World Bank releases reproductive health action plan 2010-15

15 June 2010

Source: World Bank

The World Bank has released a Reproductive Health Action Plan 2010-2015 to help less developed countries reduce high fertility and prevent the number more than 350,000 deaths of women each year in pregnancy and childbirth complications.

The tragedy of maternal mortality

"A mother's unnecessary death in childbirth is not just a human tragedy," said Julian Schweitzer, Acting Vice President of Human Development at the World Bank. "It's also an economic and social catastrophe that deprives her surviving children of nurture and nutrition and too often of the chance of education."  

"Maternal deaths are both caused by poverty and are a cause of it," said Schweitzer. "The costs of childbirth are often the single biggest cause of casting a family into poverty. And, if the mother dies in childbirth, the chances of her baby surviving the first year of life are drastically reduced."

Many of the world's poorest women turn to unsafe abortions as a last-resort means of birth control and as a result about 68,000 women die each year, while another 5.3 million suffer temporary or permanent disabilities. 

Thirty-five poor countries in Sub-Saharan Africa as well as Timor-Leste, Afghanistan, Djibouti, and Yemen have the highest birth rates (greater than five children per mother), along with the poorest social and economic situations including low levels of education, high death rates, and extreme poverty. 

Modest increase in family planning, while population rises rapidly

World population more than doubled to reach 6 billion in the second half of the 20^th Century and this has resulted in an astonishing 3-billion increase in population in only 40 years.  

Even though the rate of increase has slowed to 1.2 percent a year, the absolute size of the population being added each year is large and projected to reach 9.1 billion by 2050, with most living in the poorest regions of the world.

Reproductive health development aid is lacking

The plan warns that family planning and related programmes were not receiving adequate attention from donor governments and aid agencies. 

Although health development aid soared from 1995 to 2007 (US $2.9 billion in 1995 to US $14.1 billion in 2007, roughly a five-fold increase in 12 years) assistance for population and reproductive health programmes increased much more modestly during the same period, (from US $901 million in 1995 to US $1.9 billion in 2007).

In the 35 highest-fertility countries development assistance for family planning and reproductive programs started at US $150 million in 1995 and increased to only US $432 million in 2007. These figures in the same 35 countries compare with overall aid for health increasing from US $915 million in 1995 to US $4.9 billion in 2007.  

Millennium Development Goals not on track

Many countries are far from achieving the 2015 Millennium Development Goals (MDGs), particularly MDG 5, that aims to decrease maternal mortality ratio (MMR) by three-quarters between 1990 and 2015.

This is equivalent to an annual decrease of about 5.5 percent and increased access to universal reproductive health care by 2015 but the current global average rate of reduction is under 1 percent-only 0.1 percent in sub-Saharan Africa, where levels of mortality are the highest. And ad the present rate of progress, the world will fall well short of achieving this MDG. 

How the World Bank aims to help close the gap  

World Bank health financing in FY10 is expected to triple to an unprecedented US $4.1 billion - a 40 percent increase over the previous year's record- in support of stronger health systems; boosting the prevention and treatment of communicable diseases; and improving child and maternal health, hygiene, and sanitation.   

The World Bank through its new health action plan will help 58 countries with high maternal death and fertility rates, which have remained stubbornly high for some years, improve their reproductive health systems in various ways.

Addressing the unmet need for family planning

In 2008, of the 1.4 billion women in the developing countries of reproductive age (15-49 years), more than 800 million women wanted to avoid pregnancy and thus had a need for contraceptives.  

Out of these women, some 600 million were using modern contraceptives, that prevented 188 million unintended pregnancies, 1.2 million newborn deaths, and related 230,000 maternal deaths.  

Although contraceptive use has increased in all developing regions, it is still low in Sub-Saharan Africa, where its prevalence was still only 22 percent in 2008.  

The World Bank aims to expand the flow of information and knowledge about family planning to help motivate young women to stay in school and acquire life skills before starting their families.

Some 20 million of the estimated 200 million pregnancies every year end in unsafe abortions that put women at substantial risk of lasting injury or death. 

In the poorest countries where abortion is often restricted or illegal, deaths from unsafe abortion practices can be substantial, accounting for 13 percent of maternal mortality globally, and in some countries, as much as 25 percent of maternal deaths are due to unsafe abortion.

According to the Bank, falling maternal death rates in North Africa, East Asia, Southeast Asia, and Latin America and the Caribbean share many common features: increased use of contraception to delay and limit childbearing and better access to high-quality obstetric care services.  

Education as important as condoms and pills   

The Bank plan says that high birth rates are closely allied with fragile health, little or no education, and entrenched poverty.  

Analysis of demographic and health surveys in all regions shows that women with secondary or higher education have fewer children than women with primary or no education.  

In welcoming the Bank's new reproductive health strategy, Thoraya Ahmed Obaid, UNFPA Executive Director, said that countries and their development partners had to work even more closely together to make greater progress.

"With Millennium Development Goal 5 to improve maternal health lagging behind, greater investments are needed to achieve the two targets to reduce maternal mortality and achieve universal access to reproductive health by 2015," she said.

"During the global financial crisis, and at all times, investing in the health and rights of women is a smart choice to improve well-being, productivity, and economic growth." 

The new Reproductive Health Action Plan 2010-2015 is available here.