Research Fellow, Global Canada Initiative
Founder, Global Canada
In its election platform and later in its mandate letter for Minister of International Development Marie-Claude Bibeau, the Trudeau government committed to “closing existing gaps in reproductive rights and health.”
The government had been fairly quiet on specifics since then until Monday, when Minister Bibeau announced a first set of initiatives on reproductive health with Dr. Babatunde Osotimehin, executive director of the UN Population Fund (UNFPA), who is in Ottawa this week.
The pledge of $76 million is a positive first step. If carried through at scale, this commitment could transform the lives of millions and have a major global impact. There are many reasons to applaud Canada’s recommitment to reproductive health — here are the top 10.
1. It addresses a massive need.Today, more than 215 million women and adolescent girls in the poorest countries would like to use contraceptives but lack access — this is more than 10 times all the girls and women in Canada. In 2012, this contraceptive gap led to some 65 million unintended pregnancies and to an estimated 25 million unplanned births, eight million miscarriages or stillbirths, and 32 million (mostly unsafe) abortions.
2. It saves lives.
Pregnancy, unsafe abortion and childbirth are leading causes of death in developing countries among young women 15 to 19. Nearly 13 million adolescent girls give birth each year before they are physically and emotionally prepared.
Every day, girls and women are dying for lack of access to family planning. Many more are seriously injured or crippled for life. If the 215 million women and girls had access to contraception, each year there would be nearly 100,000 fewer dying from the effects of unintended pregnancies.
Unintended pregnancies are too often devastating for children, especially when their mother is malnourished, sick or too young. Allowing women full access to contraception would prevent over 500,000 newborn and infant deaths each year.
3. It empowers girls and women.A core rationale of sexual and reproductive health is a woman’s right to decide for herself whether, when and how many children to have. “Girl Power” means little if the girl has to drop out of school because of an unintended pregnancy and has several children by the age of 20. Empowering a woman to decide when she first becomes pregnant and to space her pregnancies thereafter allows her to complete her education, participate in the work-force, and have more control over her future.
Increased access to family planning is particularly empowering for girls and women from the poorest sections of the poorest countries. They are most likely to be married before the age of 18 and least likely to have access to family planning today.
The Trudeau government has captured the world’s attention with its commitment to gender equality. Closing gaps in reproductive rights would be another concrete delivery on this commitment.
4. It improves family health.Studies confirm that women and couples who are able to limit and space their children increase their household income and invest more in their children’s health and education.
For example, in the 1970s, half the villages in Matlab, Bangladesh, were randomly chosen to have access to contraceptives. Today, they have healthier, better-educated children and financially are far better off than the villages without access to contraceptives. A recent John Hopkins study found that “children born into smaller families in the world’s poorest nations will live an expected three years longer than those born into larger families.”
5. It increases family prosperity and national economic growth.
Studies also show that improved reproductive rights increase family income as women are able to plan their families, get education or skills and become economic actors. As Margaret Biggs, former president of the Canadian International Development Agency, has said, economies are under-powered if women are not empowered.
Improved reproductive rights and health often increase per capita economic growth for the country. As women are empowered with family planning, they tend to have fewer children. In developing countries, with relatively few senior citizens, declining family size leads to a “demographic dividend” with more adults of working age for each dependent. This demographic dividend has been responsible for up to one third of Asia’s per capita economic growth.
A recent World Bank report noted that in a number of countries with poor reproductive rights and health, particularly in Africa, continuing large family sizes meant there had been no demographic dividend, holding back economic growth.
6. It is highly cost effective.
Providing reproductive health services costs only a few dollars per woman or girl per year. The net cost is even lower. Each dollar in reproductive health saves an estimated one to two dollars in other health costs as the number of dangerous pregnancies and difficult births is reduced. The UN estimates that “for every dollar spent on family planning, between two and six dollars can be saved in interventions aimed at achieving other development goals.”
Combining the low costs and positive economic impact, the Copenhagen Consensus Center concluded in 2014 that achieving universal access to sexual and reproductive health achieved one of the highest benefit-cost ratios of any development program. They added that reproductive health services are “likely to have a particularly high return among vulnerable populations, including adolescents and poor individuals, who are often most affected by limited access to reproductive health information and services.”
