Reproductive Health: The Missing Millennium Development Goal Poverty, Health, and Development in a Changing World

Contents......Page 7
Foreword......Page 13
Acknowledgments......Page 15
Abbreviations......Page 17
PART I. REPRODUCTIVE HEALTH IN A CHANGING WORLD......Page 19
A Broad and Ambitious Agenda under Attack......Page 21
Reproductive Health and the Millennium Development Goals......Page 23
Health Systems Are Failing Women, Especially Poor Women......Page 24
Internal Threats to the Reproductive Health Agenda......Page 26
A Way Forward......Page 29
2. The Porous Boundaries of Reproductive Health......Page 31
More than Health Care......Page 32
A New Way of Doing Business......Page 34
Changing Demographics: The Demographic Transition......Page 37
3.2 Population Growth Trends, 1750–2150......Page 39
Epidemiological Transitions......Page 42
Implications of Demographic and Epidemiological Shifts......Page 45
Serial Global Initiatives: Too Much of a Good Thing!......Page 51
From Projects to Sectorwide Approaches and Budget Support Programs......Page 54
Alphabet Soup......Page 55
5. HIV/AIDS and Reproductive Health: Competitors or Natural Allies?......Page 59
Effects of HIV/AIDS on Reproductive Health......Page 60
Synergies between HIV/AIDS and Reproductive Health Programs and Services......Page 61
Competition for Resources......Page 63
5.1 Population Assistance from All Donors,1995 –2001......Page 64
5.3 Expected Costs and Benefits of PMTCT in the 14 Countries Covered by the Mother and Child HIV Initiative in 2007......Page 70
5.4 Worldwide Distribution of Curable STIs......Page 71
Conclusion......Page 73
PART II. TOOLS FOR ADAPTING TO CHANGE......Page 75
6. Pressure Points: Using the Pathways Framework......Page 77
6.1 Pathways to Reproductive Health Outcomes......Page 78
Community Factors......Page 79
Health System Obstacles......Page 80
Related Sectors......Page 81
Government Policies and Actions......Page 82
6.1 Why Did Safar Banu Die?......Page 84
The Scientific Evidence......Page 87
A Dual Role......Page 89
Policy Implications......Page 90
Conclusion......Page 93
8. Gender, Health, and Poverty......Page 95
Gender in the Market Economy......Page 97
8.1 Uganda: Structure of the Productive Economy......Page 98
8.2 The “Double Workday” of Women in Benin......Page 99
Female Genital Mutilation/Cutting......Page 100
8.1 Gender and Growth: Missed Potential......Page 101
Interdependence of Market and Household Economies......Page 103
Improving Health and Reducing Poverty by Narrowing the Gender Divide......Page 104
9. Poverty and Reproductive Health......Page 107
9.1 Rich/Poor Differences in Infant Mortality Rates in 56 Low- and Middle-Income Countries......Page 108
Who Benefits?......Page 110
There Is Hope......Page 113
10. Improving the Relevance of Health Services......Page 115
11. How Much Does It Cost?......Page 123
Motivations for Asking Cost Questions......Page 124
The Costing Quality Checklist......Page 125
Never Enough Money......Page 133
Selection Criteria......Page 134
Prioritization Approaches......Page 138
Who Loses?......Page 139
Non-Health-Sector Barriers......Page 141
Related Sectors......Page 143
Other Government Policies......Page 154
A Framework for Analyzing Stakeholders......Page 157
Consumers as Stakeholders......Page 166
Benefits and Costs of Increased Stakeholder Participation......Page 167
PART III. FROM VICTIMS OF REFORM TO DRIVERS OF REFORM......Page 169
The Health Reform Agenda......Page 171
What Is Health Sector Reform?......Page 172
What Does “Reform” Mean?......Page 173
Assessing the Impact of Reforms on Reproductive Health......Page 175
Making Reform Work for Reproductive Health......Page 180
16. Slipping through the Cracks: Organizational Reform and Reproductive Health......Page 183
Decentralization......Page 184
Decision Space......Page 188
Typical Decentralization Problems and Some Solutions......Page 193
17. Getting It and Spending It Well: Finance Reforms and Reproductive Health......Page 195
17.1 Health Spending by Income Groups and Regions......Page 196
Health Financing Reforms and Reproductive Health......Page 203
Notes......Page 205
Bibliography......Page 208
Index......Page 216
1.1 Attended Deliveries at Public Facilities: Poorest and Richest Quintiles......Page 25
3.1 Demographic Transition, 1850–2050......Page 38
3.3 Fertility Trends in Different Regions, 1950–2050......Page 40
3.4 Regional Trends in Life Expectancy, 1925–2050......Page 41
3.5 Population Pyramids of Three Countries......Page 43
3.6 Leading Causes of Death in Africa and Europe, 1998......Page 44
3.7 Age Structure Profile......Page 46
5.3 Donor Financing for RH Commodities versus Projected Need, 1990–2015......Page 65
5.2 Incidence of Pregnancy Before and After a Family Planning Intervention......Page 69
5.5 Potential Integration of HIV/AIDS and Reproductive Services for a Variety of Individuals......Page 72
8.1 Gender Disparity in Parliamentary Membership......Page 96
9.2 Use of Basic Maternal and Child Health Services in 56 Low- and Middle-Income Countries......Page 109
9.3 Beneficiaries of Public Health Subsidies in India, 1996......Page 111
10.1 Two Possible Structures for Service Delivery......Page 119
10.2 Antenatal and Delivery Care Services Defined by Level......Page 120
10.3 Standard Treatments and Inputs Specified by the World Health Organization for Antenatal and Delivery Care......Page 121
13.1 Possible Effects of Interventions on Achievement of the Maternal Mortality MDG in World Bank Regions......Page 152
14.1 Policy-Making Process......Page 160
14.2 Sample Stakeholder Positional Map......Page 163
15.1 Health System Functions, Actors, and Payment Mechanisms......Page 174
15.2 Framework for Diagnosing Health System Ills and Assessing the Impact of Reforms......Page 176
16.1 Forms of Decentralization for Government and Health Ministries......Page 185
17.1 Composition of World Spending on Health, 2000......Page 198
5.1 Typical Components of Family Planning, Maternal and Child Health, and HIV/STI Programs......Page 62
7.1 Effective Interventions for Reducing Illness, Death, and Malnutrition......Page 88
7.1 Many Barriers to Improved Maternal Health and Survival are Behavioral......Page 91
9.2 Distribution of Public Subsidies for Facility-Based Deliveries and Antenatal Care in Vietnam......Page 112
10.1 Illustrative Service Package, Including Reproductive Health and Other Primary/Preventive Services......Page 117
11.1 Comparison of Top-Down and Bottom-Up Costing Approaches......Page 127
13.1 Demand-Side Barriers to Utilization of Health Care......Page 142
13.2 Governance Indicators for Countries Grouped by MMR Level......Page 150
14.1 Stakeholders’ Levels of Power......Page 164
14.4 Stakeholders’ Alliances......Page 165
15.1 Assessing Health Reform Impacts on Reproductive Health......Page 178
16.1 Contracting Experiences......Page 189
16.2 Application of the Concept of Decision Space......Page 192
8.2 Gender and Productivity in Burkina Faso......Page 102
12.1 An Irreverent Look at Players and Objectives in the Health Budgeting Process......Page 135
14.1 Self-Assessment Exercise......Page 162