• Gyerekmunka
  • Két gyerek
  • Gyerekek a családban
  • Öregek
  • Asszony tánc
  • Asszonyok terménnyel
  • Városkép
  • Tanítás
  • Always on  the road
  • Bare Eyes
  • Black albino
  • Children of Misery
  • Kids of Kenya
  • Maasai Chief
  • Maasai children
  • Maasai village
  • Maasai women
  • Past and the future on her face
  • Smiling in chador
  • The English teacher

"Az idősödő korösszetételnek és az eljövendő számbeli csökkenésnek örülni kellene, nem sajnálkozni felettük."

Lincoln H. Day
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Renewed effort to boost birth control



There is an increased determination to spread the benefits of contraception, says Andrew Jack.


As World Population Day approaches on Wednesday, the medium – a UN website – may be glossier than ever, but the message is the same. There is wide agreement on what is required to provide reproductive health to all, but the reality is falling far short.
Nearly 20 years after governments reached consensus at an international conference in Cairo on family planning in 1994, progress has been limited and, in some cases, the trend has gone into reverse. About 215m women in developing countries seeking contraception cannot get it. That means 75m unintended pregnancies every year, threatening the health and lives of millions of mothers and their children. Meanwhile, the world population has exceeded 7bn, placing fresh pressure on economic growth, the environment and the wellbeing of communities.

The realisation of ambitious health-related targets set at international meetings since Cairo has also proved disappointing. The UN Millennium Development Goals agreed at the turn of the century called for significant reductions in infant and maternal mortality by 2015. In many countries, it is clear these targets will not be met. Yet there are signs of fresh determination to boost contraceptive
assistance. Following meetings in Uganda and Senegal, London is host to a highlevel family planning summit on July 11. The aim is to increase contraceptive access for the poor from 260m women a year today to 380m by 2020. “Since Cairo, we have had conflicts and economic crises that have hindered progress,” says Tewodros Melesse, directorgeneral of the International Planned Parenthood Federation. “Now is an opportune moment to create political momentum, bring major donors together and mobilise civil society.” Across much of the world in the past, industrialisation, improved nutrition and sanitation pushed down family size with the help of contraception. But while significant advances in immunisation and medical treatment since the second world war have sharply cut infant mortality, that has not always translated so rapidly into falling birth rates. While some women still want large families, many more do not. Aside from the health risks, there are economic consequences of this “unmet demand”. Teenage mothers tend
to drop out of school, depriving themselves, their families and societies of a more educated workforce and the prospect of stronger economic growth. “Family planning has been a huge determinant of long-term development,” says Raj Shah, head of USAID, the world’s largest donor which gives $625m a year to the field. “We have an obligation and a real need to do a better job.” Andrew Mitchell, the UK’s international development minister, adds: “In cost terms, family planning is excellent value for money. The relevant services, including the provision of contraception, cost on average less than £1 per person per year – far less than treating the complications of an unintended pregnancy.” Mobilised by fears that overpopulation would limit development, however, India ran a coercive sterilisation campaign inthe 1970s. China still operates a one-child family policy, highlighted last month by a widely publicised case of a compulsory abortion. Apart from the human rights abuses that such policies represent, evidence from other countries such as Bangladesh has shown that significant progress can be achieved voluntarily, as long as there is the political will. But if the Cairo conference condemned coercion and reached a clear consensus on how to help women meet their own desire to limit family size, momentum to provide them with the necessary support has slowed. Some argued at the time that birth rates were already falling and greater action was no longer required. Donors began to switch to different causes. Ideology and religion also played a role, with US policy requiring recipients of aid to condemn prostitution and not undertake abortions; and the hierarchy of the Roman Catholic church critical of contraception. Gary Darmstadt, director of family planning at the Gates Foundation, which has upped its own contribution, says: “There was pretty broad support for family planning in the 1970s and 1980s across people of various political backgrounds and ideologies, but then the issue became more polarised. Abortion was linked to contraception and it began to create a divide that persists today.” For him and others focused on this week’s conference, a first priority is renewed political commitment linked to fresh funding. It will cost $10bn between now and 2020 for the world’s poorest 69 countries to maintain current levels of contraceptive support for 260m women. A further $4.5bn will be required to help 120m more, including $2.3bn from donors. Efforts are focused on a combination of new money and better use of existing resources, with countries putting forward plans tailored to their own needs. Participants will also seek greater accountability and co-ordination, pushing for better scrutiny of governments and charities to
increase efficiency. But many also argue for a bigger role for both the private sector – where many women turn for contraceptives – and faith-based organisations. “Many people think that religious leaders are against family planning,” says Ray Martin, head of Christian Connections for International Health. “Of course, some are, but many, probably most, are not.” A second issue at the London summit is “market shaping” to remove regulatory hurdles, ease procurement, improve forecasting and strengthen distribution. That should help reduce uncertainty, boost volumes and push down prices for contraceptives. A third tack will be to foster improved technologies,
whether by using mobile phones to track supply shortages better or new longer-lasting contraceptive implants that are discreet, reversible, reliable and minimise the inconvenience. Given tough economic times and the longstanding reluctance of donors to cooperate and pool resources, finding money will be one challenge for richer and poorer countries alike in meeting the latest
objectives. Another will be fear that a renewed “vertical” focus on family planning risks diverting thinly stretched medical workers and undermining a more holistic “horizontal” approach to the provision of healthcare, including other still more neglected infections such as syphilis or schistosomiasis, which can in turn boost susceptibility to HIV. A final issue is the broader question of women’s power. Pam Barnes, head of Engender- Health, a New York charity, says: “Family planning is not just about commodities. It’s about health, education and empowerment. I’ve lived in places where women can’t even walk to the health post without permission. Male involvement is vital.” Ironically, while many organisations working in family planning are heavily staffed by women, they are often run by men. British officials have dropped the phrase the “golden moment” to describe the London summit’sefforts to remobilise global support for family planning. But, in the build-up to the Olympic Games, participants are hoping at least for a bronze medal in effort and funding. If they succeed, the legacy could be far longer lasting than the sporting event that follows. If they fail, human suffering and economic stagnation will certainly be greater.

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