Sexual & Reproductive Health Rights
Sexual & Reproductive Health Rights: Stats and Facts
Despite the range of available modern contraceptive methods, the unmet need for modern contraception continues to be high in developing and disaster-affected countries.
- Modern contraceptives are being used by an increasing number of African women. According to the latest Family Planning 2020 (FP2020) data, the number of women and girls has increased by 66% during 2012, from 40 million to over 66 million.
- Reference: The Arc of Progress, 2012-2020: What you need to know from the final Fp2020 progress report. (Retrieved November 9, 2021).
- Despite the success of several reported interventions targeting men through general educational methods such as counseling, promotion through local leaders, and mass media campaigns, the negative male perception of contraception continues to account for 15% of the overall unmet contraception need in Sub-Saharan Africa.
- Reference: Men’s Perspectives on Their Role in Family Planning in Nyanza Province, Kenya. (Retrieved November 9, 2021).
- In 2017, the regions of Eastern Africa, Middle Africa, Western Africa, and Melanesia, Micronesia, and Polynesia had the largest unmet need (above 20%, double the global average), with contraceptive prevalence ranging from 20% (Western Africa) to 43% (Eastern Africa).
- In the years 2015–2019, 121.0 million unwanted pregnancies occurred annually, resulting in a global rate of 64 unwanted pregnancies per 1000 women aged 15–49. Unintended pregnancies resulted in abortion in 61% of cases, resulting in 73.3 million abortions per year, resulting in a global abortion rate of 39 abortions per 1000 women aged 15–49 years.
- Reference: Unintended pregnancy and abortion by income, region, and the legal status of abortion: Estimates from a comprehensive model for 1990-2019. (Retrieved November 10, 2021).
- While the global adolescent birth rate was around 44 births per 1,000 girls aged 15 to 19, this statistic peaked in Sub-Saharan African countries between 2015 and 2020. With 115 births per 1,000 females aged 15 to 19, West and Central Africa had the highest regional adolescent birth rate.
- Reference: Early childbearing and teenage pregnancy rates by country. (Retrieved November 10, 2021).
- Teen pregnancy is particularly high in disaster-affected areas. In 2003, 30 percent of births in Congolese refugee camps in Tanzania were among girls aged 14-18. During the 2012 food crisis in Niger, 39% of adolescent girls were mothers. In Afghanistan and in Yemen, 1 in 4 women aged 20 to 24 have had their first child before the age of 18.
- Reference: Adolescent sexual and reproductive health facts and stats. (Retrieved March 20,2017).
Maternal mortality and newborn mortality remains a serious problem that falls unevenly across the globe. It particularly affects women and children in countries characterized by conflict and disaster.
-
Maternal mortality ratios (MMRs) in countries affected by conflict remain high and have been shown to increase during periods of conflict. 61% of maternal deaths worldwide occur in fragile states, many of them affected by conflict and recurring natural disasters. Syria's MMR has increased from 49 to 68 per 100,000 live births since the start of the conflict in 2011.
-
References: Briefing Paper: Ensuring Sexual and Reproductive Health and Rights of Women and Girls affected by conflict. (Retrieved in 2017).
-
- Global maternal mortality increased to 152 deaths per 100,000 live births in 2020 due to disruptions in prenatal care and delivery as a result of COVID-19 and its consequences, up from 151 deaths per 100,000 live births in 2019. In 2030, this trend predicts 133 deaths per 100,000 live births, roughly double the threshold set by the Sustainable Development Goals (SDGs).
- Reference: Global Projects and Projections for Maternal Mortality. (Retrieved November 10, 2021).
- Of the 830 women and girls who die each day from pregnancy and child-birth related causes, 507 die in countries affected by conflict or disaster. That accounts for 3/5 of maternal deaths worldwide.
- Reference: Adolescent girls in disaster and conflict: interventions for improving access to sexual and reproductive health services. (Retrieved in 2016).
- A woman's lifetime risk of maternal death is the likelihood that a woman aged 15+ will die from a maternal cause at some point in her life. This is 1 in 5400 in high-income countries, compared to 1 in 45 in low-income countries.
- Reference: Maternal mortality. (Retrieved November 10, 2021).
