The most optimistic or "constant
growth" scenario still registers a $2.1 billion deficit in
resources by the year 2000 compared to ICPD targets. Table 1 summarizes
these three scenarios.
By the year 2000 there will be 1.35
billion women between 15 and 45. Of these, 950 million are expected to
be married or in steady relationships. By 2000, if reproductive health
and family planning information and services are provided in line with
the ICPD goals, 610-640 million of these couples would be using some
form of contraception.
More Potential Family Planning Users Without
Assuming the least grave of UNFPA’s
three scenarios, the smallest shortfall in resources, 97 million
additional individuals and couples who would have chosen contraception
will not be able to do so. Under the Intermediate Growth Scenario the
figure is 130 million and with the Low Growth Scenario 170 million.
Under the first of the three
scenarios, the number of couples having access to and using reproductive
health and family planning services would be 16 per cent lower than if
Cairo resource goals are not met. The Intermediate Growth Scenario would
mean a shortfall of 21 per cent, and the worst case 30 per cent. One
effect will be that more people will use less effective traditional
contraceptive methods: others will use no method at all.
More Unwanted Pregnancies
With inadequate contraceptive
coverage, the number of unintended pregnancies will rise—by 130
million for the period 1995-2000 under the least grave scenario,
climbing to 230 million under the worst case.
For the women concerned,
unintended pregnancies can have serious life and health consequences; at
the least they mean additional costs in lost work time and perinatal
care. For their countries, the consequences of unintended births are
additional investments in health, education, housing and employment—or
perhaps just more additions to the ranks of the poor and hopeless.
Many of these unintended pregnancies
will not come to term. If resources fall short, the number of abortions
will increase dramatically—from 50 million extra abortions to more
than 90 million over the period 1995-2000, depending on the resource
Besides the negative health and other
effects on millions of women, the costs to overburdened health systems
from unsafe abortions will escalate. Complications from unsafe abortions
are among the leading causes of hospitalization for women of
reproductive age in developing countries.
More Unwanted Births
Depending on the resources scenario,
there are likely to be somewhere between 60 million and 110 million
additional unwanted births between 1995 and 2000.
These extra births imply significant
burdens in terms of health risks to the mother at time of delivery,
additional demands on health care services, and a general erosion of
resources available to poor families.
and Injuries Resulting from Pregnancy
Depending on the resources scenario,
there will be between 300,000 and 540,000 total extra maternal deaths
between 1995 and 2000, that is, between 100,000 to 180,000 annually by
the year 2000. Lack of resources would also make it more difficult to
improve emergency obstetric care, antenatal care and the proportion of
births attended by a trained health professional.
Maternal morbidity will increase
dramatically. Shortfalls in resources could result in 3.8 million to 7
million additional cases of life-threatening complications and illnesses
related to unwanted pregnancies. In the year 2000 alone, the number of
women affected would range from 1.3 million to 2.3 million.
Increased Infant and Child Mortality
Currently, around 125 million children
are born in developing countries every year. More than 7.5 million die
before reaching their first birthday, and another 3.2 million before
reaching five years of age. If Cairo resource targets are not met, these
rates will rise sharply, depending on the resources scenario. Between
1995 and 2000, even under the most optimistic of the three scenarios, an
additional 3.6 million infants and 1.3 million children will die.
Under the Intermediate Growth
Scenario, the combined number of infant and child deaths rises to 6.4
million and to almost 9 million with the Low Growth Scenario. These
additional infant and child deaths will be a direct consequence of the
enormous increase in unintended pregnancies noted earlier.
Effects of Shortfalls on Services and Infrastructure
Limited resources will hold back
efforts to improve the quality and coverage of reproductive health
services—the range of contraceptive methods available, the technical
competence of staff, and the quality of information and communication
programmes, for example.
Current resource shortfalls have
already harmed service delivery. In Tanzania, for instance,
three-quarters of all health centres and hospitals surveyed did not have
a speculum, nearly one-third lacked disposable gloves and 22 per cent
and 15 per cent, respectively, did not even have a stethoscope.
The broader effects are even more
ominous. In Nicaragua, one of the poorest countries in Latin America,
population is growing by 3 per cent a year, with mounting debt and an
increasing number of rural and urban poor. Nicaragua must find the
resources to train an extra 3,000 teachers over the next five years and
build facilities to accommodate another 30,000 students. By 2040, unless
population growth is slowed considerably, the country will need to
educate an additional 9,000 doctors, 20,000 nurses and build 2,000 new
health posts. By contrast, the cost of guaranteeing every citizen access
to appropriate family planning services has been estimated at no more
than $20 per person per year.