Reproductive rights and choices have become a reality for more women than ever, says UNFPA’s flagship report, State of World Population 2019 (SWOP -2019 report). Yet despite these gains, vast numbers of women around the world are not empowered to make fundamental decisions about their own bodies.
UNFPA’s report publishes, for the first time, data on women’s ability to make decisions over three key areas: sexual intercourse with their partner, contraception use and health care.
Across the 51 countries where this information is available, only 57 per cent of women who are married or in a relationship are able to make their own choices over all three areas.
Women’s sexual and reproductive autonomy was greatest in two countries: the Philippines and Ukraine, where 81 per cent of women are empowered to make these decisions for themselves.
It was lowest in three countries: Mali, Niger and Senegal. In these countries, only 7 per cent of women are able to make their own choices over all three areas.
Tefta Shakaj is a midwife in Albania. She says opportunities for women and girls have been
improving over the last 25 years. © UNFPA/G.
“We still have a long way to go before all women and girls have the power and the means to govern their own bodies and make informed decisions about their sexual and reproductive health,” said UNFPA Executive Director Dr. Natalia Kanem.
A story of progress
As dire as the statistics may seem, they represent massive progress in the long history of reproductive health and rights, says the new report, which is titled “Unfinished business: The pursuit of rights and choices for all.”
It was only in 1968 that leaders affirmed, for the first time in a global declaration, that individuals had the right to “determine freely and responsibly the number and the spacing of their children.”
Increasing numbers of people were able to exercise this right as family planning methods became more accessible and reliable.
And as women grew empowered to make their own reproductive choices, a wide range of benefits accrued to their health and economic well-being.
Then 25 years ago, at the International Conference on Population and Development (ICPD), governments of the world adopted a revolutionary agreement calling for women’s reproductive health and rights to take centre stage in development efforts.
Since then, access to voluntary family planning has expanded around the world. In 1994, at the ICPD, 52 per cent of women used modern contraceptives, compared to 58 per cent today.
Access to reproductive health services has improved, too. The number of women who die from pregnancy-related causes has dropped from 369 per 100,000 live births in 1994 to 216 in 2015.
A long way to go
But these gains are not enough.
Marginalized groups, in particular, face some of the highest unmet need for sexual and reproductive health services, the report says. These include ethnic minorities, youth, unmarried people, lesbian, gay, bisexual and intersex people, people with disabilities, and those living in poverty.
And in some circumstances, people are even losing access to the services they need to exercise their reproductive rights.
“We must push back against forces that would see us return to a time when women had little say in reproductive decisions or, for that matter, in any area of their lives,” said Dr. Kanem. “The fight for rights and choices must continue until they are a reality for all.”
Fifty years ago, it was hard for women to obtain contraception and relatively easy to die giving birth. Many women were unable to decide whom and when to marry, and when or whether to have children.
A worldwide movement to give women real choices in life culminated in the 1994 International Conference on Population and Development (ICPD), where a consensus was reached about the links between women’s empowerment, sexual and reproductive health, and rights and sustainable development.
Since then, women have made enormous progress in exercising their reproductive rights. Activists, advocates, public health specialists and many others have pushed relentlessly for the transformations we see around us today.
Since 1969, when UNFPA was established, much has been accomplished. But there is still more to be done before all women and girls are able to exercise their rights.
International Conference on Population and Development
The United Nations coordinated an International Conference on Population and Development (ICPD) in Cairo, Egypt, on 5–13 September 1994. Its resulting Programme of Action is the steering document for the United Nations Population Fund (UNFPA).
Some 20,000 delegates from various governments, UN agencies, NGOs, and the media gathered for a discussion of a variety of population issues, including immigration, infant mortality, birth control, family planning, the education of women, and protection for women from unsafe abortion services.
The conference received considerable media attention due to disputes regarding the assertion of reproductive rights. The Holy See and several predominantly Islamic nations were staunch critics, and U.S. President Bill Clinton received considerable criticism from conservatives for his participation, considering the fact that president Ronald Reagan did not attend or fund the previous conference held in Mexico City in 1984. The official spokesman for the Holy See was archbishop Renato Martino.
According to the official ICPD release, the conference delegates achieved consensus on the following four qualitative and quantitative goals:
- Universal education: Universal primary education in all countries by 2015. Urge countries to provide wider access to women for secondary and higher level education as well as vocational and technical training.
- Reduction of infant and child mortality: Countries should strive to reduce infant and under-5 child mortality rates by one-third or to 50–70 deaths per 1000 by the year 2000. By 2015 all countries should aim to achieve a rate below 35 per 1,000 live births and under-five mortality rate below 45 per 1,000.
- Reduction of maternal mortality: A reduction by 1/2 the 1990 levels by 2000 and 1/2 of that by 2015. Disparities in maternal mortality within countries and between geographical regions, socio-economic and ethnic groups should be narrowed.
Access to reproductive and sexual health services including family planning:
Family-planning counseling, pre-natal care, safe delivery and post-natal care, prevention and appropriate treatment of infertility, prevention of abortion and the management of the consequences of abortion, treatment of reproductive tract infections, sexually transmitted diseases and other reproductive health conditions; and education, counseling, as appropriate, on human sexuality, reproductive health and responsible parenthood. Services regarding HIV/AIDS, breast cancer, infertility, and delivery should be made available. Active discouragement of female genital mutilation (FGM).
Nairobi Conference (November-2019)
This year, a quarter century after the landmark ICPD agreement, the world must redouble its efforts to secure the reproductive health and rights of all people.
In November, the Government of Kenya, the Government of Denmark and UNFPA will convene a high-level conference in Nairobi urging leaders, governments and a wide range of partners to re-commit to realizing rights and choices for all.
“The Nairobi Summit will help us rally a broad coalition of stakeholders to protect the gains made and advance the ICPD agenda,” said Dr. Kanem, “to ensure that no one is left behind.”