Poor reproductive health is a leading cause of death and illness for women in developing countries. While family planning services are improving, they remain inadequate. In the West, unintended pregnancies remain common while sex education and family planning are under threat from social conservatives and funding restrictions.
The Guttmacher Institute estimates that more than 200 million women worldwide have an unmet need for modern contraception. Women of reproductive age (15 – 49) are considered to be in need of contraception if they or their partner are using no method of contraception — modern or traditional — but are married or are unmarried and sexually active (i.e., had had sex in the three months prior to being surveyed), are fecund and do not want a child soon (in the next two years) or at all; identify their current pregnancy as unintended; or are experiencing postpartum amenorrhea after an unintended pregnancy.
An unmet need may be because the woman or her partner cannot access contraception or because, even where it is formally available, take-up and use are limited by the degree of cultural acceptance, the level of female empowerment, affordability or problems with distribution. This means many people have much larger families than the global average, with some countries averaging five or six children per woman. In some places, high infant mortality rates can contribute to higher birth rates because parents have more children to compensate.
Contraception is only one element of a general lack of reproductive health services. Half a million women die each year during pregnancy and childbirth — this is equivalent to four full jumbo jets crashing every day.
Lack of funding
After a number of years of reduced international support, United States government funding of reproductive health programmes in developing countries has resumed. However, funding remains below the required level. One reason is that the necessary response to the AIDS crisis has resulted in the diversion of funds previously used for family planning and maternal health programmes.
In the developed world, although most parents have one, two or three children, unintended pregnancy still remains an issue — particularly in the United States and United Kingdom. Government programmes have been instigated, such as promoting more reliable long-acting reversible contraceptives, but, as yet, results have been limited.
Access to reproductive health services, including contraception, is central to slowing, halting and reversing population growth.
Population, health, environment
Communities in poorer areas face multiple challenges. One is poor health caused by a combination of poor living conditions, lack of nourishment and clean water and poor or absent healthcare. Another challenge is depleted natural resources caused by exploitation by local communities and outside interests. Growing populations exacerbate all of these problems.
Addressing only one of these issues is rarely sufficient. Aid agencies have instead had some success with multifaceted interventions. The Population Health Environment approach addresses all of three issues at the same time. The healthcare element improves well-being and significantly reduces child mortality. The environment element seeks to introduce sustainable farming, harvesting, fishing and hunting approaches, which conserves ecosystems and habitats for the long term benefit of both wildlife and local communities. Finally, the population element underpins progress in the other two areas by providing family planning supplies, education and support to enable women to determine the number and timing of their pregnancies, improving both the women’s health and ability to work and reducing population growth.
Arising from Integrated Conservation and Development Programmes in the late 1980s, a key enabler is consulting and involving all sectors of the communities in question to ensure their informed consent to and support for the programme. Successful programmes have been demonstrated in countries as diverse as Ecuador, Cambodia, the Philippines, Kenya, Tanzania and Madagascar.