UNFPA works around the world to provide reproductive health information and services so people can stay healthy and plan their families and futures. Such services include family planning, care during pregnancy and birth, counselling, prevention of infertility, dealing with the health consequences of unsafe abortion, the prevention and treatment of reproductive tract infections and sexually transmitted infections (STIs) and the prevention of HIV/AIDS. Young people and hard-to-reach and marginalized populations are of particular concern.

In many countries, people know too little about health and human sexuality or lack access to appropriate services, women are denied the freedom to manage their lives, and girls are expected to marry young and have children early - instead of attending school. These factors and others endanger the health and limit the potential of women and their families. The consequences are tragic.

Every minute:

• 380 women become pregnant; half of them did not plan or wish the pregnancy;
• 110 women experience a pregnancy-related complication;
• 100 women have an abortion; of which 40 are unsafe;
• 11 people are newly infected with HIV/AIDS;
• 1 woman dies from a pregnancy-related cause.

For both women and men, reproductive and sexual health is a vital first step towards broader choices in life, empowerment and a chance to escape from poverty. Births that come too early, too late or too close together pose significant risks.

Need for Action

• More than 500,000 women die each year from complications of pregnancy and childbirth - one every minute - and 99 per cent of these maternal deaths are in developing countries. Perhaps 15 times as many suffer injury or infection. Each year more than 50 million pregnancy-related complications lead to long-term illness and disability.

• With 40 million people now living with HIV/AIDS and 5 million new infections in 2001, the need for prevention cannot be overstated. One half of all people who become infected with HIV are under the age of 25.

• 78,000 women die each year from unsafe abortion, almost all in developing countries. Governments have agreed to reduce unwanted pregnancies and deal with the health impact of unsafe abortion as a major public-health concern.

• 350 million couples do not have access to a choice of safe and affordable contraceptive methods. Surveys from more than 60 developing countries indicate that more than 100 million women who are not currently using a contraceptive method want to delay the birth of their next child or to stop having children.

• At least one in every three women has been beaten, coerced into sex or abused - most often by someone she knows. Each year 2 million girls are at risk of female genital cutting. As many as 5,000 women and girls are killed each year in so-called "honour killings".

• Refugees, internally displaced persons and others caught in situations of conflict or natural disaster face particular challenges to their reproductive rights, from family planning needs to treatment and counselling in cases of sexual violence and rape.

Many countries now provide family planning and reproductive health information and services for women, men and young people. They also provide counselling, ensure quality of care and make their services more accessible and youth-friendly. Such voluntary services help individuals make informed, responsible decisions.

• Over the past 30 years, the development of modern contraceptive methods has given people more freedom and ability to plan their families.

• Contraceptive use has increased from less than 10 per cent of couples 30 years ago to some 60 per cent of couples today.

• Two thirds of all countries have introduced policy or legislative measures to promote gender equity and equality and the empowerment of women, including the areas of inheritance, property rights, employment and protection from gender-based violence.

But we have far to go. Death and illness resulting from pregnancy and childbirth, high rates of HIV infection among young people, unwanted pregnancy and unsafe abortion are among the major reproductive health challenges encountered today.

Family planning, safe motherhood and the prevention of sexually transmitted infections including HIV/AIDS are central to UNFPA programming for reproductive health. Their benefits are undeniable: saving lives, protecting health, promoting reproductive rights and empowering women and girls to lead healthy and productive lives.

Reproductive Rights

Reproductive health improves dramatically when rights are respected. Leaders from 179 countries pledged to protect and promote the reproductive rights of women, men and young people in the ICPD Programme of Action, which in Principle 8, paragraphs 7.2 and 7.3:

• Affirms the right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so.

• Affirms the right of all people to attain the highest standard of sexual and reproductive health.

• Affirms the right of all individuals to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents.

• Asserts that reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, and implies that people are able to have a satisfying and safe sex life, that they are able to reproduce and that they have freedom to decide if, when and how often to do so.

Prior to this, the right to plan the size and spacing of the family was agreed to in 1968 in Teheran at the International Conference on Human Rights, and elaborated in 1974 in Bucharest at the World Population Conference.

While progress in women's health in recent decades has shown results - including the more than tenfold increase in global contraceptive use and a decline in family size - more than a quarter of pregnant women in sub-Saharan Africa still receive no prenatal care and nearly half deliver babies with no help from skilled health personnel. Such problems persist to varying degrees in many developing countries. The participation of men can be a powerful force for progress in the recognition of women's rights.

Family Planning

Better reproductive health depends on being able to exercise the right to decide freely and responsibly the number and spacing of children. Family planning has been one of the great success stories of development, yet unmet need and widespread misperceptions remain.

• 350 million couples do not have access to a choice of safe, effective and affordable contraceptive methods.

• At least 120 million women want to use family planning methods but lack access to information and services or the support of their husbands and communities.

