How Reproductive Health Services Work to Reduce Poverty

How significant are reproductive illnesses?

In developing countries, reproductive illnesses are a major threat to the health of adults, many of whom are in the early years of their working lives. According to the World Bank and World Health Organization (WHO), the reproductive health burden is highest in Africa and South Asia. In sub-Saharan Africa, reproductive illnesses, including complications of unsafe abortion and AIDS, cause about one-third of all disability and premature death among females, and about one-quarter in males. In India, they cause roughly 18 percent of the total health burden of females.

How does a lack of access to reproductive health care stall economic development?

Early pregnancies undermine girls’ schooling, health and aspirations. Increasingly, girls aspire to attend and finish secondary school. Without sufficient schooling, women find it harder to improve their economic and social status. For many teenage girls, childbirth and child rearing become virtually insurmountable obstacles to school attendance and advancement. If faced with unwanted pregnancies, teenagers often resort to self-induced abortions or use the services of untrained providers. A study estimated that about 700 teenagers resort to unsafe illegal abortion each day in Kenya. Teenagers account for 30 percent to 80 percent of the cases of abortion complications in sub-Saharan African countries, and often overload the meager health care facilities that exist.

Maternal illness often locks women and children in a vicious cycle of poverty. For poor women in the poorest nations, pregnancy and childbearing are risky. The WHO estimates that more than 500,000 women die each year from pregnancy-related causes and unsafe abortion. Some 70,000 die from unsafe abortion alone. The poor and uneducated are more likely than other women to die or be disabled during pregnancy, to bear the costs and consequences of clandestine unsafe abortions, to have children who are malnourished, or to lose their children to disease. More than twice the proportion of the world’s children live in poverty (1 in 3) than do adults (1 in 7), in part because poor couples often lack access to family planning services and accurate information about contraception.

In the hardest-hit African nations, 30 percent to 75 percent of all hospital beds are occupied by AIDS patients, and one in 10 infants is projected to be orphaned by the disease during childhood. In sub-Saharan Africa, funerals for AIDS deaths now are a major cause of job absenteeism and family debt. In 2001, 2,590 Zambian teachers died of AIDS—a toll equivalent to about 6.5 percent of all teachers trained by the nation that year. Not surprisingly, UNAIDS—the United Nations agency coordinating efforts to combat HIV/AIDS—fears that in the hardest-hit countries, the dissolution of families and the ongoing loss of skilled workers will slow economic development for decades.

Who suffers most?

Women and children, especially those in poverty, bear the burden of poor reproductive health. Because women experience pregnancy and childbirth, they are about seven times more vulnerable to reproductive illnesses than men. In addition, women’s risk of acquiring HIV is five to 10 times higher than men at each exposure. Women in poverty experience the greatest reproductive risks; they lack access to the full range of services and information that could spare them from these illnesses, and they often have little power to negotiate the conditions of sexual intercourse and contraceptive use with men. Because women are disproportionately affected by reproductive health problems, the economic hardships created by these illnesses are readily transmitted to the younger generation. Numerous studies show that maternal death lowers the chances of survival and school advancement for the children left behind.

Will economic growth alone improve reproductive health

Economic growth does not eliminate each country’s need for a well-designed reproductive health program.  Economic growth is vital to the poor, in part because income and tax revenues can finance expanded health care and other social services. But even with economic growth, many countries—including developed countries—have failed to confront pressing social and health problems concerning sex and reproduction. Cost-effective reproductive health services are unlikely to develop quickly or sustainably without strong commitments from national leaders, access to a worldwide network of health information and expertise, and organized efforts to reach high-risk and underserved populations. Successful reproductive health programs promote social and economic development.

What can be done to bring reproductive health services to those who can least afford them?

• family planning for all who want it—including adolescents—and subsidized services for those who can least afford them;
• care during pregnancy and childbirth, including access to emergency obstetric care; treatment for complications of abortion;
• safe and accessible abortion in circumstances where abortion is not against the law;
• treatment of sexually transmitted infections (STIs) and promotion of safer sex and awareness of HIV/AIDS and other STIs in each and every development project.

Reproductive health and poverty reduction

The poor are those with meager resources, little opportunity and few means to rely on when they are in poor health or otherwise in need. Given the amount of disability and premature death caused by reproductive health problems in the poorest nations, it is difficult to imagine young adults—especially young women —lifting themselves from poverty without full access to basic reproductive health—information and services. If national strategies aimed at reducing poverty are to succeed, policymakers need to assure that reproductive health services operate effectively and are easily accessed by those who can least afford them.