Submission by the International Planned Parenthood Federation (IPPF) for the OECD Development Strategy This submission argues why the OECD Development Strategy must recognize the centrality of sexual and reproductive health and rights (SRHR) to sustainable social and economic development and particularly to the well-being of women and young people in a changing world. 1. Recognizes that SRHR and gender equality are essential components of sustainable social and economic development; 2. Highlights the importance of adolescents and young people’s access to comprehensive sexuality education and SRH services in advancing a sustainable social and economic development agenda; and, 3. Supports policies and legal measures that will ensure universal access to reproductive health. Human rights and sustainable social and economic development both aim to promote well-being and freedom based on the inherent dignity and equality of all people. The 1960 OECD convention states that signatories will effectively use their capacities and potentialities so as to promote the highest sustainable growth of their economies and improve the economic and social well-being of their peoples. SRHR is at the core of this. Social development contributes to sustainable and equitable economic growth and the well being of individuals and countries. Without giving individuals, particularly women and girls, the means to protect themselves from STIs, to determine their own family size and exercise their rights, regardless of gender, their ability to engage in society, socially, politically and economically is compromised. In a rapidly changing world which poses new challenges, such as political instability, rising unemployment and economic recession access to SRH services including voluntary family planning will better equip and empower individuals and communities to adapt to a rapidly changing world. IPPF therefore specifically urges the OECD Strategy on Development to: 1. Recognize that SRHR and gender equality are essential components of sustainable social and economic development; 2. Highlight the importance of adolescents and young people’s access to comprehensive sexuality education and SRH services in advancing a sustainable social and economic development agenda; and, 3. Support policies and financing measures that will ensure universal access to reproductive health. 1. Recognize that sexual and reproductive health and rights and gender equality are essential components of sustainable social and economic development The Convention on the Organization for Economic Co-operation and Development, article 1 states that the OECD should aim to promote policies designed: to achieve the highest sustainable economic growth and employment and a rising standard of living in Member countries, while maintaining financial stability, and thus to contribute to the development of the world economy. Access to SRHR information and services is critical to breaking the cycle of poverty and ensuring that individuals can contribute to achieving this. Addressing women’s reproductive health and rights positively impacts on gender equality, population growth, and economic development. Giving women the means to decide their own family size and protect themselves from STIs will enhance their capacities to accrue economic endowments such as good health and education, the agency to act on these endowments and Page 1 of 6
can take advantage of economic opportunity. Yet the lack of priority accorded to comprehensive sexual and reproductive health continues to perpetuate the inter-generational cycle of poverty and exacerbate gender inequality. Some 215 million women still have an unmet need for safe and effective family planning and are unable to meet this need because they are denied the right to choose the number, timing and spacing of their pregnancies, lack access to the relevant information and services, or the support of their partners and communities. Ninety nine per cent of this maternal mortality and morbidity occurs in developing countries where resources and priority for gender equality and sexual and reproductive health services is lacking. The dynamics between fertility and reproductive health, health, education and economic potential are powerful. In 2008, an estimated 358,000 women died due to complications developed during pregnancy and childbirth and for every woman who dies a further 20 more suffer injury, infection or disability - approximately seven million women every year.i The impact of this mortality on families is devastating. Evidence from Indonesia indicates that maternal orphans have poorer educational and nutritional outcomes than those from chronically poor familiesii. Their ability to accrue economic endowments and take advantage of economic opportunity is impacted by the poor SRH of their mother. In turn there is evidence which indicates that secondary school has a more consistent and stronger effect on delay of childbearing, increased use of contraception, desire for fewer children, and actual reduced fertilityiii. Giving women the freedom to engage in economic and social development in those critical early years increases their engagement in economic activity. The economic participation of women—their presence in the workforce in quantitative terms—is important not only for lowering the disproportionate levels of poverty among women, but also as an important step toward raising household income and encouraging economic development in countries as a wholeiv. By lowering total fertility rates, through increased uptake of family planning, we can reduce the dependency ratios between generations and increase the proportion of working-age people in the population. v Known as a demographic dividend, this population structure creates an opportunity for countries with good governance to increase investments in the economic, social and infrastructure sectors. In particular, investments made in health and education combined with female emancipation can help create a virtuous cycle where families with fewer children invest more in the education of their daughters, which in turn creates further economic growth opportunities through greater female participation in the workforce, and more gender-responsive policies as women are better represented in parliament. An emphasis on women’s sexual and reproductive health problems is essential to their economic engagement given that these morbidities account for 32 per cent of the global disease burden among women of reproductive age.vi 2. Highlights the importance of adolescents and young people’s access to comprehensive sexuality education and access to SRH services in advancing a sustainable social and economic development agenda Today, the world has the largest generation of young people in history with the least developed countries having particularly large and rapidly expanding youth populations - sub-Saharan Africa is for example, the “youngest” region in the world with 28 per cent of the population ranging between 12 and 24 years of age.vii As young people enter working age, they can significantly contribute to sustainable development. However, they can only do so provided that they benefit from good health and adequate education and meaningful employment. While everyone has important contributions to make to society, the rights, needs and contributions of young women and girls must be prioritized so as to improve health outcomes Page 2 of 6
