIDS is discussed in Chapter 6.


EDUCATION AND POVERTY Access to basic education as a human right has improved, but there is much more to be done. The poor have benefited less than the better off. The push for universal primary education has left out poor children. Rural/urban differentials remain large in many countries (18).

The content and quality as well as the level of education affect children's prospects for development. Educated mothers encourage and support the education of their children (19). They know the value of education, but they are also able to afford it. The poor cannot afford to supplement inadequate public systems with private education.

The number of siblings can affect a child's chance of education: poor families must often choose which of their children to educate. In extended families, relatives sometimes step in to cover some of the costs, but the choice falls more often on the boys, leaving the girls with little or no education. Parents may also have concerns about girls' safety at school, or going to and from school. Among older girls, pregnancy is always a risk. Even without these pressures, mothers' need for help with their many tasks often takes priority over girls' schooling. The gender gap in primary education has narrowed in many countries over the past several decades, but sometimes this is only because boys' progress has slowed.

Many children do not have the benefit of a two-parent family. The luckier ones are living in one-parent homes or fostered with relatives, but a large and growing number of children are abandoned, orphaned (increasingly by HIV/AIDS) or sold into sexual servitude. Thier lives aer likely to be short, painful and unhappy.

Education for the children of the poor, especially those who live outside the reach of families, calls for special efforts. Civil society helps reach out to young people outside the school system, but efforts are piecemeal in most developing countries. It requires a massive investment in both formal and informal education, inside and out of school.

HEALTH AND EDUCATION Educated mothers have healthier children. They know more about good nutrition, and there is less competition for food in smaller families. The combination accounts for 43 per cent of the reduction in child malnutrition between 1970 and 1995.

Educated women have fewer children, and fewer unwanted or mistimed births, but other influences help produce this effect. Educated women tend to come from educated families, and they know about and use health care and family planning. Education may stimulate the desire for better health care and smaller families, but education is neither a clinic nor a contraceptive. Women need services to give effect to their wishes and meet their needs.

With fewer children, families can invest more in each child's education (20). Unwanted children will have less education if parents must pay for it, as they increasingly must (21).

Education is discussed in Chapter 7.

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