Table of Contents
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The Education Gender Gap
Worldwide, more boys attend secondary school than girls, but girls are catching up in many places. The largest gaps in 2000-01 were in eastern and western Africa and south-central and south-eastern Asia . Togo charted the largest gap: just 24 percent of girls are enrolled in secondary school, compared to 54 percent of boys.

Secondary school enrolment is in some cases extremely low for both sexes. In Cambodia , for example, it is 24 percent for boys and 13 percent for girls. In Tanzania and Rwanda , secondary enrolment rates are almost identical for boys and girls, but both are at less than 15 percent.

Note: Some countries may show rates over 100 percent because young people outside the ordinary age for secondary school are enrolled and factored into the total gross enrolment rate. They are not considered part of the potential student population.

Graph source: UNESCO Institute for Statistics. 2003. Global Education Digest 2003: Comparing Education Statistics Across the World. Montreal , Canada : UIS.
Tracking domestic violence
In all societies, to a greater or lesser degree, women and girls are subjected to physical, sexual and psychological abuse that cuts across lines of income, class and culture. . . . Violence against women both violates and impairs or nullifies the enjoyment by women of their human rights and fundamental freedoms.

•  Beijing Declaration and Platform for Action, paragraph 112

Unfortunately, national data on measures of gender violence are scarce. Studies also lack consistency, with varying sample sizes, definitions of violence and ages of women surveyed. Comparisons among countries are therefore all but impossible. A World Health Organization multi-country study in November 2004 is addressing these issues. Much more research and survey work in this area is critical for understanding the conditions under which women live and for improving their control over their lives.
After an abortion
Most data on postabortion care (PAC) relates to individual programs funded by NGOs or foreign donors, so the data do not always reflect a country's national policies or programmes. But even information on a country's PAC policy does not reveal the true accessibility of PAC services and counselling because of lags in enforcement and implementation. Further, most developed countries do not have national PAC policies because such services are already integrated into routine medical care, both public and private.
Where Are We Now?
Meeting Health Needs

Promoting women's health and safe motherhood is a key objective of the ICPD Programme of Action—and increasing women's access to safe, affordable and effective reproductive health care and services is critical. These include family planning information and contraceptives, skilled care at childbirth, safe abortion services in countries where abortion is legal, and HIV/STI prevention, treatment and management.


Family planning is up
Access to contraceptives has improved significantly in the past decade. But in the developing world and former Soviet states, around 123 million couples, or one in six, have an unmet need for effective methods of contraception. Young women 15 to 24 account for one-third of this unmet need.1

The overall proportion of couples in the developing world with unmet need for contraception is declining, and contraceptive use is increasing. Of the countries for which data are available, the greatest annual increases in contraceptive use—10 to 25 percent—were recorded in sub-Saharan Africa and Latin America .

Worldwide, female sterilisation is the most common contraceptive method, followed by the intrauterine device (IUD), the contraceptive pill and traditional methods. Modern male methods—condoms and vasectomy—are the least favoured, with just 5 percent of couples using them. This reflects the massive disparity between female and male use of contraception.


Supplies are short
Throughout the world, millions of people of reproductive age still lack protection from unplanned pregnancy, HIV/AIDS and other STIs. Many clinics still experience “stock-outs”—zero supplies of contraceptives, safe motherhood kits or other reproductive health essentials. The shortfall is acute and growing.

One major obstacle is funding: developing countries and their citizens often cannot afford these supplies, and donor countries and agencies consistently provide much less support than is needed. By 2015, the gap between the need and the funding is projected to reach hundreds of millions of dollars annually. In addition, logistical management failures and poor donor coordination make the shortages worse.2


Too many mothers are dying
Only marginal progress has been made worldwide in saving mothers' lives. Each year, more than 525,000 women worldwide die from complications of pregnancy or delivery, almost all in the developing world—one per minute. When mothers die in childbirth, a significantly lower proportion of newborns survive to their first birthday.

Adequate care during pregnancy, labour and delivery, including access to essential obstetric care services, is an effective way to prevent most perinatal, infant and maternal deaths and disabilities, and to improve overall mother and child health.

Of the countries with data, almost half recorded at least a 1 percent annual increase in the percentage of births with a skilled attendant present. Indonesia , Bolivia , Nepal , Egypt , Togo , Yemen , Morocco , Guinea-Bissau and China made the greatest strides, improving by an average of 6 to 11 percent annually.

But in the least developed countries, less than one-third of births are attended by skilled personnel.3 Fully one-quarter of mothers in the developing world received no antenatal care whatsoever from skilled personnel during their most recent pregnancy.4

Protecting the health of the mother is critical to the health of the baby. Most countries' infant mortality rates have plummeted after three decades of improvement in vaccination rates, nutritional status, health service use, environmental health conditions and socioeconomic status. But the trend has slowed in some places, especially in countries in sub-Saharan Africa , and in some cases it has reversed. This may be due to high rates of HIV infection among parents, the increasing resistance of malaria to drug treatment, and slowing progress in the child health, environmental and economic factors mentioned.5


Abortion remains unsafe
The past decade has seen a general liberalisation of abortion laws. Yet one in every 10 pregnancies still ends in unsafe abortion—about 19 million each year.6

Since 1994, 12 countries have relaxed legal restrictions on abortion, and most countries allow abortion in instances beyond saving the life of the mother. But in some countries women continue to face difficulties obtaining safe and legal abortion services, in part because laws are not enforced or are misinterpreted.

