An Urgent Appropriations Request to Save Young Women’s Lives

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Today, young people ages 10 to 19 comprise 20 percent of the world’s population, with more than 85 percent of these young people residing in low and middle income countries. [1] Furthermore, nearly half of all people living in the world today are under the age of 25, making this the largest generation of young people in history. [2] Their reproductive and sexual health will affect the health and well being of this planet for decades to come.

For young women ages 15 to 19 in low and middle income countries, complications from pregnancy are the leading cause of death. [3] High rates of maternal mortality and morbidity among young women in these countries are fueled by too early marriage and childbearing, unplanned and/or unwanted pregnancy, lack of access to pre and post-natal care and complications from unsafe abortion.

U.S. Funds Could Greatly Increase Youth Access to Sexual Health Services

An appropriation of one billion dollars per year for international family planning would significantly increase young people’s access to family planning services and supplies and provide them with the tools they so desperately need to delay too early childbearing, avoid unplanned pregnancy, and safely space their children. Through increased access to family planning, such an appropriation would also greatly diminish young women’s need to resort to unsafe abortion and in turn, significantly reduce rates of adolescent maternal mortality.

Moreover, funding international family planning at levels of need is cost effective. For every dollar spent on international family planning efforts, governments save up to $31 in health care, water, education, housing, and other costs. [4] With resources extremely limited, international assistance must be targeted at programs that achieve significant results. Not only are the benefits of family planning investments well recognized, they also complement other areas of U.S. development assistance. Shortchanging international family planning assistance could seriously undermine achievement of the Millennium Development Goals as access to international family planning not only influences the size and spacing of families; it also affects levels of educational attainment; poverty; health outcomes for women, children, and communities; gender equity; and environmental sustainability.

Furthermore, leading international health experts recognize the critical importance of addressing adolescent pregnancy. The World Health Organization says there is an urgent need for programs that address the health and safety of pregnant adolescents and that teach young women the skills to build a successful future. [5] In addition, the U. S. Agency for International Development (USAID) identifies critical factors for improving adolescent maternal health, including access to contraception. [6]

U.S. ContrIbUtIon Has Not Kept Pace With Inflation and Population Momentum

Since the 1960s, the United States government has been a global leader in the provision of international family planning assistance, providing commodities, funding, and technical assistance for family planning services to countries throughout the world. Over the past four decades, this longterm investment in high quality family planning programs has yielded significantly greater access to family planning services for women and men of reproductive age, including youth. Greater access has provided many young women with the means to better plan their lives and their families.

Unfortunately, international family planning appropriations have not kept pace with inflation or with the growing size of the global adolescent population. U.S. aid for international family planning has decreased in real dollars while the global adolescent population has grown exponentially, and is projected to continue growing over the next three decades. [7,8] An increase in U.S. appropriations for international family planning would go a long way to meeting the increased need among these young people and in helping them to improve their lives and the lives of their families and communities.

Background

Globally, maternal mortality has seen a steady decrease over the last three decades: there were an estimated 342,900 maternal deaths worldwide in 2008, down from 526,300 in 1980. Yet, low and middle-income countries continue to suffer vastly disproportionate rates — a woman is at least 20 times as likely to die from pregnancy-related causes in sub-Saharan Africa as a woman in North America. [9] In fact, in low and middle-income countries, complications from pregnancy are the leading cause of death for young women ages 15 through 19. [10] On average, 13 percent of all maternal deaths are due to unsafe abortion, but for some countries the number rises as high as 60 percent. [11] In 2008, women in low and middle-income countries had 35 million abortions, 20 million of which were considered unsafe. [12] Adolescents in low and middle-income countries account for between 2 million and 4.4 million abortions annually. [13] This dire picture of what amounts to an unnoticed pandemic of maternal death and morbidity underscores how societies have failed women, especially young women, and their partners.

Experts estimate that contraceptive access could prevent up to 35 percent of all maternal deaths. [14] Further, studies show that when contraceptive use increases, fertility rates and subsequently infant mortality rates decline. [15] There is an urgent need to increase international family planning funds to ensure that young women and their partners have access to contraceptive supplies and services. These funds would greatly assist young people to delay too-early childbearing and to better plan and space their families, thereby reducing maternal mortality and morbidity and the need for unsafe abortion.

Why is One BillIon Dollars for Family Planning Important for Youth?

