Reproductive Health and Population Issues Within the MDGs

Stan Bernstein, a retired UNFPA senior policy adviser and former health adviser on the UN Millennium Project, attended the Seventh Annual Research Conference on Population, Reproductive Health, and Economic Development. During the conference, Bernstein reflected on the presence of reproductive health and population issues among the Millennium Development Goals and their indicators . He also commented on prospects for including relevant RH and population goals or indicators in the development agenda beyond 2015. Bernstein hailed the role of research from the PopPov network in the past and its potential contributions to future development agendas. He answers some questions for the PRB blog below.

Why is it important to include reproductive health and population issues in development goals? 

There are several reasons. First, access to voluntary sexual and reproductive health care facilitates the attainment of other consensus development outcomes in the MDGs and other monitoring frameworks including reduction of poverty and preventable deaths of women and children. It empowers women to make life choices and balance the multiple tasks of their lives: education, social participation, family formation and family welfare, employment, and household resource management. In aggregate, these choices impact prospects for socioeconomic growth and environmental quality (both local and global).

Second, population growth, movement and distribution can facilitate or impede progress on other development objectives and mask or reveal continuing challenges. For example, there has been some progress towards reducing the proportion of people living in extreme poverty since 1990 (though a lot of the decrease has been in East Asia). But in some parts of the world (e.g., sub-Saharan Africa), progress in poverty reduction has not kept pace with population growth so a decreased proportion living in poverty actually translates into an increase in numbers. Similarly, the growth in numbers of people living in urban areas (mostly due to natural increase, but also as a result of migration), reveals the inadequacy of the slum reduction objective that was included in the MDGs. Improving the living conditions of 100 million urban dwellers (an MDG target) was an inadequate aspiration. Many times more than that number of people were added to urban populations—with disproportionate increases among the underserved poor—during the MDG timeframe. Global and national goal setting must be realistically scaled to population needs as well as to the available resources.

Third, some of the greatest disparities between better- and worse-off individuals (wealth-related differences) are found in the realm of sexual and reproductive health, inc

Photo: Stan Bernstein.

luding skilled assistance at birth, maternal mortality, adolescent fertility, and the proportion of desires for postponing or avoid a birth being satisfied (a measure based on the included indicators of contraceptive prevalence and unmet need for family planning). All of these measures are included in the monitoring of MDG5 (in either the maternal mortality reduction or achieve universal access to reproductive health targets).

And fourth, these issues require attention to human rights—an underdeveloped component of the original MDG formulation.

How did the research and ideas from the PopPov network contribute to inclusion of reproductive health (or population) indicators in the MDGs?

Work undertaken under PopPov auspices (and beyond) by network members have helped modify the long-held (since the mid-1980s) orthodoxy among macroeconomists that population was a neutral factor in economic growth. As a result, we now know that early correlational work examining population growth and economic growth was a naïve and misleading specification of the relationship. Research presented through PopPov has elaborated, over years of effort, how changing age structure dynamics provide the mechanism to increase family and societal saving and investment through the demographic transition. Studies have also elaborated the similarities and differences in these impacts in different parts of the world as a function of the different paces of fertility and mortality decline, and the presence or absence of other policy and program efforts that allow the “demographic bonus” to be cashed in.

PopPov research has also historically included studies of the sexual and reproductive health situations confronted by young people as they seek to join adult society, and the evaluation of programmatic responses to their needs. Proposals sent to PopPov as well as research funded over the years, have also increasingly addressed the full continuum of care in reproductive, maternal, newborn, and child health. Such discussions made it easier to get universal access to reproductive health included in the MDG framework in 2008. Of course, beyond research specifics that persuade policymakers (on poverty reduction and health improvement), the continuing development of the PopPov network has allowed a growing community of experienced and early career professionals to refine and improve the evidence base for getting even higher priority to its concerns.

How can research (particularly research on the relationships among population, reproductive health, and economic development) contribute to the post-2015 development agenda?

Strong evidence-based communications on the relations among population, reproductive health, and economic development will be critical to elevating attention to population and reproductive in ongoing development dialog. Policymakers will use available evidence to justify and rally support for actions that can promote valued outcomes. Qualitative research can bring the conditions and felt experience of life choices to the attention of politicians. Quantitative research can help policymakers set priorities and understand the tradeoffs in policy and program decisions and can foster better measurement of conditions, impacts, and outcomes. As the global development discussion increasingly is seeking not just to address the needs of the poorest but to facilitate progress in welfare and capability across diverse economic circumstances, a deeper appreciation of these relationships through the skills and discussions stimulated by PopPov-related work can accelerate achievements.

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