and accelerate sustainable development. Yet many young women have only limited opportunities for contributing to their own well-being or to society as they are often denied the right to secondary education and essential health services, including sexual and reproductive health services. Young people account for a disproportionate burden of sexual and reproductive ill health because society continues to deny their needs. In sub Saharan Africa young women aged 15-24 are eight times more likely than their male counterparts to be HIV positive.viii This is not only a denial of their individual human rights but also makes it increasingly difficult for many countries to eliminate poverty and achieve the internationally agreed development goals, including the Millennium Development Goals (MDGs). Empowering young people in this way is critical to achieving their individual development and well-being, and human rights for all. Yet young people remain largely invisible in internationally-agreed development frameworks. As a result, their needs and the realities of their lives are largely ignored. This results in the perpetuation of a cycle of poverty from which it difficult to escape. It is vital, therefore, that any sustainable social and economic development policy takes into account the need and rights of young people to accrue economic endowments and utilize them to become economically, socially and politically active adults. Comprehensive Sexuality Educationix (CSE) helps young people develop awareness about their sexual and reproductive health and rights strengthen critical thinking skills, acquire the ability to develop healthy relationships and negotiate safer sexual practices, including whether and when to engage in sexual intercourse. However, many young people around the world lack access to CSE, which prevents them from being equipped with the knowledge, attitudes and life skills required to make informed evidence-based decisions. As is known, more and more young women and couples of
reproductive age are choosing to have fewer children than the previous generationx, but are unable to fulfill these desires because of their lack of access to sexual and reproductive health services, information or education. This in turn compromises their accrual of economic assets, economic opportunity and capacity for agency. Investing in education, including comprehensive sexuality education, plays a major role in addressing these concerns along with targeted investment in the provision of and access to sexual and reproductive health supplies, services and information. Nearly 13 million adolescent girls give birth each year in developing countries, most often before they are physically, emotionally or financially prepared to soxi. As a result pregnancy is the primary cause of death among teenage girls in developing countriesxii. This is not just a major health issue that puts significant pressure on health systems, but also affects girl’s ability to engage in economic activity. Denying 52 over cent of a countries population this right reduces the levels of innovation and wealth generation, critical to economic growth, by half. 3. Support policies and financing that will ensure universal access to reproductive health. The Millennium Development Goals (MDGs) serve as the current framework for sustainable social and economic development, setting social equity goals and targets that contribute to economic development.xiii. There is recognition that the MDGs are off track, particularly in Africa and especially MDG5 – to reduce the maternal mortality ratio by two thirds. Lack of political priority for SRH has undermined progress towards achieving all of the MDGs. Giving young women and girls at the start of their reproductive life, access to SRH information and services enables them to space births and lower fertility rates. This leads to a reduction in income poverty and improved child nutrition and health outcomes. Maternal causes are the leading cause of death amongst young women and girls, and this maternal mortality and morbidity accounts for 16 per cent of all DALYs lost among women aged 15-29 in developing countriesxiv. Reducing this burden of mortality and morbidity in young women and girls increases their capacity to participate in educational, social, economic and political life, and improve gender equality and the role of women in society. Empowered young women with more Page 3 of 6
economic and educational choices are more likely to break the intergenerational cycle of poverty currently perpetuated by reproductive ill-health and the low status of women. Unplanned pregnancies, their own, or having to take care of younger siblings is a significant reason why many young girls are forced to leave school before completing their education. This reduces critical economic endowments, and without having asset accumulation they are less likely to recover. Young women and girls are eight times more likely than their male counterparts to be HIV positivexv. Linking SRH and HIV/AIDS programmes increases effectiveness, coverage and efficiency of service delivery and reduces HIV prevalence. This increased access to health services for young women and girls increases their usage and reduces the prevalence of Malaria and other diseases. Enabling young women and girls to space and plan births results in a lower fertility rate, placing less pressure on water and sanitation and other public services, particularly in slum settings. By 2030 5 billion people are expected to live in urban settings. Measures to reduce the impact on services such as water and sanitation are critical to prevent environmental degradation and ill health related to poor quality living conditionsxvi. Currently 80 per cent of the world’s poor reside in middle income countries. To ensure that they are able to participate in and benefit from future economic growth a more nuanced approach to poverty reduction is required to ensure that societies are lifted out of poverty and able to participate in growth generation. Poverty is multi dimensional; an approach to address the multiple dimensions of poverty with SRH at its centre is required. Economic growth is critical to lifting individuals out of poverty, and labour is the most critical asset an individual has to safe guard against poverty. Poor SRH denies young women and girls the opportunity to accrue economic asset and endowments which enable their participation in the labour market. 