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Reproductive health back on the agenda

 InDepth News 21 May 2019

(Originally published: 05/2010) More than 350,000 women die each year because of pregnancy and childbirth complications. Worryingly, 99 percent of these deaths occur in developing countries. InDepth News takes a look at what is being done to improve reproductive health. (1174 words) - Richard Johnson

GENEVA, Switzerland - More than 350,000 women die each year because of pregnancy and childbirth complications. 99 percent of these deaths occur in developing countries. Because many poor women turn to abortion as a last-resort means of birth control, some 68,000 of them die each year as a result of unsafe abortion. Another 5.3 million suffer temporary or permanent disability.

Revealing these staggering figures that encapsulate the plight of human beings in developing lands around the world, the World Bank warned May 11, 2019 that "family planning and other reproductive health programmes that are vital to poor women had fallen off the development radars of many low-income countries, donor governments, and aid agencies".

Highlighting the nature of the challenge, the Bank's Acting Vice President of Human Development, Julian Schweitzer, says: "A mother's unnecessary death in childbirth is not just a human tragedy. It's also an economic and social catastrophe that deprives her surviving children of nurture and nutrition and too often of the chance of education."

"Maternal deaths are both caused by poverty and are a cause of it. The costs of childbirth are often the single biggest cause of casting a family into poverty. And, if the mother dies in childbirth, the chances of her baby surviving the first year of life are drastically reduced," adds Schweitzer.

The Bank also pointed out that 35 poor countries in Sub-Saharan Africa and other regions (Timor-Leste, Afghanistan, Djibouti, and Yemen) have the world's highest birth rates (more than five children per mother).

These also reflect some of the world's poorest social and economic results, with low levels of education, high death rates, and extreme poverty.

According to the Bank, during the second half of the 20th century, world population more than doubled to reach 6 billion, an astonishing 3-billion increase in population in just 40 years. Although this rate has slowed to 1.2 percent a year, 75 million people are being added every year this decade.

Subsequently, the world's population is projected to reach 9.1 billion by 2050, with the majority likely to live in the world's poorest countries.

However, new Bank figures show that while development aid for health soared from U.S. $2.9 billion in 1995 to U.S. $14.1 billion in 2007, roughly a five-fold increase in 12 years, aid for population and reproductive health had increased more modestly during the same period, from U.S. $901 million in 1995 to U.S. $1.9 billion in 2007.

In the 35 highest-fertility countries in Africa, Asia, and the Middle East, aid for women's family planning and reproductive programs started at U.S. $150 million in 1995 and increased to U.S. $432 million in 2007, while overall aid for health in these 35 countries went from U.S. $915 million in 1995 to U.S. $4.9 billion in 2007.

With 2010 marking the start of the five-year countdown to the 2015 Millennium Development Goals (MDGs), says the Bank, many countries are far from achieving MDG 5, which calls for a drop in the maternal mortality ratio (MMR) by three-quarters between 1990 and 2015 - equivalent to an annual decrease of about 5.5 percent - and increased access to universal reproductive health care by 2015.

Against this target, the current global average rate of reduction is under 1 percent - only 0.1 percent in sub-Saharan Africa, where levels of mortality are the highest - and at the present rate of progress, the world will fall well short of achieving this MDG.

This alarming situation forms the backdrop to the Bank's new five-year Reproductive Health Action Plan 2010-2015 to help poor countries reduce their high fertility rates and prevent the widespread deaths of their mothers and children.


The Plan released May 11 envisages that the Bank's health financing in financial year (FY) 2010 will triple to an unprecedented U.S. $4.1 billion - a 40 percent increase over the previous year's record - in support of stronger health systems; boosting the prevention and treatment of communicable diseases; and improving child and maternal health, hygiene, and sanitation.

Given the weak state of health systems in many countries, says the Bank, it has been working closely with governments, aid donors and agencies, and other partners to strengthen these systems so that women gain significantly better access to quality family planning and other reproductive health services, skilled midwives at their births, emergency obstetric care, and postnatal care for mothers and newborns.

Under its new health action plan, the Bank will help 58 countries with high maternal death and fertility rates, which have remained stubbornly high for some years, improve their reproductive health systems in the following ways:

The Bank plan says that high birth rates are closely allied with fragile health, little or no education, and entrenched poverty. Analysis of demographic and health surveys in all regions shows that women with secondary or higher education have fewer children than women with primary or no education.

"Promoting girls' and women's education and the opportunity to succeed are just as important in reducing birth rates in the long run as promoting contraception and family planning," says Dr. Sadia Chowdhury, co-author of the new plan and a Senior Reproductive and Child Health Specialist at the World Bank.

"Education and greater gender equity become a form of social contraception for women. Time and time again we see how women's education provides life-saving knowledge, builds job skills that allow her to join the workforce and marry later in life, gives her the power to say how many children she wants and when - and these are enduring qualities she will hand down to her daughters as well."

Chowdhury says getting an education - even if only at primary school level - is a good predictor of low fertility. The regions with the widest fertility gap between women with secondary education and those who have no education are South Asia, Sub-Saharan Africa, and Latin America and Caribbean.



The new Bank plan strongly welcomes the re-emergence of maternal and child health among countries, donors, and other partners, which has jumpstarted more than 80 new national and international partnerships, including the Partnership for Maternal, Newborn and Child Health. In addition, an informal group of heads of four health-related organizations (WHO, UNICEF, UNFPA, and the World Bank - called the "H-4") was formed and meets regularly on measures to strengthen country efforts to improve maternal and child health and avoid fragmentation of donor efforts and financing - for example, harmonizing and coordinating the efforts of donors at country level to support countries to improve maternal health.

In welcoming the Bank's new reproductive health strategy, Thoraya Ahmed Obaid, UNFPA Executive Director, said that countries and their development partners had to work even more closely together to make greater progress.

"With Millennium Development Goal 5 to improve maternal health lagging behind, greater investments are needed to achieve the two targets to reduce maternal mortality and achieve universal access to reproductive health by 2015," she said.

"During the global financial crisis, and at all times, investing in the health and rights of women is a smart choice to improve well-being, productivity, and economic growth."

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