I am very happy to join all of you here today. Meeting reproductive health supply needs is a key element of the global effort to improve people’s lives by protecting their reproductive and sexual health. Given the increased international attention now being paid to slowing the further spread of HIV/AIDS, this meeting could not be timelier. This message rang very loudly and clearly during the African Summit on HIV/AIDS and other related diseases that I attended last week in Nigeria, with many of our partners, especially the co-sponsors of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
I would like to thank all the members of the Interim Working Group Planning Committee, and particularly, Population Action International; John Snow, Inc.; the Program for Appropriate Technology in Health, and the Wallace Global Fund, for their diligent efforts in organizing this meeting. The advance work, including the January planning meeting in Barcelona and the sharing of information through a very useful web site, has given us a clear focus for the next three days.
Special thanks are due to the Bill and Melinda Gates Foundation, represented here by Gordon Perkin and Suzanne Cluett, for funding this important undertaking.
In my first four months as UNFPA Executive Director, I have met with many of the Fund’s major collaborators, including donor governments, non-governmental organizations (NGOs) and United Nations system partners. These discussions, on the numerous challenges we face in promoting reproductive health and rights and fighting HIV/AIDS, have been productive. This meeting, though, offers a unique opportunity: a chance to strategize with partners from programme-country governments, donor governments, supportive foundations, and the NGOs that best understand the critical challenge of providing reproductive health supplies to all who need them.
Six and a half years ago, the ICPD in Cairo called for universal access by 2015 to reproductive health care, including the information and services couples need to determine the size of their families. This goal was affirmed as a human rights imperative and development requirement: essential to empowering women, slowing and eventually stabilizing population growth and fostering sustainable economic growth in the world’s poorest countries.
In 1999, an intergovernmental review showed that countries were successfully moving to a rights-based and needs-driven approach to reproductive health and family planning. Providers are being trained to give more attention to quality-of-care issues like interpersonal communications, privacy, counselling and follow-up.
But key shortcomings were identified, too. These include inadequate progress in making motherhood safer, in stemming HIV/AIDS, and in protecting young people against unwanted pregnancy and sexually transmitted diseases.
Another serious problem is the gap between available resources and programme needs. The ICPD estimated that $17 billion was needed annually by the year 2000, mostly for reproductive health services. The needs would increase to nearly $22 billion by 2015. Two thirds of this amount was to come from developing countries themselves, the rest from international donors.
It is widely recognized that investing in sectors that support reproductive health, like education, pays tremendous dividends in the quality of people’s lives, and ultimately in the productivity of countries. Nevertheless, external support for reproductive health programmes has stagnated at less than one half of the $5.7 billion required to meet the ICPD target for 2000.
Donor support specifically for contraceptives has actually declined. UNFPA estimates that, in 1999, it reached its lowest level ever in proportional terms and that the shortfall in that year was as much as $86 million. Every $1 million shortfall in contraceptive commodities is likely to result in some 360,000 unwanted pregnancies, 150,000 abortions, more than 800 maternal deaths and 11,000 infant deaths.
A shortfall in funds for family-planning supplies has grown so desperate that many countries are struggling to meet current needs and are prevented from addressing urgent demand and closing the unmet need gap. An estimated 350 million couples worldwide lack access to the full range of modern contraceptive methods. Surveys suggest that some 120 million non-users worldwide would be using family planning if it were more easily available and if husbands, families and communities were more supportive.
And this gap is likely to widen. The number of reproductive-age women in developing countries will grow by more than one fifth in the next 15 years, to 1.55 billion. Together with expected increases in the proportion of people using contraceptives, total demand is likely to grow by more than 40 per cent by 2015 --assuming services can be provided.
Inadequate funding for contraceptive supplies also impedes progress towards the Cairo objective of ensuring that clients can choose among a range of safe, effective and appropriate family planning methods, which is a key element of quality care.
An analysis of funding requirements prepared by the UNFPA for this meeting shows that the global sums needed for contraceptives and additional condoms to prevent sexually transmitted infections and HIV/AIDS will increase from about $810 million in 2000 to some $1.8 billion in 2015.
If donors continue to support the 41 per cent of these requirements as they did for contraceptive commodities between 1992 and 1996, they would need to provide a minimum of $385 million for contraceptive commodities and condoms for STDs/HIV prevention in 2002. This begs the question as to what proportion developing country governments will be able to meet of the remaining $555 million required for commodities.