• Worldwide, 62 per cent or 650 million of the more than 1 billion married or in-union women of reproductive age are using contraception. In the more developed regions, 70 per cent of married women use a method of contraception, while in the less developed regions 60 per cent do. In Africa, only 25 per cent of married women are using contraception, whereas in Asia and Latin America and the Caribbean prevalence of contraceptive use is fairly high - 66 per cent and 69 per cent, respectively.

UNFPA supports voluntary family planning programmes that bring about healthier and smaller families, empower women to make choices and encourage men to take a responsible role as caring partners.

Safe Motherhood

Saving women's lives by making childbirth safer is a high priority. The vast majority of deaths and disabilities could be prevented if women had access to basic and emergency medical treatment during pregnancy, childbirth and the post-partum period. Interventions for safe motherhood also save the lives of infants and children.

• More than 500,000 women die each year in pregnancy and 15 times as many suffer acute complications.

• Complications of pregnancy and childbirth are the leading cause of death and disability for women aged 15 to 49 in most developing countries. When a mother dies, her children are also more likely to die.

• Women in developing countries are 30 times more likely to die from pregnancy-related causes than those in developed countries.

• Only 53 per cent of deliveries in developing countries take place with a skilled birth attendant.

• Meeting the unmet need for contraceptives could reduce maternal mortality by 20 per cent or more.

Most maternal deaths can be prevented when women have:

• Care before pregnancy (antenatal)
• Skilled birth attendants
• Access to emergency obstetric care
• Care after pregnancy (post-partum) for haemorrhage, hypertension and infection.

In situations of conflict and natural disaster, UNFPA provides emergency reproductive health essentials that help make childbirth safer.

Of major concern as an issue of safe motherhood is obstetric fistula. This neglected condition has severe physical and social consequences and affects at least 2 million women. It occurs as a result of prolonged and obstructed labour, often in very young women who are not yet physically mature. Torn tissues between the vaginal wall and the bladder or rectum result in incontinence, infections and ulcerations. Women are often ostracized and abandoned, and their babies usually die as a result of the obstructed labour. To combat this problem, which has been all but eliminated in industrialized countries, UNFPA has launched an international campaign to prevent fistula and increase access to its surgical repair.

Sexually Transmitted Infections

An estimated 333 million new cases of sexually transmitted infections (STIs) occur every year. Worldwide, the disease burden of STIs in women is more than five times that of men. Many sufferers are infected by more than one disease. Almost two thirds of cases of infertility are attributable to STIs.

• Each day, 500,000 young people are infected with an STI, most in the 20 to 24 age group, followed by the 15 to 19 age group. In addition, half of all new HIV infections occur among young people.

• The presence of one or more STIs increases the risk of becoming infected with HIV by two to nine times. Condoms help reduce this risk.

Young people are particularly vulnerable to STIs. Most know very little about them and are reluctant to seek services. Those who become sexually active early are more likely to change sexual partners and risk greater exposure.

For women of all ages, greater susceptibility to STIs is based on both biological and social realities. STIs cause pregnancy-related complications, sepsis, spontaneous abortions, premature birth, stillbirth and congenital infections. Other problems include pelvic inflammatory disease and cervical cancer.

UNFPA supports the prevention and treatment of STIs through reproductive health programmes including family planning, safe motherhood, adolescent reproductive health and HIV/AIDS prevention.

Quality of Care

Improving the quality of care - and access to it - cuts across all areas of our work and is a constant consideration in the provision of services. In family planning, studies are conducted to determine if the methods available meet the unique needs of each user, and the supply of contraceptives in monitored country by country. Monitoring helps ensure that supplies have the maximum shelf life and that a wide range of services and a variety of contraceptives must be available to suit individual needs. For adolescents, care is taken to ensure that services are youth-friendly, age-appropriate and promote youth participation.

To significantly improve quality of care, UNFPA supports efforts to increase women's awareness of reproductive rights and their capacity to influence decisions about health services. Quality increases the effectiveness of any effort.

• In family planning, the importance of quality services cannot be overstated: up to a third of maternal death (mortality) and injury and infection (morbidity) could be avoided if all women had access to a range of modern, safe and effective family planning services that would enable them to avoid unwanted pregnancy.

Examples of UNFPA in Action

Women of the Ngöbe, indigenous to Panama, are overcoming their marginalized status through a UNFPA programme to increase access to reproductive health services, provide training for health workers, and raise awareness through activities in 32 communities.

• In Nigeria, UNFPA has implemented a model project to upgrade and equip 900 primary health facilities and train 900 midwives with life-saving skills. Activities will increase the number of births attended by skilled assistants and expand family planning services.

• Training for village midwives took place throughout Sudan as a major effort of the Ministry of Health with support from UNFPA. Training materials were provided to many villages where midwives play a central role in pregnancy, delivery and post-partum care.

• Improving the quality of sexual and reproductive health care by increasing cooperation between UNFPA and NGO partners is a focus of efforts in India, Kyrgyzstan, Mauritania, Nepal, Peru and Tanzania.