Stats and Facts

 

Despite the range of available modern contraceptive methods, the unmet need for modern contraception continues to be high in developing and disaster-affected countries.

  • In least developed countries, only 40% of women (married or in relationships) use any kind of contraception. In Africa, only 33% do so. [1] This can be made worse in situations of conflict and emergencies. For example, a study on contraception access in conflict-affected Northern Uganda (2004-2005) found that 91% of female Acholi adolescents had trouble accessing condoms.[2]
    References: 1. UN Department of Economic and Social Affairs, Trends in Contraceptive Use Worldwide: 2015. 2. UNFPA (2016). Adolescent girls in disaster and conflict: interventions for improving access to sexual and reproductive health services.
  • In most countries within Sub-Saharan Africa, less than half of sexually active men (aged 15-24) use any contraceptive method or rely on their partner’s method.
    Reference: The Guttmacher Institute (2003). In Their Own Right: addressing the sexual and reproductive health needs of men worldwide.
  • Unmet need for modern contraception is particularly high among these groups: adolescents, migrants, urban slum dwellers, refugees and women in the postpartum period – particularly those in developing countries, with low income and limited education.
    Reference: Guttmacher Institute (2016). Unmet need for Contraception in Developing Countries. 2016 data: WHO (2016). Fact sheet: family planning/contraception.

 

Stats and Facts

 

Despite the range of available modern contraceptive methods, the unmet need for modern contraception continues to be high in developing and disaster-affected countries.

  • In least developed countries, only 40% of women (married or in relationships) use any kind of contraception. In Africa, only 33% do so. [1] This can be made worse in situations of conflict and emergencies. For example, a study on contraception access in conflict-affected Northern Uganda (2004-2005) found that 91% of female Acholi adolescents had trouble accessing condoms.[2]
    References: 1. UN Department of Economic and Social Affairs, Trends in Contraceptive Use Worldwide: 2015. 2. UNFPA (2016). Adolescent girls in disaster and conflict: interventions for improving access to sexual and reproductive health services.
  • In most countries within Sub-Saharan Africa, less than half of sexually active men (aged 15-24) use any contraceptive method or rely on their partner’s method.
    Reference: The Guttmacher Institute (2003). In Their Own Right: addressing the sexual and reproductive health needs of men worldwide.
  • Unmet need for modern contraception is particularly high among these groups: adolescents, migrants, urban slum dwellers, refugees and women in the postpartum period – particularly those in developing countries, with low income and limited education.
    Reference: Guttmacher Institute (2016). Unmet need for Contraception in Developing Countries. 2016 data: WHO (2016). Fact sheet: family planning/contraception.
  • Worldwide, an estimated 44% of pregnancies were unintended from 2010-2014.
    Reference: Bearak, Jonathan et al. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. The Lancet Global Health, Volume 6.
  • In developing regions, the unintended pregnancy rate fell 16% from 77 per 1000 women aged 15-44 years to 65 per 1000. Whereas the decline in the unintended pregnancy rate in developed regions coincide with a declining abortion rate, the decline in developing regions coincided with a declining unintended birth rate. 
  • Reference: Bearak, Jonathan et al. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. The Lancet Global Health, Volume 6.
  • Teen pregnancy is particularly high in disaster-affected areas. In 2003, 30 percent of births in Congolese refugee camps in Tanzania were among girls aged 14-18. During the 2012 food crisis in Niger, 39% of adolescent girls were mothers. In Afghanistan and in Yemen, 1 in 4 women aged 20 to 24 have had their first child before the age of 18.
    Reference: Inter-agency working group on reproductive health in crisis (Retrieved March 20, 2017). Adolescent sexual and reproductive health facts and stats.

Maternal mortality and newborn mortality remains a serious problem that falls unevenly across the globe. It particularly affects women and children in countries characterized by conflict and disaster.

