What women and girls want matters: UNFPA

The world's population continues to grow rapidly – the number of people on Earth is projected to be almost 8.5 billion in 2030, 9.7 billion in 2050, and 10.9 billion in 2100. According to the United Nations Population Fund (UNFPA), this growth is fueled by increasing numbers of people surviving to reproductive age. It's also happening despite falling fertility rates – in the early 1970s women had an average of 4.5 children each, but by 2015 that number had fallen to 2.56 children per woman.

These and other trends, including increased life expectancy and urbanization, the UNFPA says, have "far-reaching implications" for economic development, employment, income distribution, poverty and social protections, as well as efforts to ensure universal access to health care, education, housing, sanitation, water, food and energy.

Women and girls will be among the most affected by these changes.

In this context, the UNFPA has declared this year's World Population Day on July 11 be dedicated to "Unleashing the power of gender equality: Uplifting the voices of women and girls to unlock our world’s infinite possibilities."

To mark World Population Day, we interviewed Dr. Julitta Onabanjo, the UNFPA's technical division director, who is also a public-health physician by profession and an expert in sexual and reproductive rights, about the agency's efforts to ensure a safe and equitable world for women and girls in the context of population dynamics.

The theme for this year's World Population Day is ‘Unleashing the power of gender equality: Uplifting the voices of women and girls to unlock our world’s infinite possibilities.’ Could you elaborate on how ensuring the health and rights of women and girls contributes to overall improved global health outcomes and sustainable development?

Dr. Onabanjo: On World Population Day this year, we are mindful that women and girls make up 49.7% of the global population. Yet their desires for their lives, families, and careers are often ignored in discussions on demographics and their rights are not fully recognized or reflected when population policies are designed.

The result is a world that excludes, marginalizes, and limits the potential of every other person on the planet – a problem that will prevent all of us, not just women and girls, from experiencing a more prosperous, peaceful, and sustainable future. At the root of this problem is gender inequality, which is a pervasive injustice keeping women and girls out of schools, the workforce, and leadership positions. It also limits their agency and ability to make decisions about their health and sexual and reproductive lives and it heightens their vulnerability to violence, harmful practices and preventable maternal death.

At UNFPA, the health and rights of women and girls is fundamental to everything that we do and that’s because we recognize how critical it is in terms of being able to achieve the 17 Sustainable Development Goals which all UN Member States have signed up to. Unfortunately, there’s a long way to go to safeguard the health of women and girls, which COVID- 19 and many other emergencies have painfully reminded us of.

The data underscores this too. In fact, the most recent UN estimates on maternal mortality show that a woman dies during pregnancy or childbirth every two minutes. And research shows that 44% of women worldwide still cannot make their own choices about their reproductive health, the use of contraception, and whether or not they can say no to sex. In fact, in some parts of the world, an acceleration rate of five times is needed to meet the SDG target of 70 maternal deaths per 100,000 live births.

However, investing in women's health, particularly during pregnancy and childbirth, leads to healthier mothers and infants. When women have access to quality prenatal care, skilled birth attendants, and essential healthcare services, maternal and child mortality rates decrease. It also promotes health throughout the life course and can contribute to healthy ageing practices.

Likewise, these investments have ripple effects to the wider health system and strengthen the ability of countries to respond to the health needs of everyone in their communities. By addressing the specific health and wellbeing needs of women and girls, promoting gender equality, and empowering women, we can create healthier societies, reduce health disparities, and lay the foundation for long-term social and economic progress. This positively impacts the overall health of communities and contributes to sustainable development by fostering a healthier and more productive population.

Gender equality and women's empowerment are also crucial aspects of achieving better health outcomes. What are some strategies or initiatives that the UNFPA is implementing to address these issues on a global scale?

Dr. Onabanjo: Indeed, addressing gender inequality and women’s empowerment are key to achieving better health outcomes. When women have access to quality healthcare including the full range of comprehensive SRH [sexual and reproductive health] services, they are more likely to be empowered in all aspects of their lives. Furthermore, delivering health services for women and girls, including SRHR [sexual and reproductive health and rights] services, provides important entry points to better prevent and respond to gender-based violence, including referral to police, justice, and social services.

