A World She Deserves

Family planning session in Bangladesh.
Family planning session in Bangladesh.

By Susann Roth

Investing in sexual and reproductive health is not only the right thing to do – it benefits women, families, and the entire economy.

I grew up in Germany, where 87% of women use birth control, and was able to plan my children. Now I live in the Philippines, where sexual and reproductive health is taught in public schools only in grade 7; where the first reproductive health bill—which legalizes access to contraception—was only passed in late 2012; where women earn on average 60% less than men; and where although abortion is illegal, the unpublished data on abortion rate is among the highest in the world.

Every year, while 123 million women around the world experience pregnancy as a harbinger of happiness, another 87 million face it with dismay. World Health Organization (WHO) statistics show that after becoming pregnant unwillingly, many of these women are presented with risk of death, disability and lower educational and employment potential. Reducing the number of unwanted pregnancies could avert 60% of maternal deaths, and 57% of child deaths.

As undesired pregnancies disproportionately affect the poor and vulnerable, access to family planning remains a great concern to redress global inequity.

But despite many pledges, MDG 5—access to reproductive health—was the most off-track of all the Millennium Development Goals. Although contraceptive prevalence is growing and unmet needs declining, the absolute number of married women who either do not use contraception or who have an unmet family planning needs is projected to grow.

The new Sustainable Development Goals (SDGs) have ushered in a renewed global commitment to upholding the reproductive rights of women. SDG3 in particular aims to ensure healthy lives and promote wellbeing for all through universal health coverage (UHC), including universal access to sexual and reproductive health services. SDG5 addresses gender equality and women’s empowerment.

But despite the fact that most countries in Asia and the Pacific are committed to achieving UHC, birth control is often not covered by public or private health insurance schemes. Asian women spend hundreds of dollars a year simply to control their own fertility. For many women, this out-of-pocket cost is just too high. Across the region, 69% of women aged 15-49 who are married or have a live-in partner use birth control. This figure ranges, though, from 29% in Afghanistan to 79% in Thailand. The unmet need for birth control is as high as 30%, and we don’t even have data for single women.

Sexual and reproductive health is not taught in many Asian countries before high school. By then it is often too late, and 5.2 million adolescent pregnancies a year in this region can attest to that. The highest incidence of teen pregnancy is in the least developed countries: Afghanistan, Bangladesh, Cambodia, Lao PDR, Nepal and Papua New Guinea. These pregnancies can be life threatening, and limit girls’ opportunities to complete higher education. The situation is not getting better over time. We don’t see a projected decline in the adolescent birth rate, so we must act now.

Family planning is highly personal, but it is also a matter of population health. When governments invest in family planning, they need to look at their overall health system’s readiness. India for many years relied heavily on mass sterilization programs for women, which didn’t help with birth spacing and in my personal view interfered with freedom and choice. Male sterilization is much easier and has fewer complications – but of course this never promoted. India is now starting to support temporary injectable birth control, which is great, but must be supported by sound primary healthcare to address side effects as well as sexual and reproductive health education.

For every dollar spent on family planning, $2-6 can be saved for interventions to achieve other development goals. The largest benefits are in education and maternal health, was well as water and sanitation, immunization, and malaria programs. Current evidence shows that family planning—in conjunction with other progressive development policies— is a highly cost-effective measure for reducing poverty and stimulating economic growth.

Investing in sexual and reproductive health is therefore not only the right thing to do – it is also the smart thing to do for women, families and the entire economy. It’s clearly a public health best buy. Yet family planning still accounts for only 0.2% of official development assistance flows, and this percentage is decreasing. Family planning also receives low funding from government budgets. This must change.

Representatives from ADB, WHO, the Philippine government and civil society will meet today to discuss how investments in sexual and reproductive health can be accelerated and how to roll out accountability mechanisms for safe, affordable and accessible sexual and reproductive health programs.

The economics of family planning are clear. And I am sure I am not alone when I wish for my children to have their own families in a world where every pregnancy is wanted, every child is born safely, and every young person’s potential is fulfilled.