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

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

Investing for Health, Fighting Poverty

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 economic growth.

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).

29 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 ages.

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 service costs).

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 (37). Countries 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 development opportunities.

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.

30 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 and poverty.

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 efforts.

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 participation.

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 approaches.

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.

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