The huge level of disability and premature death due to sexual and reproductive problems is rising around the world, with over half a million women dying each year in pregnancy and childbirth, yet financial support for family planning is falling amid growing political interference, according to a new United Nations-backed ‘wake-up call’ study.
“These statistics represent an appalling catalogue of human tragedy,” UN World Health Organization (WHO) Assistant Director-General for Family and Community Health Joy Phumaphi said of the evaluation appearing in this week’s edition of the British medical journal The Lancet, the first-ever global study of sexual and reproductive health.
“Far from making progress we seem to have been going backwards since the notion of reproductive health was born [at the International Conference on Population and Development] in Cairo in 1994. The issue is dropping down the international agenda and governments seem to be reluctant to tackle this most fundamental threat to health and well-being,” she added.
The analysis, coordinated by WHO and being published in The Lancet Series on Sexual and Reproductive Health over the coming weeks, reveals a picture of growing unmet needs and neglect and an overall reluctance to tackle threats to sexual and reproductive health. Unsafe sex is the second most common cause of illness and death in developing countries and ninth in developed countries.
It calls for a mix of prevention strategies and caution against quick fixes and a “one size fits all” approach, urging greater efforts to tackle the links between sexual and reproductive ill-health and poverty, gender inequalities and negative social attitudes.
“Sexual behaviours and norms vary enormously around the world and unfortunately many people, including politicians and even health professionals, are uncomfortable dealing with such matters,” WHO Director of Reproductive Health and Research Paul Van Look said.
“This survey sounds an urgent alarm that if we do not address sexual and reproductive health openly and directly the toll of death and disability will remain with us for many years to come,” he added.
The study shows that access to contraception has increased worldwide but there are still an estimated 120 million couples who do not get the contraceptives they would like or need. An estimated 80 million women have unintended or unwanted pregnancies each year, with 45 million ending in abortion, 19 million of them unsafe, leading to 68,000 deaths and millions of injuries and permanent disabilities. Yet between 1995 and 2003, donor support for family planning fell from $560 million to $460 million.
Family planning services in Africa need an extra $70 million just to achieve the mid- range of fertility projections recommended by the UN. Funding for contraceptive development has also declined compared to microbicide research for HIV/AIDS. As well as surveying the statistical evidence on the increase in sexual and reproductive ill-health, the series highlights the importance of understanding sexual behaviour.
The survey of data from 59 countries shows that contrary to common belief, there is no universal trend to earlier first sexual intercourse, but later marriages mean that there are more opportunities for premarital sex, resulting in high rates of unintended pregnancy, unsafe abortions and sexually transmitted infections among the young.