Last week the United Nations Population Fund (UNFPA) released its 2012 State of the World Population report entitled, “By Choice Not By Chance: Family Planning Human Rights and Development.” What most interested me about this year’s report was the clear re-affirmation of the long-accepted international agreement that access to family planning services is a basic human right and is central to development. The report’s title reflects a right’s perspective well—that is, deciding if, when and how many children to have should be a choice that everyone can make throughout their lives, not only a choice that some can make or that can only be made some of the time. The report sheds light on critical trends and shifts in sexual behavior that affect universal access to reproductive health; articulates barriers that prevent equal access to quality family planning services; articulates the many benefits of family planning; provides recommendations; and unabashedly brings particular attention to the often overlooked rights of young people and other specific groups.
A rights-based framework for family planning was first articulated and affirmed by the international community in the seventies, and was re-affirmed by 179 governments in the 1994 Cairo the Programme of Action at the International Conference on Population and Development. Still, almost 20 years later, this right continues to elude millions around the world, especially young women. As noted in the report, unmet need is highest among the 300 million adolescent women between the ages 15 and 19. Even when using contraception, across all countries, the discontinuation rates among adolescents are about 25 percent higher than those for older women.
Furthermore, the risks of childbearing for both mother and infant are highest for adolescent mothers and adolescents and youth account for approximately 40 per cent of unsafe abortions worldwide.
While the these numbers are important and give us a sense of the magnitude of need, as reflected in the report, family planning as a human right is about people and the urgent responsibility that we have as a global society to uphold this right. This is about Sharmila in Nepal who as a young woman in an arranged marriage, became infected with HIV, by chance, as was her son. This is about Nicolette in Jamaica who at age 14 became pregnant, by chance, because she did not feel that she could purchase condoms or negotiate their use. This is about Shandi in Nigeria who became pregnant, by chance, because she did not know how to use or access contraception and later experienced complications from unsafe abortion. his is about Savita, who just died in Ireland, by chance, because doctors would not perform an abortion to save her life. All of these women supposedly have a right to family planning and reproductive health, yet they have experienced unintended pregnancy, HIV infection, forced marriage, and maternal morbidity and mortality, by chance.
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There is no excuse for this kind of “chance” in today’s society. We, as a global community have a responsibility to ensure that everyone has true choice when it comes to family planning and reproductive health—and that means unapologetically addressing barriers that continue to infringe upon this right, including barriers faced by young people. The report can help us promote true choices if it leads to policies and programs that are rights-based and address unmet need, eliminate barriers to choice, and consider the many social and economic benefits of family planning. As we begin to define a post-2015 sustainability development agenda, now more than ever before, we must ensure that family planning as a human right is at its core—unless of course we prefer to leave it up to chance.