7. It redresses a public policy failure.
Despite the massive need, reproductive rights and health have been massively underfunded and often out-right neglected. The share of reproductive health in health development assistance fell by more than half over the last 20 years. In 2012, bilateral donor assistance for family planning was only one percent of total official development assistance.
As a result, key targets in reproductive health have been missed. In the Millennium Development Goals (MDG), the global community committed to “achieve, by 2015, universal access to reproductive health,” including eliminating the unmet need for family planning. The MDG final review in 2015 concluded that progress “fell far short of the global goal and targets. This leaves an unfinished agenda to ensure that all people receive comprehensive sexual and reproductive health services.”
Underinvestment in reproductive rights and health was arguably one of the biggest public policy failures of the last two decades. Canadian leadership could help redress this imbalance.
8. It provides leadership at a critical time.
The last few years have seen the beginning of a renewed commitment to reproductive health. Thanks to active engagement by government and civil society, the UN Sustainable Development Goals, agreed last September, contain strong commitments to reproductive health.
Family Planning 2020 (FP2020) was launched as a global movement in 2012 in support of the rights of women and girls to decide—freely and for themselves—whether, when and how many children they want to have. With the strong support of the Gates Foundation and other leaders, FP2020 aims to provide family planning to 120 million more women and girls by 2020.
As a result, from a low base, donor support for reproductive health has slowly started to rise. Girls and women are starting to benefit from new funding and innovative approaches. For example, in the last four years, the Ouagadougou Partnership has provided reproductive services to an additional one million women across seven countries in West Africa with some of the world’s highest fertility rates and lowest levels of contraceptive use. It aims to assist an additional 2.2 million by 2020. Around the world, 24 million more women have family planning than in 2012.
However, this new momentum is not enough. Despite progress, FP2020 needs more support to meet its 120 million women goal by 2020.
At this critical time, Canadian leadership—in advocacy, in funding, in innovative programming—could play a key role in closing existing gaps in productive rights and health.
What does leadership require? Canada committed $3.5 billion over five years ($700 million per year) to play a leadership role in Maternal, Newborn and Child Health (MNCH). For a fraction of that, Canada could play a transformative leadership role in reproductive health. With an investment of $250 million per year, equivalent to five percent of Canada’s present international assistance, Canada could become a Top 3 global leader in reproductive health after the U.S. and U.K.
9. It builds on Canadian strengths.Reproductive health complements Canada’s existing commitment to MNCH. In fact, reproductive health is the missing link between Canada’s principled leadership against early and forced marriage and support for MNCH.
Due to MNCH, Canada is working with, and has credibility with, many of the key actors involved in family planning and reproductive health. Canada’s countries of focus are well aligned with the biggest opportunities to make a difference in reproductive health whether in Africa, Haiti, or Afghanistan.
The Trudeau government’s stated approach to development “driven by evidence and outcomes, not ideology,” fits well with the challenges of reproductive health. Use of big data and real-time data measurement have proven critical to ensuring that women’s needs for reproductive health are well-understood and that key supply chain issues in providing support are quickly addressed. A sensitive, pragmatic, results-driven Canadian contribution could make a huge difference to reproductive health.
10. It has a massive, measurable impact.
Full achievement of
reproductive rights and health will not be a short-term challenge. Here in Canada, there is still considerable
work to be done.
Nevertheless, there are a number of areas where, with determined leadership, major progress could be achieved in a few years. In family planning, for example, FP2020 partner countries and civil society have identified and costed the key opportunities to achieve success by 2020. Rigorous annual impact reviews in many countries are tracking real progress on the ground.
If done at scale, Canadian leadership in reproductive health could improve the lives of over 10 million women and girls in some of the poorest countries in the world—equivalent to more than half of all the girls and women in Canada today. By leveraging key existing initiatives like FP2020, Canada could achieve this within four years.
Closing existing gaps in reproductive rights and health is one of the highest impact investments Canada could make in international development.
What will it take? First, sustained leadership, from the prime minister on down. Second, strong engagement with Canadian and international partners. Third, a whole of Canada approach. Federal government leadership will be key, but provincial governments, Canadian foundations, universities, the private sector, civil society and individuals could all make major contributions in expertise, funding, advocacy or implementation.
Canadian leadership in reproductive rights and health will require a collective effort to have a global impact.