Investing in Reproductive Health and Rights to Achieve MDG5 and Accelerate Sustainable Development

24 April 2010

Your Excellencies,
Ladies and Gentlemen,

It is with great pleasure that I join you today to talk about how investing in MDG 5 saves money.

UNFPA is proud to co-host this meeting with the Government of the Netherlands and the World Bank, as a follow-up to the high-level meeting on maternal health that took place last year in Addis Ababa.

I would like to thank you for taking the time to join us for this breakfast.

Why are we here/expected outcomes

We are here to answer the Addis Urgent Call to Action for Maternal Health. We are here to find ways to better support women so they can enjoy healthy pregnancies and safe deliveries.

These issues are key to the right to development and to rights of women, men, young people and children to a better quality of life.

We are here to explain how investments in reproductive health and rights are crucial not just for the achievement of MDG5 to improve maternal health but also for the other MDGs – to eliminate extreme poverty and hunger, ensure universal education, reduce child mortality, curb the spread of HIV and AIDS, promote gender equality, and ensure sustainable development.

And we are here to call on you as Ministers of Finance to do what needs to be done and use your power to invest in women’s health because it is smart economics. Together we can ensure that this message reverberates throughout the 10-year review of the Millennium Development Goals leading up to the high-level meeting at the United Nations in September.

Link between Poverty, Reproductive Health and Rights

Today poor sexual and reproductive health is a leading cause of death and disability in the developing world. It limits life expectancy, hinders educational attainment, diminishes personal capability and productivity, adds to the costs of health care at the tertiary level and thus impacts directly on economic growth and poverty reduction.

Every year, about half a million women die during childbirth, over 95 percent in Africa and Asia. A mother’s death lowers family income and productivity, affecting the entire community. It is estimated that pregnancy-related death among women and newborns results in a combined $15 billion loss in productivity each year in the developing world.

While devastating, these global statistics do not fully convey the tragedy that a family encounters when a mother dies during childbirth. This tragedy can be easily averted. We know how to prevent these needless deaths. Effective interventions exist. And this is what makes these deaths doubly tragic.

The vast majority of maternal deaths could be averted if every woman had access to reproductive health services, especially family planning, skilled attendance at birth and emergency obstetric care.

One in four women who want to avoid or space a pregnancy are not using an effective method of contraception. This means that 215 million women have an unmet need for family planning. And we know that effectively addressing this current unmet need would prevent 150,000 maternal deaths and 640,000 newborn deaths each year. The final speaker, Sharon Camp, will tell you more findings like this from our new joint report, Adding it Up.

The point is that this lack of essential health services keeps women trapped in a vicious cycle of poverty that runs from one generation to the next.

It is this poverty trap that must be broken if we are to achieve the Millennium Development Goals. Investing in sexual and reproductive health can play a significant role in making this happen and that is why the second target under MDG5 is universal access to reproductive health.

Benefits of Investing in Reproductive Health and Rights

Good reproductive health enables couples and individuals to lead healthier, more productive lives, and in turn to make greater contributions to their household incomes and to national savings.

The health benefits of these investments are well known, well documented and substantial.

They include the prevention of deaths due to pregnancy and childbirth, the prevention of HIV, the prevention or reduction of conditions such as obstetric fistula and other sexual and/or reproductive illnesses and disabilities; better nutritional status and decreased risk of anemia for women; and increased survival rates and better health of infants.

It is estimated that ensuring access to voluntary family planning could reduce maternal deaths by up to 40 per cent, and child deaths by as much as 20 per cent. The World Bank estimates that ensuring skilled care in delivery and particularly access to emergency obstetric care would reduce maternal deaths by about 74 per cent.

These are significant benefits. But as striking as these numbers are, the personal, social, environmental and economic benefits of reproductive health services may be even more important.

These benefits are extremely important for human welfare and economic development. They include improvements in women’s status and greater equality between women and men, slower population growth, as well as benefits at the individual, household and societal levels.

These investments in reproductive health in general, and particularly in family planning, bring government savings. That is why we say that family planning is not an item of expenditure; it is an investment that brings high returns.

