By Glenda Crank Holste
Tuesday, August 7, 2001
The numbers of persons at risk of unwanted pregnancy or infection with a sexually transmitted disease grows each year, yet the dollars and political will for buying and distributing health aids are falling.
(WOMENSENEWS)--Global population and women's health groups are raising alarms about worldwide shortages of contraceptive and condom supplies.
The shortage has become so extreme that it was the subject of a major population conference held in Istanbul, Turkey, that concluded that an increasing population and demand, a shortfall in international donations, the rise of HIV-AIDS and widespread bureaucratic inefficiencies have led to widespread unavailability of a basic public health aid.
The Istanbul conference in May brought together representatives of 100 governments, international and nongovernmental organizations to discuss the consequences of the lack of basic supplies to prevent the spread of disease and to assist in family planning.
The Istanbul meeting concluded that the four primary reasons for shortages of contraceptive supplies were: growing interest in contraceptive use; rising numbers of people entering reproductive age, especially in the developing world; insufficient and poorly coordinated donor funding; and inadequate logistical capacity in developing countries.
"One woman dies every minute due to pregnancy-related causes. We must take immediate action to bridge the gap in contraceptive shortages," said Thoraya Obaid, executive director of the United Nations Population Fund, UNFPA. She made the remarks during a telephone conference with U.S. and European journalists to explain issues facing those at the Istanbul conference.
"No one should die for want of a three-cent condom," added Dr. Peter Piot of Belgium, executive director of UNAIDS, the Joint United Nations Program on HIV/AIDS.
The contraceptive commodities conference was called "Meeting the Reproductive Health Challenge: Securing Contraceptives and Condoms for HIV/AIDS Prevention." It was organized by the Interim Working Group on Reproductive Health Commodity Security, a collaborative composed of Population Action International, the Program for Appropriate Technology in Health, the Wallace Global Fund and John Snow Inc.
"People are dying. Whether we talk about 2.5 million people who died of AIDS last year or the more than 500,000 women who died in childbearing and pregnancy, the tragedy of this issue is that we know what to do about it," said Amy Coen, president of Population Action International and conference organizer. "People have agreed on what to do about it, but the resources to do the job are lacking,"
Coen's Washington-based organization advocates the expansion of voluntary family planning, other reproductive health services, and educational and economic opportunities for girls and women.
Population growth and large recent generations tell much of the story of the contraceptive crisis: The number of women of reproductive age may grow by 191 million between now and 2015. That would be an increase of 36 percent.
The number of contraceptive users will increase by 28 percent in the next five years and by 79 percent by 2015, experts told the conference. That translates into 105 million more people seeking family planning supplies and education.
The situation in the developing world is acute because poverty, deficient health care and delivery and poor education combine to increase vulnerability to deadly diseases.
The UNFPA's Obaid told a press conference that data from 1999 found the gap between donations and the demand for contraceptives was $86 million. This gap, she said, "means that per minute, there are 380 pregnancies out of which 190 are unwanted or unplanned. Out of these 190 pregnancies, there are 11 cases of HIV infections and one person dies."
Seven years ago, a U.N. conference on reproductive health and the environment called for universal access to contraception and family planning education, basic maternal health care, AIDS prevention and other reproductive health care services.
The costs at that time to international health care agencies were projected to be $17 billion in the year 2000 and $22 billion in the year 2015--in 1993 dollars.
Since that time, however, overall spending has fallen significantly short of that mark, and is now between $4 billion and $10 billion for reproductive health services, said Coen.
Developing nations have done better than the developed ones in meeting individual commitments set at the Cairo meeting, Coen said, but the overall failure to reach funding goals is undermining success.
Even as the spending for health care is dropping, the cost of condoms and other contraceptives to international health organizations is expected to increase from an estimated $810 million in 2000 to $1.8 billion in 2015, the conference was told, and the cost of delivering services is estimated to rise from $4 billion to $9 billion over the same period.
Experts agree that donors supporting contraceptive supply are insufficient and poorly coordinated. This lack of coordination among national governments and among donors causes gaps and even duplicated efforts to deliver contraceptive supplies.
The conference called for donors to simplify their procedures to acquire commodities and provide them at the minimal cost. There was also consensus that governments should take the lead in coordinating donor efforts.
However, for the supplies to reach those who need them, developing countries must improve their health care delivery, including family planning and maternal health services. One necessary feature would be a system that produces a sustained supply of contraceptive commodities, the conference's experts said. This would require developing nations to fully commit to family planning and wealthy nations to expand assistance to ensure the supply chain is not broken.
Glenda Crank Holste is a journalist who covers social and economic policy. She lives in Minnesota.