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Cutbacks Imperil Health of World's Women
Published on Saturday, May 25, 2002 in the Boston Globe
Cutbacks Imperil Health of World's Women
by Cesar Chelala

THE BUSH administration's recent cutbacks of funds appropriated by Congress for the United Nations Population Fund will have serious repercussions in that agency's support for reproductive health activities in developing countries.

The decision is aggravated by reduced contributions from Japan and Denmark.

The agency is accused of condoning forced abortions in China and of making abortions in general part of its policy. This charge was made by the Population Research Institute, an antiabortion group that has branches worldwide.

Officials from the institute say US funds are being used ''illegally'' to pay for coercive practices in China. Spokesmen for the agency say that money from the United States is not used for programs in China and that the agency's work in China aims to replace compulsory use of family planning and birth quotas with appropriate counseling and informed consent, a greater range of contraceptive method choices, and higher reproductive health services.

Amy Cohen, the president of Population Action International, an organization active in voluntary population planning, said the freeze is motivated by domestic politics. She has criticized the cutbacks for their negative impact on the prevention of unwanted pregnancy and the spreading of HIV.

One of the Population Fund's activities that may be affected is the supplying of condoms to men in high-risk groups to prevent HIV infection. The cost of these supplies is estimated to be close to $300 million for this year.

According to officials, the loss of US funds would translate into 2 million unwanted pregnancies, 800,000 induced abortions, 4,700 maternal deaths, and 77,000 infant and child deaths.

Lack of funds comes at a time when there are increasing demands for contraceptives in developing countries, demands that are expected to rise by 40 percent over the next 15 years. It is estimated that worldwide 120 million women who want to plan their pregnancies are unable to get contraceptives.

A panel on reproductive health convened by the US National Academy of Sciences said that between 20 and 60 percent of births in developing countries are unintended - either unwanted or mistimed. As a result, they pose hardships to families and jeopardize the health of millions of women and children.

Since its creation, the agency has contributed to the improvement in women's health and in essential services for pregnant women worldwide, particularly in developing countries. The agency's policies have stressed the importance of adequate pre- and postnatal care as well as the need to space births.

That need is particularly pressing in developing countries. Studies carried out by the World Health Organization have shown that having many children without a proper interval among them in women who are not in good health already leads to a further deterioration.

Pregnancies, particularly when they are frequent and closely spaced, can lead to the ''maternal exhaustion syndrome.'' When women in this situation give birth and then, without having completely recovered, conceive again, they increase their chances of having premature and low-birth-weight children.

This creates a vicious cycle with a negative impact on the health and well-being of mothers and their children. Worldwide, more than 600,000 women die each year from pregnancy-related causes, and almost 8 million infants are stillborn or die in the first week of life.

Without proper assistance and education, women who don't want to have any more children end up having abortions, which are illegal in many countries. In those cases, women, particularly of limited means, either perform the abortion themselves or have one performed by inexperienced persons, in many cases without the appropriate techniques and care.

In those conditions, illegal abortions become an important cause of maternal death. It is estimated that 50 million induced abortions are performed each year and that approximately 20 million of them are performed in unsafe circumstances or by untrained personnel.

I have seen the work carried out by the local UN Population Fund offices, where the stress is on quality of care for the mothers and their children. That was also the most important aspect of missions that I carried out in the past on behalf of that agency in Egypt, Equatorial Guinea, and Sao Tome and Principe.

To ignore these achievements is detrimental to the health of women worldwide. If anything, governments should increase their contributions to organizations such as the UN Population Fund working on issues critical to women's health.

Dr. Cesar Chelala is an international medical consultant and the author of ''Prevention of Maternal Mortality in the Americas,'' a publication of the Pan American Health Organization.

© Copyright 2002 Globe Newspaper Company


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