“I’d like to start by stating emphatically that since addressing global inequality and inequity are our overall principles in revising the MDGs [Millennium Development Goals], we must focus on health inequities to have a meaningful and lasting impact on human development,” said Beth Schlachter of the State Department’s Bureau of Population, Refugees, and Migration, speaking at the Wilson Center on January 9. “And for the most vulnerable – women and girls – that means we must focus on sexual and reproductive health and reproductive rights.” [Video Below]

The Millennium Development Goals, which have been the dominant international development framework since their inception, expire in 2015. Schlachter was joined by John May of the Center for Global Development and Georgetown University, Kelly Castagnaro of the International Planned Parenthood Federation’s Western Hemisphere Region, and Suzanne Ehlers of Population Action International to discuss how population and reproductive health should be incorporated into what comes next.

Reproductive Health is Key

Schlachter emphasized that it is impossible to support development without addressing sexual and reproductive health (SRH):

Mortality and morbidity related to SRH, particularly for women and adolescent girls, are still unacceptably high in many regions of the world. These illnesses and deaths occur in the prime years of life, and have lifelong consequences for women and girls and their families who suffer the direct health and economic consequences. Poor SRH also have a negative impact on the overall health and viability of communities, with significant implications for sustainable development because of the lost opportunity for education, reduced labor productivity, and related changes to population size and structure.

While changing population dynamics impact communities and countries, “individuals are at the heart of the post-2015 framework.” Schlachter said. “Whether we succeed or fail depends on our ability to empower people, particularly women and young people, to make decisions for themselves.”

Schlachter described some of the potential options for incorporating reproductive health issues in future sustainable development goals, including creating a separate explicit reproductive health goal, incorporating reproductive health under an overall health goal, or integrating gender and reproductive health across a number of other goals. She urged advocates to make their case on these issues while the United States and others are still in the early phases about thinking about what comes next after the MDGs.

Further, framing new development goals presents an “important opportunity” to educate experts in other sectors about population in general, she said. Since population will shape fields ranging from agriculture to education to water, it is crucial to begin emphasizing it now.

“Global population in future years will be decided by the policies we adopt today,” Schlachter said. “It will matter a great deal whether we reach 9 billion in 2050 or if we reach 10 billion, and, of course, both options are still possible.”

Population Challenges and Opportunities

“Population issues are not over, but they are very, very different from what they were before,” said John May. He described the three different demographic categories: high fertility, transitioning fertility, and low fertility.

High fertility countries, like Nigeria, have total fertility rates greater than four children per woman; 16 percent of the world lives in high fertility countries, he said, which are generally the least developed.

Other countries, like Pakistan, are transitioning from high to low fertility. Their average fertility rates are between 2.1 and 4.0 children per woman; higher than replacement level, but lower than they once were.

May noted that low fertility countries (less than 2.1 children per woman) are often overlooked, though they make up 46 percent of the world’s population, including the United States, China, Japan, and most of Europe. “These countries will face different problems,” he said, including aging and even depopulation for some. Some leaders of these countries do recognize the challenges that low fertility will bring. In his state of the nation address in December, Russian President Vladimir Putin, for example, said that “if the nation is not capable of preserving itself and reproducing, if it loses it vital bearings and ideals, then it doesn’t need foreign enemies – it will fall apart on its own.”

May also cautioned that it is important to “acknowledge that there have been in the past abuses about family planning,” including coerced contraception or sterilization that took place around the world during the 1970s. But the conversation shifted after the International Conference on Population and Development in Cairo in 1994.

“People were really concerned about human rights, about freedom of choice, etcetera. But also there was the realization that family planning was a necessary but not sufficient agent to bring change. I think it was kind of clear that family planning alone was not going to do the trick.”

For the future, May pointed to inequality, poverty, urbanization, and migration as major challenges that future developmental goals will have to consider. And as the global population grows, each of these factors will become more challenging and more pressing. While the demographic dividend – the prospect of economic growth caused by a large proportion of a country’s population in the labor force – is an important opportunity, he noted that “you need sound economic policies to capture these demographic dividends, and the window of opportunity is limited in time.”

Inequality, Youth, Ethnicity Common Barriers

Kelly Castagnaro agreed that a focus on human rights has changed the international development agenda, and stressed that sexual and reproductive rights are “central” to this “broad and rights-based approach.”

“We believe that when everyone has access to sexual and reproductive health, the right to bodily integrity, and control over all matters related to sexuality, sustainable development, health and gender equality will be achieved,” she said, speaking on behalf of the International Planned Parenthood Federation.

But, like May, Castagnaro said that “scandalous” income inequality in places like Latin America and the Caribbean makes access to sexual and reproductive health services difficult for the poorest women. Indigenous women in particular have less access to these critical services.

Young people too can face barriers. Castagnaro described a 2006 law in Peru that criminalized sexual relations between adolescents; as a result, many young people were afraid to seek reproductive health services or prenatal care.

Civil society organizations have an important role to play in delivering services and monitoring the government, she said. In the case of the Peruvian adolescent sex law, civil society organizations successfully challenged the law in the high constitutional court. But often these groups “are given neither the resources nor the authority to carry out this work and hold governments accountable to the international agreements they signed and affirmed.” Greater investments in these types of organizations are needed to allow them to continue to play a vital role in the future.

Development of a New Paradigm

Each of the panelists spoke of the need to educate policymakers about the opportunities presented by demography, and the consequences of ignoring reproductive health.

“I like the concept of public demography…where you really try to convey key messages to policy leaders, and you really have to convey them in a simple way,” said May.

“So much of what we heard today only happens if we engage in partnership and collaboration and dialogue,” said Suzanne Ehlers. “It’s hard work if you actually do it well and you really act on what you learn from each other.”

Some of this type of collaboration has already begun. “Around the world, the changing climate and lack of access to family planning affect so many people, in so many ways, that no one group of stakeholders can solve the challenges on their own,” writes Cat Lazaroff of Resource Media in a blog post about the event. “To succeed in turning the tide and creating a healthier and more prosperous future for communities everywhere, we must build broader constituencies that cross traditional boundaries of politics, issue silos, and even world views.”

Though Schlachter remarked on the eventual inclusion of gender and health in the Rio+20 document agreed to last spring, she said “it’s clear that we can do better, and we should.”

Now that new development frameworks are being drafted, it is important to emphasize sexual and reproductive health and reproductive rights, Schlachter said, because “lack of access to sexual and reproductive health care is one of the greatest moral, human rights, and development challenges of our time, and our world’s largest health inequity.”

“The next few years will see the end of a series of international commitments, and the development of a new paradigm for global development,” said Castagnaro. “This presents us with the un-paralleled opportunity to secure a world of justice, choice, and wellbeing for all people, which will ultimately lead to a sustainable and just planet.”

Event Resources:

• John May’s Presentation
• Photo Gallery
• Video

Sources: International Planned Parenthood Federation, Los Angeles Times, Reuters, Time, UN Population Division.

Photo Credit: USAID.