Focus on reproductive health
Each year, The State of World Population report provides data, or “indicators,” that show progress and challenges in implementing various aspects of the International Conference on Population and Development (ICPD) and that show changes in national, regional and global demographics.
The 2010 edition of the report includes for the first time an analysis of selected indicators, with a focus this year on reproductive health.
The goal of universal access to reproductive health, a central element of the Programme of Action of the ICPD, was reaffirmed as a development priority when it was adopted in 2007 as a target for inclusion in Millennium Development Goal 5. Progress towards universal access to reproductive health is measured using data on adolescent birth rates, contraceptive prevalence, unmet need for family planning and access to antenatal care.
Universal access to reproductive health is a critical element of a “continuum of care,” which, in turn, yields benefits in other areas. When women and girls have the power to decide for themselves when and if they will become pregnant, they are more likely to have healthy pregnancies and to seek antenatal care. Their children are more likely to survive infancy and early childhood. Girls whose mothers survive are more likely to continue their education and, in turn, are less likely to marry early and more likely to delay having children until they are in their 20s, thus lowering their risk of dying from causes related to pregnancy and childbirth. But despite increasing evidence of these positive links, progress towards universal access to reproductive health remains a major challenge.
The tables on the following pages show the selected demographic, social and economic indicators, which together contribute to a comprehensive accounting of progress towards development priorities defined in the ICPD Programme of Action and towards the Millennium Development Goals.
The ICPD-related indicators in this report track progress towards the Millennium Development Goals that deal with education and health. These indicators also illustrate aspects of the continuum of care for reproductive, maternal, newborn and child health. The health indicators include maternal and infant mortality, contraceptive prevalence, HIV/AIDS and adolescent birth rates. Additional indicators along the continuum of care, including the availability of skilled care at births, are included in the second set of tables, which feature a range of demographic indicators.
The tables that follow place indicators of reproductive health access within a more comprehensive accounting of demographic trends, living conditions, access to resources and other factors that are connected to women’s empowerment, access to education and access to health services. Displaying data this way yields a broad view of factors that shape women’s and men’s quality of life. These tables also provide information about national wealth, educational attainment, and level of urbanization: three issues which have significant bearing on access to reproductive health.
Data are not disaggregated by socio-economic characteristics within countries, but factors such as level of education, wealth and place of residence (urban/rural) do point to significant disparities.
When considered within the context of other socio-demographic characteristics, ICPD-related data show that although adolescent birth rates have declined over the past 10 years and contraceptive use has increased, progress overall towards universal access to reproductive health has slowed.
Women’s access to reproductive health is often correlated with their relative level of social and economic status. Even in many countries where progress towards universal access to reproductive health has been slow, significant gains have been seen among those women who have a relatively higher economic and social status. In some of these countries, such as Madagascar, there has been significant progress in the last 10 years, but the rates of progress have varied, with the largest gains reported among the more privileged groups. In the same period, many other countries, such as those with a low contraceptive prevalence rate and a high unmet need for family planning, women from the wealthiest households, women with a secondary or higher education and women in urban areas are far less likely to become mothers, more likely to use contraceptives and less likely to have an unmet need for contraception than their peers who have no education and limited household wealth or who live in rural areas.
The significant disparities between the wealthiest and the poorest women, the best-educated and least-educated, and women who live in urban areas and rural areas can be observed at both the regional and national levels and within countries and regions. The significance of economic development is most apparent where country-level data are grouped according to economic development. For example, adolescent birth rates are very high in the least-developed countries, with an average of 103 births per 1,000 women between the ages 15 and 19—which is about five times as high as the average for the more-developed regions, where the adolescent birth rate is 21 births per 1,000 women of the same age cohort. Within developing regions, these disparities often extend to the levels of sub-regions and individual countries. For instance, African sub-regions have adolescent birth rates ranging from 32 in North Africa to 167 in Middle Africa. Among the sub-regions that make up sub-Saharan Africa, there are major differences: Southern Africa’s adolescent birth rate is 61, while Eastern, Middle and Western Africa have rates higher than 110. Overall contraceptive prevalence, and, in particular, use of modern methods of contraception, varies widely and remains low in much of the world. By income, use of modern methods ranges from 22 per cent in the world’s least-developed regions, to 55 per cent in less-developed countries and 58 per cent in more-developed countries. Regionally, rates of contraceptive prevalence for modern methods range from 23 per cent in Africa to 64 per cent in Latin America and the Caribbean.
Current data on adolescent birth rates and contraceptive prevalence reflect persistent disparities among regions, whether defined by relative wealth, level of development or geography. Globally, more women are using contraception, and fewer girls are becoming mothers every year. But the rate of progress has generally slowed since 2000. Meanwhile, declines in adolescent birth rates have also slowed, and in many countries, especially the least-developed ones, rates may have even increased slightly. For contraceptive prevalence, the rates for least-developed countries remain relatively low: 28 per cent using any method and 22 per cent using modern methods of contraception. These rates are far lower than in the more-developed regions, where 68 per cent of women use any method of contraception and 58 per cent use modern methods, and the less-developed countries, where 61 per cent of women use any method, and 55 per cent use modern methods.
When countries are grouped by regions, rates also vary. For example, in Europe, which has the lowest adolescent birth rate—17 births per 1,000 girls between the ages of 15 and 19—while in Africa, the rate is 103. Regional averages show global disparities in contraceptive use and adolescent birth rates but can also mask significant disparities in access to reproductive health within regions. For example, within Africa, data for subregions vary immensely: among sub-Saharan African regions, Southern Africa has by far the lowest adolescent birth rate—61 per 1,000 girls—and the highest contraceptive prevalence, at 59 per cent for all methods and 58 per cent for modern methods. In contrast, the rest of the subregions in sub-Saharan Africa have adolescent birth rates well over 100 per 1,000 girls, and contraceptive prevalence rates at 26 per cent or less. The highest adolescent birth rate is in Middle Africa, at 167 per 1,000 girls, while its contraceptive prevalence rate is 19 per cent for all methods and only 7 per cent for modern methods.
The collection of indicators in this report illustrates an important range of factors that relate both directly and indirectly to progress towards universal access to reproductive health, while they combine to provide a significant set of data on progress towards women’s and men’s overall well-being, including their access to resources, health and education. While it is important to caution against jumping to the conclusion that individual indicators should not be read to determine cause and effect, these data build on significant evidence of strong links between socio-demographic characteristics and women’s access to reproductive health. These links, combined with the overall slowing of progress, underscore the persistent inequities that must be overcome to attain universal access to reproductive health.