The State of World Population 2017 Worlds Apart: Reproductive Health and Rights in an Age of Inequality
Our world is increasingly unequal. But this inequality is not only about money. It’s also about power, rights and opportunities. And it has many dimensions that feed on each other. One dimension of inequality that has received too little attention is in the enjoyment or denial of reproductive rights and the effects of that on half of humanity. This is the focus of the UNFPA flagship report, The State of World Population 2017.
Consider this:
In most developing countries, the poorest women have the least power to decide whether, when or how often to become pregnant. The poorest women also have the least access to quality care during pregnancy and childbirth. This inequity has lasting repercussions for women’s health, work life and earnings potential and for their contribution to their nations’ development and elimination of poverty.
Let me give you an example of the impact of inequality on the reproductive rights of women and girls:
Obstetric fistula, a wound that leaves a hole in the birth canal, is caused by prolonged, obstructed labour. It has been virtually eliminated in the world’s wealthier countries and in better-off communities within developing countries. Fistula is preventable and treatable, but persists due to weak health systems, poverty, gender inequality, and early marriage and childbearing. A fistula is a tragic manifestation of our failure to protect the reproductive rights of the poorest, most excluded women and girls.
As a medical doctor myself and as a former Representative of UNFPA in Tanzania, I have seen firsthand the devastating and needless suffering caused by fistula, and heard the most heartbreaking stories. One young woman suffered from a fistula for eight years before she was able to get surgical treatment at the hospital in Dar es Salaam. When the doctor asked her what happened, and why it took her eight years to seek surgery… whether she had been aware that such treatment was available… the young woman responded: Yes, she was aware. But it took her all those years to save up the bus fare to get to the hospital.
Her story is not unusual. More than 2 million women still have this condition and cannot afford or cannot reach treatment.
Contraception, too, is often out of reach for the poor, particularly those who are less educated and living in rural areas. And this puts women and adolescent girls at greater risk of unintended pregnancy. An unintended pregnancy can set in motion a lifetime of missed opportunities and unrealized potential, trapping a woman and her children in an endless cycle of poverty. The economic slide can continue for generations.
We also know that many emergencies and humanitarian crises are fuelled by inequalities. And inequalities and the vulnerabilities engendered by them are magnified in times of crisis.
In South Sudan, one of the 150+ countries where we serve, poor pregnant and breast-feeding women who barely had any access to life-saving maternal health care suddenly found themselves with no care at all as deadly clashes near the Ugandan border drove tens of thousands of people from their homes earlier this year.
Economic inequality divides countries into haves and have-nots. Inequalities in reproductive health and rights and gender inequality divide people into cans and cannots.
A woman or adolescent girl who cannot enjoy her reproductive rights is one who cannot stay healthy, cannot complete her education, cannot find decent work outside the home and cannot chart her own economic future.
Inequality in reproductive health and rights disenfranchises untold millions of women. It also bolsters social and economic systems that enable a privileged few to rise to the top and stay there. This inequality also drags the vast majority to the bottom, robbing individuals of their rights and denying whole nations the foundations for development.
Countries seeking to tackle economic inequality should start by addressing related and underlying inequalities, such as in reproductive health.
Reproductive health and rights are critical but under-appreciated variables in the solution to economic inequality and can propel countries towards achieving the top United Nations Sustainable Development Goal: eliminating poverty. The Sustainable Development Goals aim to build a more equitable world--for people, planet and prosperity for all. Achieving shared prosperity requires supporting the capabilities of the furthest behind first.
Expanding options and choices for the poorest women by empowering them to enjoy their right to make their own decisions about the timing and spacing of pregnancies is one important pathway towards their economic security and independence. It is also a pathway towards more balanced economies and societies.
Investments are needed not only to meet all the unmet demand for family planning but also in services, such as child care, that enable women to enter or remain in the paid labour force and protect them from the so-called motherhood penalty.
If poor women are disadvantaged, poor adolescents, especially girls, are even more so. Investments in adolescent girls are critical.
A recent study in The Lancet showed that improving the physical, mental and sexual health of adolescents, at a cost of about $4.60 per person per year, would yield more than 10 times as much in benefits to society. Moreover, the highest returns would be in the lowest income countries that are suffering the greatest burden of adolescent death.
Innovation and creative solutions are needed to reach the furthest behind first.
In Mongolia, for instance, an innovative telemedicine project, supported by UNFPA, enables specialists in the capital to give teleconsultations to provincial doctors and patients hundreds of miles away and to share medical data for analysis. Since its launch, the project has reached at least 60 per cent of all pregnant women in the country, where care would otherwise be out of reach. And we think the best measure of this project’s success is that fact that Mongolia is one of only nine countries to have achieved the Millennium Development Goal on reducing maternal deaths.
The gap between rich and poor grows wider as wealth is concentrated in the hands of fewer and fewer people, while the ranks of the poor remain disproportionately large. Extreme economic inequality can undermine countries’ prospects for growth and thwart development. It can spawn political extremism and, if unaddressed, can shatter peace.
As Helen Keller once stated:
"Although the world is full of suffering, it is also full of the overcoming of it."
Stopping the present downward spiral of inequality will require a new vision for inclusive societies, where all human potential is realized. This is the vision that informed the goals of the UNFPA Strategic Plan, 2018-2021, which is the first of three Plans to get us to the Sustainable Development Goals 2030 target.
Working with other United Nations agencies, partners and governments, UNFPA is committed to a future where zero is the only acceptable number:
zero deaths in childbirth,
zero unintended pregnancies
and zero gender-based violence and harmful practices, including female genital mutilation and child marriage.
We, therefore, call today for action on multiple fronts to tackle all forms of inequality of sexual and reproductive health and rights from the root, laying the foundation for an alternative--equitable--future. A future where all women govern their own lives with equal access to sexual and reproductive health care, where they are free from unintended pregnancies.
A future where all women, men, girls and boys may understand and enjoy their rights and have the knowledge and the power to set their own course in life.
So, to close, inequality is indeed about power--about the few who have it and the many who do not. Worlds Apart--the 2017 UNFPA State of the World Population report--is a clarion call for putting power in the hands of women to control their reproductive choices and their futures. With that power in women’s hands, Worlds Apart no longer holds. With that power, instead of separation and inequality, fairness prevails--and a more equitable world for women and girls is the reward.
