The ability of humanity to reap the benefits of its ingenuity depends on its skill in governance and management, and on strategies for dealing with problems such as widespread poverty, increased numbers of aged persons, inadequate health care and limited educational opportunities for large groups of people, limited capital for investment, environmental degradation in every region of the world, and unmet needs for family planning services in both developing and developed countries. In our judgement, humanity's ability to deal successfully with its social, economic, and environmental problems will require the achievement of zero population growth within the lifetime of our children.

HUMAN REPRODUCTIVE HEALTH

he timing and spacing of pregnancies are important for the health of the mother, her children, and her family. Most maternal deaths are due to unsafe practices in terminating pregnancies, a lack of readily available services for high-risk pregnancies, and women having too many children or having them too early and too late in life.

Millions of people still do not have adequate access to family planning services and suitable contraceptives. Only about one-half of married couples of reproductive age are currently practicing contraception. Yet as the director-general of UNICEF put it, “Family planning could bring more benefits to more people at less cost than any other single technology now available to the human race”. Existing contraceptive methods could go far toward alleviating the unmet need if they were available and used in sufficient numbers, through a variety of channels of distribution, sensitively adapted to local needs.

But most contraceptives are for use by women, who consequently bear the risks to health. The development of contraceptives for male use continues to lag. Better contraceptives are needed for both men and women, but developing new contraceptive approaches is slow and



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The ability of humanity to reap the benefits of its ingenuity depends on its skill in governance and management, and on strategies for dealing with problems such as widespread poverty, increased numbers of aged persons, inadequate health care and limited educational opportunities for large groups of people, limited capital for investment, environmental degradation in every region of the world, and unmet needs for family planning services in both developing and developed countries. In our judgement, humanity's ability to deal successfully with its social, economic, and environmental problems will require the achievement of zero population growth within the lifetime of our children. HUMAN REPRODUCTIVE HEALTH he timing and spacing of pregnancies are important for the health of the mother, her children, and her family. Most maternal deaths are due to unsafe practices in terminating pregnancies, a lack of readily available services for high-risk pregnancies, and women having too many children or having them too early and too late in life. Millions of people still do not have adequate access to family planning services and suitable contraceptives. Only about one-half of married couples of reproductive age are currently practicing contraception. Yet as the director-general of UNICEF put it, “Family planning could bring more benefits to more people at less cost than any other single technology now available to the human race”. Existing contraceptive methods could go far toward alleviating the unmet need if they were available and used in sufficient numbers, through a variety of channels of distribution, sensitively adapted to local needs. But most contraceptives are for use by women, who consequently bear the risks to health. The development of contraceptives for male use continues to lag. Better contraceptives are needed for both men and women, but developing new contraceptive approaches is slow and

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financially unattractive to industry. Further work is needed on an ideal spectrum of contraceptive methods that are safe, efficacious, easy to use and deliver, reasonably priced, user-controlled and responsive, appropriate for special populations and age cohorts, reversible, and at least some of which protect against sexually transmitted diseases, including AIDS. Reducing fertility rates, however, cannot be achieved merely by providing more contraceptives. The demand for these services has to be addressed. Even when family planning and other reproductive health services are widely available, the social and economic status of women affects individual decisions to use them. The ability of women to make decisions about family size is greatly affected by gender roles within society and in sexual relationships. Ensuring equal opportunity for women in all aspects of society is crucial. Thus all reproductive health services must be implemented as a part of broader strategies to raise the quality of human life. They must include the following: Efforts to reduce and eliminate gender-based inequalities. Women and men should have equal opportunities and responsibilities in sexual, social, and economic life. Provision of convenient family planning and other reproductive health services with a wide variety of safe contraceptive options, irrespective of an individual's ability to pay. Encouragement of voluntary approaches to family planning and elimination of unsafe and coercive practices. Development policies that address basic needs such as clean water, sanitation, broad primary health care measures and education; and that foster empowerment of the poor and women. “The adoption of a smaller family norm, with consequent decline in total fertility, should not be viewed only in demographic terms. It means that people, and particularly women, are empowered and are taking control of their fertility and the planning of their lives; it means that children are born by choice, not by chance, and that births are better planned; and it means that

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families are able to invest relatively more in a smaller number of beloved children, trying to prepare them for a better future.”* SUSTAINABILITY OF THE NATURAL WORLD AS EVERYONE'S RESPONSIBILITY n addressing environmental problems, all countries face hard choices. This is particularly so when it is perceived that there are short-term tradeoffs between economic growth and environmental protection, and where there are limited financial resources. But the downside risks to the earth — our environmental life support system — over the next generation and beyond are too great to ignore. Current trends in environmental degradation from human activities combined with the unavoidable increase in global population will take us into unknown territory. Other factors, such as inappropriate governmental policies, also contribute in nearly every case. Many environmental problems in both rich and poor countries appear to be the result of policies that are misguided even when viewed on short-term economic grounds. If a longer-term view is taken, environmental goals assume an even higher priority. The prosperity and technology of the industrialized countries give them greater opportunities and greater responsibility for addressing environmental problems worldwide. Their resources make it easier to forestall and to ameliorate local environmental problems. Developed countries need to become more efficient in both resource use and environmental protection, and to encourage an ethic that eschews wasteful consumption. If prices, taxes, and regulatory policies include environmental costs, consumption habits will be influenced. The industrialized countries need to assist developing countries and communities with funding and expertise in combating both global and local environmental problems. *   Mahmoud F. Fathalla, “Family Planning and Reproductive Health: A Global Overview,” invited paper presented at the 1993 Science Summit, Delhi, India, 26 October 1993.