At UNFPA, our strategic plan guides all of our action across the world in achieving our three transformative results – ending the unmet need for family planning; ending preventable maternal deaths; and ending gender-based violence and harmful practices.

In terms of our actions with countries and partners, we take a multi-pronged approach to address gender inequality and to facilitate impact and change at scale. One aspect is our work to enhance women's bodily autonomy, agency, and decision- making power through initiatives that focus on education, health, and economic empowerment. Our programs provide women and girls with skills training, access to quality education, and opportunities for income generation.

UNFPA also places significant emphasis on ensuring access to comprehensive sexual and reproductive health services, including family planning, safe childbirth, and prevention and treatment of sexually transmitted infections. By promoting SRHR, UNFPA aims to empower women and girls to make informed decisions about their bodies and reproductive choices.

And of course, UNFPA works towards preventing and responding to gender-based violence and harmful practices including female genital mutilation and child marriage. The organization supports programs that address the root causes of violence, strengthen national policies and legislation to prevent it, and we provide essential services to survivors. All of this would not be possible without the data and research which drives our work with countries and partners including the global advocacy that we promote.

Adolescents and youth play a critical role in shaping the future of our world. What measures are UNFPA taking to address the unique health needs of young people and ensure their access to comprehensive sexual and reproductive health services?

Dr. Onabanjo: First, I want to highlight that at UNFPA we value all of the young people in the world which right now is approximately 1.8 billion - the largest youth population ever! We know that many of the young people today will grow up in low-and-middle income countries and humanitarian settings, and that the global context including the impact of COVID-19, unprecedented conflict in many parts of the world, and multiple humanitarian disasters are undermining their future health and wellbeing including their rights and choices.

So, we are really stepping up implementation of our global strategy for adolescents and youth entitled, “My Body, My Life, My World." We’re investing more in the roll-out, which is supported through a robust operational framework, and we are also working more with countries to document best practices that can be scaled up in other settings.

We’re also building on the power of our partnerships including the work we do with key stakeholders through our role as co- convenors of the Global Partnership Forum on Comprehensive Sexuality Education and as members of the Compact for Young People in Humanitarian Action.

Likewise, we are revitalizing the UNFPA youth engagement reference group to ensure that we have a robust platform for engaging with young people and integrating their perspectives into our programming. And in addition to being excited to further expand our work with UN partners including the UN Youth Office and the Peacebuilding Support Office, we are also very keen to strengthen the capacity of young people to be agents of change.

Fundamentally though, health systems need to be designed in ways that are responsive to young people’s needs. Today, young people can often be reached best through digital spaces and what they are prioritizing in terms of their sexual and reproductive health preferences needs to be respected and taken into consideration in order to make certain that health services and information is serving their needs in the best ways possible.

UNFPA is a key partner on the Exemplars in Global Health project on women’s health and wellbeing, studying how Cambodia and Ethiopia have become positive outliers by making progress across multiple dimensions. Can you share UNFPA’s perspective on why a multi-dimensional and a life course approach to health and wellbeing are important?

Dr. Onabanjo: We’re really so proud to be partners on the Exemplars project on women’s health and wellbeing across the life course and that’s because we recognize how women and girls have specific needs and opportunities to optimize their health at every phase of life!

We believe that a life course approach helps optimize health and wellbeing at all ages and phases, including newborn, childhood, adolescence, maternal, adulthood and aging, and that it also underscores a commitment to person-centered care which is a central element of quality healthcare.

A multi-dimensional and intersectional approach is critical, because it recognizes that people do not exist in silos. Determinants of health are not only physical and mental, but also social, economic, financial and both distal and proximal. This is why UNFPA’s work spans the socio-ecological model, looking at the impact of structures and systems, societies and organizations, communities and interpersonal relationships on health.