Unsafe abortion remains a major public health concern—and is almost entirely preventable. A woman dies every seven minutes—nearly 70,000 each year—from an unsafe abortion, and hundreds of thousands more suffer chronic damage to their health.7 The causes are lack of family planning and safe abortion services, and lack of emergency obstetric care. In Africa , one in every 150 abortions leads to death, compared to one in every 85,000 procedures in the developed world.

Evidence from a dozen countries in Central Asia and Eastern Europe shows that an increase in contraceptive use, especially modern contraceptives, leads to a decline in abortion rates. In Kazakhstan , for example, the rate of modern contraceptive use rose by 50 percent between 1991 and 1998, and abortions fell by the same rate during that period.

Legal and health system reform also lowers the incidence of unsafe abortion. Where abortion is legal, it should be safe and accessible.


Adolescence is not getting easier
Little progress has occurred since 1994 in reducing adolescent pregnancies—except where it is a political priority. These places recognised the need: half the world's 6.4 billion people are under age 25, and more than one billion are between age 10 and 19. This largest generation of young people ever requires reproductive health information and services to make responsible decisions and lead healthy lives.

The ICPD Programme of Action notes that early motherhood can deter young women from improving their educational, economic and social status. It recommends ways to reduce adolescent pregnancies and protect young people from unsafe abortion, sexually transmitted diseases and gender-based violence.

Average fertility levels among both married and unmarried adolescents have remained practically constant since 1994. However, in Ghana , where the government adopted a national Adolescent Reproductive Health Policy, and other places where reducing early childbearing has been a political priority, teen pregnancies have declined dramatically.

Teen birth rates are highest in the Democratic Republic of the Congo, Angola, Liberia, Niger, Somalia and Sierra Leone, where more than one in five girls age 15 to 19 gives birth each year. In the United Kingdom , only 1 in 40 teens give birth per year; in the United States , it is 1 in 19—the highest rate among industrialised countries.

HIV infection disproportionately affects young people, especially young women, who often become sexually involved with older infected males. In sub-Saharan Africa , girls age 15 to 24 are up to 2.5 times more likely to be infected with HIV than boys their age.8


HIV/AIDS is a continuing threat
The HIV/AIDS pandemic has exploded worldwide since 1994. While some countries have succeeded in limiting its spread, infection rates are rising in others where it had not been prevalent.

In 2003, five million people became infected with HIV and another three million died of AIDS. Over 95 percent of these deaths and new infections occurred in the developing world.

Sub-Saharan Africa remains the epicentre of the pandemic, with more than two-thirds of all new infections and three-quarters of deaths in 2003. In Namibia, for example, AIDS-related illnesses accounted for more than half of all deaths in 2002.9 In some African countries, a third or more of adults are infected with HIV, and across the region, women account for 55 percent of all infected people. Yet the regional level of condom use is the lowest in the world, at just 1 percent of married couples.

Preventing the further spread of HIV will require a range of interventions, including barrier contraceptive methods. Social norms and behaviours, as well as physiological, economic and legal factors, make women especially vulnerable to HIV. Women need economic and social autonomy, inheritance and property rights, and legal support, as well as education, in order to better protect themselves.

> Next section: Where to go from here?
Notes

  1. John A. Ross and W.L. Winfrey, “Unmet Need for Contraception in the Developing World and the Former Soviet Union : An Updated Estimate”, International Family Planning Perspectives 28, no. 3: 138-143.

  2. The Supply Initiative, “Out of Stock: Supply Shortfalls Hurt Sexual and Reproductive Health”, Fact Report 2 (2003).

  3. World Health Organization (WHO), “Global, regional and sub-regional estimates of the proportion of births with skilled attendant”, Global Monitoring and Evaluation Database, 2004 estimates, http://www.who.int/reproductive-health/global_monitoring/ data_regions.html (accessed 29 April 2004 ), table 2.

  4. INFO Project, Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health, “New Survey Findings: The Reproductive Revolution Continues”, Population Reports Series M, no. 17: 1-2.

  5. S. Rutstein, “Factors Associated with Trends in Infant and Child Mortality in Developing Countries During the 1990s”, Bulletin of the World Health Organization 78, no. 10: 1256-1268.

  6. Unsafe abortion is defined by the World Health Organization as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both.

  7. The Alan Guttmacher Institute (AGI), Sharing Responsibility: Women, Society and Abortion Worldwide (New York: AGI, 1999).

  8. UNAIDS, AIDS Epidemic Update: December 2003 ( Geneva : Joint United Nations Programme on HIV/AIDS, 2003).

  9. “Namibia Rolls Out Third National AIDS Plan”, Integrated Regional Information Networks (IRIN), April 19, 2004 , quoted in AF-AIDS mailing list, April 22, 2004 , http://archives.hst.org.za/af-aids/msg01346.html.