An Urgent Appropriations Request to Save Young Women’s Lives

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Today, more than 1.2 billion people are ages 10 to 19, and 88 percent of these adolescents live in low- and middle-income countries.[1] Furthermore, nearly half of all people living in the world today are under the age of 25, making this the largest generation of young people in history.[2] Their reproductive and sexual health will affect the health and well-being of this planet now and for decades to come.

For young women ages 15 to 19 in low- and middle-income countries, complications from pregnancy are the leading cause of death.[3] High rates of maternal mortality and morbidity among young women in these countries are fueled by too early marriage and childbearing, unplanned and/or unwanted pregnancy, lack of access to pre- and post-natal care and complications from unsafe abortion.

U.S. Funds are urgently needed to Increase Youth Access to Sexual Health Services

An appropriation of one billion dollars per year for international family planning and reproductive health programs is needed to increase young people’s access to family planning services and supplies and provide them with the tools they need to delay too early childbearing, avoid unplanned pregnancy, and safely space their children. Increased access to family planning would also greatly diminish young women’s need to resort to unsafe abortion and in turn, significantly reduce rates of adolescent maternal mortality.

Moreover, funding international family planning and reproductive health at levels of need is cost effective. For every dollar spent on international family planning efforts, governments save up to $31 in health care, water, education, housing, and other costs.[4] With resources extremely limited, funding must be targeted at programs that achieve significant results. Not only are the benefits of family planning investments well-recognized, they also complement other areas of U.S. development assistance. Shortchanging these investments could seriously undermine achievement of the broader international development agenda as access to international family planning not only influences the size and spacing of families; it also affects levels of educational attainment; poverty; health outcomes for women, children, and communities; gender equity; and environmental sustainability.

This is why, in July 2012, world leaders at the London Summit on Family Planning pledged $2.6 billion in donor funding for international family planning. These commitments build not only upon the development framework laid out through the International Conference on Population and Development (ICPD), Beijing+20, and the Sustainable Development Goals, but also the United States’ leadership as the largest bilateral donor of international family planning funds.

Furthermore, leading international health experts recognize the critical importance of addressing adolescent pregnancy. The World Health Organization recognizes there is an urgent need for programs that address the health and safety of pregnant adolescents and that teach young women the skills to build a successful future.[5] In addition, the U.S. Agency for International Development (USAID) identifies critical factors for improving adolescent maternal health, including access to contraception.[6]

THE U.S. Contribution Has Not Kept Pace with Inflation and Population GROWTH

Since the 1960s, the United States has been a global leader in the provision of international family planning and reproductive health assistance, providing contraceptives, STI testing, antenatal and postnatal care, counseling, technical assistance, and other reproductive health services to countries throughout the world. Over the past four decades, this long-term investment in high-quality family planning programs has yielded significantly greater access to family planning and reproductive health services for women, men, and youth. This access has, in turn, provided many young women with the means to better plan their lives and their families.

Unfortunately, international family planning and reproductive health appropriations have not kept pace with inflation or with the growing size of the global adolescent population. Since 1995, U.S. financial assistance for international family planning and reproductive health has declined by more than 30 percent when adjusted for inflation. At the same time, the global adolescent population has grown exponentially, and is projected to continue growing over the next three decades. An increase in U.S. appropriations for international family planning would go a long way to meeting the increased need among young people and in helping them to improve their lives and the lives of their families and communities.

Background

Globally, maternal mortality has steadily decreased over the last two decades: there were an estimated 287,000 maternal deaths worldwide in 2010, a decline of 47 percent from 1990.[7] Yet low- and middle-income countries continue to suffer from vastly disproportionate rates: sub-Saharan Africa and Southern Asia accounted for 85 percent of the global burden of maternal deaths in 2010.[8] Two countries, India and Nigeria, account for a third of global maternal deaths.[9] In fact, in low- and middle-income countries, complications from pregnancy are the leading cause of death for young women ages 15 through 19.[10] On average, 13 percent of all maternal deaths are due to unsafe abortion, but in some regions the number rises as high as 18 percent.[11] In 2008, women in developing countries had approximately 21 million unsafe abortions, compared to 360,000 in developed countries.[12] Approximately three million adolescents aged 15-19 receive unsafe abortions annually.[13] This dire picture of what amounts to an unnoticed pandemic of maternal death and morbidity underscores how societies have failed women, especially young women, and their partners.

Current contraceptive use averts 272,000 maternal deaths worldwide every year, and experts estimate that satisfying the global unmet need for contraception could reduce maternal deaths by an additional 30 percent.[14] Further, studies show that when contraceptive use increases, fertility rates and subsequently infant mortality rates decline.[15] There is an urgent need to increase international family planning and reproductive health funds to ensure that young women and their partners have access to contraceptive supplies and services to help them delay too early childbearing and to better plan and space their families, thereby reducing maternal mortality and morbidity and the number of unsafe abortions.