  • Maternal mortality ratios (MMRs) in countries affected by conflict remain high and have been shown to increase during periods of conflict. 61% of maternal deaths worldwide occur in fragile states, many of them affected by conflict and recurring natural disasters. Syria's MMR has increased from 49 to 68 per 100,000 live births since the start of the conflict in 2011. 
  • There are an estimated 290,000 - 303,000 maternal deaths a year, nearly all in the global south. 7.5 - 7.9% of them are due to complications related to unsafe abortion.
    References: World Health Organization (2015). Trends in Maternal Mortality: 1990 to 2013.  Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva: WHO. Guttmacher Institute (2016). Unmet need for Contraception in Developing Countries
  • Of the 830 women and girls who die each day from pregnancy and child-birth related causes, 507 die in countries affected by conflict or disaster. That accounts for 3/5 of maternal deaths worldwide.
    Reference: UNFPA (2016). Adolescent girls in disaster and conflict: interventions for improving access to sexual and reproductive health services.
  • In most industrialized nations, the lifetime risk of a woman dying in childbirth is 1 in 8,000. That risk for women in parts of sub-Saharan Africa can be as high as 1 in 7.
    Reference: World Health Organization, United Nations Children’s Fund, United Nations Population Fund and the World Bank, Maternal Mortality in 2005: Estimates developed by WHO, UNICEF,UNFPA and the World Bank, WHO, Geneva, 2007, p. 35.
  • Risk of death in pregnancy and delivery for girls under age 15 is five times higher than for women in their 20s.
    Reference: World Health Organization. (2003). Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. Geneva, WHO.

Humanitarian/emergency settings represent particular challenges against access to SRH services and rights.

  • In emergencies, people face heightened risks of gender-based violence (GBV) and HIV. Adolescent girls in particular face heightened risks of unwanted pregnancy, child, early and forced marriage, maternal mortality and disability, rape and sexual exploitation and abuse.
    Reference: UNFPA (2016). Adolescent girls in disaster and conflict: interventions for improving access to sexual and reproductive health services.
  • Displaced and disaster-affected people face additional barriers limiting from accessing SRH services due to locality, language, registration status as a refugee or immigrant. In addition, women and girls face distinct cultural barriers against mobility and accessing SRH services independently.
    Reference: UNFPA (2016). Adolescent girls in disaster and conflict: interventions for improving access to sexual and reproductive health services.
  • Spikes in child marriage rates during times of conflict and disaster have been documented across multiple countries cross the globe, including Haiti, Pakistan, Syria, Niger and Guinea. (Also see discussion on GBV)
    Reference: Inter-agency working group on reproductive health in crisis (Retrieved March 20, 2017). Adolescent sexual and reproductive health facts and stats.

 

Power and SRHR

Within populations, unequal power relationships – at home, school, work and beyond – exacerbate risks to SRHR:

 

Power and SRHR

Within populations, unequal power relationships – at home, school, work and beyond – exacerbate risks to SRHR:

