Interview with Renate Bähr, Executive Director of the DSW (German Foundation for World Population)
Sexual and reproductive health and rights (SRHR), being well informed and having access to appropriate services and supplies – for example in relation to family-planning methods – are fundamental human rights. However, this right is still far from being a reality for many people in the world. The DSW (German Foundation for World Population), a non-governmental organization, is one of the partners engaged in awareness programs and political lobbying work to fight for better SRHR services. In this interview, Renate Bähr, the DSW's Executive Director, explains why giving women and couples the freedom to decide whether, when and how many children they would like to have is not just an abstract wish, but an urgent necessity.
Self-determined family planning is named by the United Nations in its Millennium Development Goals as an important factor for development.What are the connections between family planning and sustaina
Securing all people’s fundamental rights is the basis of all sustainable development – and this includes the right to unrestricted access to counseling and medical care in the field of sexual and reproductive health. The Millennium Goals take up self-determined family planning as an important factor for improving maternal health. It also benefits the development opportunities of entire countries. It’s more difficult for parents with very many children to provide for all of them and to send them to school. Yet without a school education the young generation lack important prerequisites enabling them later to feed their own family. And if women can decide the time of a pregnancy, they also have better chances to themselves train for a professional qualification, generate their own income and play an equal role in society.
How are overall social objectives related to people's private wishes?
Self-determined decisions by individual people and a positive development by the countries go hand-in-hand. If couples can themselves determine when to start a family and how many children to have, they will do this in line with their resources, so that their children grow up healthy with good prospects for the future. In turn, a strong, well-educated young generation also ensures a productive future for the country. Unlike the industrialized countries, the developing countries will not suffer from child poverty and an aging society in the coming decades. The countries can cash in on this 'demographic dividend' if they take the right decisions now and invest in their young people’s health, education and training, sex education and employment prospects.
From the point of view of development policy, access to contraceptives pursues the objective of slowing down rapid population growth. Do women in countries with fast growing populations really want to
The prejudice that the industrialized countries are trying to export their own family model has been around ever since sex-education and family-planning programs were first introduced. It unfortunately even survives today in certain circles. This makes it all the more important to make a clear distinction. It is indeed that case that the desire for a large family is statistically greater in developing countries than in the industrialized nations, and nobody wants to talk these people out of this wish. On the contrary, the whole point is for every woman and every couple to determine themselves exactly how many children they want. On the other hand, however, every child should be wanted, and here is the reality is different. A study published in 2012 has shown that more than 220 million women in developing countries want to use contraceptives but don’t have the opportunity to do so. That's one in every four women!
In some countries, though, children are people’s only provision for old age.
That's true. However, a high birth rate also reflects a desperate attempt to compensate for a high infant mortality rate: it’s then not a desire for a lot of children, but a hope that some children at least will reach adulthood. This is a vicious circle because too many pregnancies in quick succession increase the risk of miscarriages and infant mortality; the World Health Organization and the US Agency for International Development USAID recommend an interval of two to three years. Yet motherhood often offers the only prospects for girls and women in society. Such factors have little to do with self-determination; the high birth rate is then partially caused by a lack of alternatives.
What practical impact does an unwanted pregnancy have on the life of the women concerned?
Unwanted pregnancies are one of the causes of the high level of maternal mortality in developing countries. In millions of cases, girls and women see abortion as the only way out, and the operations are often carried out under extremely precarious conditions. Furthermore, many also suffer from health problems caused by complications during pregnancy or childbirth. And finally, an unwanted pregnancy can mean that the woman is no longer available to work and the family is economically weakened. If there is also a lack of resources to ensure the health and education of all children, the poverty risk is passed on to the next generation.
You are committed to providing sex education for young people and giving them access to family-planning methods. What obstacles you encounter in this context?
There is a huge lack of knowledge about sexuality and little practical access to contraceptives. Talking about sexuality is a social taboo in many regions of the world. Some parents and conservative opinion leaders worry that sex education and providing teenagers with contraceptives could in itself encourage them to become sexually active. At the same time, their own knowledge about sexuality is scanty. Sadly, governments often lack the political will: in very conservative countries the issue of sexuality is simply not talked about. They don’t want to make contraceptives available – certainly not to adolescents and unmarried young people. Not least, costs are also a factor in this context: 8.1 billion US dollars a year would be needed to ensure that all girls and women worldwide have the option of using contraceptives; yet not even half of this amount is currently available.
2015 is the target date for the UN Millennium Goals. Yet when it comes to self-determined family planning, the finishing line still stills a long way off.
Let me begin with a positive message: the latest United Nations progress report shows that overall progress is being made with the Millennium Goals. Some of the goals, for example on poverty eradication, drinking water and education, have even been reached ahead of schedule. But it’s true: especially when it comes to improving maternal health and access to reproductive health, there is still a great deal of pressure to act. It’s clear that the international community is not providing enough funds. Whilst five donor countries are contributing the promised 0.7 percent of their gross national income for development cooperation, most of them are missing this target by a long way. Even in the medium term there seems little likelihood of achieving anything more than declarations of intent from these countries. Money isn’t everything, but, like it or not, it's what you need to launch projects, build infrastructure, teach adolescents and young adults about reproduction, and give them a range of safe contraceptive methods to choose from – as it should be with a free choice. The governments in developing countries also need to get more involved.
Was the Millennium Goals project too optimistic?
I would say no. After all, it's all about the lives and the rights of men, women, children and young people – above all in the poorest countries of the world. Emphatically demanding improvements here is a matter of human dignity.
What will happen after 2015 – what measures do you believe should definitely be implemented?
It’s clear that our work – including the international community, civil society and business corporations – must continue beyond 2015 without any letup. A new set of goals is currently under negotiation at the United Nations. From our point of view it’s important that progress be made measurable and that we establish a differentiated way of collecting data. Up to now, certain groups like homosexuals, people with disabilities and adolescents have not been mentioned separately at all in the statistics. Yet they are particularly at risk when it comes to issues like HIV or teenage pregnancies, and ought to be specifically targeted. Another thing that will be important is to consistently demand that targets be met. This means political lobbying urging governments to honor their pledges and making sure they know how important it is for their countries' future and sustainable development to promote sustainability and secure the population's fundamental rights. This applies to both developing and developed countries, because the future agenda for the period after 2015 will apply to all countries.
Would you like universal access to sexual and reproductive health to be made the number-one goal in the new set of objectives?
We would like this issue to be no longer linked exclusively to improving maternal health. Sexual and reproductive self-determination is a fundamental right. Sex education is an integral part of a thorough education, and the availability of contraceptives is part and parcel of every good healthcare system. Reducing child mortality levels, cutting the number of abortions, strengthening the role of women in society: all of these issues belong together. We would like sex education and self-determined family planning to be understood as a key issue all the parties involved.