Population, Poverty and Global Development Goals: the Way Ahead
Providing reproductive health services, including family planning,
offers clear and direct benefits for empowering women, improving
lives, and reducing poverty:
- Better prenatal and delivery services help mothers go through
pregnancy safely and children survive the risky first years of life;
Reducing sexually transmitted diseases improves adult survival
rates and spares men and women from suffering;
- Fewer unwanted pregnancies improves women's health;
- Spaced births and fewer pregnancies overall improves child survival;
for women it means more time with each child, and more
opportunity for employment and other options.
Having fewer young dependents compared to the workingage
population helps families escape from poverty. It opens a demographic
window, an opportunity for countries to achieve faster
Continued progress depends on continued
investment, domestic and international (32).
Decades of social and economic
research show that reproductive health programmes, including
family planning, are among the most cost-effective health
and social development programmes. The World Bank included
family planning and other reproductive health programmes
among its set of highest-priority health interventions
in its seminal 1993 World Development Report: Investing
in Health (33).
There are no agreed methodologies
for estimating the ratio of costs to benefits-both are
hard to calculate with certainty-but benefits are there
to be seen. This report has outlined the depth and diversity
of gains to be expected. Confining the benefits to the
health sector, the benefits in savings from averted
illness alone are significantly greater than the cost
of the services (34).
Rigorous methodologies for estimating
more-distant effects can also demonstrate powerful returns
to reproductive health investments. The environmental
benefits of avoiding unwanted births-through lower resource
consumption and greenhouse gas emissions, for example-far
outweigh the costs (35).
REPRODUCTIVE HEALTH ESSENTIALS
UNFPA is coordinating
an initiative to ensure the reliable supply of
reproductive health essentials. This programme is designed to
provide high-quality commodities to developing countries at
the lowest possible negotiated price.
Demand for modern contraceptives will increase by over
40 per cent during the next 15 years as the result of unmet
need, increased demand and growing populations of reproductive
Only 53 per cent of births are attended by trained practitioners,
and access to emergency obstetric care is extremely
low, particularly among poor and rural women. To save
women's lives, there must be a large increase in essential
equipment and medications for safe delivery.
UNFPA estimates that contraceptive requirements for family
planning and prevention of STIs and HIV/AIDS call for total
donor support in 2015 of $739 million, an increase of $405
million over 2000. These are a fraction of overall programme
needs (commodities costs are only about a fifth of total
COMPARING APPROACHES Among reproductive health interventions,
the cost-effectiveness of different approaches to solving a
single problem can be compared.
In HIV/AIDS prevention, for example,
the focus of UNFPA's work against the pandemic, is 28
times more cost-effective than highly active antiretroviral
therapy (HAART) (36).
Of course, a comprehensive approach to HIV/AIDS recognizes
the synergies between prevention and treatment: HAART
for example reduces the viral load, making transmission
less likely. Balance will also be needed between efforts
addressing health impacts and those affecting the social
and institutional contexts that place people at risk
need national strategies and institutions with particular
comparative advantages and strategic strengths.
INTERACTION OF BENEFITS AND
COSTS Integrated service delivery has long been
recognized, notably in the ICPD Programme of Action,
as both cost-effective and most likely to ensure a client-centred
approach to health. The Commission on Macro-economics
and Health recognized this professional consensus in
promoting the "Close-To-Client" service system (38).
The global costs of gender violence and abuse are difficult
to assess. They include the direct costs of, for example, treating the
health effects of violence; ill health; missed work; law enforcement
and protection; shelter; marital dissolution; child support; and
all the other consequences of adapting to or escaping abuse. They
also include the indirect costs of preventing women from working
or contributing in other ways, and of missed education, including
holding young girls out of school to avoid exposure to boys. In
poor communities, the costs are reckoned largely in these missed
Elsewhere, the direct costs are equally important and often
substantial. The World Bank estimates that in industrialized
countries sexual assault and violence take away almost one in five
healthy years of life of women aged 15-44.
POLICY DIALOGUE ON POVERTY REDUCTION IN NICARAGUA
A Nicaragua's per capita income in 2001 was
$486, the second lowest in Latin America. Its foreign debt is
twice its annual GNP. Pervasive poverty, exacerbated by rapid
population growth, gender inequity, and wide income and educational
disparities, inhibit the consolidation of democracy and
sustained economic development.
Educated women in higher income groups have an average
of two children; illiterate poor women tend to have six to eight.
Adolescent fertility is the highest in the region: almost half of
all Nicaraguan girls become pregnant by age 19. Fertility is particularly
high among girls who are poor and out-of-school.
Recognizing that rapid population growth undermines its
ability to provide quality education and basic social services,
the Government has called for a rapid and urgent attention to
population issues, involving civil society and donors.
Nicaragua's Strengthened Economic Growth and Poverty
Reduction Strategy (SEGPRS) addresses Millennium
Development Goals related to poverty reduction, primary education,
water and sanitation, illiteracy, malnutrition, and
maternal and child mortality.
As a result of UNFPA advocacy, the strategy calls for reproductive
health information and services for adolescents in and
out of school, and calls attention to violence against women.
But it does not mention HIV/AIDS.
UNFPA's Nicaragua office offered technical assistance in
developing tools to implement the strategy, including the
Ministry of Health's 2002 National Sexual and Reproductive
Health Programme and the Population Plan of Action.
SEGPRS analyses some population and development linkages,
but does not yet address other key issues, such as
migration flows, distribution of the population, rapid urban
growth and sustainable use of space, and their links with environment
However, the Government's new vision of development
proposes wealth generation with the poor and for the poor; this
assumes population factors are relevant to sustainable development
Investments in education bring
substantial returns. Female education, apart from empowering
the woman herself and widening her life choices, is
particularly cost-effective because benefits pass on
to her children (39).
However, the investment can be dissipated if lack of
choice about the number, timing and spacing of children
and rigid gender roles reduce women's social and economic
Reproductive health adds another dimension to the improvement
in "human capital". Reductions in maternal, infant and child
mortality are development ends in themselves, and they have
added effects on future economic production, fertility, informal old
age support and other advantages.
The interaction of higher education, reduced fertility, women's
economic and social participation, and greater investments in
children's health and education amply justifies investments
in both education and reproductive health in holistic development
The international goals for poverty reduction and improvement
of life quality offer an ennobling vision. Achieving and protecting
them will require both a focus on the goals themselves and sensitivity
to the context. Universal access to reproductive health care,
universal education, and women's empowerment are goals in their
own right, but they are also conditions for ending poverty.