Contraceptive Shortfall

I am Timothy Wirth, President of the United Nations Foundation. I have the privilege today of moderating this telephone conference call.

On the line this afternoon will be Dr. Thoraya Obaid, the Executive Director of United Nations Population Fund; Ms. Amy Coen, President of Population Action International; and Mr. Michael Fox, who is with the UNAIDS Department of Social Mobilization and Information of Youth and AIDS, the UN agency responsible for AIDS coordination.

We are today and for the next few days in Istanbul for an international conference focused on the contraceptive shortage. In the last 10 years since the Cairo programme of action was put together in the Cairo Conference on Population and Development, a number of developments have occurred around the world.

First, the numbers of people entering their childbearing years in the last 10 years has dramatically increased; and they are the largest population in the history of the world who over the next generation will be having their own children. So the potential for an enormous population explosion exists. The need for focus on the reproductive healthcare of those people also has accelerated.

The second trend of great importance is the accelerating AIDS crisis around the world, particularly in Sub-Saharan Africa. The AIDS crisis is closely related to that of reproductive healthcare and the population issue. Both reproductive healthcare policy and AIDS prevention policy depend upon the availability of contraception, particularly condoms.

And third, as these two trends have developed, the increase of young people and the increase of AIDS, we have seen a very disturbing shortfall in the availability of condoms around the world. Most of the people assume that condoms are available and that other contraceptives are also available. Unfortunately, there has been a sharp decline in the funding for and availability of contraception and other commodities around the world.

The purpose of the conference in Istanbul is to try to understand how these three trends come together and to work to make sure that efforts are coordinated internationally. We are very pleased to the UN who are deeply involved in this issue; and the individual most engaged in this issue, most responsible for helping to coordinate this is Dr. Thoraya Obaid.

Dr. Obaid is the Executive Director of UNFPA and I'm going to put her on the line. She is a Saudi national, the first Saudi national to hold this kind of a senior position within the UN system. She has been with the UN for a number of years and has recently taken over as the executive director of UNFPA. So with that, let me turn this over to Dr. Thoraya Obaid.

DR. THORAYA OBAID, EXECUTIVE DIRECTOR, UNITED NATIONS POPULATION FUND: Hello. This is Thoraya Obaid.

The main issue that UNFPA deals with is to ensure implementation of the agreement that was reached in Cairo in the International Conference on Population Development in Cairo in 1994. And that agreement basically calls for the universal access by 2015 to reproductive healthcare, which includes among other things ensuring that all couples who would like to plan their families, will have access to both information and services including contraceptives.

In 1999 we reviewed, and the governments reviewed what was happening and the result was progress and development. There were changes. More people were having access to family planning. However, a serious problem was identified and that was the gap between available resources and the program needs, especially in terms of providing contraceptives services within the programs.

And 1999 was really the lowest donor support has declined and the gap was as much as $86 million. Now just to show you the implication of such a gap in contraceptives I'll give you just quick statistics. It means that per minute, there are 380 pregnancies out of which 190 are unwanted or unplanned. Out of these 190 pregnancies, there are 11 cases of HIV infections, and 1 person dies. These grim statistics per minute occur when we don't provide the necessary commodities for families to plan their lives and for women in particular to have safer motherhood and determine the size and the spacing of the children.

This has implications on the social and economic development of the country. Not only does population growth place greater burden on institutions -- family institutions in terms of expenditures, but also on government institutions such as schools, health services, employment and so on. It also means that children in large families are more likely to suffer ill health.

WIRTH: Thank you, Dr. Obaid. I would now like to introduce to you Mr. Michael Fox, who is a Brazilian doctor who has been working on AIDS issues for the last 12 years. For the last six years he has worked with the new agency established at the UN to coordinate international AIDS relief activities. The agency is called UNAIDS. Mr. Michael Fox.

MR. MICHAEL FOX, UNAIDS: Hello. As just introduced, my name is Michael Fox. And just one correction, I'm not a medical doctor. But yes, as explained I'm representing Dr. Peter Piot in this conference call. Dr. Piot unfortunately, is still traveling, in fact he should be landing in Istanbul right at the moment was but was, unfortunately, unable to meet for this particular press briefing. I will gladly answer any questions you might have.

My work is directly related to reproductive health commodity needs and costs, which is the reason why I am at this conference. The global AIDS epidemic, or perhaps better it's handling worldwide, has had a tremendous effect on this.

Just to put this in some perspective, there are today over 36 million people living with AIDS in the world. There are approximately 15,000 people infected with HIV every single day, on average. Last year alone over three million people succumbed to diseases related to AIDS.

This has made AIDS today the leading cause of death from infection in the world. And as most of you probably know as well, since it is currently concentrated in developing countries, and specifically, at the moment, in Africa, which has almost over 70 percent of AIDS cases. And Africa is already the number one nation for persons dying of AIDS. However, that doesn't mean that other regions of the world are not seriously affected, of course they are. For example, in my own region, Latin America, HIV is the leading cause of death among women of reproductive age.

This of course, places tremendous demands on countries, on individuals, families, communities, countries and national organizations. How do we combat this crisis, how can we limit these conditions in some form or another? Of course, commodities play a key role in this.

As a point of clarification, when we speak of AIDS and commodities people tend to think only of condoms. Condoms are, of course, the principal commodity, but also we must speak of commodities involved in the treatment of sexually transmitted disease and infection and commodities involved in diagnostics.

This, of course, is within the total of reproductive health. As Dr. Obaid very accurately pointed out, this is not a separate issue. Everything is connected. It is connected and has a tremendous effect on the impact of poverty and any potential we may have or at least attempt can be extremely beneficial.

AIDS has effectively reduced the gains that have been made over the last couple of decades in many countries in terms of health and in terms of prolonging life. We've now reached a point where the commodities that are needed to prevent the continued spread of this infection are definitely needed and there must be high-level coordination at all levels of the society. We must bridge the gap between what is available and what is needed: not only what is needed in the provision of commodities, but what is needed in order to get the commodities used and to become aware of the risks of not using the commodities -- not using condoms.

The main form of infection today in the world -- I'm averaging -- is through sexual transmission, and the only existing products that we have available at the moment to prevent this are condoms. That does not mean condoms are the only form of prevention, of course not.

Condoms are used within the context of prevention. There are other forms of transmission possible between sexual partners. All of these forms are preventable, but condoms are necessary. So on that note, I'd like to get back to Timothy Wirth.