585,000 women die every year from complications of child birth and pregnancy. According to the United Nations, the single most important step that could be taken to reduce this tragic toll is to make high-quality family planning services universally accessible. Combining family planning with good maternal health could bring about a radical decline in the likelihood that women will die as a result of complications from pregnancy and childbirth.
High fertility contributes to the very high rates of infant mortality in the developing world. Four factors are known to increase the likelihood that an infant will die during the first year of life: if the mother is very young, if the mother had a previous birth less than 2 years earlier, if the mother is over 35 or if the mother has already had more than 4 children. These conditions are commonplace in the developing world. Simply helping women space births and avoid pregnancies during early adolescence or late in the reproductive years would significantly reduce the risk of infant mortality.
More than 120 million women want to postpone or stop childbearing but lack access to family planning services.The ability of women to gain control over their lives and improve their social and economic status is fundamental to development. This perforce includes having the ability to make informed, voluntary choices about the number and timing of children. For millions of women, access to services is denied or severely hindered because services are unavailable or of poor quality or because they lack the information needed to make informed decisions.
More than 250 million new sexually transmitted disease (STD) infections occur annually worldwide, at least 1 million of which are HIV infection. Some developing-country family planning, antenatal, and maternal and child health clinics find that as many as 1 or 2 women in every 10 are infected with an STD. The World Health Organization estimates that STDs (excluding HIV) are the second leading cause of healthy days lost in women in developing countries, after pregnancy-related morbidity and mortality.
Rapid population growth exacerbates the challenges faced by developing countries.The United Nations projects an increase in global population to 7.1 billion or 7.8 billion in 20 years. While the magnitude of the impact is conditioned by the local context, rapid population growth makes it more difficult for developing nations to achieve gains in per capita income to sustain land and water resources and provide basic health services and education for their populations.
Health care institutions in the developing world are often unable to provide essential reproductive health services. A combination of inadequate resources, insufficient technical skills and weak systems undermines the capacity of local institutions to respond to the need for family planning, maternal health care and control of sexually transmitted diseases.
Communities are in need of knowledge and organizational resources to mobilize for reproductive health care. While communities are acutely aware of the problems, they too often lack the information, organizational infrastructure and resources to secure appropriate services.
CARE is engaged in a wide-ranging attack on poverty in the developing world. Our fundamental mission is to help families move out of absolute poverty by helping them acquire the skills and resources to improve their lives. Hence, we work with families in their efforts to secure sufficient food, to increase household income, to protect the natural environment on which household economies depend, and to protect the health and well-being of families, particularly women and children.
Providing access to family planning and other basic reproductive health services is an indispensable component of CARE's program for helping families. CARE believes that family planning is an integral part of its package of services because of the beneficial effects on maternal and child health, the status of women and family income.
Accordingly, CARE has established the following objectives for its population and reproductive health program:
To provide women and men with access to a basic package of reproductive health services that includes family planning, maternal health care, and prevention and management of sexually transmitted diseases, including HIV/AIDS.
To build the capacity of local institutions to deliver high-quality reproductive health services so that services can be provided over the long term with diminishing levels of external assistance.
To empower families and communities to serve as informed, effective consumers of reproductive health care and to serve as advocates on their own behalf in securing essential reproductive health services.
During the 1996-2001 period, CARE expects to help 14 million women and their partners in 28 countries gain access to new or improved services.
CARE's population and reproductive health program includes the following elements:
providing women and men with access to the widest practicable range of contraceptive methods and the information needed to make informed, voluntary choices;
providing women with essential maternal health services, including prenatal care, safe delivery, emergency obstetrical care and postnatal care;
preventing the spread of sexually transmitted diseases, including HIV/AIDS, and providing appropriate diagnostic and disease management services to afflicted individuals;
strengthening the capacity of local institutions to provide high-quality services through training, technical assistance and development of management systems;
increasing the ability of local communities to mobilize on their own behalf through programs of education, leadership training, organizational development and resource mobilization.
CARE population and reproductive health projects must adhere to CARE's general programming principles: addressing significant problems, working with poor people, participation, adaptability, sustainability and fundamental change.
CARE supports family planning as an essential component of maternal and child health programs. CARE supports the right of individuals and couples to make voluntary, informed choices about the number and timing of their children and the services needed to exercise those choices.
CARE believes women must have access to the essential services that promote safe pregnancy and healthy children.
CARE supports efforts to reduce the spread of sexually transmitted diseases, including promotion of responsible, ethical sexual behavior.
CARE supports the right of family planning and reproductive health care clients to be treated with dignity and respect at all times and to receive high-quality, confidential care.
CARE believes that both men and women have important roles to play in family planning and reproductive health; CARE's programs will be gender sensitive and engage both men and women in matters related to family planning, reproductive health and parenting.
CARE will help women avoid unwanted pregnancies by providing contraceptive information and services. CARE will work with a wide range of organizations that share this goal and the ethical principles underlying CARE's population and reproductive health program.
CARE is committed to building the capacity of local institutions to provide reproductive health services to their populations. This includes respecting the right of local organizations to serve as peaceful advocates of their beliefs in a manner consistent with local law and custom.
CARE is committed to helping communities in their efforts to secure appropriate reproductive health services (family planning, maternal health care, and prevention and management of sexually transmitted diseases, including HIV/AIDS) and to advocate for government policies that will facilitate access to such services.
CARE will continue to speak out for family planning and reproductive health in developing countries, placed in the context of our overall approach to providing family household livelihood security. As and when appropriate, CARE will engage in this dialogue with concerned members of the U.S. public and the legislative and executive branches of the United States Government. Specific policy issues of programmatic content, funding levels and geographic focus will wax and wane over the next few years. The following principles will serve as the basic premises for CARE's policy dialogue.
The current level of over-all U.S. development assistance is inadequate and inappropriate to the leadership role that the U.S. plays in world affairs. The U.S. population and reproductive health program should be sustained in the context of an expanded, renewed and invigorated development assistance program.
CARE will serve as an advocate for policies that are consistent with its organizational principles for population and reproductive health/reproductive health programs and within CARE's overall mission.
The United States population and reproductive health program should be consistent with the Programme of Action of the United Nations International Conference on Population and Development (ICPD) which the U.S. signed in 1994. CARE recognizes that reasoned dialogue will be needed concerning the application and sequencing of the many recommendations contained in the Programme of Action.
US. leadership in the field of population is unmatched. Our comparative advantage is due to a corps of professionals with technical expertise which support population activities throughout the world. In order to promote and achieve sustainable progress, the U.S. population program must remain stable over a significant period with respect to programmatic focus, countries and funding levels.
The U.S. population program should respect the sovereignty of other nations and foreign recipients of U.S. funds should be free of overly restrictive regulations and constraints that inhibit the optimal deployment of resources within the limits of the 1973 Helms amendment to the Foreign Assistance Act. Foreign recipients have a concomitant responsibility to ensure good and appropriate stewardship of funds provided by the U.S. population assistance program.
Organizations must be held fully accountable for the responsible use of government funds and for demonstrating the impact of their programs. At the same time, U.S. organizations receiving U.S. population assistance funds must have sufficient latitude to make reasonable choices about the optimal use of funds, without undue administrative or legislative interference.
