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A bold and ambitious agenda was set forth in the Millennium Development Goals to raise the quality of life of all individuals and promote human development. The MDGs represent our collective aspirations for a better life and provide a minimum road map on how to get there. However, they can only be achieved if Governments, civil society and international agencies work together to address population issues as a development priority, in particular to secure the reproductive health and rights of people, especially the poor and particularly women. This vision is contained in the Programme of Action of the International Conference on Population and Development (ICPD), which was adopted by 179 Governments in 1994. The ICPD goal of universal access to reproductive health by 2015 is a target in the MDG monitoring framework, under MDG 5, to improve maternal health. Access to reproductive health can have a powerful impact on development, not only to improve maternal health but also to achieve all the MDGs.
Link among poverty, reproductive health and rights. Worldwide, illnesses and deaths from poor reproductive health account for one fifth of the global burden of diseases and nearly one third for all women. Every year, more than half a million women die during childbirth, with more than 95 per cent of them in Africa and Asia. Every minute, four people are newly infected with HIV and 2.1 million die of AIDS each year.
While devastating, these global statistics do not fully convey the true tragedy to a family when a mother dies during childbirth or when a child loses a family member to AIDS. This is a double tragedy because we know how to prevent these deaths. Effective interventions exist. Yet today, poor people have the least access to education and health care, including reproductive health, and this keeps them trapped in a vicious cycle of poverty and poor health, which often runs from one generation to the next. It is this poverty trap that must be broken if we are to achieve the MDGs. Investments in sexual and reproductive health play a significant role.


Benefits of investing in reproductive health and rights. Good reproductive health enables couples and individuals to lead healthier, more productive lives and, in turn, make greater contributions to their household incomes and to national savings. The health benefits of these investments are well known and documented. They are substantial. They include the prevention of deaths due to HIV/AIDS, cancer, complications of childbirth and unsafe abortion; the prevention or reduction of debilitating conditions, such as obstetric fistula and other sexual and reproductive illnesses; better nutritional status and decreased risk of anaemia for women; and increased survival rates and better health for infants. It is estimated that ensuring access to voluntary family planning could reduce maternal deaths by 20 to 35 per cent, and child deaths by as much as 20 per cent. Moreover, the World Bank estimates that ensuring skilled care in delivery, particularly access to emergency obstetric care, would reduce maternal deaths by about 74 per cent.
These are significant benefits. But as striking as these numbers are, the personal, social and economic benefits of reproductive health may be even more important. They are extremely important for human welfare and economic development. They include improvement in women's status and greater equality between women and men, as well as benefits at the individual, household and societal levels. A study in Mexico found that for every peso the Mexican social security system spent on family planning services between 1972 and 1984, it saved nine pesos in expenses for treating complications of unsafe abortion and for providing maternal and infant care. In Thailand, every dollar invested in family planning programmes saved the Government more than $16. Even more dramatically, analysis in Egypt found that every dollar invested in family planning saved the Government $31. This projection included government spending on education, food, health, housing and water and sewerage services.
Studies also show that the benefits go beyond government savings. Where mortality is high, parents are likely to have more children, but invest less in each child's health and education, impeding economic prospects. It is also known that chronic disease, poor health and low productivity discourage foreign direct investments in business and infrastructure. Furthermore, reproductive health investments, particularly in family planning, can produce what is called a demographic bonus. This is spurred by lower rates of fertility and mortality, and a larger healthy working population with relatively fewer dependents to support. If jobs are generated for the working population, this bonus results in higher productivity, greater savings and larger economic growth. In East Asia, where poverty has dropped dramatically, the demographic bonus is estimated to account for about one third of the region's unprecedented economic growth from 1965 to 1990. Given the world's largest youth generation in history, now is the time to focus investments on young people. The extent to which they enjoy education, health and job opportunities will determine our common future.
Investing in reproductive health works against HIV/AIDS. There is also no doubt that investing in sexual and reproductive health is strategic for curbing the HIV/AIDS epidemic. With over 75 per cent of HIV cases due to sexual transmission, delivery and breastfeeding, it makes sense to link HIV/AIDS efforts with sexual and reproductive health, which would benefit particularly women and young people who suffer disproportionately from the disease.
Stronger linkages can result in more relevant and cost-effective programmes with greater impact. By using the same services, the same health workers and the same infrastructure -- with investment in training and upgrading -- we can scale up responses that are so urgently needed to improve maternal health, decrease child mortality, prevent HIV infection and provide counselling, treatment and care. The countries that have significantly reduced HIV-infection rates have used reproductive health interventions. In Brazil, Thailand and Uganda, for example, community mobilization and behaviour changes, including condom use, played a vital role.
Investing in reproductive health is investing in development. The final synthesis report of the Millennium Project, Investing in Development, stresses the importance of investing in sexual and reproductive health as part of overall development efforts, especially to strengthen health systems and improve public health. Expanding access to sexual and reproductive health services, including family planning, has been identified as one of the "quick wins" for the achievement of the MDGs. But these arguments are only words, unless bold and decisive action is taken. Strengthened political will, partnership and investment are needed to make reproductive health and rights a reality.