Contraceptives prevented an estimated 272,040 maternal deaths in 2008, reducing worldwide maternal mortality by 44 percent, according to a recent paper by Saifuddin Ahmed, Qingfeng Li, Li Liu, and Amy O. Tsui, published in The Lancet. But the prevention of maternal deaths could have been even higher. The study, “Maternal Deaths Averted by Contraceptive Use: An Analysis of 172 Countries,” estimates that an additional 104,000 maternal deaths – many occurring in developing parts of Africa and South Asia – could have been averted simply by satisfying existing unmet need for contraception. In sub-Saharan Africa, for example, only 22 percent of women who are married or sexually active use contraception – a far cry from the 65 percent which the study suggests is the point at which maternal deaths avoided by contraceptive use begin to plateau. Not surprisingly, this has also yielded some of the highest regional fertility rates in the world.

Such high fertility rates are driving growing concerns about scarcity and capacity in the region, and how climate change might exacerbate already-difficult development hurdles. This nexus of issues was the subject of a recent policy brief by Population Action International and the African Institute for Development Policy, titled Population, Climate Change, and Sustainable Development in Africa. The brief points out that “a large share of Africa’s population lives in areas susceptible to climate variation and extreme weather events,” and that there is an inherent tension the continent faces as it seeks to balance high population growth with climate change-induced reductions in the availability of natural resources, like water and arable land.  The authors urge policymakers, rather than focusing on environment, population, and health individually, to “connect population dynamics and climate change” to address their interlinked challenges together.

“It is plausible that key transitions in human evolutionary history have been driven in large part by climate change,” write Eugene A. Rosa and Thomas Dietz in “Human Drivers of National Greenhouse-Gas Emissions,” a literature review published by Nature Climate Change. “Changes in climate will doubtless be a key force in the future evolution of social systems, including all aspects of social, economic, and political life, while impinging on the health and well-being of the individuals who populate them.” Rosa and Dietz cite numerous studies to argue that nearly every facet of society will be affected by climate change. “The critical point,” they write, “is that population, affluence, technology, and all other drivers act not alone or additively but in a multiplicative fashion.” For example, rapid population growth can lead to an increase in urbanization, which generates “substantial demand for goods and services that can induce emissions in distant places.” They conclude that huge changes must be made in technology and consumption in order to combat the effects of climate change that are being caused by a growing population and an increasingly affluent world.

Afghanistan has one of the highest rates of maternal mortality in the world: 327 out of every 100,000 women who give birth die during childbirth. Despite some recent improvements, political, social, cultural, and economic factors present enormous challenges. Last month, the Center for Population and Development Activities hosted an online viewing and dialogue discussion of the PBS Independent Lens film Motherland Afghanistan, which follows Afghan-American filmmaker Sedika Mojadidi and her father, Dr. Qudrat Mojadid, as they return to their home country and visit the Laura Bush Maternity Ward in Kabul. The conditions they find are devastating and underscore not only the need for greater commitment to reproductive health services, but also the advancement of women’s and girl’s access to education, security, and political participation.

“Given the option, [women in developing countries] will have fewer children,” said Melinda Gates in a TEDxChange talk in April. “The question is: are we going to commit to helping them get what they want now? Or are we going to condemn them to some century-long struggle, as if this were still revolutionary France and the best method was still coitus interruptus?”

The Guttmacher Institute has updated their estimates for global contraceptive services, putting the number of women around the world who have an unmet need for modern family planning at 222 million (up from 215 million). Authors Susheela Singh and Jacqueline E. Darroch, in Adding It Up: Costs and Benefits of Contraceptive Services Estimates for 2012, also examine the estimated current costs of contraception, cost of meeting the current unmet need, and the money saved from having fewer unintended pregnancies. An estimated four billion dollars is currently spent on contraception in the developing world, and “the total cost of fully meeting the contraceptive needs of all women in the developing world with appropriate services would…be $8.1 billion per year.” Singh and Darroch note that there are substantial benefits to increasing access to contraception, including reduced infant and maternal mortality and lower education and health costs as smaller populations put less strain on existing systems. They conclude that “the gains that derive from meeting the contraceptive needs of all women in the developing world more than outweigh the financial costs.”

A new framework for sexual and reproductive health is needed, argued panelists in a recent event at the Wilson Center, and the Rio+20 conference on sustainable development would have been the place to start. An international consensus around women’s human rights was developed at the International Conference on Population and Development in Cairo in 1994, but Carmen Barroso, director of the International Planned Parenthood Federation’s Western Hemisphere Region, said there has been slow implementation, little funding, and furthermore the world has changed significantly since then.

While I was visiting with youth peer educators yesterday with the Brazilian Society for Family Welfare in the Cachoeirinha favela (see Vicky Markam’s post for details – we were on the same trip), UN member states reached consensus in the Rio+20 negotiations. But, according to reports, although the outcome document includes some mention of reproductive health, gender equality, and women’s empowerment, it fails to explicitly recognize the link between reproductive rights and sustainable development.

Excerpted below is the adapted abstract, by lead authors Eliya Msiyaphazi Zulu and Violet Murunga. The full report is available for download from the Wilson Center’s Africa Program.

Despite commitments to the program of action for the 1994 International Conference on Population and Development and Millennium Development Goal 5 (focused on maternal and reproductive health), little progress has been made in improving access to family planning and slowing rapid population growth in Africa. Lack of political will has been highlighted among the key factors behind the lackluster performance in addressing these sensitive development issues. However, the situation is changing with some African governments embracing family planning as a key tool for improving child and maternal health, slowing population growth, preserving the environment, and enhancing broader efforts to alleviate poverty.