1. From choice, a world of possibilities History of the Family Planning Movement in in Latin America and the Caribbean Carmen Barroso IPPF Director of the Western Hemisphere Region Successes and Challenges

2. An unlikely place to start a revolution in RH in the 1960s  High birth rates  Large desired family size  Negative attitudes of governments  Opposition from Catholic Church  Strong nationalism in public opinion  Competing health priorities

3. The need  High maternal mortality  High incidence of unsafe abortion  High infant mortality

4. Rapid population growth was beginning to be perceived as a problem. But a majority of the leaders in the region did not see it as a problem in their own countries.

5. Main actors in early efforts  Male physicians as leaders  Governments: bystanders or timid supporters  Creation of NGOs  Poor women as clients (not as protagonists)  Middle class women as consumers of pills  Mass media disseminating new life styles  International support

6. Dates in which IPPF/WHR Members were created

7. Opposition  Catholic Church hierarchy vs. local priests  Hierarchy influence on governments vs. individuals’ conscience  The left’s concern with diversion from development goals  The feminist concern with clients’ rights  The public health concern with the side effects of contraceptives

8. NGOs paved the road to access to contraceptives  Creating demand  Disseminating information  Providing services  Distributing contraceptives free of charge  Collecting data  Giving technical assistance to governments  Engaging in political advocacy

9. Role of IPPF  Funding  Institutional support  Technical assistance for programs  Exchange of lessons learned  Capacity building for sustainability  Access to modern contraceptives

10. USAID funding for RH Latin America and the Caribbean ($millions) Source: USAID

11. Results: health and demographic Increase in contraceptive use Decrease in fertility rate Decrease in population growth rate Decrease in maternal and infant mortality and morbidity

12. Increase in CPR since the 1950s Source: USAID, based on PRB data

13. Decrease in fertility

14. Decrease in Population Growth Rates Source: ECLAC, Social Panorama of Latin America, 2004

15. Decrease in maternal mortality rates

16. Sources of Modern Contraceptives –All Users of Modern Methods Source: Reproductive, Maternal and Child Health in Central America: Health Equity, USAID

17. Institutional results NGOs developed a large network of services NGOs developed innovative tools NGOs established high quality standards Governments included SRH in public health systems Governments passed legislation and created policies on SRH Governments allocated funds for procuring contraceptive supplies

18. Persistent problems  Inequalities between countries  Inequalities between social classes  Inequalities between youth and adults  High rates of teenage pregnancies  High rates of unsafe abortion

19. Inequalities between countries Use of Modern Methods in Selected Countries

20. Inequalities between social classes Proportions of Unsatisfied Demand of Modern Contraceptives for Highest and Lowest Wealth Quintiles (1996-2000)

21. Inequalities between youth & adults Use of Modern Contraceptives for LAC Countries by age Groups (2002-2005)

22. Early marriage still widespread % of Women in Different Generations who were Married by Age 18

23. Adolescent Fertility Rate (per 1,000) in selected LAC Countries, Lowest and Highest Quintiles

24. Unsafe Abortions per 1,000 Women Aged 15-44

25. Maternal Deaths due to Unsafe Abortions, 2000

26. Cost of Unsafe Abortions in LAC  71 to 95 million dollars per year spent by Latin America’s health systems  In 2004, Brazil’s government spent 18 million dollars to treat complications from unsafe abortions.  Access to safe abortion is cheaper than treating abortion complications, as shown by Mexico

27. Persistent institutional problems  Sustainability of NGOs’ programs  Sustainability of government programs  Renewed attacks from the opposition  Change in donors’ priorities

28. Conclusions  Importance of a strong civil society  Importance of collaboration between local and international institutions  Importance of public-private partnerships  Importance of quality of services  Need to address persistent problems

29. Thank you!