Population and Reproductive Health: Key to the Achievement of the MDGs

Statement by Thoraya Ahmed Obaid, Executive Director, UNFPA

Good afternoon,

It is my pleasure and honour to join you today. I hope you enjoyed our short film. I look forward to our discussions.

Before coming here, I met this morning with the Standing Committee on Foreign Affairs, and the President of the Canadian International Development Agency (CIDA), the Senior Vice-President and Branch Vice-Presidents. I have just come from a lunch and media event with our partners, Action Canada for Population and Development (ACPD), parliamentarians and other non-governmental organizations (NGOs). And now, I am pleased to be able to talk with you as staff of the highly respected CIDA.

We are all partners in development. We are committed to raising living standards in larger freedom, as the founders of the United Nations stated 60 years ago.

But while we have made some progress, we have a long way to go. Today, we face new threats and challenges. These threats include poverty, infectious disease, terrorism, weapons of mass destruction and civil conflict. There are also demographic challenges to global security as well as the need for adequate public health systems and infrastructure to address HIV and AIDS.

These threats transcend all borders and require a global response. There is no doubt that international peace and security are linked to international development.

Today, we have a central framework and focus to guide us in our efforts for development—the Millennium Declaration and the Millennium Development Goals (MDGs). These goals build on the United Nations global conferences of the 1990s, including the 1994 Cairo International Conference on Population and Development (ICPD) and the 1995 Beijing Fourth World Conference on Women. The Cairo and Beijing Conferences stressed the centrality of women’s empowerment, gender equality and reproductive health and rights to international development.

As you know, we have just concluded the 10th anniversary of the Cairo Population Conference and I am pleased to report that governments in all regions – not least the Government of Canada - reaffirmed their support for the Cairo agenda.

Let us recall it was at the Cairo Conference that governments agreed that population and demographic factors affect all aspects of development and, therefore, must be addressed in development plans, policies and programmes.

It was at the Cairo Conference that the world’s governments agreed that sexual and reproductive health is a human right. There, one hundred seventy nine governments agreed that all people should have access to comprehensive reproductive health services by the year 2015. These services include voluntary family planning, care during pregnancy and childbirth, treatment for complications of unsafe abortion, and services to prevent and treat sexually transmitted infections, including HIV/AIDS.

Governments agreed to take action to ensure universal education and reduce maternal and child mortality, and violence against women and girls.

It was at the Cairo Conference that world leaders agreed on the priority objective of advancing gender equality and the empowerment of women, as ends in their own rights, but also as a means to advance development and human well-being.

Many of the goals of Cairo are now reflected in the MDGs. United Nations Secretary-General Kofi Annan has stated:

"The Millennium Development Goals, particularly the eradication of extreme poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And that means stronger efforts to promote women’s rights, and greater investment in education and health, including reproductive health and family planning."

Ladies and Gentlemen,

It is particularly useful that we meet just a month following the launch of the reports of the Millennium Project. This independent advisory body has proposed the best strategies for meeting the MDGs. These Goals are to:

1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability, and
8. Develop a global partnership for development.

On 17 January, the team launched its reports and I would like to highlight some of their key findings and recommendations.

In terms of demographics, the Millennium Project team concluded that there are strong links between rapid population growth, high fertility, ill-timed pregnancies and poverty.

They pointed to the existence of “a demographic-related poverty trap”. We know that the poorest people have the highest fertility and the largest families. What is less widely understood is that this is because they have the least access to education and health care.

In order to break the poverty trap, people need reproductive health and rights, including voluntary family planning. This will allow them to time and space their births and invest more of their resources into the health and education of each child, and thereby break the cycle of poverty that runs from one generation to the next.

Another finding is that each region’s prospects for progress towards the MDGs are affected by demographic conditions. Poorer countries are more likely to have demographic regimes marked by high fertility and high mortality, resulting in large youth populations with low adult ratios—an equation they say is associated with greater risks of conflict.

