Advancing Sexual and Reproductive Health and Rights
 
International Family Planning Perspectives
Volume 29, Number 1, March 2003
UPDATE


CAIRO AGREEMENT STANDS, DESPITE U.S. OPPOSITION

At a conference held in Bangkok in December 2002 to develop ways to implement the program of action adopted in Cairo at the 1994 International Conference on Population and Development, Asian and European delegations overwhelmingly rejected U.S. attempts to add language denouncing abortion to the Cairo document.1 The Cairo plan promotes reproductive health and the provision of safe abortion services in countries where the procedure is legal; it does not support abortion as a method of family planning. Nonetheless, contending that the terms "reproductive health services" and "reproductive rights" promote abortion, the U.S. delegation pressed the representatives of more than 30 other countries meeting in Bangkok to amend those phrases or delete them from the Cairo document. Representatives of the Bush administration also tried to have a provision expressing "general reservation" about abortion and language promoting abstinence as the healthiest choice for unmarried adolescents inserted into the Cairo document, and pushed for removing references to adolescents from a section on reproductive rights, which it said promoted sexual activity among teenagers. While debate over the U.S. proposals "almost completely consumed" the conference, in the voting at the end of the week, the United States stood alone, and the Cairo document remained unchanged.

1. Dao J, Over U.S. protest, Asian group approves family planning goals, New York Times, Dec. 18, 2002, p. A7.

HALF OF ALL ADULTS WITH HIV ARE WOMEN

Half of the world's 39 million adults with HIV/AIDS are women, according to a report of the latest data on the epidemic.1 Women also made up half of the 2.5 million adults who died of AIDS in 2002 and half of the 4.2 million adults who were newly infected during that year. Sub-Saharan Africa, where HIV spreads mainly through heterosexual activity, remains the region with the highest HIV/AIDS prevalence among adults (8.8%) and has the highest proportion of HIV-positive adults who are women (58%). Proportions of infected women are also high in North Africa and the Middle East (55%) and in the Caribbean (50%), despite lower adult prevalence rates (0.3% and 2.4%, respectively). In contrast, in Australia and New Zealand, where HIV spreads mainly as a result of sex between men, 0.1% of adults have HIV, of whom 7% are women. Noting that programs targeting young women have helped to lower HIV prevalence--for example, by more than one-third in Addis Ababa, Ethiopia, between 1995 and 2001, and by one-quarter among pregnant teenagers in South Africa between 1998 and 2001--the report suggests that "the future trajectory of the global HIV/AIDS epidemic depends on whether the world can protect young people everywhere."

1. Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO), AIDS Epidemic Update: December 2002, Geneva: UNAIDS and WHO, 2002.

LOWERED FERTILITY SPEEDS ECONOMIC GROWTH

Since 1970, developing nations with lower fertility and slower population expansion have achieved faster economic growth, according to the United Nations Population Fund (UNFPA).1 In Brazil, for example, declining fertility led to decreased poverty equaling 0.7% annual gains in the per capita gross domestic product. Noting that more than one billion people live on less than $1 a day and that the world's population will increase to nine billion by 2050, UNFPA suggests that family planning is key to reducing poverty. The agency also calls for efforts to provide reproductive health services, to reduce unwanted fertility, to increase literacy and to combat discrimination against women. However, in 2000, donor nations supplied less than half of their agreed $5.7-billion contribution to population and reproductive health programs; developing countries contributed three-quarters of their $11.4-billion commitment. UNFPA concludes that "governments, communities, the private sector and the international community must cooperate to make best use of their comparative advantages."

1. United Nations Population Fund (UNFPA), State of World Population 2002. People, Poverty and Possibilities: Making Development Work for the Poor, New York: UNFPA, 2002.

MORTALITY FROM INDUCED ABORTION IN WEST AFRICA

Complications of induced abortion account for nearly one-third of all maternal deaths in West Africa, according to a study conducted in 12 hospitals in Benin, Côte d'Ivoire and Senegal between May and October 1999.1 During that period, 4,116 women were admitted for obstetric complications during the first trimester of pregnancy, of whom 42 died of maternal causes, including 37 from complications of induced abortion. An additional 10,744 women were admitted for delivery, of whom 79 died of major complications such as hemorrhage, sepsis or uterine rupture. Thus, complications of induced abortion were responsible for 37 of 121 maternal deaths during the period studied. Accordingly, the researchers suggest that "previous [World Health Organization] estimates that complications of abortion may account for about 15% of all maternal mortality should be revised upward."

1. Thonneau P, Goufodji S and Sundby J, Abortion and maternal mortality in Africa, letter, New England Journal of Medicine, 2002, 347(24):1984-1985.