  • Girls’ and women’s status within families and relationships in many countries across the globe deny fundamental rights on when or if to marry or have children. This is codified in law in multiple countries that require male permission for women to access contraception, and social expectations tied to bride price and dowry. It is also evident in the dynamics of GBV against women and girls in the home.
    References: Bawah, A., Akweongo, P., Simmons, R. and Phillips, J. (2003). Women's Fears and Men's Anxieties: the impact of family planning on gender relations in Northern Ghana. Studies in Family Planning, 30(1): pp. 54-66; Doctors of the World (2016). Unwanted pregnancies and abortions: comparative analysis of socio-cultural and community determinants; Blanc, A. (2001). The Effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Studies in Family Planning, 32(3): pp. 189-213.
  • A WHO Multi-country Study on Women’s health and Domestic Violence found that 3-24% of women reported their first sexual experience was forced. For most, this occurred during adolescence.
    Reference: Partners for Prevention (retrieved March 20, 2017). Facts and figures.
  • Age is also an important factor that exposes people to sexual violence. In a multi-country survey, across 7 countries in Sub-Saharan African and Haiti, 9-21% of boys reported experiencing sexual violence before the age of 18. This figure was 20-33% for girls.
    Reference: Together for girls (2016). Data from the violence against children surveys.
  • Linked to these trends, WHO mortality data reported suicide and death by self-harm now out-ranks maternal causes of death for girls, ages 10-19, globally.
    Reference: World Health Organization (2017). More than 1.2 million adolescents die every year, nearly all preventable.
  • HIV disproportionately affects transgender women at 19.2% prevalence in comparison to a 0.8% prevalence rate among the general population. Sex workers across genders are also disproportionately at risk (27.3% prevalence among transgender women, 14% among men, 11.8% among women sex workers).
    Reference: The Lancet (2014). Infographic: HIV and sex workers.
  • A Pacific Islands report found stigma against people living outside gender norms (including LGBTQI people, sex workers, single mothers and unmarried women) delay many individuals associated with these groups from seeking services and care.
    Reference: Pacific Feminist Coalition (2013). Report on strategy meeting of feminists advancing sexual and reproductive rights in the Pacific: Cairo@20 and more. 

     

 

Criminalization of sexual and reproductive rights and its impact

Criminalization and denial of contraception and abortion services risks lives:

 

Criminalization of sexual and reproductive rights and its impact

Criminalization and denial of contraception and abortion services risks lives:

  • Studies find that criminalization of abortion is linked to higher rates of unsafe abortion services that can result in injury and death. On the converse, in South Africa for example, legalization of abortion is linked to a 90% reduction in abortion-related deaths.
    Reference: Cohen, S. (2012). Access to safe abortion in the developing world: saving lives while advancing rights. Guttmacher Policy Review, 15(3).
  • In the US, legalizing access to contraception for individuals has contributed to a 60% reduction in maternal mortality rates, and a 76% decline in infant death rates, and a drastic decline (from 20% in 1965 to 8.9% in 2011) of unwanted births among married women.
    Reference: Planned Parenthood (2015). Griswold v. Connecticut - the impact of legal birth control and the challenges that remain.
  • Unwanted pregnancies and unsafe abortion contribute to mortality and disability of young and older women. Around 25 million unsafe abortions are estimated to take place worldwide each year. Unsafe abortion and complications related to it account for 25% of pregnancy-related deaths and injury.
    Reference: Cohen, S. (2012). Access to safe abortion in the developing world: saving lives while advancing rights. Guttmacher Policy Review, 15(3); Doctors of the World (2016). Unwanted pregnancies and abortions: comparative analysis of socio-cultural and community determinants; WHO (2018). Preventing unsafe abortion.
  • Girls in particular bear a heavy social cost for unwanted pregnancies, ranging from social stigma, social and family exclusion and economic marginalization.
    Reference: Doctors of the World (2016). Unwanted pregnancies and abortions: comparative analysis of socio-cultural and community determinants.
  • Addressing contraception needs can reduce abortion rates. If women’s needs for contraception were met, it would reduce the burden of medical care for complications related to unsafe abortion by 74% (8.4 – 2.2 million).
    References: Cohen, S. (2012). Access to safe abortion in the developing world: saving lives while advancing rights. Guttmacher Policy Review, 15(3); Singh, S., Darroch, J., Ashford , L. (2014). Adding it up: the costs and benefits of investing in sexual and reproductive health 2014. Guttmacher Institute.
  • An index of youth family planning across 9 countries found the highest rates of teen pregnancy in countries that actively restrict women and girls’ access to contraception in terms of external authorization requirements, age restrictions and/or marital status. Those with the most supportive policy and community support environments had higher use of modern contraception among women, regardless of their marital status.
    Reference: Population Reference Bureau (February 2017). Global Youth Family Planning Index.
  • In South Africa, where sex between men is criminalized, HIV prevalence among men who have sex with men is now estimated at 26.8%. Due to their sexuality, men also reported experiencing high rates of fear to access health services (18.5%), fear to walk in the community (19%), blackmail against them due to their sexuality (21.2%), denial of health care because of their sexuality (5.1%) and denial of housing for reasons other than lack of funds (6.9%).
    Reference: Baral, S. (2009). HIV risk and human rights violations among African gay men and other men who have sex with men. Johns Hopkins School of Public Health; AVERT (2018). HIV and AIDS in South Africa.