A study in Mexico found that for every peso the Mexican social security system spent on family planning services between 1972 and 1984, it saved nine pesos in expenses for treating complications of unsafe abortion and providing maternal and infant care.

In Thailand, every dollar invested in the family planning programme saved the government more than $16.

Even more dramatic is the analysis in Egypt, which found that every dollar invested in family planning saved the government $31. This included savings on government expenditures on education, food, health, housing and water and sewage services.

Studies also show that the benefits go beyond government savings. Where mortality is high, parents are likely to have more children but to invest less in each child’s health and education, impeding their economic prospects and their health.

Guaranteeing universal access to reproductive health services reduces adolescent birth rates which, in turn, positively affect educational achievement among adolescents in general and girls in particular.

It is also true that reproductive health investments, particularly in family planning, can produce what is called a "demographic bonus".

This is a one-time window of opportunity that opens for economic growth that is spurred by lower rates of fertility and mortality, and a large healthier working population with relatively fewer dependents to support. If jobs are generated for the working population, this bonus results in higher productivity, savings and economic growth.

In East Asia, where poverty has dropped dramatically, the demographic bonus is estimated to account for about one-third of the region’s unprecedented economic growth during 1965 to 1990.

There is also no doubt that investing in sexual and reproductive health is strategic for curbing the HIV/AIDS epidemic. This is important for improving maternal health because AIDS-related maternal deaths are rising in highly affected areas such as sub-Saharan Africa.

This is why UNFPA is working with UNAIDS, the Global Fund and PEPFAR to more fully integrate policies and programmes for HIV and AIDS with sexual and reproductive health. Stronger linkages will result in more relevant and cost-effective programmes with greater impact.

These are just a few examples of the benefits of investing in reproductive health and rights. As I said when I began, we know what needs to be done. We know what works.

Increased Financing needed to Strengthen Health Systems

We also know that we need to strengthen health systems. If a health system can deliver for women, it is a strong health system that benefits all.

The health-related MDGs, 4, 5 and 6 to reduce child mortality, improve maternal health and combat HIV and AIDS are interdependent. And they are best addressed through a health systems approach that includes community participation. Of course, building a solid health system with skilled health workers, drugs and supplies and health information systems requires adequate governance, stewardship and financing.

Yet when it comes to financing, in many countries it is a challenge to raise adequate funds for universal health coverage. Even though funding for global health rose considerably during the past decade, funding for reproductive health remained stagnant and actually declined for family planning. We need to remedy this funding gap urgently.

To achieve MDG5 and improve women’s health, we need to move from speech lines to budget lines. Strengthening health systems requires sustained investment over time.

The High Level Task Force on Innovative Financing for Health Systems calculates that strengthening health systems to ensure rapid progress towards the health MDGs in 48 low income countries would require a gradual increase of investment up to $36-$45 billion by 2015, on top of the $31 billion that is spent today.

So we need to increase financing to improve health and human capital and remove the health barriers to economic growth. The relationship between health and economic growth is mutually reinforcing. The report of the Commission on Macroeconomics and Health found that spending on health brings a sixfold return on investment. Improved health is not just a consequence of economic growth but also a crucial weapon against poverty.

I am encouraged by new global health partnerships and national efforts to get more money for health and more health for the money. This includes the plan that emerged from last week’s retreat of UN Secretary-General Ban Ki-moon to improve the health of women and children. There is also the initiative of Canada as the G8 host this year to make maternal and child health a development priority. And there is the upcoming Women Deliver Conference here in Washington, D.C. in June, and the African Union Summit on Maternal and Child Health in July in Kampala.

Momentum is building rapidly and exponentially.

Call to Action

To answer the Addis Urgent Call to Action for Maternal Health, there are three things that you can do as Finance Ministers.

First, make reproductive health, including family planning, a priority in national budgets and efforts to strengthen health systems.

Second, use your leadership and stature to promote the health and rights of women and girls as a vital investment to improve economic growth, equity and stability. Investing in women is smart economics.

And third, increase investments in the education, health and livelihoods of adolescents. This will improve human capital and productivity now and for generations to come.

What we need now for success is the political will and action to make universal access to reproductive health a reality so that no woman dies giving life.

Thank you.

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