Why is One Billion Dollars for INTERNATIONAL Family Planning and reproductive heaLth programs Important for Youth?

• As population has increased dramatically over time, international family planning funding has not kept pace. Despite recent increases, since 1995, international family planning funds have declined almost 30 percent when adjusted for inflation. At the same time, approximately 3 billion members of the world’s population are under the age of 25 and are entering reproductive age. More funding—particularly investment in young people’s sexual and reproductive health—can create a pathway for accelerated development.[16]  

• Worldwide, there is still a tremendous unmet need for family planning, especially among young people. Current efforts to provide family planning services are not enough — over 222 million women wish to delay or prevent pregnancy, but are not using modern effective contraception.[17] Furthermore, young people have consistently higher levels of unmet need for family planning than adults.[18]
• Adolescent girls are much more likely to die during pregnancy and childbirth than older women. An estimated 16 million adolescents between 15 and 19 give birth each year, about 95 percent of which occur in low- and middle-income countries.[19] In the poorest regions of the world, one in three girls gives birth by the age of 18.[20]Adolescents age 15 through 19 are twice as likely to die during pregnancy or childbirth as those over age 20; girls under age 15 are five times more likely to die.[21][22]
• Unmet need for family planning results in millions of unintended pregnancies each year. In low- and middle-income countries, lack of access to family planning results in some 80 million unintended pregnancies each year.[23] In fact, the root cause of most abortions is a pregnancy for which the woman or the couple did not plan, or believed would not occur.[24]
• Unsafe abortion puts young mothers at greater risk where adequate family planning services could protect them. Unsafe abortions are a leading cause of maternal mortality. Each year approximately 3 million young women in low- and middle-income countries undergo unsafe abortion in order to terminate an unintended pregnancy.[25] Pregnant adolescents are more likely to have an unsafe abortion than adults and less likely to obtain skilled care.[26] Unsafe abortion can have devastating consequences, including cervical tearing, perforated uterus, hemorrhage, chronic pelvic infection, infertility, and death.[27]
• Newborns are dying because their mothers are too young to give birth. Every year, over three million newborns die within the first month of life.[28] In fact, stillbirths and newborn deaths are 50 percent higher among infants born to adolescent mothers than among infants born to mothers aged 20-29.[29] Two of the contributing factors to this disproportionate newborn and infant mortality rate are the higher risk of premature delivery among adolescent girls and the higher likelihood of obstructed labor due to adolescent mothers’ bodies not being fully developed and ready for childbirth.[30]

What Would One Billion Dollars FOR INTERNATIONAL FAMILY PLANNING AND REPRODUCTIVE HEALTH PROGRAMS Accomplish for Young People?

Because young people make up a significant proportion of those of reproductive age, a one billion dollar investment in international family planning and reproductive health assistance would reach a significant amount of young people.

• Maternal and infant deaths would be dramatically reduced. If all women who currently have an unmet need for modern contraceptives were given access to such methods, 79,000 maternal and 1.1 million infant lives would be saved, as more women and men would have greater agency in planning their pregnancies and caring for their children.[31]
• Reductions in unintended pregnancies for young women would significantly reduce abortions. If funding levels rose to meet the need for modern contraceptive methods, the world would see an estimated 54 million fewer unintended pregnancies and 26 million fewer abortions per year, 16 million of which would be unsafe.[32] Millions of young women who undergo unsafe abortions every year would not have to risk their lives.
• Sufficient funding would increase the awareness, acceptability, and use of contraceptives among youth. One billion dollars for international family planning and reproductive health programs would result in an estimated 52 million more women and couples receiving contraceptive services and supplies.[33] Considering the amount of young people accessing this information, this would help create a culture among youth in which contraceptives are accepted and used.

• Family planning funding is about more than just improving access to contraception. USAID utilizes international family planning funds to work towards a multitude of ends including: responding to the unique sexual and reproductive health needs of young people; promoting gender equity; addressing harmful traditional practices such as female genital cutting and early marriage; and preventing and treating obstetric fistula, among many others.[34]

Written by Brian Ackerman, Nicole Cheetham, and Debra Hauser, 2008. Updated by Janine Kossen, 2010, and Richael O’Hagan, 2013.

References

[1] UNFPA (2011). The World at 7 Billion. New York: United Nations Population Fund, http://www.unfpa.org/webdav/site/global/shared/documents/7%20Billion/7B_fact_sheets_en.pdf, accessed April 9, 2013.

[2] Ibid.

[3] World Health Organization (WHO) (2012). Early marriages, adolescent and young pregnancies: Report by the Secretariat. Geneva: World Health Organization, http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_13-en.pdf, accessed April 9, 2013.

