UNFPAState of World Population 2004
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HOME: STATE OF WORLD POPULATION 2004: Reproductive Health and Family Planning
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Reproductive Health and Family Planning

Family Planning and Sexual Health
Contraceptive Access and Use
Unmet Need
Choice of Methods
Sexually Transmitted Infections
Quality of Care
Stronger Voices for Reproductive Health
Securing the Supplies
Men and Reproductive Health

Gaps in reproductive and sexual health care account for nearly one fifth of the worldwide burden of illness and premature death, and one third of the illness and death among women of reproductive age.(1)

At the Cairo conference, the international community embraced a new, broad concept of reproductive health and rights, including family planning and sexual health. It called for integrating family planning and maternal and child health care within a wider set of services including the control of HIV and sexually transmitted infections (STIs). Expanding access to services and meeting clients’ expressed needs and wishes were seen as essential to reducing unintended pregnancies, improving maternal health and curbing the HIV/AIDS pandemic.

The ICPD set the goal of ensuring universal voluntary access to a full range of reproductive health care information and services by 2015. Delegates also agreed that sexual and reproductive health is a human right, part of the general right to health.

There has been important progress since 1994 towards the ICPD goal of universal access to reproductive health services. The 2003 UNFPA global survey found that most countries have established or broadened reproductive health policies and programmes. Many have significantly changed the ways maternal and child health services and family planning are provided,(2) reorienting services to improve their quality and better meet clients’ needs and desires. Rising contraceptive use among couples indicates greater access to family planning.(3) Greater attention has been given to reproductive rights in laws and policies.

REPRODUCTIVE HEALTH—A HOLISTIC CONCEPT

Reproductive health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.

—ICPD Programme of Action, para. 7.2

Since 1994, governments, international agencies and NGOs have focused on increasing the demand for contraception, not just expanding supply. Raising demand means better meeting clients’ needs and desires, and offering a broad mix of family planning methods and higher quality care, with well-supplied facilities and well-trained, informative and courteous personnel.

But millions of people—particularly the poor— still lack access to quality services, including modern family planning methods, emergency obstetric services, and prevention and management of STIs. Demand is growing faster than resources to meet it. And in many countries, a variety of factors have constrained progress in integrating existing services and realizing the synergies envisioned by the ICPD.

GLOBAL SURVEY RESULTS. Country responses to the 2003 UNFPA global survey indicate progress in expanding access to reproductive health and in integrating family planning with other services. But they also reported considerable challenges. In the decade since the ICPD, countries have embraced the idea and the practice of reproductive health. They have broadened programmes to reach more people in need of services, and integrated family planning with preand post-natal care, delivery services, STI and HIV/AIDS prevention, cervical cancer screening, and referral for treatment where appropriate.

An increasing emphasis has also been placed on improving access for underserved groups, including the very poor and people living in rural areas, and on ensuring that the poor have a stronger voice in policymaking, so that information and services are adapted for their special circumstances. Countries are also integrating reproductive health, including family planning and sexual health, with primary health-care services in the context of health-sector reform and far-reaching changes in organizational, administrative and financing arrangements.

LEGAL DEVELOPMENTS. Since the ICPD, many countries have adopted laws to expand access for all women and men to reproductive health care and to ensure that pregnant women and adolescents are not barred from or discriminated against in school or employment. The UNFPA global survey found that 46 countries had enacted new laws and legislation since 1994.

For example, in Papua New Guinea the requirement for a “husband’s consent” for contraceptive use has been removed and adolescents over age 16 can access reproductive health services without parental consent. The Lao People’s Democratic Republic has adopted a national birth-spacing policy, reversing a pro-natalist policy adopted in the 1990s. Under the new policy contraception is provided for free and without coercion.

Belize’s National Health Policy outlines reproductive rights, including voluntary counselling and testing for HIV infection; ensures tax exemption for NGOs in providing health services; and sets protocols for family planning services.

Twenty countries reported in the global survey on communications/advocacy campaigns that promote reproductive rights. Eighteen highlighted institutional changes. For example, in Micronesia, pregnant students are allowed to continue at school and adolescents are allowed access to contraception without written parental consent. Ten countries adopted family laws and legislation to make men more responsible for reproductive health.

12 WHO ADOPTS GLOBAL STRATEGY ON REPRODUCTIVE HEALTH TO ACHIEVE MDGs

In May 2004, the 57th World Health Assembly adopted the World Health Organization’s first strategy on reproductive health. The aim is to accelerate progress towards meeting the Millennium Development Goals and the reproductive health goals of the ICPD and its five-year follow-up.

The strategy identifies five priority aspects of reproductive and sexual health:

  • Improving antenatal, delivery, postpartum and newborn care;
  • Providing high-quality services for family planning, including infertility services;
  • Eliminating unsafe abortion;
  • Combating STIs, including HIV, reproductive tract infections, cervical cancer and other gynaecological morbidities;
  • Promoting sexual health.

The Assembly recognized the ICPD Programme of Action, and urged countries to:

  • Adopt and implement the new strategy as part of national efforts to achieve the MDGs;
  • Make reproductive and sexual health an integral part of planning and budgeting;
  • Strengthen health systems’ capacities to provide universal access to reproductive and sexual health care, particularly maternal and neonatal health, with the participation of communities and NGOs;
  • Ensure that implementation benefits the poor and other marginalized groups including adolescents and men;
  • Include all aspects of reproductive and sexual health in national monitoring and reporting on progress towards the MDGs.
See Sources

Family Planning and Sexual Health

The ICPD called on all countries to take steps to meet the family planning needs of their populations and to provide, by 2015, universal access to a full range of safe and reliable family planning methods. The aims were to help couples and individuals meet their reproductive goals; to prevent unwanted pregnancies and reduce high-risk pregnancies; to make quality family planning services affordable, acceptable and accessible to all; to improve the quality of family planning information, counselling and services; and to increase men’s participation in the practice of family planning.

BENEFITS OF CHOICE. Family planning enables individuals and couples to determine the number and spacing of their children—a recognized basic human right. Practical benefits are gained at many levels:

  • To individuals, improved maternal and infant health; expanded opportunities for women’s education, employment and social participation; reduced exposure to health risks; and reduced recourse to abortion;


  • To families, reduced competition and dilution of resources; reductions in household poverty; and more possibility for shared decision-making;


  • To the society, accelerated demographic transition; and the opportunity to use the “demographic bonus” (see Chapter 2) to speed economic development.


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