It’s estimated that every year nearly 360,000 women die from pregnancy-related causes. Most of the deaths are in sub-Saharan Africa. As the United Nations General Assembly opens a new session, it’s being called on to provide more family planning services to hundreds of millions of women.
In 1994, the international community agreed that family planning should be an integral part of reproductive health. The International Conference on Population and Development in Cairo issued a program of action that called for “the provision of universal access to reproductive health services, including family planning and sexual health.”
But 17 years after the conference, advocates say promises remain unfulfilled.
Action needed now
The Global Leaders Council for Reproductive Health says family planning services are needed now more than ever as the world population soars. It’s expected to reach 9 billion by 2050. The council is made up of current and former senior leaders from more than a dozen countries, as well as other health advocates.
“Reproductive health is not just important to women. It’s important to humanity, as we all know. I mean it’s the basis of our survival and the propagation of the human race,” said Joy Phumaphi, former minister of health in Botswana and a member of the council.
“It is absolutely critical that at any point in time a family only has the number of children that it can afford to take care of and bring up into well-rounded citizens. And it is also critical that a family is able to space these children and have them at intervals that enable them to bring up each child effectively,” she said.
Out of sight, out of mind?
“It seems to have dropped off the radar in recent years. When HIV became uppermost and funding had to be got for HIV, It looks as if family planning lost priority,” said Dr. Fred Sai of Ghana, a former professor of medicine and past president of the International Planned Parenthood Foundation. He, too, is a member of the Global Leaders Council of Reproductive Health.
Sai said in Ghana early marriage is a common practice - one that can put the health of young girls at risk.
“A girl gets married at about 14. I don’t say she should be. It would be best if we can give them education so they don’t get married at 14. But if they do, if they have no preventive, they start getting pregnant. This leads to a whole lot of health problems,” he said.
Without readily available family planning, Sai said a country’s social and health services can be overwhelmed.
“We want free education for our children. We want free health services for our children and people. And the more we try to build the competencies to deal with education, competencies to deal with health, facilities to deal with health, the more we have new entrants,” he said.
Former Botswana health minister Phumaphi agreed.
“We have countries in sub-Saharan Africa where over 50 percent of the population is either young people or children. We have this youth bulge. We have a child bulge, which we cannot keep pace with,” she said.
At the 1994 Cairo conference, recommendations included family planning counseling, pre- and post-natal care and education on human sexuality and reproductive health.
Opposition came from the Vatican, Muslim nations and conservatives in the United States. One concern was that the recommendations would promote abortion as a fundamental right and would encourage it as a method of family planning.
Dr. Sai said a woman’s health should not be a matter of religion or politics.
“People should be left without knowledge so that they die in ignorance when the health things are there to save them, when they can prevent it. I find that argument very difficult because some say that when you teach youngsters how to look after their bodies, then you are tending to teach them how to be promiscuous. I think it’s only in this field that you teach somebody something and then they do the wrong thing only. We teach things so they know what the choices are,” he said.
Sai said he wants African families to have the same family planning choices as Americans. Phumaphi says it’s time to invest in family planning.
“We have to make it a priority in the same way that we made HIV/AIDS a priority, that we made malaria a priority. We have to make it a priority,” he said.
The Global Leaders Council for Reproductive Health is chaired by former Irish president Mary Robinson. It’s calling for a doubling of investment in reproductive health in poor countries to $6.7 billion.
Critics have said lowering fertility rates will not necessarily bring economic benefits and that family planning programs are not always effective. Other criticisms include concerns that such programs may coerce women to take part rather than volunteer. And that the programs may be culturally insensitive or violate religious beliefs.