- Eclampsia, puerperal endometritis, and systemic infections are more common in adolescent moms aged 10–19 years than in women aged 20–24 years.
- Reference: Adolescent pregnancy (Retrieved November 10, 2021).
- Pregnant women could be at risk of pregnancy-related complications during the COVID-19 crisis. Disruption of services and diversion of resources away from essential sexual and reproductive health care because of prioritizing the COVID-19 response is expected to increase risks of maternal and child morbidity and mortality.
- Reference: Centering sexual and reproductive health and justice in the global COVID-19 response. (Retrieved November 10, 2021).
Humanitarian/emergency settings represent particular challenges against access to SRH services and rights.
- In emergencies, people face heightened risks of gender-based violence (GBV) and HIV. Adolescent girls in particular face heightened risks of unwanted pregnancy, child, early and forced marriage, maternal mortality and disability, rape and sexual exploitation and abuse.
- Reference: Adolescent girls in disaster and conflict: interventions for improving access to sexual and reproductive health services. (Retrieved in 2016).
- Displaced and disaster-affected people face additional barriers limiting from accessing SRH services due to locality, language, registration status as a refugee or immigrant. In addition, women and girls face distinct cultural barriers against mobility and accessing SRH services independently.
- Reference: Adolescent girls in disaster and conflict: interventions for improving access to sexual and reproductive health services. (Retrieved in 2016).
- Spikes in child marriage rates during times of conflict and disaster have been documented across multiple countries cross the globe, including Haiti, Pakistan, Syria, Niger and Guinea. (Also see discussion on GBV)
- Reference: Adolescent sexual and reproductive health facts and stats. (Retrieved March 20, 2017).
Sexual and Reproductive Health Rights and COVID-19
-
Sexual and reproductive health providers and clinics, which are the primary care providers and the safety net for women of reproductive-aged, youth, those uninsured for health care, and people on low incomes in many countries including in the USA, may be deemed non-essential and diverted to respond to COVID-19.
-
Reference: Centering sexual and reproductive health and justice in the global COVID-19 response. (Retrieved November 10, 2021).
-
-
Sexual and reproductive health care delivery service channels have had to adjust their methods due to COVID-19; the dependence on telemedicine has increased as donor-funded international SRH programs have switched to mobile outreach to deliver free contraception in remote rural or under-served urban locations.
-
Reference: Reproductive health under COVID-19 - challenges of responding in a global crisis. (Retrieved November 10, 2021).
-
Power and SRHR
Within populations, unequal power relationships – at home, school, work and beyond – exacerbate risks to SRHR:
- Girls’ and women’s status within families and relationships in many countries across the globe deny fundamental rights on when or if to marry or have children. This is codified in law in multiple countries that require male permission for women to access contraception, and social expectations tied to bride price and dowry. It is also evident in the dynamics of GBV against women and girls in the home.
- References:
- Women's Fears and Men's Anxieties: the impact of family planning on gender relations in Northern Ghana.
- Unwanted pregnancies and abortions: comparative analysis of socio-cultural and community determinants
- The Effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. (all Retrieved November 10, 2021).
- References:
- A WHO Multi-country study on Women’s health and domestic violence found that 3-24% of women reported their first sexual experience was forced. For most, this occurred during adolescence.
- Reference: Partners4Prevention: Facts and Figures. (Retrieved March 20, 2017).
- Age is also an important factor that exposes people to sexual violence. In a multi-country survey, across 7 countries in Sub-Saharan African and Haiti, 9-21% of boys reported experiencing sexual violence before the age of 18. This figure was 20-33% for girls.
- Reference: Data from the violence against children surveys. (Retrieved November 10, 2021).
- Linked to these trends, WHO mortality data reported suicide and death by self-harm now out-ranks maternal causes of death for girls, ages 10-19, globally.
- Reference: More than 1.2 million adolescents die every year, nearly all preventable. (Retrieved November 10, 2021).
- HIV disproportionately affects transgender women at 19.2% prevalence in comparison to a 0.8% prevalence rate among the general population. Sex workers across genders are also disproportionately at risk (27.3% prevalence among transgender women, 14% among men, 11.8% among women sex workers).
- Reference: Infographic: HIV and sex workers. (Retrieved November 10, 2021).
