Governments and donors have not lived up to their promises to support family planning programs in poor countries and, as a result, shortages of contraceptive supplies pose a growing problem, a World Bank report said on Wednesday.
The report, “Population Issues in the 21st Century: The Role of the World Bank,” said the priorities of donors and development agencies have shifted away from family planning to other areas because fertility rates have fallen in most low- and middle-income countries outside of Africa.
Also, getting birth control supplies to clinics and pharmacies in rural areas was a problem in many poor countries, the report said.
“Global funds and initiatives have largely bypassed funding of family planning, with less attention being focused on the consequences of high fertility, even in those countries that are lagging in achieving sustainable population growth,” it said.
It found that in 35 countries, mostly in sub-Saharan Africa, most women give birth to more than five children.
And, of the estimated 210 million women worldwide who become pregnant every year, more than 500,000 women die during pregnancy and childbirth, and about one in five of them resorts to abortion because of poor access to contraception, the report said.
It also found that around 68,000 women die each year as a result of unsafe abortions, 5.3 million suffer temporary or permanent disability and many can face being ostracized within their own communities.
“Poor women endure a disproportionate burden of poor sexual and reproductive health because they run into financial or social barriers getting access to these basic but vital programs,” said Joy Phumaphi, the bank’s vice president for human development and a former health minister in Botswana.
“Their full and equal participation in development depends directly on accessing essential sexual and reproductive health care,” she added.
Phumaphi said the World Bank was committed to helping women make voluntary and informed decisions about fertility, wading into a controversial issue for some of the bank’s biggest shareholder nations.
In April, European nations objected to efforts by the United States to alter language on reproductive health services, including abortions, in a new World Bank health strategy for poor countries.
The Bush administration has frequently been accused of denying funds to groups or clinics that even offer advice on abortion. It has also been accused of trying to limit access to birth control, although the U.S. government does distribute more condoms globally than any other country.
The dispute between the United States and European nations followed on the heels of reports that the bank’s Managing Director Juan Jose Daboub had deleted all references to family planning in a bank strategy for Madagascar.
But Phumaphi said the bank had a central role in providing policy advice and financial assistance to countries to ensure women have access to reproductive programs.