Washington, DC — Nearly 20 years ago, 179 countries came together and made a commitment to provide sexual and reproductive health care, including family planning, to their people. The consensus reached at the International Conference on Population and Development remains the guiding principle for the United Nations Population Fund (UNFPA).
Wednesday, the UNFPA released its newest report, By Choice, Not By Chance, which calls for a rights-based approach to ensuring all women and girls have access to family planning. Babatunde Osotimehin, the UNFPA's executive director, spoke to AllAfrica's Kylé Pienaar about the report's findings and about how he sees access to family planning as a liberating force for women and girls.
What are the most important findings or ideas in this new report?
The key message is that we have been able to demonstrate that when family planning is provided on a rights-based approach it makes a difference to the lives of women and girls around the world. So it's not just about child spacing, it's about the holistic development of their lives.
For example, young women who have an age-appropriate sexuality education and are able to make choices in their lives because they have access to services would be able to complete school. They would also be able to avoid unwanted pregnancy and also avoid infection or HIV. And in that sense, they would be able to actualize themselves and reach their full potential. The ability of a young woman to take that decision implies that when she reaches full potential she can be an active participant in the development of her community and her nation. And that liberating force is a major one.
With women who are in union (married), they can make choices about the number of children they want, the spacing they want in between them, and have just that number they can afford to provide for, house, feed, clothe and educate. It makes a lot of difference because at the end of the day that ensures that there is quality in their lives, for their children and themselves.
Those women also can take time and run their own economic activities, be able to start a business, be able to do other things outside of the house, so they are not bogged down looking after numerous children who are not well spaced. And I think that it also ensures that the cycle of poverty that we get with women who have too many children too close together, we can also eliminate that. The realization of self in both girls and women and their ability to participate in their community also positions them in a gender frame within community. It's about being able to exercise the right to make choices. Also it's an economic thing.
What needs to be addressed so women are empowered to make those choices? What are the main obstacles?
I think the first step, which is the most important, is the issue of access. Two hundred twenty-two million women in the developing world today want family planning and they're not getting it. That's huge. So the issue of access is not just about access to services themselves. It is the physical access to a provider. It's also about information. So many of them don't have the information so they don't have the enabling environment to make their choice. Many of them even if they have information they have access that sometimes they cannot afford.
It's also about resources. There's a supply side and a demand side to it and I think that is huge, because we have found that when we do provide reproductive health services in the developing world, the uptake is huge. People come and have it. That's something that we need to continue to push: provide access, provide education, provide information to make sure that the individual girl or woman can afford the services. That is one.
The second is about gender-power relations in some communities in terms of the ability of the woman to make that choice without being obstructed by societal norms or community norms or what happens within the microenvironment of her home. That is also is something we have been able to overcome in many parts of the world.
How have you been able to overcome that?
I want to believe that UNFPA has engaged men, men as partners and men in various situations to enable them to understand the benefits of family planning and what it means to the lives of their wives, of their daughters in terms of not only the health outcomes but also the economic outcomes, and also the liberating effect of being able to exercise the right to choose.
UNFPA says it takes a culturally sensitive approach to work. How do you balance reproductive rights with religious liberty?
We work in about 150 countries around the world. We work with stakeholders on the ground so we first seek to have a community dialogue, understand what the issues are and use that to provide information and education and correct some misinformation. It's just being culturally sensitive and understanding what the mores in those communities are. But at the end of the day what is most important to us is the ability to empower women to make those choices freely and without coercion, and I think that is the major focus we continue to pursue.
Family planning is often discussed in the context of marriage and child spacing. The report says there should be more focus on young and unmarried people. How do you shift this focus?
I think again it's about engaging communities. We are encouraging particularly young girls to stay in school until they are 18, sometimes into their early 20s. The reality that we face all the time is the fact that within that period of time, they will have sex. Our ability to educate everybody about that reality and to tell the community that we can empower young people by comprehensive sexuality education - to understand what the risks are and enable them to make the right choices in their lives - that really for me is the starting point. And to then go to offer services subsequent to that.
I think the most important is empowering them with education and ensuring that they understand that these are vulnerabilities they are exposed to and they can get pregnant when they don't want to. They can also contract HIV and other sexually transmitted infections when they don't want to - that's how we teach it.
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Could you address the future of funding for increased access to family planning services?
Our hope is to work with all governments around the world to acknowledge that budgets must be made available for contraception and family planning on a continuous basis. It is an essential part of providing services to the women and girls in their society. I think that is going down well because at the family planning summit in London we had program countries actually commit to about two billion dollars of new investments into family planning. That's huge. That in itself is a testimony to the fact that they understand this is something they have to take on. And we at UNFPA have been advocating with various governments and succeeded in getting them to put this in the budget of the countries.
I think we must continue to do that, because at the end of the day international development assistance only provides about 10 percent of the resources spent for health in the developing world. Most of these funds still come from domestic resources. The only other advocacy that I believe we need to address is that when we talk about domestic resources in a developing country a good part of that - 70 percent in many parts of Africa - is out-of-pocket expenses. Now that's not sustainable.
Citizens should not be made to pay out of pocket for those things. So we need to continue to advocate a budget but in which the bigger issue is a social protection floor so everybody can access a minimum package of care which would include family planning.
