Sexual and reproductive health: progress and outstanding needs

Abstract

We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion. Yet aggregate gains mask stark inequalities, with low coverage of services for the poorest women. Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 80 developing countries highlight persistent disparities in skilled birth attendance by household wealth: in 70 of 80 countries (88%), ≥80% of women in the highest quintile were attended by a skilled provider at last birth; in only 23 of the same countries (29%) was this the case for women in the lowest wealth quintile. While there have been notable declines in HIV incidence and prevalence, women affected by HIV are too often bereft of other SRH services, including family planning. Achieving universal access to SRH will require substantially greater investment in comprehensive and integrated services that reach the poor.

Keywords: ICPD; maternal health; sexual and reproductive health.

Figure 1.. The percentage of women who had a skilled attendant (doctor, nurse or mid-wife) at birth increased approximately 15% globally from 1990 to 2010, but with notable distinctions in progress between regions.

Source: DHS and MICS data, as reported in UN-ECOSOC (2014b).

Figure 2.. Trends from select countries display the changing inequalities by household wealth in the percentage of women who had a skilled attendant (doctor, nurse or mid-wife) at last birth between 1990 and 2010.

Source: DHS and MICS data, as reported in UN-ECOSOC (2014b).

Figure 3.. Proportion of women in select Asian countries with access to management of post-partum haemorrhage in 2005, with specific focus on urban versus rural access.

Source: UN-ECOSOC (2014b); Analysis based on data from the Maternal and Neonatal Program Effort Index (MNPI): http://www.policyproject.com/pubs/mnpi/getmnpi.cfm.