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

2. 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.

3. 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

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

5. Fertility Rates WorldwideUK
Europe
North America 2.0
Latin America 2.6
Asia
Asia (excl China) 3.0
Africa
World

6. 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

7. 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

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

9. 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.

10. 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

11. Teenage Pregnancy
Every year 15 million 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.

12. Teenage Pregnancy England
The teenage pregnancy rate for year-olds fell from 46.6 per 1000 in 1998 to 42.1 per 1000 in 2003.
The rate for 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 year olds getting pregnant in 2003=39, % 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 reported having first intercourse before the age of 16 (Great Britain)

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

14. 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

15. Maternal deaths per 100,000 live births
Afghanistan
Ethiopia
Bangladesh
Tanzania
Bolivia
South Africa
Iran
Russia
USA UK
Norway

16. 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 are most vulnerable to STI’s
Prevention programmes stress safer sex through condom use

17. 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 million women in LDC’s have an unmet need for family planning

18. 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

19. 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

20. 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

21. 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?

22. 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