83% of women aged 15-19 in Sub Saharan Africa live in low income countries. With access to SRH information, services and measures to promote gender equality they could be the future innovators, political leaders and generators of wealth. Low fertility and a large population of people of employment age will contribute to sustained and rapid economic growth, and increased income per capita. The needs of the poorest and the most vulnerable, particularly young women and girls, must be addressed through social protection interventions to protect them from crisis and to ensure that they can still develop economic endowments such as health and education in those critical early years. Making SRH services central to these interventions, such as inclusion in National Health Insurance Schemes will give young women the means to delay pregnancy and protect themselves from STIs, thereby accelerating social and economic mobility, particularly for young people. These will ensure that the poorest are not excluded from social, economic and political participation when they become adults. The structural causes of poverty should also be addressed through social transformation. Protecting the rights of young women and girls and reducing the gender inequalities by increasing educational opportunities, improving access to SRH information and services, supporting legislation that protects women’s ownership of property and land and increases political participation will increase their capacity to fully participate in the human and economic development of their societies. This will help break the cycle of intergenerational poverty and ensure that future generation participates fully in the sustained social and economic growth of their country. The OECD and the forthcoming Strategy on development has a critical role to play in this. The current turbulence in financial markets offers opportunities to re visit what growth means and ensure that economic growth is equitable, reaching all sectors of society, particularly vulnerable Page 4 of 6
and underserved populations. It also offers opportunities to clearly define inclusive growth and ensure it is inclusive of all, and meets the needs of the most marginalised and underserved groups. The OECD has played an important role in monitoring the implementation of the principles of the Paris Declaration. The global economic crisis will significantly impact the volume and structures of aid. To ensure that the volume of development assistance will continue to be adequate new and innovative ways of generating resources are required. Whether this means increased taxes such as the Financial Transaction Tax, increased involvement of the private sector or tax generation at developing country level the OECD has a part to play. To ensure that often under resources issues such as SRH are adequately resourced through aid and other revenue sources. Between 2000 and 2008, funding from Official Development Assistance (ODA) for family planning declined from 8.2% to 3.2 % meaning there are now less resources to fund reproductive and maternal health programmes than in the year 2000. xvii Protecting the principles of the Paris Declaration particularly country ownership and mutual accountability, recognizing the role of civil society in policy development and as a watchdog for implementation and results.
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i
The World Health Report 2005: Make every mother and child count. World Health Organization, Geneva 2005. http://www.who.int/whr/2005/whr2005_en.pdf ii Suryaddarma, D et al (2009) “The effects of parental death and chronic poverty on children’s education and health: evidence from Indonesia”. Chronic Poverty Research Centre Working Paper No 133 [http://www.dfid.gov.uk/r4d/PDF/Outputs/ChronicPoverty_RC/133-Suryadama-Pakpahan-Suryahadi.pdf] accessed 20 November 2011 iii Ian Diamond et al., “Female Education and Fertility: Examining the Links,” in Critical Perspectives on Schooling and Fertility in the Developing World, ed. Caroline H. Bledsoe et al. (Washington DC: National Academies Press, 1999): 23-45. iv World Economic Forum (2005)” Women’s empowerment: measuring the gender gap” [https://members.weforum.org/pdf/Global_Competitiveness_Reports/Reports/gender_gap.pdf] accessed 20 November 2011 v World Bank: Health Nutrition Population: Discussion Paper, Population Issues in the 21st Century. vi Paul Hunt, Judith Bueno De Mesuita, (January 2008), Human Rights Centre, University of Essex, International Assistance and Cooperation in Sexual and Reproductive Health: A Human Rights Responsibility for Donors. vii The World Bank (2008) Youth in Africa’s Labor Market: 25 viii Joint United Nations Programme on HIV/AIDS (2010) UNAIDS Report on the Global AIDS Epidemic 2010. Geneva: UNAIDS. P10. ix Comprehensive sexuality education is “Education about sexuality and its expressions. It seeks to equip young people with the knowledge, skills, positive attitudes and values they need to determine and enjoy their sexuality – physically, individually and emotionally. Topics include relationships, love and emotions, individual and societal attitudes towards sexuality, sexual roles, gender relations, social pressures, sexual and reproductive rights, information about sexual and reproductive health, services and communication skills training.” IPPF, Glossary 2011 available at: http://www.ippf.org/NR/rdonlyres/5603D072DA1B-4D86-8CDE-C3028BFE1896/0/IPPFGlossary.pdf x Zlotnik, H (2009) Does population matter for climate change? UNFPA Experts Meeting on Climate Change. Population Division, DESA. xi UNFPA, State of World Population 2003: Investing in Adolescents’ Health and Rights, New York, 2003. xii WHO: http://www.who.int/mediacentre/factsheets/fs334/en/index.html [accessed 2 September 2011] xiii UNDP, Sustainable development and the MDGs, http://www.undp.org/fssd/crosscutting/sustdevmdg.html xiv Guttmacher Institute, IPPF, (2010) Facts on the SRH of Adolescent Women in the Developing World. New York xv Joint UN Programme on HIV/AIDS, (2010) UNAIDS Report on the Global AIDS Pandemic 2010. Geneva xvi UNFPA, Linking Population poverty and Development: Urbanization a majority in cities [http://www.unfpa.org/pds/urbanization.htm] Accessed 29 August 2011 xvii United Nations Department for Public Information, DPI/2650 E/Rev.1 - September 2010, see: http://www.un.org/millenniumgoals/pdf/MDG_FS_5_EN_new.pdf