 13 April 2008
One month from
now, on Tuesday
13 May, marks the
40th anniversary
of the basic human
right to family
planning. Mark
your calendars
and find out what
advocates are
doing to mark this
turning point in
reproductive justice. If
you are holding
an event or meeting,
generating articles
or letters to the
editor, or find
other ways to promote
family planning,
one of the three
pillars of maternal
health, as a human
right, please write
us at info@womendeliver.org.
Looking for background? Read on:
It Was Forty Years Ago…
The year 1968 was tumultuous in much of the world, but in one important way it was a banner year: on May 11, 1968, the International Conference on Human Rights met in Tehran and declared,
“Parents have a basic human right to determine freely and responsibly the number and spacing of their children.”
World leaders, in other words, formally recognized parenthood, with all its joys and sorrows, as a choice. For women, it was a revolutionary moment, to put it mildly.
Progress on Women’s Health and Empowerment
For millennia, motherhood was inevitable for most women, usually their only career option and often their only acknowledged purpose. Women’s rights under law and in society revolved around their role as mothers, and chiefly as mothers of heirs. Little else about them seemed to matter – except to women themselves. Cleopatra is said to have tried using gold pellets as contraceptives, and women ever since have sought means of controlling their childbearing.
Not just for career reasons. Until the medical advances of the 20th century, all women faced a high risk of death in trying to give life. Even today, more than 40 percent of all pregnancies everywhere suffer complications, and in 15 percent of pregnancies the complication is life-threatening. The death rate rises if the mother’s general health and education are poor, as in most of the developing world; if she is very young, as in many places where child brides are common; and if her pregnancies are many and follow in quick succession. The Taj Mahal is an Indian emperor’s monument to his favorite wife, who died at the age of 39 bearing his 14th child.
In 1900, six to nine of every 1,000 U.S. women died in childbirth, and one in five children died before their fifth birthday, according to the U.S. Centers for Disease Control. It was illegal to distribute information about contraception or to counsel anyone about birth control. Worldwide, women bore an average of six children each. Unsafe abortion attempts killed countless women and filled hospitals with millions more who were injured and disabled.
The modern birth control movement began in 1912 when Margaret Sanger, a New York public health nurse, began passing out information leaflets on birth control, and was promptly arrested. She opened the first family planning clinic in 1916, in Brooklyn, and it was promptly closed. Decades of court battles and persistence eventually won legal exceptions – for private doctors to provide advice on contraceptives for health reasons, then to prescribe them, and finally for public health services to do the same. But contraceptive use was still illegal in general.
The modern birth control pill and intra-uterine device became available in 1960. In 1965, the U.S. Supreme Court’s Griswold v. Connecticut ruling struck down state laws barring contraceptive use by married couples, and in 1968 came the global human rights decree. Around the world, modern contraceptive use rose from 10 percent of married couples then to 65 percent today. By the 1980s fertility rates had fallen by a third. Women now bear half as many children as their grandmothers did—an average of three each.
The Up-hill Road Ahead
It sounds like a world success story, but the averages disguise huge disparities between rich and poor countries, and between the rich and the poor in all countries. Maternal deaths in industrialized areas have plummeted for three essential reasons: wide access to comprehensive reproductive health care, including contraceptives; skilled attendance during labor and childbirth; and access to emergency care for mothers and infants with complications. Only one American woman in 4,800 is now at risk of dying in childbirth over her lifetime.
But in much of the world, these three “pillars” of safe motherhood are absent. A woman still dies from pregnancy-related causes every minute somewhere in the world – more than 536,000 per year. In Afghanistan, for example, high fertility and a shattered health care system raise a woman’s lifetime risk so that one in every eight women will die of pregnancy-related causes.
In all countries, a third of those maternal deaths could be averted with access to safe and effective contraceptives.
But more than 200 million women who would like to plan their families still lack that access, and nearly all of them live in developing countries. Every year, millions more young people become sexually active, and most again are in the developing world, where acute contraceptive shortages already plague many health systems. With this unprecedented youth boom, rising populations and growing awareness of HIV/AIDS prevention needs, global demand for contraceptives is expected to increase by 40 percent in the next 15 years.
While demand is rising, funding for family planning is not. Many donors are phasing out family planning support in favor of HIV/AIDS prevention programs or general budget support. The urgent need for family planning assistance seems to have fallen off the world’s agenda.
Meanwhile, new estimates of resources needed to provide universal sexual and reproductive health care have risen well beyond the projections of the International Conference on Population and Development (ICPD) in 1994, largely because of the AIDS pandemic. The new need is for US$30 billion per year by 2010 and US$36 billion per year by 2015, compared to the $21 billion and $22 billion ICPD estimates.
Without this investment, about half the world’s annual 190 million pregnancies will continue to be unwanted, and 50 million women will resort to abortion every year. Some ten million women will continue to die of pregnancy-related causes in every generation. Without their care, creativity, energy and economic production, the world is destined to fall short of achieving Millennium Development Goals related to curbing poverty, improving maternal health and reducing infant deaths.
Family planning may have been an official human right for 40 years, but it is not yet a reality.
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