- A Pacific Islands report found stigma against people living outside gender norms (including LGBTQI people, sex workers, single mothers and unmarried women) delay many individuals associated with these groups from seeking services and care.
- Reference: Report on strategy meeting of feminists advancing sexual and reproductive rights in the Pacific. (Retrieved November 10, 2021).
Criminalization of sexual and reproductive rights and its impact
Criminalization and denial of contraception and abortion services risks lives:
- Studies find that criminalization of abortion is linked to higher rates of unsafe abortion services that can result in injury and death. On the converse, in South Africa for example, legalization of abortion is linked to a 90% reduction in abortion-related deaths.
- Reference: Access to safe abortion in the developing world: saving lives while advancing rights. (Retrieved November 15, 2021).
- In the US, legalizing access to contraception for individuals has contributed to a 60% reduction in maternal mortality rates, and a 76% decline in infant death rates, and a drastic decline (from 20% in 1965 to 8.9% in 2011) of unwanted births among married women.
- Reference: Griswold v. Connecticut - the impact of legal birth control and the challenges that remain. (Retrieved November 15, 2021).
- Unwanted pregnancies and unsafe abortion contribute to mortality and disability of young and older women. Around 25 million unsafe abortions are estimated to take place worldwide each year. Unsafe abortion and complications related to it account for 25% of pregnancy-related deaths and injury.
- Girls in particular bear a heavy social cost for unwanted pregnancies, ranging from social stigma, social and family exclusion and economic marginalization.
- Reference: Unwanted pregnancies and abortions: comparative analysis of socio-cultural and community determinants. (Retrieved November 15, 2021).
- Addressing contraception needs can reduce abortion rates. If women’s needs for contraception were met, it would reduce the burden of medical care for complications related to unsafe abortion by 74% (8.4 – 2.2 million).
- References:
- An index of youth family planning across 9 countries found the highest rates of teen pregnancy in countries that actively restrict women and girls’ access to contraception in terms of external authorization requirements, age restrictions and/or marital status. Those with the most supportive policy and community support environments had higher use of modern contraception among women, regardless of their marital status.
- Reference: Global Youth Family Planning Index. (Retrieved November 15, 2021).
- In South Africa, where sex between men is criminalized, HIV prevalence among men who have sex with men is now estimated at 26.8%. Due to their sexuality, men also reported experiencing high rates of fear to access health services (18.5%), fear to walk in the community (19%), blackmail against them due to their sexuality (21.2%), denial of health care because of their sexuality (5.1%) and denial of housing for reasons other than lack of funds (6.9%).
- Reference:
- HIV risk and human rights violations among African gay men and other men who have sex with men.
- HIV and AIDS in South Africa. (all Retrieved November 15, 2021).
- Reference:
Social and political structures shaping SRHR
Social norms and values shape GBV dynamics, sexual and reproductive health related behaviors of individuals as well as the attitudes and response of communities and institutions. For example, a review of studies on young people’s sexual behaviors found:
- Norms related to femininity prevent women’s knowledge on sexual health and prohibit women and girls’ from taking control over their bodies. These norms also discourage women and girls from refusing sex in fear of losing a partner or retribution. Girls also reported pressure not to speak about issues of violence within intimate partners, and the need to be feminine when in a partnership. Girls also expressed fear that a failed partnership would reflect poorly on their worth. Women and girls are also often discouraged from carrying or asking for condom use, though they are also often considered responsible for prevention of pregnancy.
- Reference: Factors that shape young people's sexual behavior: a systematic review. (Retrieved November 16, 2021).
- Norms and expectations related to masculinity encourage men and boys to show few emotions (outside of anger), express dominance and defend their honor with violence if need be, be seen as having multiple sexual partners and follow expectations for other stereotypical masculine traits, which can be harmful to their own and others’ health.
- Reference: Factors that shape young people's sexual behavior: a systematic review. (Retrieved November 16, 2021).
- Norms facing men also act in ways that discourage male partners from becoming more involved in women’s and children’s health.
- Reference: The Effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. (Retrieved November 16, 2021).
- Homophobia stigmatizes same-gender sexual relationships which limits safe opportunities for sex, and limits access to high-quality health care. It also exposes individuals to hate violence, related to their gender and sexuality (i.e. rape, murder, assault, etc.).
