In 2008, of the 1.4 billion women in the developing countries of reproductive age (15-49 years), more than 800 million women wanted to avoid pregnancy and thus had a need for contraceptives.  

Out of these women, some 600 million were using modern contraceptives, that prevented 188 million unintended pregnancies, 1.2 million newborn deaths, and related 230,000 maternal deaths.  

Although contraceptive use has increased in all developing regions, it is still low in Sub-Saharan Africa, where its prevalence was still only 22 percent in 2008. 

One obstacle to providing contraceptive supplies is the poor state of logistics and transportation in many of the countries.

A sound logistics system can distribute contraceptives and other reproductive health supplies much more efficiently so that each clinic or pharmacy has enough stock on hand to meet clients' needs. 

Other changes, including household behaviors is vital for increasing the use of family planning programs.

Other factors such as cultural and social disapproval by family and communities, and men’s roles in family size decisions, can deter women who might otherwise be interested in family planning help as well as the failure to reach vulnerable groups such as unmarried adolescents.

In addition to expanding information/knowledge about family planning and avoiding HIV/AIDS and sexually transmitted infections,

The World Bank aims to expand the flow of information and knowledge about family planning to help motivate young women to stay in school and acquire life skills before starting their families.

Some 20 million of the estimated 200 million pregnancies every year end in unsafe abortions that put women at substantial risk of lasting injury or death. 

In the poorest countries where abortion is often restricted or illegal, deaths from unsafe abortion practices can be substantial, accounting for 13 percent of maternal mortality globally, and in some countries, as much as 25 percent of maternal deaths are due to unsafe abortion.

More than one-fourth of the estimated 20 million unsafe abortions per year are performed on women aged 15 to 19.

The World Bank considers unsafe abortion a serious public health issue for women and supports family planning services that help to prevent or reduce unsafe abortions as part of a country’s basic health programme.

More Frequent Antenatal Visits―Women who continue pregnancies need care during this critical period for their and their babies’ health. 

Since the 1990s, the proportion of pregnant women in the less-developed regions who had at least one antenatal care visit jumped from around 64 percent to 79 percent.

But fewer than 50 percent of pregnant women in the period 2003-2008 were attended to at least four times during their pregnancy by skilled health personnel, as recommended by WHO and UNICEF.

Since the 1990s, the presence of skilled birth attendants at delivery has increased in all developing regions, though the percentage of births attended by skilled health personnel in Sub-Saharan Africa was only 44 percent and 42 percent in Southern Asia.

Most maternal deaths are avoidable and the health care solutions to prevent or manage the complications are well-known. 

Severe bleeding after birth, which can be quickly fatal, can be effectively controlled by drugs such as Oxytocin.

Sepsis, which is the second most frequent cause of maternal death, can be eliminated if treated early. Eclampsia can be detected during pregnancy, and drugs such as magnesium sulfate can be used to lower the risk of fatal convulsions.

Obstructed labor can be recognized by skilled practitioners in enough time to perform a Caesarean Section to save a mother and her baby.

However, since some complications are unpredictable, all women need care from skilled health professionals during pregnancy, childbirth, and in the weeks after delivery.

It is widely recognized that skilled care at childbirth is most important for the survival of women and their babies, and that the availability of qualified and trained health personnel to assist deliveries is key to ensuring optimal pregnancy outcomes; yet one-third of all deliveries occur without a skilled attendant. 

One important way to strengthen health systems, therefore, is to train new health workers and strengthen the skills of the existing health workers with midwifery skills and effectively deploy them.  

Training programs for traditional birth attendants have not yielded expected results and have generally been unsuccessful in reducing maternal mortality. 

Working closely with all high-MMR countries, the Bank will focus on identifying gaps in the availability of health workers skilled in midwifery as well as doctors with obstetric skills, task shifting, and setting in place training programs aimed at meeting the shortage.  

According to the Bank, falling maternal death rates in North Africa, East Asia, Southeast Asia, and Latin America and the Caribbean share many common features: increased use of contraception to delay and limit childbearing and better access to high-quality obstetric care services.  

Education As Important As Condoms and Pills   

The Bank plan says that high birth rates are closely allied with fragile health, little or no education, and entrenched poverty.  

Analysis of demographic and health surveys in all regions shows that women with secondary or higher education have fewer children than women with primary or no education. 

“Promoting girls’ and women’s education and the opportunity to succeed are just as important in reducing birth rates in the long run as promoting contraception and family planning,” says Dr. Sadia Chowdhury, co-author of the new plan and a Senior Reproductive and Child Health Specialist at the World Bank.  

“Education and greater gender equity become a form of social contraception for women. Time and time again we see how women’s education  provides life-saving knowledge, builds job skills that allow her to join the workforce and marry later in life, gives her the power to say how many children she wants and when—and these are enduring qualities she will hand down to her daughters as well.” 

Chowdhury says getting an education—even if only at primary school level— is a good predictor of low fertility. The regions with the widest fertility gap between women with secondary education and those who have no education are South Asia, Sub-Saharan Africa, and Latin America and Caribbean. 

Alliance with UNFPA and Other Lead Health Agencies Vital

The new Bank plan strongly welcomes the re-emergence of maternal and child health among countries, donors, and other partners, which has jumpstarted more than 80 new national and international partnerships, including the Partnership for Maternal, Newborn and Child Health.

In addition, an informal group of heads of four health-related organizations (WHO, UNICEF, UNFPA, and the World Bank—called the “H-4”) was formed and meets regularly on measures to strengthen country efforts to improve maternal and child health and avoid fragmentation of donor efforts and financing (e.g., harmonizing and coordinating the efforts of donors at country level to support countries to improve maternal health).

In welcoming the Bank’s new reproductive health strategy, Thoraya Ahmed Obaid, UNFPA Executive Director, said that countries and their development partners had to work even more closely together to make greater progress.

"With Millennium Development Goal 5 to improve maternal health lagging behind, greater investments are needed to achieve the two targets to reduce maternal mortality and achieve universal access to reproductive health by 2015," she said.

"During the global financial crisis, and at all times, investing in the health and rights of women is a smart choice to improve well-being, productivity, and economic growth." 

To read the new Reproductive Health Action Plan 2010-2015, click here.   

For more on the Bank’s Health, Nutrition, and Population work, please visit: www.worldbank.org/hnp.

MaximsNewsGlobalHealth is being launched this month to publish news on such Global Health issues as hunger, HIV/AIDS, childhood mortality, maternal health, environmental health, malaria and other diseases. 

MaximsNewsGlobalHealth is publishing news from the U.N., its agencies and important development organizations and presenting it within the context of the United Nations’ Millennium Development Goals (MDGs).