LONDON, September 20. The death-rate among African women giving birth is so large that "it is not uncommon for women... when about to give birth, to bid their older children farewell" says the UN Population Fund (UNFPA), today. This is just one of a multitude of appalling stories and statistics in the UNFPA's annual State of the World Population Report,
In developing countries, complications of pregnancy and childbirth take the life of about 1 out of every 48 women. The report estimates that some 500,000 maternal deaths occur each year in developing countries, where only 53% of all births are professionally attended. According to the report, in Tanzania mothers have a saying: "I am going to the sea to fetch a new baby, but the journey is long and dangerous and I may not return."
Post-partum care is especially important, according to UNFPA. Of women who die of pregnancy-related causes, 24% die during pregnancy, 16% during delivery and 61% after delivery, from post-partum haemorrhage, hypertensive disorders and sepsis.
Women also undergo an estimated 50 million abortions, 20 million of which are unsafe; some 78,000 women die and millions suffer injuries and illness as a result. At least one quarter of all unsafe abortions are to girls aged 15–19, the UNFPA says.
Some 130 million girls and young women are estimated to have undergone 'female circumcision', or 'female genital mutilation' (FGM). FGM is practised in about 28 countries in Africa — where the prevalence varies widely, from 5% in the Democratic Republic of the Congo to 98% in Somalia — and in the Arabian Peninsula and the Gulf region. It also occurs among some minority groups in Asia, and among immigrant women in Europe, Canada and the United States, the report says.
"The immediate health risks include haemorrhage of the clitoral artery, infection, urine retention, and blood poisoning from unsterile, often crude, cutting implements. Later complications are mainly due to the partial closing of the vaginal and urethral openings, which trigger chronic urinary tract infections, repeated reproductive tract infections and back and pelvic pain. Particularly where the more drastic forms of this practice have been carried out, the girl will be at increased risk of experiencing a difficult delivery and dying in childbirth," the report says.
And so far we haven't got to violence. "Around the world, at least one in every three women has been beaten, coerced into sex, or abused in some other way — most often by someone she knows, including her husband or another male family member" the report says. "One woman in four has been abused during pregnancy... As many as 5,000 women and girls are killed annually in so-called 'honour' killings, many of them for the 'dishonour' of having been raped."
On top of that the UNFPA estimates that 4 million women and girls are bought and sold worldwide each year, either into marriage, prostitution or slavery. "Although the greatest volume of trafficking occurs in Asia, Eastern European women are increasingly vulnerable," the report adds.
But appalling though they are, why should the UNFPA emphasise these matters now? Why this shaking compilation of studies on women's ill-treatment from a body most would think would be concerned more about contraception than women's health and rights?
The answer undoubtedly lies in its claim that "if women could have the number of children they wanted, the average family size in many countries would fall by nearly one child," coupled with the great coming increase in the number of women of child-bearing age. The hidden argument is that quite apart from the question of rights, if these young women were better treated and respected, population growth would fall.
One in three pregnancies — about 80 million a year — are unwanted or mistimed, according to the UNFPA. Meanwhile the need for family planning services in developing countries will increase by more than 40% by the year 2015: to 742 million compared with 525 million in 2000. Just over half of the increase will be due to rise of a fifth in the numbers of women of reproductive age (15-49) in these countries, to 1.55 billion by 2015. The rest of the increase in family planning service users will result from increased demand as the proportion of people using contraception rises.
What can be done to improve women's status and reproductive rights? Of course the UNFPA makes the usual plea to governments and donors, but it does so with little conviction and seems to hold out most hope for the work of non-governmental organizations (NGOs) and networks.
Many citizens' groups are praised and dozens are explicitly singled out in the report for playing crucial roles. To take just two examples, in Bangladesh the UNFPA estimates that NGOs carry out 25% of reproductive health activities. One, the Bangladesh Rural Advancement Committee, founded in 1972, has a staff of more than 20,000 and reaches 2.1 million women and girls in 65,000 villages and 34,000 schools. And Profamilia, an affiliate of the International Planned Parenthood Foundation in Colombia, provides more than 60% of national family planning services, according to the report.
"Social change cannot be brought about merely through legislation; it must be encouraged by leadership and example" the UNFPA says. But governments and donors are falling way behind their obligations. "Donors in the 1990s have not met even half of the agreed resource targets in the area of population and reproductive health; international assistance for education and women's empowerment is also woefully inadequate. The shortage of funding to help countries advance gender equality harms the interests of women and men, their countries and the global future," the UNFPA says.