- References:
- For child marriage, norms perpetuating the practice include parental pressure to control girls’ sexuality rather than support positive environments for exploring sexuality and choice:
- Value on girls’ virginity at marriage as a reflection of family honor, and fears of pregnancy before marriage. This is linked to social pressure to marry girls following cases of rape.
- Silencing of girls from expressing their preferences and needs against coercive practices can put them at risk – both to child marriage as well as other SRHR risks.
- Expectations for male dominance, virility and control in sexual relationships, alongside women’s subordination.
- Reference: Engaging Men and Boys to End the Practice of Child Marriage. (Retrieved November 16, 2021).
In many countries, laws and policies represent major structural barriers against the fulfillment of SRHR:
- Examples of these legal restrictions are: prohibitions on emergency contraception and access to some modern methods of contraception; lack of guarantees of privacy and confidentiality; censorship of scientifically accurate sexual and reproductive health information; criminalization of same-gender sex and consensual sex work and restrictions on access to safe abortion.
- Reference: WHO, Sexual Health, Human Rights and the Law, 2015. (Retrieved November 16, 2021).
- In 2017, the US Government also reinstated the draconian Global Gag rule, which restricts non-US organizations receiving any federal funds global health work for supporting safe abortion services, even when funded via other sources (US law already prohibits the US Government funds for abortion services).
- Reference: CARE Responds to reinstatement of Global Gag Rule. (Retrieved November 16, 2021).
Gains and progress toward SRHR
Research findings analyzed across a broad range of countries underpins an emerging consensus that reproductive health improvements extend life expectancy for mothers and children.
- Increase incentives to invest in schooling and other forms of human capital.
- Create opportunities for participation in labor markets.
- Raise individual’s capacities to be productive in labor markets.
- Lead to higher incomes and higher levels of asset accumulation.
- Reference: Reproductive Health and Economic Development: What Connections Should We Focus On? (Retrieved November 16, 2021).
However, we know the gains for meeting needs for modern contraception and antenatal as well as postnatal care would be huge:
- Unintended pregnancies could be cut by 70% from 74 to 22 million.
- Maternal deaths could go down by 67% and newborn deaths could fall by 77%;
- Care work related to disability related to pregnancy and delivery would reduce by 66%;
- Transmission of HIV from mother to child could be practically eliminated (reducing by 93%).
- References:
- Trends in Maternal Mortality: 1990 to 2013.
- Unmet need for Contraception in Developing Countries. (all Retrieved November 16, 2021).
- References:
There are many proven practices that have demonstrated how dramatic progress can be made on these issues.
- Satisfying information and demand for family planning alone could prevent 70,000 maternal deaths annually. The cost of meeting all women's needs for contraceptive, maternal, and newborn care is estimated to be on average US $9 per capita annually in developing regions.
- References:
- Unmet need for Contraception in Developing Countries.
- Fact sheet: family planning/contraception
- Adding it up: the costs and benefits of investing in sexual and reproductive health 2014.
- Accelerate Progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. (all Retrieved November 16, 2021).
- References:
- Two-thirds of newborn deaths could be prevented if known health measures are provided at birth and during the first week of life.
- Reference: Newborn death and illness. (Retrieved November 16, 2021).
- Decriminalization of sex work could reduce HIV infections by 33-46%.
- Reference: Infographic: HIV and sex workers. (Retrieved November 16, 2021).
- Evaluations of comprehensive sex education programs have found youth participants delay onset of sexual activity, reduce number of partners and frequency of sex, and increase use of contraception and condoms.
- Reference: Comprehensive sex education: research and results. (Retrieved November 16, 2021).
- Studies have found that men’s involvement in family planning leads to better outcomes for women’s health.
- Reference: The Effect of power in sexual relationships on sexual and reproductive health: an examination of the evidence. (Retrieved November 16, 2021).
Globally, there has been heartening progress on contraception use and maternal health in past decades.
- Globally, contraceptive prevalence almost doubled between 1970 and 2015 (from 36% to 64%).
- From 1990-2015, maternal mortality dropped by approximately 44% worldwide
- Reference: Maternal mortality fact sheet. (Retrieved November 16, 2021).
NOTE: Denial of SRHR is closely intertwined with gender-based violence. Follow this link for a discussion on it.