Today is World Population Day. On this day in 1968, world leaders proclaimed that individuals have a basic human right to determine the number and timing of their children. Forty years later, population issues remain a real challenge even in Britain, where greater cohesion is still needed for policy in action.
Inevitably much of the focus since then has been on women, and especially maternal health and education.
There can be no doubt at all that a failure of health care during pregnancy and birth takes a terrible toll on lives, both maternal and infant. Multiple unplanned pregnancies are a leading cause of premature death and tragic disability for many women and their children, especially in very poor countries.
Access to family planning
UNFPA, the United Nations Population Fund, says active use of family planning in developing countries has increased from 10-12% in the 1960s to over 60% today. But despite these improvements, a World Bank report just released says that 35 countries – 31 of them in sub-Saharan Africa – still have very high fertility rates and grim mortality rates from unsafe deliveries or abortions.
According to this World Bank report, women in developing countries experience 51 million unintended pregnancies each year because of lack of access to effective contraception That is a great deal of heartache, even apart from the enormous issues it raises for global ecosystems.
Not just a a ‘Third World’ issue
But this is not a problem only for people in the poorest developing countries.
Most of us are aware that people in the ‘developed’ countries use hugely more energy and other resources than do those in poor countries. Even with our much lower fertility rates we are currently much more of a threat to global sustainability than are people in Africa.
Blighted lives in the Western world too
“Promoting girls’ and women’s education is just as important in reducing birth rates in the long run as promoting contraception and family planning,” says Sadia Chowdhury, a co-author of the World Bank report.
That is also true even in places such as today’s Britain. Teenage pregnancy – and unintended pregnancy overall – remains a serious issue for many families in the U.K. even now.
There is an essential synergy between prospects for women in education and employment, and elective motherhood. Each benefits from the other. And each also brings benefit for the children who are born, including better prospects even for their very survival.
IMR inequalities relate to social class
Currently differences in infant UK infant death rates can be huge, and can often be attributed to occupational and class differentials. In 2002-4 a baby born in Birmingham was eight times more likely to die before its first birthday than one in Surrey, with rates of 12.4 and 2.2 infant deaths per thousand live births respectively. (Bradford is another very high-risk area, and set up its own enquiry to see how to improve.)
This is not an easy matter to discuss politically, but it could not be more important, even in Britain, one of the wealthiest nations in the world.
Improving family health
One main health objectives of the British Government is to improve infant mortality rates (IMR: the number of babies who die before their first birthday, against each one thousand born), so that the infants of poorer parents have better outcomes, like those of more advantaged parents.
The target for England is a 10% reduction in the relative gap (i.e. percentage difference) in infant mortality rates between “routine and manual” socio-economic groups and England as a whole from the baseline year of 1998 (the average of 1997-99) to the target year 2010 (the average of 2009-2011).
Life outcomes and expectation
To focus this up: for each baby in the UK who dies before his or her first birthday, there will be about ten who survive with enduring disability, and often with diminished life expectancy.
At present, often through lack of knowledge, or sometimes difficulties in accessing appropriate care, this distressing outcome is much more likely to affect families where women are poorly educated, than those where women have a good education and good jobs or careers.
Preventable tragedy
It does not have to be like this.
The Government is absolutely right to tackle this difficult matter, but effective action requires co-ordinated delivery by all who provide care and support for parents and children. There must be no room for professional maternity care in-fighting, such as is reported by Sir Ian Kennedy, chair of the Healthcare Commission to exist between obstetricians and midwives.
Children’s Centres as a way forward?
The national transition from Sure Start to the encompassing provision of Children’s Centres, underpinned by the fundamental philosophy of the Every Child Matters initiative, is now underway.
To date there has been little discussion about how family planning support needs to be built into this really important development.
Professional obligation
This may be a tricky issue, but it’s one where the professionals could, if they chose, much help the Government to help all of us.
When are we going to hear those who provide early years and family support saying, loud and clear, that ‘every child a wanted child‘ is a basic requirement for everyone in Britain as well as elsewhere?
A not-to-be repeated opportunity?
The need for effective family planning in parts of the developing world remains desperate, and must be met.
But that doesn’t excuse skirting the issue here at home, just at a point when new and joined up services focusing directly on families and children are being created, with the aim of eradicating child poverty and increasing wellbeing for everyone.
And given the political sensitivities, surely it’s the practitioners – in health, education, welfare and the rest – who have to lead the way?
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