An Urgent Appropriations Request to Save Young Women’s Lives

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Today, there are approximately 1.2 billion young people in the world and according to the United Nations Population Fund (UNFPA), more than 600 million adolescent girls, most of who are living in low- and middle-income countries. Although young women and adolescent girls comprise a large part of the population, not enough is being done to advance sexual and reproductive health and rights worldwide.

Young women face considerable challenges, including poverty; geographic and social isolation; harmful traditional practices, including child marriage and female genital cutting; gender-based violence; risk of unplanned pregnancies and HIV; and stigma and discrimination, including due to sexual orientation and gender identity. When combined, the affect that these factors have on the health and well-being of this planet now and for decades to come is unquestionable.

For young women ages 15 to 19 in low- and middle-income countries, complications from pregnancy and childbirth are the second leading cause of death. 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

A congressional appropriation of $1.5 billion bilateral and multilateral 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 each additional dollar spent on contraceptive services above the current level, the cost of pregnancy-related care would be reduced by $2.22. 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.

That’s 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 continued to build not only upon the global 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, international health experts recognize the critical importance of addressing adolescent pregnancy. The World Health Organization (WHO) underscored the 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 and improve their links to social networks and social supports. In addition, the U.S. Agency for International Development (USAID) identifies critical factors for improving adolescent maternal health, including access to contraception.

THE U.S. CONTRIBUTION HAS NOT KEPT PACE WITH INFLATION AND POPULATION GROWTH

Since the 1960s, the U.S. 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 young people. 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 is needed to meet 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. 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. Two countries, India and Nigeria, accounted for a third of global maternal deaths. In fact, in low- and middle-income countries, complications from pregnancy are the leading cause of death for young women ages 15 through 19. On average, between 4.7 percent and 13.2 percent of maternal deaths can be attributed to unsafe abortion, but in some regions the number rises as high as 18 percent. Around 25 million unsafe abortions were estimated to have taken place worldwide each year, almost all in developing countries. Among these, 8 million were performed in the least-safe or dangerous conditions, and the risk of dying from an unsafe abortion was the highest in sub-Saharan Africa. 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.

U.S. investments in family planning and reproductive health programs are cost-effective and deliver real results. In FY2017, the U.S. will invest $607.5 million in international family planning, which will have a real impact. For example, it would be possible for 25 million women and young people to receive contraceptive services; 7.4 million unintended pregnancies to be prevented; and 15,000 maternal deaths to be averted. Further, studies show that when contraceptive use increases, fertility rates and subsequently infant mortality rates decline. 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 1.5 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 when adjusted for inflation. At the same time, the world’s population of young people who are entering reproductive age is increasing. More U.S. funding—particularly investment in young people’s sexual and reproductive health—can create a pathway for accelerated development and positively impact their lives.
• 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 214 million women of reproductive age wish to delay or prevent pregnancy, but are not using modern effective contraception. This number includes 155 million who use no method of contraception and 59 million who rely on traditional methods. Furthermore, young people have consistently had higher levels of unmet need for family planning than adults.
• Adolescent girls are much more likely to die during pregnancy and childbirth than older women. An estimated 16 million adolescent girls between 15 and 19 and some one million girls give birth each year, most of who live in low- and middle-income countries. In the poorest regions of the world, one in three girls gives birth by the age of 18. In low- and middle-income countries, children born to young women under 20 years of age face a 50 percent higher risk of being still born or dying in the first few weeks versus those born to mothers aged 20-29.
• Unmet need for family planning results in millions of unintended pregnancies each year. Between 1981 and 2011, unintended pregnancy has become increasingly concentrated among poor and low-income women. In low- and middle-income countries, lack of access to family planning results in an estimated 80 million unintended pregnancies each year. 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.
• 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 millions of young women in low- and middle-income countries undergo unsafe abortion to terminate an unintended pregnancy. Pregnant adolescents are more likely to have an unsafe abortion than adults and less likely to obtain skilled care. Unsafe abortion can have devastating consequences, including cervical tearing, perforated uterus, hemorrhage, chronic pelvic infection, infertility, and death.
• 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. In fact, stillbirths and newborn deaths are higher among infants born to adolescent mothers than among infants born to mothers aged 20-29. 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.

WHAT WOULD 1.5 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 1.5-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, 15,000 maternal deaths would be averted, as more women and men would have greater agency in planning their pregnancies and caring for their children.
• 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. 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. An estimated $1.5 billion dollars for international family planning and reproductive health programs would result in an estimated 25 million more women and couples receiving contraceptive services and supplies. 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.

Written by Brian Ackerman, Nicole Cheetham, and Debra Hauser, 2008. Updated by Janine Kossen, 2010, Richael O’Hagan, 2013, and Preston Mitchum, 2017.