Making family planning services available to all is one of the most effective pathways to improved women’s and children’s health. Access to safe abortion to all will reduce maternal mortality by 1/3. In addition, availability of family planning and abortion would have a significant environmental benefit. Why is it then not being addressed?
In spite of good progress on a number of Millennium Development Goals (MDGs), maternal health (MDG 5) covering maternal mortality and access to family planning is unlikely to reach the goals set. There is also little evidence that the ICPD agenda will be met and that women’s rights and freedom of choice relating to reproductive health has improved. In addition, progress recorded on maternal health is driven by progress in China, other Asian countries as well as the more developed states of India. The situation in sub-Saharan Africa, large areas of South Asia and for the poorest women in all regions remains unchanged.
Why is this problem not being solved?
In the past decades there has been a marked mismatch between the burden of disease and the levels of funding for and global attention to maternal health, and on reproductive health more generally. This may be explained by fragmentation within the global donor community; the absence of a powerful lead institution or funding mechanism to champion the issue; the relative political powerlessness of the victims of maternal mortality (poor women, most often in countries with marked gender inequalities); and a lack of consensus on which interventions should be prioritised and how progress should be monitored.
In addition, the promotion of the more controversial aspects of Sexual and Reproductive Health and Rights (SRHR) has always been initiated by women’s health and rights organizations and networks and other NGOs and civil society organizations (CSOs). In the North, SRHR – and especially the more controversial part of the ICPD agenda – was historically launched by and advocated by courageous and farsighted individuals and non-government entities – and only much later taken up by Governments.
Similarly, in the Global South, it is civil society that must take the lead, but unless strong efforts are made, their voice is likely to not be effective. In developing countries, most CSOs, and especially those who engage in advocacy for and promotion of SRHR issues, do not have easy access to reliable sources of funding and it is particularly difficult for them to raise money to invest in strengthening their own core capacities to influence and monitor the implementation of adequate policies and programmes.
In the North, many smaller CSOs, which have traditionally played a very important role in promoting SRHR and capacity building of South CSOs, have lost their funding or experienced significant reductions in support as donors move towards making larger grants to a small number of large organizations. Although a substantial number of global health (funding) initiatives have been set up, most have been for HIV/AIDS while other aspects of SRHR have been neglected and thus have not benefited to any significant degree.
How would the local and global community benefit from addressing this problem?
While the provision of voluntary family planning services to all who want them is one of the single most effective pathways to improved women’s and children’s health, and access to safe abortion services to all who need them will reduce maternal mortality by 1/3 it is now clear that meeting existing global unmet need for these services would deliver an additional environmental benefit., Empowering the 200 million women worldwide who have an unmet need for family planning to have control over their fertility, would have a significant effect in reducing greenhouse gas emissions through curbing population growth, while simultaneously improving the health and wellbeing of women and children around the world. This could make a large contribution to the estimated 8-15% reductions in emissions needed to avert dangerous climate change. The cost of providing family planning services, at roughly six billion $US per year, is minimal compared to other emission reduction strategies. It is time for family planning to take its place as also being one of the most cost effective strategies for climate change reduction.
Why is it important to help SRHR civil society now?
Since 2000, more conservative forces have advocated strongly against the more progressive SRHR agenda – and heavily influenced and financed governments and NGOs in the South to promote a conservative view such as criminalizing abortion and homosexuality, reducing access to family planning and restricting young, unmarried people’s access to information and services. Even within the EU, the UN and other international fora, this more conservative view, which has made a strong attempt to roll back the agreed ICPD Agenda, is gaining strength. A similar coordinated effort to promote the full agreed ICPD agenda internationally and at country level has not taken place; this now poses a real threat to achieving the MDGs and the ICPD agenda.
The entire global community therefore has a stake in making sure that the analytical work and policy dialogue that will result from these anniversaries renews and strengthens commitment to SRHR.