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Women's Health in Developing Countries--The Role of the United Nations

A talk by Charlotte Houde-Quimby to the League of Women Voters, November 19, 2002
Page one: an Overview
Page two: Contraception
Page three:  Safe Motherhood
Page four:  HIV/AIDS

2. Contraception

It took most of human history for the population to reach one billion people. That happened in 1800. From 1987 to 1999, the population grew from 5 to 6 billion people. At the current rate, we will reach 13 billion by 2050. 95% of this growth will be in Africa, LAC, and Asia.

Data prepared by UNFPA highlights some of the specific needs created by this level of population:

War and the effects of war also create major health crises that impact most directly and harshly on women and children. A letter in the NY Times on October 28 quoting a study for Physicians for Human Rights in Afghanistan, for example, found that 593 women died during childbirth for every 100, 000 live births in Afghanistan.

(The developing world rate is generally considered to be 400/100,000; the developed world, 25 or less.) Women in Afghanistan reported having to obtain permission from a husband or male relative to seek health care, and if they did receive any medical attention, it was woefully inadequate. The lack of trained health workers in rural areas means that a trained health care worker attends less than I percent of women during labor. The author goes on to state that improving women's health in war torn countries can't happen without the protection and expansion of women's rights. The UN and US must provide resources and infrastructure to combat these public health disasters.

UNFPA provides contraception and safe birth kits and works against the spread of HIV and against FGM in the world's poorest countries. While fertility rates are declining and contraceptive use increased by over a fifth in the last decade, many women continue to face obstacles to contraceptive use. This year, the US Congress approved 34 million dollars for UNFPA, but President Bush cancelled that contribution. Thoraya Obaid Director of UNFPA said these 34 million US dollars would have helped prevent

In their most recent report Promises to Keep: The Toll of Unintended Pregnancies on Women's Lives in the Developing World' (recently reviewed in the Valley News) Nils Daulaire and his colleagues at the Global Health Council (with offices in Washington, DC and Wilder, VT) undertook a statistical analysis to assess progress made toward achievement of the ICPD goals, particularly those pertaining to survival of women. The study was designed to determine whether more FP might reduce the deaths of women in pregnancy and childbirth. Their results revealed that in the six years following Cairo, more than 300 million pregnancies were unintended. During this six-year period, nearly 700,000 women died as a result of unintended and unwanted pregnancies. The majority, more than 400,000, died as a result of complications resulting from abortions carried out in unsafe, unsanitary and often illegal conditions....abortions that would have been unnecessary with modem contraceptive availability.

Because women seldom make independent decisions about matters affecting their reproductive health, men's roles and responsibilities in sexual relations, contraceptive decision-making, childbearing and rearing, and prevention of sexually transmitted diseases are also extremely important considerations. Men's reproductive health and reproductive responsibility are of concern in their own right. But as Frances Donnay of UNICEF points out: " ...there is nothing affecting men that causes nearly as much death and suffering as do reproductive problems among women."2

The USAID office of Global Health Population and Reproductive Health program is one of the success stories in US development assistance. Among the major accomplishments of USAID is the decrease in the average family size in the developing world from six children per family in the 1960s to 4 in the 1990s. USAID is directly linked to the use of FP by 50 million couples, and to improved methods of contraception. USAID research shows that when couples are treated with dignity, obtain a method of their own choosing which they can afford, with good counseling, they continue using these modern, more effective methods. In countries receiving USAID assistance, infant mortality has decreased and vaccinations have increased. Working with the Pan American Health Organization, the CDC, and Rotary International, USAID has virtually eradicated polio. The major RH strategy of USAID is to stabilize world population by increasing the quality, availability and use of essential health and family planning services for families in the developing world. Since the launch of the program in 1965, many families are better able to feed, clothe, educate, and provide health care for their children. Healthy mothers are children's first line of defense against death, malnutrition, and a cycle of poverty and disease.'

USAID recognizes that the major burden for health care traditionally takes place at the family or individual level, and the greatest responsibility for this care falls on women. Providing for her own and the family's care frequently includes:

These are acknowledged as women's work in communities the world over. As Perdita Huston has said in her work Invisible Agents for Change: "If we examine the roles (productive and reproductive) that women play-on a daily basis- in most societies, women's s involvement is clearly essential to success. When women, for example, produce 80% of all family food in Africa, it is imperative to factor in women's work in an assessment of their economic progress. For this work, they collect only 30% of the profit."4

Women in developing countries (like women the world over!) have many babies for a myriad of reasons: they don't have access to quality family planning services; their cultural environment rewards them for fertility; their pleasures in life are largely invested in their children; AND, they can't be certain their children will live beyond five years of age. According to the WHO, the vast majority of child deaths can be prevented through adequate birth spacing, prevention of births among very young women, and prevention of birth among women with four or more children.

Malnourished,, married too early, bearing children too young, pregnancy puts young women's health at risk; it means lost education and lifelong loss of earnings.

Women educators are organizing women's groups in Africa and Asia and are cajoling teens and their families into at least enough education to achieve functional literacy. Not only do educated women generally marry later and have access to better jobs, they tend to have a broader worldview. They are more likely to believe that they can do something about the conditions of their life, including the number of pregnancies they have.
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