As population has increased dramatically over time, international family planning funding is still lacking despite recent increases. Since 1995, international family planning funds have declined almost 40 percent when adjusted for inflation. [16] At the same time, 1.5 billion members of the world’s population are between the ages of 10 and 25, just entering reproductive age. While significant increases in family planning were enacted in the most recent two fiscal years to help restore previous cuts, more funding is necessary to support the needs of the largest cohort of young people in human history. [17]

• Worldwide, there is still a tremendous unmet need for family planning, especially among young people. Current efforts to provide family planning services are not enough — over 215 million women have no access to modern, effective contraception. [18] Furthermore, it is estimated that the unmet need for family planning among young people is twice that among adults. [19]

• Adolescent girls are much more likely to die during pregnancy and childbirth than are older women. An estimated 14 million adolescents beween 15 and 19 give birth each year. These girls are twice as likely to die during pregnancy or child birth as those over age 20 and girls under age 15 are five times more likely to die. About 90 percent of all adolescent births occur in low and middle- income countries, where one quarter to one half of adolescent girls become mothers before they reach age 18. [20,21]

• Unmet need for family planning results in millions of unintended pregnancies each year. In low and middle-income countries, lack of access to family planning results in some 75 million unintended pregnancies each year. [22] In fact, the root cause of most abortions is a pregnancy for which the woman or the couple did not plan, or believed would not occur. [23]

• Unsafe abortion puts young mothers at greater risk where adequate family planning services could protect them. Unsafe abortions are a leading cause of maternal mortality. Each year at least 2.5 million young women in low to middle-income countries undergo unsafe abortion in order to terminate an unintended pregnancy. Adolescents are more likely than older women to delay abortions, go to unsafe providers, use unsafe methods, and delay seeking help for complications. [24] Unsafe abortion can have devastating consequences, including cervical tearing, perforated uterus, hemorrhage, chronic pelvic infection, infertility, and death. [25]

• Newborns are dying because their mothers are too young to give birth. Every year, four million newborns die within the first month of life. [26] In fact, babies born to mothers under the age of 20 have mortality rates 73 percent higher than babies born to older mothers. [27] Two of the contributing factors to this disproportionate newborn and infant mortality rate are the higher risk of premature delivery among adolescent girls and the higher likelihood of obstructed labor due to adolescent mothers’ bodies not being fully developed and ready for childbirth. [28]

What Would One Billion Dollars Accomplish for Young People?

Because young people make up a significant proportion of those of reproductive age, a $1 billion investment in international family planning assistance from the U.S. government would reach a significant amount of young people.

• Maternal and infant deaths would be dramatically reduced. Forty thousand maternal and 700,000 infant lives would be saved as more women and men would have greater agency in planning their pregnancies and caring for their children. [29]

• Reductions in unintended pregnancies for young women would significantly reduce abortions. The world would see an estimated 21 million fewer unintended pregnancies and over eight million fewer abortions per year if funding levels rise to respond adequately to unmet need. [30] Millions of young women who undergo unsafe abortions every year would not have to risk their lives.

• Sufficient funding would increase the awareness, acceptability, and use of contraceptives among youth. With just one year of $1 billion of investments in international family planning assistance, the world would have an estimated 36 million new contraceptive users. [31] Considering the amount of young people accessing this information, this would help create a culture among youth in which contraceptives are accepted and used.

• Family planning funding is more than just improving access to contraception. USAID utilizes international family planning funds to work towards a multitude of ends including: responding to the unique sexual and reproductive health needs of young people; promoting gender equity; addressing harmful traditional practices such as female genital mutilation and early marriage; and preventing and treating obstetric fistula, among many others. [32]

Support for the $1 bIllIon Ask for International Family Planning Appropriations

Over 15 nationally recognized organizations working in the development, sexual and reproductive health, education, environment, and public health fields support the one billion dollar ask for international family planning appropriations. These organizations include: Advocates for Youth, American Jewish World Service, Americans for UNFPA, Catholics for Choice, The Centre for Development and Population Activities (CEDPA), Feminist Majority, Global Health Council, International Women’s Health Coalition, Izaak Walton League of America, Jewish World Watch, NARAL Pro-Choice America, National Council of Jewish Women, National Family Planning and Reproductive Health Association, Planned Parenthood Federation of America, Population Action International, Population Connection, Population Services International (PSI), Rabbinical Assembly, and the Sierra Club.