     

 

Social and political structures shaping SRHR

Social norms and values shape GBV dynamics, sexual and reproductive health related behaviors of individuals as well as the attitudes and response of communities and institutions. For example, a review of studies on young people’s sexual behaviors found:

 

Social and political structures shaping SRHR

Social norms and values shape GBV dynamics, sexual and reproductive health related behaviors of individuals as well as the attitudes and response of communities and institutions. For example, a review of studies on young people’s sexual behaviors found:

  • Norms related to femininity prevent women’s knowledge on sexual health and prohibit women and girls’ from taking control over their bodies. These norms also discourage women and girls from refusing sex in fear of losing a partner or retribution. Girls also reported pressure not to speak about issues of violence within intimate partners, and the need to be feminine when in a partnership. Girls also expressed fear that a failed partnership would reflect poorly on their worth. Women and girls are also often discouraged from carrying or asking for condom use, though they are also often considered responsible for prevention of pregnancy.
    Reference: Marston, C. and King, E. (2006). Factors that shape young people's sexual behavior: a systematic review.The Lancet, 368(9547): 1581-6.
  • Norms and expectations related to masculinity encourage men and boys to show few emotions (outside of anger), express dominance and defend their honor with violence if need be, be seen as having multiple sexual partners and follow expectations for other stereotypical masculine traits, which can be harmful to their own and others’ health.
    Reference: Marston, C. and King, E. (2006). Factors that shape young people's sexual behavior: a systematic review.The Lancet, 368(9547): 1581-6.
  • Norms facing men also act in ways that discourage male partners from becoming more involved in women’s and children’s health.
    Reference: Blanc, A. (2001). The Effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Studies in Family Planning, 32(3): pp. 189-213.
  • Homophobia stigmatizes same-gender sexual relationships which limits safe opportunities for sex, and limits access to high-quality health care. It also exposes individuals to hate violence, related to their gender and sexuality (i.e. rape, murder, assault, etc.).
    Reference: Marston, C. and King, E. (2006). Factors that shape young people's sexual behavior: a systematic review.The Lancet, 368(9547): 1581-6; Singh, S., Darroch, J., Ashford , L. (2014). Adding it up: the costs and benefits of investing in sexual and reproductive health 2014. Guttmacher Institute.
  • For child marriage, norms perpetuating the practice include parental pressure to control girls’ sexuality rather than support positive environments for exploring sexuality and choice:
    • Value on girls’ virginity at marriage as a reflection of family honor, and fears of pregnancy before marriage. This is linked to social pressure to marry girls following cases of rape.
    • Silencing of girls from expressing their preferences and needs against coercive practices can put them at risk – both to child marriage as well as other SRHR risks.
      Reference: UNICEF (Retrieved March 20, 2017). Gender and HIV/AIDS: Prevention among young people; Girls Not Brides (2015). Why does child marriage happen? ABAAD (2015) Regional seminar on Child Marriage during democratic transition and armed conflicts; CARE Jordan Urban Refugee Protection Project Evaluation
  • Expectations for male dominance, virility and control in sexual relationships, alongside women’s subordination.
    Reference: Greene, M., Perlson, S., Taylor, A. and Lauro, G. (2015). Engaging Men and Boys to Address the Practice of Child Marriage. Washington, DC: GreeneWorks.  