[4] UNFPA (2008). Family Planning and Poverty Reduction Benefits for Families and Nations. New York: United Nations Population Fund, http://www.unfpa.org/rh/planning/mediakit/docs/sheet4.pdf, accessed April 9, 2013.

[5] WHO (2012). Early marriages, adolescent and young pregnancies: Report by the Secretariat. Geneva: World Health Organization.

[6] USAID (2009). “Technical Areas: Adolescent Maternal Health”. Washington, DC: United States Agency for International Development. http://transition.usaid.gov/our_work/global_health/mch/mh/techareas/adolescent.html, accessed April 9, 2013.

[7] WHO (2012). Trends in Maternal Mortality: 1990 to 2010. Geneva: World Health Organization, http://whqlibdoc.who.int/publications/2012/9789241503631_eng.pdf, accessed April 9, 2013.

[8] Ibid.

[9] Ibid.

[10] WHO (2012). Early marriages, adolescent and young pregnancies: Report by the Secretariat. Geneva: World Health Organization.

[11] WHO (2011). Unsafe Abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. Geneva: World Health Organization, http://whqlibdoc.who.int/publications/2011/9789241501118_eng.pdf accessed April 9, 2013.

[12] Ibid.

[13] WHO (2012). “Adolescent Pregnancy Factsheet,” http://www.who.int/mediacentre/factsheets/fs364/en/, accessed April 9, 2013.

[14] Ahmed, S., Qingfeng, L., Liu, L., & Tsui, A.O. (2012). Maternal deaths averted by contraceptive use: an analysis of 172 countries. The Lancet, 380(9837), 111-125. doi: 10.1016/S0140-6736(12)60478-4.

[15] Guttmacher Institute. Family Planning Can Reduce High Infant Mortality Levels [Issues in Brief, 2002, no. 2] New York: Alan Guttmacher Institute, http://www.guttmacher.org/pubs/ib_2-02.html, accessed August 30, 2010.

[16] UNFPA (2011). The World at 7 Billion. New York: United Nations Population Fund.

[17] Singh, S. & Darroch, J.E. (2012). Adding it Up: Costs and Benefits of Contraceptive Services Estimates for 2012. New York: Guttmacher Institute and United Nations Population Fund. http://www.guttmacher.org/pubs/AIU-2012-estimates.pdf, accessed April 9, 2013.

[18] Pathfinder International (2011). Promoting the Sexual and Reproductive Rights and Health of Adolescents and Youth: Building on the Global Health Initiative Country Strategies and Supplemental Guidance on the Women, Girls, and Gender Equality Principle, http://www.pathfinder.org/publications-tools/pdfs/Promoting-the-sexual-and-reproductive-rights-and-health-of-Adolescents-and-Youth.pdf, accessed April 9, 2013.

[19] WHO (2012). “Adolescent Pregnancy Factsheet.”

[20] Ibid.

[21] UNFPA (2012). State of World Population, 2012; http://www.unfpa.org/webdav/site/global/shared/swp/2012/EN_SWOP2012_Report.pdf, accessed April 17, 2013.

[22] WHO & UNFPA. Pregnant Adolescents. Geneva: WHO, 2006.

[23] Singh, S. & Darroch, J.E. (2012). Adding it Up: Costs and Benefits of Contraceptive Services Estimates for 2012. New York: Guttmacher Institute and United Nations Population Fund.

[24] WHO (2011). Unsafe Abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008.

[25] WHO (2012). “Adolescent Pregnancy Factsheet.”

[26] Ibid.

[27] WHO (2011). Unsafe Abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008.

[28] WHO (2011). “Newborn Death and Illness”. http://www.who.int/pmnch/media/press_materials/fs/fs_newborndealth_illness/en/, accessed April 10, 2013.

[29] WHO (2012). “Adolescent Pregnancy Factsheet.”

[30] UNFPA (2005). State of World Population 2005: The Promise of Equality. New York: United Nations Population Fund. http://www.unfpa.org/public/home/publications/pid/1343, accessed April 10, 2013.

[31] Singh, S. & Darroch, J.E. (2012). Adding it Up: Costs and Benefits of Contraceptive Services Estimates for 2012. New York: Guttmacher Institute and United Nations Population Fund.

[32] Ibid.

[33] Guttmacher Institute (2012). Just the Numbers: The Impact of U.S. International Family Planning Assistance. http://www.guttmacher.org/media/resources/FB-Family-Planning-Assistance.pdf, accessed April 11, 2013./p>

[34] USAID. Fast Facts: Family Planning. Washington, DC: United States Agency for International Development. http://transition.usaid.gov/our_work/global_health/pop/news/issue_briefs/fp_fastfacts.pdf, accessed April 9, 2013.