A new global initiative for reproductive health

For the past 15 years or so, the international community has been working closely with developing countries to provide access to a wide range of reproductive health services, including contraception and maternal care. The world health organization (WHO) has led the way, developing and delivering free standardized training courses to hundreds of thousands of frontline healthcare professionals, who in turn have been able to provide counselling and contraceptives to women, allowing them to decide when and if to have children.

For the past year or so, a group of public health professionals, researchers, and advocates have been championing a new approach to reproductive health – one that puts the needs of women first, rather than relying on traditional methods of population control.

Inspired by the recently revised International Code of Marketing of Foods for Special Dietary Uses, which puts a greater focus on the health and well-being of women rather than the number of children a woman can bear – and concerned that the traditional model for family planning is still based largely on limiting the number of children a woman has – the Reproductive Health Partnership (RH Partnership) was launched last August.

As its name would suggest, the RH Partnership is bringing together an unprecedented array of stakeholders, including governments, civil society organizations, the private sector, and foundations, to achieve its vision of “empowering women to plan their families and manage their own health”.

The initiative will seek to eliminate the double-bind that women face when it comes to reproductive health: in particular, the dilemma that often arises when a woman is pressured to become a mother, but lacks the information and resources to do so safely and with her own preferences in mind.

Over the last decade, there has been a paradigm shift in thinking about population policy, with the focus moving from “population control”, which emphasizes reducing the number of births, to “reproductive health”, which aims to improve the quality of life of women and girls by ensuring they have the information and means to have healthy pregnancies and give birth to children. The shift in mindset has been catalyzed by a growing body of evidence which shows that having too many children can have disastrous effects on a woman’s health, putting her at risk of death in childbirth, or from complications during or after pregnancy.

While the traditional model is to have large families, with up to seven or eight children born to a single mother, a 2018 report by the International Monetary Fund (IMF) examined the connection between increasing urbanization and rising income levels and concluded that “the number of children born to unmarried mothers is likely to decline in the near future.” The report also found that in high-income countries, the number of women opting for multiple births has decreased significantly over the years, while in middle-income countries there has been a rise in the number of mothers choosing to have one child. This is because of a variety of factors, including the promotion of contraceptive methods and the easing of child-care costs, as well as the increasing demand for a better quality of life and life expectancy.

Alongside the growing body of evidence about the dangers of overpopulation, there is also an acknowledgment that an unplanned pregnancy can have serious repercussions for a woman’s physical and mental health, and that in many cases this can be devastating. The unplanned pregnancy and childbirth of a woman aged 15 or more increases their risk of dying during pregnancy or childbirth. This is especially true for women in developing countries, where the risk of dying during pregnancy is three times higher than that of women in developed countries. Additionally, an unplanned pregnancy increases a woman’s risk of suffering from depression and anxiety, and it can also lead to an addiction to alcohol or other substances. Pregnancy and childbirth can also cause a woman to lose her job, her housing, and her access to the health care she needs.

Traditional methods of family planning, such as the IUD and sterilization, can also have serious side effects. According to the Guttmacher Institute, a reproductive health research organization, the IUD can cause infection, malfunction, and even infertility. It is one of the most common causes of hospital admission for reproductive health issues in women. With respect to sterilization, the WHO states: “Although people sometimes believe that being sterilized prevents them from having future children, this is not necessarily true…it can have serious side effects, such as pain during intercourse and malfunctioning of the urinary tract.”

On the other hand, several studies have shown that early and accurate child-bearing information, alongside the ability to plan and have abortions when desired, can improve a woman’s health considerably. The risk of breast cancer drops by 50% in women who have their first child at the age of 20, and the risk of ovarian cancer drops by 60%. There is also evidence to suggest that having children later in life can be associated with an increased risk of cardiovascular disease and dementia.

The role of government

Governments have a crucial role to play in promoting reproductive health – not just of their people, but of the planet. The global community is in need of major reforms when it comes to sustainable family planning. The current approach, which privileges population growth and limits access to reproductive health services, is neither effective nor environmentally friendly. It is well known that families in developed countries enjoy a considerably higher standard of living than those in developing countries, which is largely due to the fact that they have more financial security and access to better health care. While it is evident that the world’s poor need access to reproductive health care, it is also vital that they are not further undermined by unethical marketing and the lack of government regulation. The United Nations Population Fund (UNFPA), which was established in 1970 to provide reproductive health care and counselling to refugees and displaced persons, has identified the following issues as key to improving the state of reproductive health globally:

• The need for governments to “prioritise women’s sexual and reproductive health and rights and ensure that policy measures are implemented to strengthen these rights”
• The need for governments to “ban the practice of providing information that misleads about sexual and reproductive health”
• The need for governments to “ban indirect payments for health services, and provide universal coverage of all costs associated with abortion”
• The need for governments to “reduce the financial barriers to accessing reproductive health services”
• The need for governments to “reduce the number of unnecessary pregnancies and give every woman the information and support she needs to make her own decisions”
• The need for governments to “promote sexual education, access to contraception and abortion, and maintain a legal framework that protects all individuals’ right to privacy”
• The need for governments to “increase contraceptive supplies and ensure that all healthcare providers have the skills to provide quality services”
• The need for governments to “ensure that all healthcare providers have the necessary supplies and adequate support to provide quality services”
• The need for governments to “eliminate all forms of violence against women and girls, including marital rape”
• The need for governments to “protect women’s access to healthcare, and ensure that their human rights are respected”
• The need for governments to “protect women’s right to decide how to manage their sexual and reproductive health”
• The need for governments to “establish national family planning programmes, provide adequate funding and support for these programmes, and review the effectiveness of family planning policies and programmes”
• The need for governments to “establish a global fund to support family planning and reproductive health services for developing countries”
• The need for governments to “ensure that women enjoy legal, social, and economic equality with men, and that their human rights are respected”

Why the partnership approach

The above points suggest that there is plenty of evidence to suggest that a new approach to family planning is needed. Yet, as the WHO makes clear, “The family planning field has been dominated by a limited number of organizations, largely controlled by governments and international non-governmental organizations, that have promoted specific policies and programmes to advance their goals”. In many cases, these goals are conflicting, and a woman’s right to determine the number and spacing of her children can easily be overlooked in the pursuit of eradicating poverty and promoting economic growth.