 

In many countries, laws and policies represent major structural barriers against the fulfillment of SRHR:

  • Examples of these legal restrictions are: prohibitions on emergency contraception and access to some modern methods of contraception; lack of guarantees of privacy and confidentiality; censorship of scientifically accurate sexual and reproductive health information; criminalization of same-gender sex and consensual sex work and restrictions on access to safe abortion.
    Reference: WHO, Sexual Health, Human Rights and the Law, 2015.
  • In 2017, the US Government also reinstated the draconian Global Gag rule, which restricts non-US organizations receiving any federal funds global health work for supporting safe abortion services, even when funded via other sources (US law already prohibits the US Government funds for abortion services).
    Reference: CARE (2017). CARE Responds to reinstatement of Global Gag Rule.

 

 

Gains and progress toward SRHR

Research findings analyzed across a broad range of countries underpins an emerging consensus that reproductive health improvements extend life expectancy for mothers and children

 

Gains and progress toward SRHR

Research findings analyzed across a broad range of countries underpins an emerging consensus that reproductive health improvements extend life expectancy for mothers and children

  • Increase incentives to invest in schooling and other forms of human capital.
  • Create opportunities for participation in labor markets.
  • Raise individual’s capacities to be productive in labor markets.
  • Lead to higher incomes and higher levels of asset accumulation.
    Reference: Joshi, Shareen, Reproductive Health and Economic Development: What Connections Should We Focus On? (Research Brief) PopPov Research Network, January 2012.

However, we know the gains for meeting needs for modern contraception and antenatal as well as postnatal care would be huge:

  • Unintended pregnancies could be cut by 70% from 74 to 22 million.
  • Maternal deaths could go down by 67% and newborn deaths could fall by 77%;
  • Care work related to disability related to pregnancy and delivery would reduce by 66%;
  • Transmission of HIV from mother to child could be practically eliminated (reducing by 93%).
    References: World Health Organization (2015). Trends in Maternal Mortality: 1990 to 2013.  Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva: WHO. Guttmacher Institute (2016). Unmet need for Contraception in Developing Countries

There are many proven practices that have demonstrated how dramatic progress can be made on these issues.  

  • Satisfying information and demand for family planning alone could prevent 70,000 maternal deaths annually.The cost of meeting all women's needs for contraceptive, maternal, and newborn care is estimated to be on average US $9 per capita annually in developing regions.
    Reference: Guttmacher Institute (2016). Unmet need for Contraception in Developing Countries. 2016 data: WHO (2016). Fact sheet: family planning/contraception; Singh, S., Darroch, J., Ashford , L. (2014). Adding it up: the costs and benefits of investing in sexual and reproductive health 2014. Guttmacher Institute.; [2] The Lancet Commissions (2018). Accelerate Progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission.
  • Two-thirds of newborn deaths could be prevented if known health measures are provided at birth and during the first week of life.
    Reference: The Partnership for Maternal, Newborn and Child Health. (Updated 2011). “Newborn death and illness”.
  • Decriminalization of sex work could reduce HIV infections by 33-46%.
    Reference: The Lancet (2014). Infographic: HIV and sex workers.
  • Evaluations of comprehensive sex education programs have found youth participants delay onset of sexual activity, reduce number of partners and frequency of sex, and increase use of contraception and condoms.
    Reference: Advocates for Youth (2009). Comprehensive sex education: research and results.
  • Studies have found that men’s involvement in family planning leads to better outcomes for women’s health.
    Reference: Blanc, A. (2001). The Effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. Studies in Family Planning, 32(3): pp. 189-213.

Globally, there has been heartening progress on contraception use and maternal health in past decades.

  • Globally, contraceptive prevalence almost doubled between 1970 and 2015 (from 36% to 64%).
  • From 1990-2015, maternal mortality dropped by approximately 44% worldwide
    Reference: World Health Organization (2016). Maternal mortality fact sheet.

NOTE: Denial of SRHR is closely intertwined with gender-based violence. Follow this link for a discussion on it.

 

More Information

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