In other words, the risks of civil conflict generated by demographic factors may be much more significant than generally recognized. One study suggests that recent progress along the demographic transition—a population’s shift from high to low rates of birth and death—is associated with continuous declines in the vulnerability to civil conflict.

If this is the case, then a range of policies promoting small, healthy and better-educated families, with longer life expectancies among developing country populations is good for security.

Irrespective of the security dimensions, UNFPA is committed to these investments in women and reproductive health because they are solid investments that support human rights and have been shown to jump-start development and save millions of lives.

The Millennium Project has identified 17 quick wins to achieve the MDGs, one of which is expanding access to sexual and reproductive health information and services, including family planning and contraceptive information and services, and closing existing funding gaps for supplies and logistics.

I would like to thank Canada for the contributions for reproductive health commodities. We are making progress to close the gap, but there are still severe shortages of female and male condoms and contraceptives in several countries. We are working to find sustainable solutions.

Allow me now to elaborate why these investments are critical. First of all, they are critical because they fight poverty, improve health and reduce the spread of HIV/AIDS.

The benefits of better sexual and reproductive health would be particularly great in the world’s most disadvantaged regions where the gap in services and resulting health burden are most acute: sub-Saharan Africa, North Africa, and West and South Asia.

Providing sexual and reproductive health services contributes to:

• Greater opportunity for education for all family members, particularly girls, as families become smaller;
• A healthier and, therefore, more productive workforce with higher rates of savings and economic growth;
• Higher levels of social and political participation;
• Reduced public expenditures related to maternal health problems, family subsidies and orphan care.

Family planning is one of the biggest success stories in international development—successful, particularly in Asia and Latin America, beyond the expectations of many. The biggest lesson from the past 40 years of experience is that, even in the poorest countries such as Bangladesh and Nepal, family planning works.

Due to the spread of family planning programmes, women in the developing world today have an average of 4 children, compared to 6 just 25 years ago. They are better able to give each child education and health care, which helps break the cycle of poverty and poor health.

The use of family planning in the developing world has increased from 38 per cent of women in the 1970s to 52 per cent today. This constitutes a demographic revolution that has literally changed the face of the earth.

Overall, population growth is slowing—but it is by no means over. Each year, 77 million people are added to the planet, 146 every minute, and most of these people are being born in the developing world. The population of the poorest nations is expected to nearly triple in the next 45 years.

For these nations, increased investment in comprehensive reproductive health that simultaneously addresses family planning, HIV prevention and maternal health is absolutely critical.

The ability of women to control their own fertility is absolutely fundamental to women’s empowerment and equality. When a woman can plan her family, she can plan the rest of her life. When she is healthy, she can be more productive. And when her reproductive rights—including the right to plan her family in terms of birth timing and spacing, and to make decisions regarding reproduction free of discrimination, coercion and violence—are promoted and protected, she has freedom to participate more fully and equally in society.

Reproductive rights are essential to women’s advancement.

Reproductive health and family planning also play a key role in achieving the MDGs to reduce child mortality and improve maternal health.

A healthy mother is the first step towards a healthy child. Today, poor maternal health care causes nearly half of all infant deaths. Each year, more than 4 million newborn children die during the first month of life, and 4 million more are stillborn. And many of these deaths are due to complications their mothers experienced during pregnancy or childbirth.

Reproductive health and rights are also essential to improving maternal health. Today, the highest proportion of women’s ill-health burden is related to their reproductive role. Sexual and reproductive ill health accounts for one third of the global burden of disease amongst women of reproductive age in the developing world; it is a leading cause of death for women. This has high economic and social costs. Each year, millions of children are left without their mothers.

Today, a woman in sub-Saharan Africa faces a 1 in 16 chance of dying during pregnancy and childbirth compared to 1 in 8,700 for a woman in Canada. This is simply outrageous because we know how to prevent these needless deaths.

