Universal Access to Reproductive Health Care and Family Planning

In Uncategorized on January 13, 2010 at 12:42 pm

Susan Wang, Staff Writer

According to the United Nations, in 2008 nearly 536,000 women died worldwide from preventable and treatable child-bearing and pregnancy-related causes. Half of these women live in Africa. In the United States, 1 in 4800 dies from a prenatal or birthing complication. In Liberia, however, the rate of maternal death is 1 in 12.

With such startling statistics, it becomes evident that action must be taken in order to increase access to reproductive health care. However, to increase access, both funding and social awareness of health-related issues are needed.

Financial challenges are one of the most obvious problems with access and the problem that is on the forefront of every organization dedicated to increase access. The GDP of all of Sub-Saharan Africa was $744 billion in 20081; for comparison, the state of Florida’s GDP was also $744 in 2008.[2]

Due to this economic disparity, Sub-Saharan Africa continues to possess wide gaps in accessibility to maternal health care. A quarter of the women in Sub-Saharan Africa claim they prefer to stop having children or delay their next pregnancies but are unable to practice family planning. Furthermore, Sub- Saharan Africa also suffers from a disproportionate amount of HIV/ AIDS: 22 million people there have HIV/AIDS, which accounts for 67% of those with HIV/AIDS worldwide.[3]

However, financial challenges are merely the tip of the iceberg. Even in the United States, where the GDP is the highest in the world and people are among the richest, universal reproductive health care is not yet attainable.

In an interview with HCGHR, Lisa Maldonado, executive director of the Reproductive Health Access Project, an organization dedicated to training health care professionals about reproductive health care, claimed that part of the problem is that “clinicians are not trained sufficiently in the area of reproductive health. Less than five percent of medical schools are covering reproductive health problems so medical students must take it upon themselves to educate themselves in these issues.”[4]

Why do problems with providing reproductive health services persist globally? The reason is that besides poverty, other underlying problems are still impeding universal access to reproductive health care.

One such prominent obstruction is religious beliefs.

Female circumcision is a common practice in many Islamic countries: in fact, 80% of girls in north and central Sudan are circumcised. However, the practice of female circumcision has been shown to lead to lifelong reproductive health problems including scar formation, cyst growth, pain during urination, and difficulties with childbirth. Indeed, this contributes significantly to the high maternal mortality rate in Sudan.[5]

Even in the United States, religious beliefs can hinder women’s access to reproductive health care. Eesha Pandit, Director of Advocacy at MergerWatch, an advocacy group for women’s health care services, commented to HCGHR that in New York, religious hospitals were acquiring secular ones and “in the process of merging, the secular hospitals are obliged by the Catholic directives for health care. Therefore, those hospitals will not be able to provide emergency contraceptives, abortions, information about HIV/AIDS and a whole host of other critically important services for women.”[6]

Religious obstacles aside, many cultural beliefs also pose problems in the delivery of reproductive health care.

Newly-wed wives in India are under considerable pressure from parents and relatives to have children quickly because it is believed that fertility decreases with age.[7] These women also receive false information from village doctors that causes them to mistrust spacing methods such as the pill and Intrauterine Devices, which are contraceptives devices for women similar to condoms for men.[7] This reduces these women’s likelihood of using such methods to space their pregnancies and may contribute to more complications related to pregnancies and childbirths.

Around the world, many stigmas persist in obstructing universal access to reproductive health care.

Eesha Pandit noted that “abortion services are the only health care service that is both safe and legal in most developed countries that is singled out for exclusion under bills such as the Hyde amendment, which prohibits the use of federal funding for abortion care.”[6]

Globally, unsafe abortions kill approximately 70,000 women each year. Three million women who experience serious complications from unsafe procedures are left untreated.[8]

What does this mean for attempts to increase reproductive health care access? As Dr. Yves Bergevin commented to the HCGHR, “medical services must be offered in a way that is socially and culturally acceptable and welcomed in a community.”[9]

These obstacles may also require creative solutions tailored to each individual community or country. Eesha Pandit gives her account of how MergerWatch helped a merger of a secular and religious hospital in New York keep critical reproductive health services for women: “We discovered money available to alleviate the process of this merger and we brought the community together to protest about this issue. Therefore, the hospital ended up keeping the services in the Ambulatory Care building which was in a separate building, so the hospital could still comply with the directive and still keep the services.”[6]

Indeed, without these creative solutions, dedicated organizations, politicians, and individuals, and sufficient funding, situations such as the one described by Dr. Bergevin may become commonplace.

“Women without proper access may seek illegal means of abortive care and die from these unsafe procedures. All of these nightmares that you see in the Bronx that you do not see in Canada will all be multiplied in developing countries, simply because the government does not have enough resolve to have universal access to reproductive health care.”[9]


1 “50 Factoids About Sub-Saharan Africa.” Africa Development Indicators, 2008. 15 Oct. 2009. Web. http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/EXTPUBREP/EXTSTATINA/0,,contentMDK:21106218~menuPK:824080~pagePK:64168445~piPK:64168309~theSitePK:824043,00.html
2 Gross Domestic Product by State. Bureau of Economic Analysis, 2008. 15 Oct. 2009. Web. http://www.bea.gov/regional/gsp/action.cfm
3 Gribble, James and Haffey, Joan. “Reproductive Health in Sub-Saharan Africa.” Population Reference Bureau, 2008.
4 Maldonado, Lisa. Personal Interview. 13 Oct. 2009.
5 Gruenbaum, Ellen. “Islam, Gender, and Reproductive Health.” Woodrow Wilson Center for International Scholars. 5 Nov. 2004. Address.
6 Pandit, Eesha. Personal Interview. 15 Oct. 2009.
7 Greydanus, Donald, Senanyake, Pramilla, and Gains, Michelé. “Reproductive Health: An International Perspective.” Indian J Pediatrics: 1999, 415-424.
8 “Abortion and Unintended Pregnancy Decline Worldwide as Contraceptive Use Increases.” Guttmacher Institute, 2006.
9 Bergevin, Yves. Personal Interview. 13 Oct. 2009.


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