UNFPAState of World Population 2002
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HOME: STATE OF WORLD POPULATION 2002: Population, Poverty and Global Development Goals: the Way Ahead
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Population, Poverty and Global Development Goals: the Way Ahead

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Resources for Population and Reproductive Health
Investing for Health, Fighting Poverty

Resources for Population and Reproductive Health

Since 1969, UNFPA has been the largest multilateral source of population assistance, providing some $6 billion for population programmes.

ICPD RESOURCE GOALS In 1994, at the International Conference on Population and Development, nations committed themselves to the goal of universal access to reproductive health by the year 2015(25). The five-year review of the ICPD and subsequent international and regional conferences reaffirmed this goal (26).

The goal remains a priority for the international community. It figures in the monitoring standards of bilateral assistance agencies (including the development agencies of the United States and the United Kingdom), the World Bank and the evolving efforts of developing countries.

As part of the ICPD consensus, the international community accepted expert estimates of the cost of a package of services towards the goal of universal access to reproductive health. The package included family planning; safe delivery; prevention of sexually transmitted diseases; other reproductive health services; and population data collection and analysis. These estimates were reaffirmed at the UN General Assembly's five-year review of ICPD implementation in 1999.

This commitment was directed to seeing that every pregnancy would be a wanted pregnancy and every child a wanted child, born with care assuring that both the mother and the baby would be healthy and free from sexually transmitted diseases.

Estimated needs were $17.0 billion a year in the year 2000. The requirement was projected to increase to $18.5 billion in 2005, $20.5 billion in 2010, and $21.7 billion in 2015. The international community was called on to provide one third of these amounts.

The services included in the package can be delivered through primary health care systems. Additional resources will be required for basic health infrastructure development, tertiary care, emergency obstetrical care, specialized HIV/AIDS prevention interventions (27), and the treatment and care of those living with HIV/AIDS.

ADDITIONAL RESOURCES NEEDED Further resources are needed for other population-related development goals in the Programme of Action. Among these are:

  • universal basic education;
  • the empowerment of women;
  • environmental concerns;
  • employment generation;
  • poverty eradication.

More detailed costing for the Millennium Development Goals will elaborate some of these additional requirements.

Some reproductive health needs were not fully foreseen in 1994, and call for additional resources. Among these are much broader and more urgent efforts to prevent HIV/AIDS infection; and expanded information, care and services for people in emergency situations.

PROGRESS IN MOBILIZING THE RESOURCES Donor countries are contributing less than a quarter of current expenditure towards the goal of universal access to reproductive health by 2015. Their commitment was one third of a much larger total.

At the ICPD, countries agreed that one third of the $17 billion annual requirement for basic reproductive health and population programmes in 2000, or $5.7 billion, was to come from the international community; two thirds, or $11.4 billion, was to be provided by developing countries and other countries needing assistance.

In the year 2000, total expenditure was $10.9 billion. Assistance totalled $2.6 billion. This is less than a quarter (24 per cent) of total expenditure, and less than half (46 per cent) of the commitment. Developing countries contributed $8.3 billion, 76 per cent of the total spent and about 73 per cent of their commitment. A few large countries account for much of this expenditure. Africa is the region with the largest share (70 per cent) of allocations coming from international sources.

BROADER FOCUS NEEDED The Millennium Summit adopted a disease-oriented approach to health. Issues such as unwanted pregnancy and family planning, which are not diseases, did not figure prominently in the Summit decisions, and thus not in the Millennium Development Goals.

The Commission on Macro-economics and Health (28) did not fully cost family planning, a key element in reproductive health, when estimating needs for essential health interventions. It included only the cost of family planning commodities, for one year after the birth of a child, though WHO standards suggest that the health gains for children and for mothers of spacing births 24 to 30 months apart are considerable.

Resources are therefore needed to ensure an adequate supply of temporary methods of contraception, such as condoms. The United Nations Population Division estimates for less-developed regions (29) indicate that over 100 million couples-over 20 per cent of all users-use temporary methods. IUD users, an additional 27 per cent, also need resupply, but at longer intervals.

The excellent foundation provided by the Commission can be further elaborated as the follow-up process continues, recognizing these additional needs and acknowledging the importance of universal access to reproductive health, including family planning, for reaching the Millennium Development Goals (30).

NEW INVESTMENTS IN FAMILY PLANNING In the area of family planning, the necessary programme investments-all as part of strengthening health infrastructure-include:

  • commodities and logistic systems;
  • management and quality control;
  • counselling and follow-up (including adjustments in method choice, if indicated);
  • sociocultural research to address barriers to effective or proper use, and to facilitate introduction of new methods or options for service delivery;
  • introduction of both cost-sharing and equity systems;
  • establishing appropriate public-private partnerships;
  • operations research and contraceptive development.

Research is needed on effective, user-friendly and culturally acceptable methods of family planning, especially those a woman herself can control. Preventing sexually transmitted diseases, including HIV/AIDS, calls for additional investment in contraceptives that are also microbicides.

This should be part of the response to the Commission's call for "a significant scaling up of financing for global R&D [research and development] on the heavy disease burdens of the poor ...." (31) Contraceptive development, supply, logistics and management should also be included in the estimates of capital and recurrent investments needed.

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