AFGHAN WOMEN LACK BASIC RIGHTS

Lack of access to basic human needs and rights may be a major factor in Afghanistan's high maternal mortality.1 Data from Herat Province, where an estimated 593 women die for every 100,000 births, show that many women do not have sufficient food (cited by 41% of those surveyed), adequate shelter (18%) or clean water (14%). They also lack access to adequate health care: More than one-third of the region's 27 health care facilities that are listed by the World Health Organization are not operational, and the five facilities offering essential obstetric care are more than half a day's walk from rural areas. Only 11% of respondents had received prenatal care and just 1% had had a trained health care worker present when they gave birth. The researchers also note limitations in women's ability to negotiate terms of sex--80% of respondents believed that a woman should have sex with her husband even if she does not want to, and 45% believed that a man has the right to beat his wife if she disobeys him. The investigators conclude that in Herat Province, "the high rates of maternal mortality may be an indicator of violations of women's human rights."

1. Amowitz LL, Reis C and Iacopino V, Maternal mortality in Herat Province, Afghanistan, in 2002, JAMA, 2002, 288(10):1284-1291.

ARAB MEN ARE UNLIKELY TO USE MALE METHODS

Men in the United Arab Emirates do not commonly use male contraceptive methods and show only moderate levels of contraceptive knowledge, according to a cross-sectional survey conducted among randomly selected monogamously married fathers attending primary health care centers from January to February 2001.1 Only 27% of the 348 respondents had used a male method in the previous 12 months--42% of these men had used condoms, 32% withdrawal and 26% periodic abstinence; just one man had been sterilized. Overall, 85% of respondents were aware of male methods of contraception; some thought those methods included a pill (19%) or an injectable (15%). Varying proportions knew of female methods, such as combined pills (38%) and implants (6%), and nearly half of the respondents (47%) reported that their wife had used a method. Additionally, two-thirds of respondents objected to the use of male contraceptive methods and roughly one-half to the use of female methods, mainly because of religious beliefs. The researchers conclude that in the United Arab Emirates, the "responsibility of contraception falls mainly on the women."

1. Ghazal-Aswad S et al., A study on the knowledge and practice of contraception among men in the United Arab Emirates, Journal of Family Planning and Reproductive Health Care, 2002, 28(4):196-200.

HIV PREVALENCE IN SOUTH AFRICA

Eleven percent of the South African population older than two are infected with HIV, according to the country's first nationally representative study of HIV prevalence and sexual behavior.1 Researchers used results of saliva-based tests to estimate that 16% of the population older than 24, 9% of those aged 15-24 and 6% of those aged 2-14 were HIV-positive in 2002. In logistic regression analyses, odds of infection were elevated for females and for people with a history of sexually transmitted infection (odds ratios, 1.4 and 2.6, respectively) but reduced for nonblacks (0.1-0.4). Focusing on behavioral risks, the researchers found that nearly all respondents older than 24 and more than half of 15-24-year-olds had ever had sex. Among those who had had sex in the past year, males were more likely than females to report having had more than one partner (14% vs. 4%); 75% of females and 70% of males had not used a condom at last sex. Although levels of basic HIV knowledge were high, just one in five respondents who knew about voluntary counseling and HIV testing services had used them. The investigators recommend regular follow-up surveys, because the findings "allow interventions to be directed towards specific segments of the population that need them most."

1. Shisana O and Simbayi L, Nelson Mandela/Human Sciences Research Council (HSRC) Study of HIV/AIDS. South African National HIV Prevalence, Behavioral Risks and Mass Media: Household Survey 2002, Cape Town, South Africa: HSRC, 2002.

IN BRIEF

• Only about one-half of births in developing countries involve a skilled attendant, according to the World Health Organization (WHO). Sub-Saharan Africa had the lowest proportion of such deliveries in 2000--42%, which was just 5% higher than the level in the region in 1990 (40%). WHO comments that "in countries where maternal mortality is highest, the proportion of deliveries at which a skilled attendant is present has not improved substantially." [World Health Organization, Skilled attendants at delivery: the decade's progress, 51 developing world countries, 1990 to 2000, Safe Motherhood, 2002, Issue 29, Table 1, p. 3.]

• Seven women and 11 men were elected as judges on the International Criminal Court on Feb. 7, 2003; 10 of the 43 candidates were women. The Women's Caucus for Gender Justice, which had lobbied for "fair representation" of female and male judges, as mandated by the U.N. High Commissioner for Human Rights, called the result "an unprecedented and historic development." The court is the world's first permanent international tribunal to try individuals for genocide, war crimes and crimes against humanity. [Women on the Court Now! Women's Caucus for Gender Justice, <www.iccwomen.org>, accessed Feb. 20, 2003.]

• China is now producing three drugs that can be used in combination to treat AIDS. The State Drug Administration has granted permission to Shanghai Desano Biopharmaceuticals Company to manufacture the "cocktail"--didanosine, stavudine and nevirapine. Although the drug combination is estimated to cost patients $360-600 a year--one-tenth of the price of imported drugs--the locally made versions (which can be produced without patent infringement) will still be too expensive for many rural people with HIV/AIDS. [Parry J, China makes its first antiretroviral drugs for treating AIDS, British Medical Journal, 2002, 325(7375):1257.]