To close this gap, women need:

• Family planning,
• Skilled attendants at birth, and
• Emergency obstetric care.

Because these basic reproductive health services are not more widely available, accessible and affordable, more than half a million women die each year from complications of pregnancy and childbirth. They are denied the very basic right to life, let alone the right to health. Universal access to reproductive health services would save women’s lives and the lives of their children, reduce the incidence of abortion, and allow us to achieve key Millennium Development Goals.

If modern contraceptive services were available to all 201 million women with unmet need in the developing world, the number of unplanned births would decline by 72 per cent and 1.5 million lives would be saved each year. The World Bank estimates that, if 99 per cent of women had access to professionally delivered interventions, up to 74 per cent of current maternal deaths could be averted. Today, just 58 per cent of women in developing countries have the assistance of skilled birth attendants at the time of delivery.

Another reason why we must increase access to reproductive health services is to combat HIV and AIDS. With over 75 per cent of HIV cases due to sexual transmission, sexual and reproductive health care is a strategic entry point for maximizing the impact of HIV/AIDS prevention efforts.

There is wide recognition that these services provide an important opening for HIV prevention and testing, as well as for preventing and treating other sexually transmitted infections, which can increase the risk of HIV infection by a factor of two to nine. This is especially important for women, who are experiencing rising HIV infection rates in every region.

 

• Over the past two decades, the percentage of women among adults living with HIV has risen from 35 to 47 per cent worldwide.
• Young women are hit hardest—globally young women represent over 60 per cent of all 15-24-year-old persons with HIV.
• In southern Africa, young women make up 75 per cent of all new infections in this age group.
• In South Asia, young women account for 62 per cent of infections in the 15-24-year-old group.
• And, increasingly, it is married women who are becoming infected.

These figures suggest that young women are becoming virtually an “endangered species” in some high-prevalence countries. They also provide an urgent reality check that our current efforts to help women and girls protect themselves from AIDS are not working.

And I would like to stress that I am not just talking about health services, I am also talking about the protection of women’s human rights and concrete action to address gender discrimination and violence, which fuel the spread of AIDS. Linking or integrating reproductive health and HIV services is a sure way to scale up responses, to reach the largest number of women and young people, and to optimize the use of available human, financial and institutional resources.

Ladies and Gentlemen,

I have outlined some of the reasons why population and demographics and reproductive health must be addressed to achieve the MDGs. But allow me now to be more specific in what we must do to ensure that these issues ARE addressed and given the priority they deserve.

Just how far the world has come in reaching the MDGs will be measured this year during the fifth-year review of the Millennium Declaration. As you may know, the United Nations Secretary-General is preparing a report on the subject, which will be launched in March. And all efforts will culminate in a summit meeting in the General Assembly in September at which key actions for the next decade will be spelled out.

Last October, I had the honour of meeting with the ministers of development cooperation of the European Union (EU). Their commitment to reproductive health was later reflected in EU Council Conclusions, which called for the Cairo Programme of Action to be central to the high-level review of the implementation of the Millennium Declaration. So, this is an important step forward.

Another important step will take place this April. There will be a high-level meeting in Stockholm with ministers of finance and development from both developed and developing countries, to increase – as a critical development investment – awareness, commitment and funding for sexual and reproductive health.

The price of inaction—roughly 2.5 million maternal deaths, 7.5 million child deaths and 49 million maternal injuries in the next 10 years…in Africa alone—is too high to contemplate.

My friends,

Behind all of these statistics are human beings who yearn for a better life. No one knows this better than Canada with your strong commitment to human rights, including women’s rights and reproductive rights. If we are serious about halving poverty and achieving the MDGs, sexual and reproductive health must be addressed and made a priority. This is particularly important given the world’s largest youth generation. Today, half of all people are under the age of 25. The choices and opportunities they have will determine the future of humankind.

Thank you.