The estimates of requirements cited above are for commodities alone. The annual cost of making them accessible through quality services, which was about $4 billion in 2000, will rise to $9 billion in 2015.
The most alarming consequences of the financial shortfall, however, are in the area of HIV/AIDS prevention. UNAIDS reports that 5.3 million people became infected with HIV last year, the vast majority due to unprotected intercourse. Widespread availability of male and female condoms, combined with effective efforts to change people’s behaviour, is central to any prevention strategy. But, in all affected countries, the supply of condoms is far short of what they need.
To confront this crisis is an enormous challenge, but not impossible to overcome. After too many years of disastrously inadequate attention to HIV/AIDS and its consequences, the international community seems to be waking up. Last week, in Abuja, Nigeria, African leaders issued a firm declaration of their resolve to take more effective action against HIV/AIDS. The strong interest in next month’s United Nations General Assembly special session on HIV/AIDS is another indication that governments are developing the political will needed to reverse the pandemic. Of course, sustained support for comprehensive prevention programmes will be the real test of commitment.
On the donor side, commitment must be measured by committed resources. Discussions now under way about creating a global fund to combat HIV/AIDS and other infectious diseases may portend new, more appropriate levels of support that add to available resources for reproductive health commodities security and not merely redistribute these resources.
Although we come to this meeting from three different types of organizations, we must work together in a complementary manner that accommodates the comparative advantages of each one of us and promotes the common objectives that bind us.
While UNFPA’s special niche in contraceptives for family planning and condoms for STDs/HIV/AIDS prevention is procurement, it works in all the broader areas of the population package of the ICPD Programme of Action, with its comparative advantages of universality and neutrality.
For its part, UNFPA has developed a Global Strategy for Reproductive Health Commodity Security to help developing countries meet the Cairo goals in this regard. We will continue to play our Cairo-mandated leadership role and assist countries in procuring quality, low-cost reproductive health supplies. Working closely with the groups represented here and other partners, we intend to expand our advocacy for resource mobilization, and help develop technical resources, including early-warning mechanisms for shortfalls and mechanisms for follow-up, as well as work with the World Health Organization to develop standards, protocols and training materials. Within programme countries, we will work with national counterparts on ways to better identify gaps and coordinate donor, NGO and private sector support.
In the past six months, the Netherlands and the United Kingdom have given the UNFPA a combined total of nearly $80 million to address the current commodity shortfall. Canada last month added another half a million. These contributions and others make me confident that, in spite of the Fund’s own recent funding gap, this strategy will succeed.
It will only work, of course, as an integral part of a larger strategy. We have to promote gender equality and combat violence against women; to expand the reach of reproductive health services; and to overcome economic, social and cultural factors driving the spread of HIV/AIDS. To prevent unwanted pregnancies and the transmission of HIV/AIDS among youth, more education and information are needed, including information on responsible sexual behaviour and abstinence. Young women and girls, in particular, need access to services to help them protect themselves as well as to education. All women, and especially young women, need to be empowered to say NO to sexual relations or to unsafe sex. Men need to be supported to respect women's positions and to understand the significance of their NO.
We need more innovative programmes that do all of these things. One good example of such a programme is the African Youth Alliance, a Gates Foundation-funded partnership among the UNFPA, PATH and Pathfinder International to fight HIV/AIDS and improve adolescent reproductive health in four African countries. Another important initiative has been the recent funding by the United Nations Foundation for projects by UNAIDS and its partners in several countries.
This meeting is a key step towards meeting the goals of the ICPD, and, in particular, towards ensuring reproductive choice and halting the spread of HIV/AIDS. Our task is to highlight the worldwide problem of securing contraceptive supplies and condoms for HIV/AIDS prevention, and identify what needs to be done in response. But, it must be clear through our behaviour change communication and advocacy work that men and women do make choices about their sexual lives, including their choice to abstain or to have access to a range of reproductive health commodities and services. It should also be clear that whatever each one decides should be fully respected and supported. We need to work together to ensure that men and women have a spectrum of choices for their lives. For reproductive health commodities, we need to work together to ensure their availability within quality services. By working together, we can help ensure that the global community will finally make the necessary funding available.
Thank you.