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Why it could cost less than R120 per year to save a life

Maternal deaths in developing regions would fall by 73% if all women had access to contraception and maternal healthcare, shows new research.


Nearly 25 years ago, representatives from 179 countries gathered in Cairo to negotiate a new global agenda on population and development. The final document from that conference put forth an idea that was radical at the time: that the ability of all individuals to make free and informed reproductive decisions is critical to the sustainable development of our planet. The legacy of that landmark agreement has been to recognize that health, human rights, environmental protection and economic growth are inextricably linked.

But despite the progress made since Cairo, the international community has not achieved consensus about how to move forward on sexual and reproductive health and rights. Weak political commitment, inadequate resources, persistent discrimination against women and girls, and an unwillingness to openly address issues related to sexuality have taken an enormous toll on communities worldwide.

To tackle the scope of the unfinished agenda, we brought together 16 multidisciplinary experts from Africa, Asia, Europe, the Middle East, North and South America two years ago to form the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights.

Today in Johannesburg, we release our findings and recommendations, presenting a bold and evidence-based vision for achieving universal sexual and reproductive health and rights.

Our vision underscores that improving health depends on advancing rights. It stresses that for too long, many policymakers have taken a narrow view of sexual and reproductive health and rights—a view that has typically excluded sexual rights altogether.

Meaningful change will require a holistic approach that encompasses the right of all individuals to make decisions about their bodies and lives—free of stigma, discrimination and coercion.

At the heart of this vision is a package of essential sexual and reproductive health interventions. The package includes interventions that governments typically focus on, such as contraceptive provision, HIV prevention and treatment, and maternal and newborn health services.

In addition, the Commission’s vision calls for attention to frequently neglected components of sexual and reproductive health, such as safe and legal abortion care; infertility treatment; appropriate and nonjudgmental services for lesbian, gay, bisexual, transgender, queer and intersex people; and prevention, detection and counseling for gender-based violence.

The time is now to pursue this more inclusive and comprehensive plan of action.

Despite national and international efforts to advance family planning services, each year in developing regions, more than 200-million women want to avoid pregnancy but are not using a modern method of contraception.

More than 30-million women deliver their babies outside of a health facility.

Worldwide, more than 25-million unsafe abortions take place annually, and nearly two million people become infected with HIV.

Countries have the means to ensure that all people receive essential sexual and reproductive health services—services that could prevent these devastating outcomes. The Guttmacher-Lancet Commission’s vision is ambitious, but achievable and affordable.

In fact, we found that meeting the needs for modern contraception, safe abortion, and maternal and newborn health care in developing regions would cost just US$9 (R113) per person per year. Half of that amount is already being spent to cover the cost of current levels of care.

The benefits to women and their families from this investment cannot be overstated.

Maternal deaths in developing regions would fall by 73% from 2017 levels if women’s needs for contraception were fully met and essential care was provided for all pregnant women—including those who have miscarriages, stillbirths or abortions—and newborns.

Further, newborn deaths would drop from a staggering 2.7-million to 538 000 each year.

The human consequences of inaction should be reason enough for countries and donors to prioritise this type of investment. But beyond the impact on individuals’ health, evidence shows that access to high-quality sexual and reproductive health services increases productivity and household income, and has multigenerational benefits by also improving children’s health and well-being.

South Africa provides a compelling illustration of what can be achieved when governments commit to protecting sexual and reproductive health and rights.

Since the country liberalised its abortion law in 1997, complications from unsafe abortion have dramatically declined. Between 1994 and 2001, deaths from unsafe abortion fell by 91%, according to a 2008 scientific letter published in the South African Medical Journal.

We have the knowledge and tools we need to accelerate and expand these gains worldwide.

Achieving universal access to sexual and reproductive health and rights is essential to the health, equitable development and human rights of all people—and it starts today. 

Alex Ezeh is the former executive director of the African Population and Health Research Center.

nn Starrs is the president and CEO of the US reproductive health think tank the Guttmacher Institute. Ezeh and Starrs co-chaired the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights.