26 October 2011
Dr Nata Duvvury, Co-Director of the Global Women’s Studies Programme, NUI, Galway speaking at launch of UNFPA State of World Population Report in Dublin
Thank you Kevin. Hon’ble Minister and Distinguished Guests
UNFPA’s State of the World’s Population Report, 2011 is clear call for accelerated action to capitalise on the immense opportunities that a global population of 7 billion represents. It is also a call for action to address inherent challenges for achieving a sustainable and peaceful prosperity that is inclusive and equitable. It is an inspiring report bringing to fore the voices of the active and dynamic young and old across the globe, who are at the heart of building the future. It draws out the lessons we have learned and makes the case for sound planning and investment in empowering women and men, girls and boys to exercise agency and choice and thereby lay the basis for a productive future.
In this talk I wish to focus specifically on sexual and reproductive health rights, which are so critical to ultimately shifting gender norms that limit women and girls as well as men and boy from realizing their full potential. The Millennium Development Goals have recognized the importance of gender equality in addressing poverty and promoting well-being. However as per the latest report on progress towards the MDG, it is widely agreed that the MDGs, and the specific targets set out for the Goals, are unlikely to be achieved in a majority of the countries of the Global South. The progress has been particularly slow in terms of targets set for child malnutrition, maternal mortality, contraceptive use, adolescent fertility rate, and condom use in high-risk sex. In other words, progress has been slowest in the area of sexual and reproductive health (SRH). Maternal mortality has declined but not one country has achieved the target of reducing maternal mortality rate by 3/4ths by 2015. Equally worrisome is that contraceptive prevalence rate has increased at a slow rate and in sub-Saharan Africa – approximately only one-third of women (rate of 27% in 2009) use contraceptives. With the exception of Latin America and Eastern Asia, all other regions of the Global South do not across a rate of 62%. More worrying is that adolescent fertility has remained stagnant from the 1990s; in sub-Saharan Africa the rate remains at 122 per 1000 women 15-19 at 2008. The 2011 MDG progress notes number of women aged 15 to 19 is estimated to reach 300 million, with the fastest growth expected in sub-Saharan Africa, posing serious challenges to improved sexual and reproductive health of women in light of the current trend in declining resource allocation to family planning programs specifically and reproductive health services generally. In terms of HIV and AIDS, there is progress in terms of decline in new incidence; however young women account for a larger share of those newly infected and women constitute a majority of those living with HIV and AIDS across the developing region. Condom use by young women continues to be significantly lower than that of young men suggesting the intractability of gender power balance in sexual relations.
Both the Guttmacher Institute and the Population Action International have extensively documented the impact of resource allocation to reproductive health services, including family planning. In a recent brief, the Guttmacher Institute argues that doubling the investment in family planning and maternal and newborn health services from the current level of $11.8 billion to $24.6 billion would save lives of 250,00 women and 1.7 million newborns, lower unintended pregnancies by 53 million and reduce unsafe abortions by 14.5 million (Guttmacher, 2010). Population Action International suggests that the opportunity cost of not investing in SRH is high – with higher resources needed to meet the maternal and newborn health services of women who become unintentionally pregnant. Citing research in Zambia, they suggest a dollar investment in family planning results in a four-dollar saving in other development areas such as education and child health (Population action International, 2010).
Despite the clear evidence of the significant positive outcomes of investments in reproductive health, and particularly family planning and maternal and newborn services, there is a slow downward trend in the resources devoted to reproductive health programs. Part of the decline is due to the slowing down of resources given to family planning with the emergence of conservative values regarding right of the unborn, sexuality in the context of the HIV and AIDS epidemic, and upholding the traditional family in a period of rising divorce, expanding co-habitation and increasing numbers of single parent families. Equally significant is the impact of the economic crisis with international assistance only marginally increasing from $10.46 billion in 2010 to $10.8 billion in 2011. However the UN Secretary General warns that these figures are provisional and maybe significantly less depending on the depth and length of the economic crisis (UN 2011a). The report on financial flows presented In April 2011 in the UN also indicates that from 2000 a marked shift occurred in the distribution of resources expended across the four categories of family planning, HIV and AIDS, reproductive health and basic research; expenditure devoted to HIV and AIDS more than doubled from about 30% in 2000 to 70% in 2009 while the share of family planning declined from 30% to less than 5% and the share of reproductive health also declined from 28% to 18% in the same period UN 2011a).
These trends in the lack of progress in MDG targets in the areas of reproductive health and the declining investment in SRH, despite the clear benefits of such investment in terms of well-being, indicates an rigid mindset among decision makers regarding sexual and reproductive rights of women. Partly this is due to the almost axiomatic understanding that poor sexual and reproductive health is a direct outcome of poverty, reduce poverty and there will be an automatic improvement in SRH. A body of research and programmatic evidence has developed regarding the mutual interaction between reproductive and sexual health and gender equality on the one hand and poverty and gender equality on the other. However the interaction between sexual and reproductive health and poverty has received relatively less in-depth exploration. Both in policy formulation and programmatic emphasis, poverty reduction has been prioritised as the key to sexual and reproductive health outcomes. The line of argument being that poverty is the basic constraint to improved sexual and reproductive health of women. What is not reconciled, however, is the evidence that even in non-poor households women’s ability to access reproductive health services, to influence decisions on marriage, fertility and sexual practices, and to realise bodily integrity is often deeply constrained resulting in poor sexual and reproductive health. The underlying role of gender norms suggests that sexual and reproductive rights maybe a critical starting point as their primary focus is on women’s control over their bodies and enhancing their role in decision making which would in turn have significant impact on work participation, expenditure on welfare of children, formation of human capital of the next generation – all elements that contribute to improvements in household income. Furthermore, as the SWOP 2011 suggests, sex and sexuality education for young people, including girls and boys, have found to be hugely important in changing the underlying dynamic of fertility decisions. However, as Carlos Arnaldo, a demographer at Eduardo Mondlane University in Maputo, Mozambiquesays “Family planning is being implemented, but women are not the decision-makers. Men are against family planning because they want more children.” Attention has to be focused on young men to open up the possibilities of new arrangements of gender relations, of a new masculinity that values share work, communication and joint decision making in the intimate relationship. A study in China by Li in 2004 clearly showed that in couples where the household division of labor was shared, women were likely to have better sexual and reproductive health outcomes as they were more likely to get antenatal services, rest during pregnancy, and give birth in aseptic conditions. Ultimately we need not only investment in reproductive health services to guarantee access but also a collective commitment to fundamentally challenge gender norms that restrict the realization of sexual and reproductive well-being of women and men – and in doing so lay the foundation for economic and social well-being of families and communities.
 This paragraph draws on data presented in the UN 2011. The Millennium Development Goals Report 2011. New York: UN.