World Population Day (July 11) is a time for us as development professionals to celebrate and take stock of our accomplishments, of which there have been many. At the same time, it is important to recognize the challenges that lie ahead.
For me, health is a basic human right, as well as one of the key indicators of a country’s development progress. On the global level, progress across several health indicators has been noteworthy since the first World Population Day was observed in 1989. Maternal and child mortality rates continue to decline, with maternal mortality dropping from 380 to 210 deaths per 100,000 live births between 1990 and 2013 and child mortality falling from 90 to 48 deaths per 1,000 live births during the same period. Contraceptive prevalence rate (CPR), the number of couples currently using a contraceptive method, increased from 54 percent in 1990 to 63 percent in 2010.
That is the good news. The more sobering side of the equation is there are still approximately 74 million unintended pregnancies annually. It is estimated that these pregnancies result in 36 million abortions, 8 million miscarriages, 590,000 newborn deaths, and 90,000 maternal deaths each year. Part of the reason for these numbers is that there is a significant unmet need for family planning services.
A woman is described as having unmet need when she is of reproductive age and wants to avoid pregnancy but is not using a family planning method. The Guttmacher Institute estimates that there are 225 million women in developing countries who want to avoid a pregnancy are not using an effective contraceptive method. Addressing unmet need is an important implementation issue, as women who want to avoid pregnancy but are not using contraceptives account for approximately 80 percent of the unintended births annually. Consequently, if all the women who wanted to avoid pregnancy were using modern contraceptives, the number of unintended pregnancies in developing countries would drop significantly. If we could meet all unmet need and ensure all pregnant women and their newborns receive care at the standards recommended by World Health Organization, mother-to-child transmission of HIV would be reduced by 93 percent to 9,000 cases per year, and the burden of disability related to pregnancy and delivery experienced by women and newborns would drop by two-thirds.
So what can we do?
- One main reason cited for not using family planning is concern about contraceptive side-effects and other associated health risks. To combat this, we can invest in more comprehensive community education programs to increase knowledge about contraceptive effectiveness, benefits, and side-effects.
- At individual service sites, providers can focus more on individual needs, knowledge, and reproductive intentions, getting away from a one-size-fits-all service delivery approach. The goal of services should be to help couples make an informed contraceptive choice — even if that choice is to not use a contraceptive method.
- Expanding contraceptive choices is also key. A diverse mix of contraceptive options will allow couples to switch methods to meet their reproductive intentions, regardless of whether they want to delay, limit, or stop childbearing.
The time for action is now. Fifty percent of the unmet need is confined to 24 countries, most of which are in sub-Saharan Africa. Combine that with the fact that at the current growth rate, the population of sub-Saharan Africa is likely to double by 2045 — meaning that 20 percent of the world’s population will live in the region. Moreover, sub-Saharan Africa’s working-age population is expected to exceed China’s by 2030 and India’s by 2035. This means more people with family planning and reproductive health needs will be seeking services. Without a sustainable, meaningful set of interventions, the unmet need for all services will only increase.