Global Population and Reproductive Health: Trends and Policies Karen Rosen Interact Worldwide

Interact Worldwide Interact Worldwide believes in the fundamental right of all human beings to access quality sexual and reproductive health services. We believe that unless people have access to these services they will never be able to lift themselves out of poverty. As such, we provide sexual and reproductive health services in some of the worlds poorest communities and campaign internationally for the right of all people to these services.

World Population Demographics History and dynamics of population growth (fertility, mortality and migration) Demographic transition in more developed and less developed countries Future population projections

Current issues Are we experiencing a population explosion or birth dearth? Both LDCs: Population momentum MDC’s: ageing.

Fertility Rates Worldwide UK 1.7 Europe 1.4 North America 2.0 Latin America 2.6 Asia 2.6 Asia (excl China) 3.0 Africa 5.1 World 2.7

Why are Fertility Rates High? High infant mortality Lack of welfare state Lack of education Low status of women/son preference Early marriage Agricultural dependency Culture and religion Limited or no access to contraception

Effects of high fertility rates Maternal mortality/disability Infant mortality Competing priorities for family resources Inter-generational consequences Lack of female participation in society Governments unable to meet demand for services

ICPD – Cairo 1994 Linked population & poverty New concept of reproductive health Stronger on adolescents Cairo Programme of Action Committed governments financially

Reproductive Health Reproductive Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity, in all matters relating to the reproductive system and to its functions and processes.

Elements of Reproductive Health Contraceptive information and services Prenatal care Safe childbirth and postnatal care Prevention and treatment of STIs, including HIV/AIDS Abortion (where legal) and postabortion care Prevention and treatment of infertility Elimination of harmful practices such as female genital cutting, sexual trafficking, and violence against women Other women's health services such as diagnosis and treatment for breast and cervical cancers

Teenage Pregnancy Every year 15 million 15-19 year olds give birth (about 10% of the total) 13 million of these are in less developed countries Another 5 million teenage pregnancies end in abortion each year.

Teenage Pregnancy England The teenage pregnancy rate for 15-17 year-olds fell from 46.6 per 1000 in 1998 to 42.1 per 1000 in 2003. The rate for 13-15 year olds fell from 8.9 per 1000 in 1998 to 7.9 per 1000 in 2002. However, we still have the highest teenage pregnancy rate in Western Europe. The number of 15-17 year olds getting pregnant in 2003=39,560. 46% led to abortions. 13-15 number 7,395 (over 55% led to abortions) Teenage pregnancy rates in England have fallen for the third year in a row but the rate among girls younger than 14 has stayed the same despite governmental efforts to reduce it. TPR is five times that of Netherlands, three times of France and double German. Still less than ½ of U.S. and much less than LDC’s. In a Family Planning Association study in 2000, 26% of females and 30% of males aged 16-19 reported having first intercourse before the age of 16 (Great Britain)

Annual births per 100 women aged 15-19 Netherlands .4 Japan .4 France .9 Germany 1.1 UK 2.9 New Zealand 3.4 USA 5.1 Mexico 7 India 11.2 Uganda 18

Maternal Mortality Every year 529,000 women die due to pregnancy or childbirth-related causes, almost all in the developing world WHO/World Bank estimate it would cost just $3.00 per capita per year to provide standard mother and baby care for women in low income countries

Maternal deaths per 100,000 live births Afghanistan 1700 Ethiopia 1400 Bangladesh 850 Tanzania 770 Bolivia 650 South Africa 230 Iran 120 Russia 75 USA 12 UK 9 Norway 6

Sexually Transmitted Infections Worldwide, more than 1 adult in 10 acquires an STI each year, and some 333 million new infections occur annually. Young people 15-24 are most vulnerable to STI’s Prevention programmes stress safer sex through condom use

Contraceptive Use Worldwide contraceptive use has increased from 10% of couples forty years ago to 60% of couples today However, it is estimated that between 100-150 million women in LDC’s have an unmet need for family planning

Education Most influential investment that can be made in the developing world Cairo PoA calls for universal access to and completion of primary education and reduction of the gender gap in secondary education Women with more education usually have first sexual experience later, marry later, want smaller families and are more likely to use contraception

China One Child Policy in place since 1979 Statistics show TFR is now 1.7/probably above 2 Limits urban couples to one child (two if both parents are only children or ethnic minorities) and allows rural couples two if the first is a girl Criticised for coercive and heavy handed nature Concerns about the girl child- census data shows a lack of females Slight reorientation since ICPD UN working in China to demonstrate voluntary and rights based approaches to family planning

India Pre ICPD First developing country to adopt population policy in 1950’s Over emphasis on demographic targets and ‘contraceptive acceptance rates’ Under Gandhi in 1970’s more coercive methods pursued Programmes ignored wider needs of women and coercive practices led to distrust of family planning Pressure on health workers to meet targets led to the falsifying of reported figures

India Post ICPD Elimination of nationally mandated targets 1996 Reproductive and Child Health Approach (Target Free) trialled in Rajasthan and Tamil Nadu Contraceptive usage initially declined (largely due to previously inflated figures) before increasing again Broader range of contraceptives promoted with less pressure to accept sterilisation National TFR at 3.1 but wide disparity between states Concern about the girl child-census data shows a lack of females 2 child policy?

Conclusions We take a rights-based approach to our work Everyone has the right to decide freely and responsibly the number and spacing of their children and to make these decisions free of coercion or violence We believe young people should be educated and informed about their rights and choices Instead of pointing fingers when discussing population issues we should look at our own consumption patterns and make changes at home