Written by Brian Ackerman, Nicole Cheetham, MHS and Debra Hauser, MPH, 2008.
Updated by Janine Kossen, Director, Public Policy, 2010. Advocates for Youth © September 2010

References

1. Blum, R. (2005) “Adolescent Health: Global Issues, Local Challenges.” Ejournal USA: Global Issues. Washington, D.C.: United States Department of State, http://usinfo.state.gov/ journals/itgic/0105/ijge/blum.htm, accessed August 30, 2010.
2. UNFPA (2005). State of World Population 2005: The Promise of Equality. New York: United Nations Population Fund, http://www.unfpa.org/webdav/site/global/shared/documents/publications/2005/swp05_eng.pdf, accessed September 5, 2010.
3. UNFPA (2004). State of World Population, 2004: The Cairo Consensus at Ten. New York: United Nations Population Fund, http://www.unfpa.org/swp/2004/english/ch9/page5.htm, accessed September 5, 2010.
4. UNFPA (2007). Family Planning and Poverty Reduction Benefits for Families and Nations. New York: United Nations Population Fund.
5. World Health Organization, UNFPA (2006). Pregnant Adolescents. Geneva: WHO, http://whqlibdoc.who.int/ publications/2006/9241593784_eng.pdf, accessed September 5, 2010.

6. USAID (2005). Technical Areas: Adolescent Maternal Health. [Maternal and Child Health], http://www.usaid.gov/our_work/ global_health/mch/mh/techareas/adolescent.html, accessed August 30, 2010.

7. Population Action International, “Trends in U.S. Population Assistance,” http://www.populationaction.org/Issues/U.S._ Policies_and_Funding/Trends_in_U.S._Population_Assistance. shtml, accessed August 30, 2010.
8. “Global Adolescent Population 1950-2050”—Data derived from the United Nations Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2008 Revision Population Database, http://esa.un.org/unpp/ p2k0data.asp, accessed August 30, 2010.
9. Hogan, M.C. et al. Maternal Mortality for 181 Countries, 1980- 2008: A Systematic Analysis of Progress Towards Millennium Development Goal 5. Lancet 375, 2010.
10. UNFPA (2004). State of World Population, 2004: The Cairo Consensus at Ten.
11. Ipas. “Children, Youth, and Unsafe Abortion,” http://reproductiverights.org/sites/default/files/documents/pub_fac_adoles_unsafeab.pdf, accessed August 23, 2010.
12. Singh, S. et al. (2009), Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health, New York: Guttmacher Institute and United Nations Population Fund.
13. Ipas. “Children, Youth, and Unsafe Abortion.”
14. UNFPA (2005). State of World Population 2005: The Promise of Equality.
15. Alan Guttmacher Institute. Family Planning Can Reduce High Infant Mortality Levels [Issues in Brief, 2002, no.2] New York: Alan Guttmacher Institute, http://www.guttmacher.org/ pubs/ib_202.html, accessed August 30, 2010.
16. Population Action International, “Trends in U.S. Population Assistance.”
17. UNFPA, “Population Issues: Supporting Adolescents and Youth,” http://www.unfpa.org/adolescents/overview.htm, accessed August 30, 2010.
18. Singh, S. et al. (2009), Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health.
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19. UNFPA (2003), State of the World Population, 2003: Making 1 Billion Count: Investing in Adolescents’ Health and Rights. New York: United Nations Population Fund.
20. Temin, M, and Levine, R. (2009). Start with a Girl: A New Agenda for Global Health. Washington, D.C.: Center for Global Development.
21. Levine, R. et al. (2008). Girls Count: A Global Investment & Action Agenda. Reprint, 2009. Washington, D.C.: Center for Global Development.
22. Singh, S. et al. (2009), Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health.
23. Singh, S. et al. (2009). Abortion Worldwide: A Decade of Uneven Progress. New York: Guttmacher Institute, http://www. guttmacher.org/pubs/AWWfullreport.pdf, accessed September 5, 2010.
24. Temin, M, and Levine, R. (2009). Start with a Girl: A New Agenda for Global Health.
25. Singh, S. et al. (2009). Abortion Worldwide: A Decade of Uneven Progress.
26. Singh, S. et al. (2009), Adding it Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health.
27. Levine, R. et al. (2008). Girls Count: A Global Investment & Action Agenda.
28. UNFPA (2005). State of World Population 2005: The Promise of Equality. New York: United Nations Population Fund.
29. Nils Daulaire. Global Health Council. Written testimony to the Senate Committee on Appropriations, Subcommittee on State, Foreign Operations and Related Operations. April 18, 2007.
30. Ibid.
31. Ibid.
32. United States Agency for International Development. Fast Facts: Family Planning http://www.usaid.gov/our_work/global_health/pop/news/issue_briefs/fp_fastfacts.pdf, accessed August 30, 2010.