July 23, 2007—A new World Bank discussion paper warns that poor countries, wealthy donors, and aid agencies are losing sight of the value that contraception, family planning, and other reproductive health programs add to the development process.
The paper argues that such programs help boost economic growth and reduce the high birth rates that are strongly linked to endemic poverty, poor education, and high numbers of maternal and infant deaths.
According to the new report – "Population Issues in the 21st Century: The Role of the World Bank" – 35 countries, mostly in Sub-Saharan Africa, have birth rates of more than five children per mother. Of the estimated 210 million women who become pregnant every year worldwide, more than 500,000 women die during pregnancy and childbirth.
About one in five of them resort to abortion because of poor access to contraception. The report says that some 68,000 women die each year as a result of unsafe abortions, some 5.3 million suffer temporary or permanent disability, and many also end up being ostracized within their own communities.
Priorities Shifts to Other Areas
The report also says that because fertility rates have declined significantly in most low- and middle-income, countries outside of Africa, "…the priorities of donor countries and development agencies have shifted toward other issues, and global funds and initiatives have largely bypassed funding of family planning, with less attention being focused on the consequences of high fertility, even in those countries that are lagging in achieving sustainable population growth."
"Poor women endure a disproportionate burden of poor sexual and reproductive health because they run into financial or social barriers getting access to these basic but vital programs," says Joy Phumaphi, the World Bank’s Vice President for Human Development, a former WHO Assistant Director General, and former Health Minister of Botswana, 1999–2003, who co-chaired the InfoShop launch along with South Asia Vice President Praful Patel.
"Their full and equal participation in development depends directly on accessing essential sexual and reproductive health care. The Bank is committed to helping these women, along with the UN Population Fund, WHO, and the technical health agencies, to make voluntary and informed decisions about fertility," Phumaphi said.
Phumaphi adds that falling birth rates cannot be achieved through better health programs alone. She says that improved education outcomes for girls, equal opportunities for women in society, and a reduction of the proportion of households living below the poverty line are necessary elements of a strategy to achieve sustainable reductions in fertility.
Highest Birth Rates in Sub-Saharan Africa
The report says that the globe’s highest birth rates are found in Sub-Saharan Africa, where average fertility remains above five children per woman. While demographic patterns are converging in many regions, countries that are lagging in fertility decline and mortality reduction are increasingly different from the rest of the world.
“The longer it takes for countries to move to a low-fertility, low-mortality pattern, the greater the danger that high birth rate countries will continue to experience greater inequalities in education, jobs, life expectancy, and adult prevalence of HIV/AIDS, than their wealthier counterparts,” says Joy Phumaphi, the World Bank’s Vice President for Human Development, a former WHO Assistant Director General, and a former Health Minister in Botswana, 1999-2003.
What Can the Bank Do?
The World Bank continues to play a central role in ensuring access to all reproductive services through policy advice and financial assistance. In its policy discussions with client countries, the Bank will continue to affirm its long-standing and strong commitment to the Cairo Consensus, the landmark 1994 agreement on family planning and sexual and reproductive health, and to provide countries with whatever financial and technical help they request in this area.
This commitment is a cornerstone of the World Bank’s new health, nutrition, and population strategy, which will help developing countries strengthen their health systems to improve the health and well-being of millions of the world’s poorest people, boost economic growth, reduce poverty caused by catastrophic illness, and provide the structural ‘glue’ that combines multiple health-related programs within client countries.
More Money, Better Logistics Can Also Help
Family planning programs have been particularly susceptible to under-funding. Both governments and donors have not lived up to their financial commitments to support family planning and, as a result, shortfalls of contraceptive supplies pose a growing problem. The Bank, with its sector and fiscal analysis capacity, as well as engagement in policy dialogue with senior stakeholders, can help address this critical issue through donor harmonization, aid alignment, and mainstreaming family planning financing needs within a country’s national health system.
Another factor limiting contraceptive supplies is the inadequate state of logistics in many poor countries. At the country level, a sound logistics system can distribute contraceptive commodities and other supplies smoothly and efficiently so that each clinic or pharmacy has enough stock on hand to meet clients' needs.
Changing household behaviors is also recognized as vital for increasing the use of family planning programs. Social and cultural factors such as disapproval by family and communities, and men’s roles in deciding family size, can deter women who might otherwise be interested in family planning help, while in some countries, providers and even programs may deny such care to vulnerable groups such as unmarried adolescents.
"The low status of women often poses a barrier because in many societies, women lack the power to make their own decisions about using contraceptives or using other reproductive healthcare," says HD’s Joy Phumaphi. "Educating girls, improving economic opportunities for women, while giving them control over the design, management, and oversight of reproductive health programs, are very important ways to encourage better access to these essential health services."
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