Evidence is now overwhelming that enabling women to have children by choice rather than chance not only dramatically cuts infant and maternal deaths but also reduces poverty, and increases participation in both education and the workforce

The ability to decide when to have children, and how many, is seen as one of the most significant social advances of recent decades. However, this quiet but profound revolution has not yet touched all parts of the world equally. Over half a century after modern family planning programmes began to be extended widely across the globe, millions of women are still denied access to them.

Indeed, The State of the World Population 2012 report from UNFPA, the United Nations Population Fund, published on Wednesday highlights how around 222 million women, largely in the poorest countries, want to use modern family planning methods but can’t access them. This has a seriously damaging impact not just on their lives, but on the health and strength of their families and communities.

The evidence is now overwhelming that enabling women to have children by choice rather than chance not only dramatically cuts infant and maternal deaths, but also improves the health of mothers and children. Complications around pregnancy remain the greatest killer of teenage girls in the developing world.

It is no surprise that the Millennium Development Goal where there has been least progress is the reduction of maternal deaths. Without steep improvements in the availability of family planning services, it will not be possible for many nations to cut deaths by the target of 75 per cent by 2015.

Nor will we see the progress we desperately need to reduce infant deaths. One recent study found that enabling women in the poorest countries to space pregnancies by three to five years could reduce infant deaths by 46 per cent.

But the impact goes far beyond both health and the individual. Studies have shown that investing in voluntary family planning reduces poverty, increases participation in both education and the workforce and gives women a greater say in their households and communities. The result is higher incomes for families and improved prosperity for countries. Failure to enable women to make free and informed decisions about their own reproduction is a serious brake on social and economic development.

There are several reasons why so many women still lack reliable and high-quality family planning. In many poor countries, contraceptives may not be available or families may lack the money to buy them. But social barriers and family resistance are also powerful barriers. So too is the lack of proper health or distribution systems or trained workers to give confidential advice.

This huge unmet need comes despite the fact that there is almost universal agreement that access to family planning is a human right. By denying this right, we are putting other basic rights at risk across the world. The right to education is of little use if teenage girls are forced to leave school because they are pregnant.

Yet, despite this failure and the far-reaching damage it causes, our report finds that financial support for family planning has declined in real terms. Donor contributions fell $500 million short of what was needed and expected in 2010. The result is that contraceptive use has hardly increased in recent years.

There are welcome signs, however, that this failure is at last being addressed. In July this year, donor countries and foundations pledged an additional $2.6 billion dollars to half the unmet need for family planning by 2020 at a special summit in London. Developing countries pledged $2 billion. Extending family planning to 120 million more women could cut infant deaths by three million.

This is just a first step. Our report shows that an additional sum of $4.1 billion is needed each year if we are to provide voluntary family planning services for all 222 million women who lack them. If we can find this additional funding — as we must — it will more than pay for itself. We estimate that $5.7 billion would be saved in reduced demand for newborn and maternal health services alone. The full rewards, including in increased participation in the workforce, would be far greater.

Extra funding, although vital, is not enough on its own. We need a concerted approach to remove all the barriers in the way of allowing women and families control over their reproductive health.

This includes reinforcing the rights-based approach to family planning so that we consider its broader impact on our ambitions for our world. All countries must be encouraged — and helped — to step up efforts to educate communities about the benefits of giving women a genuine choice over family planning.

Health systems must be strengthened, and extending family planning made a key plank of the global development agenda that will follow the Millennium Development Goals after 2015 so it remains a global priority. We also need urgent action to eliminate child marriage and to challenge harmful traditional practices.

For too long, lack of voluntary family planning has been a major barrier to achieving many of our hopes for the world. We now have a chance, by building on the momentum from the family planning summit in July, to make significant progress.

(Dr. Osotimehin is a United Nations Under-Secretary-General and Executive Director of UNFPA, the United Nations Population Fund.)

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