State of World Population 2012 - UNFPA Haiti

Studies suggest that HIV may have adverseeffects on both male and female fertility (Lyerly,Drapkin and Anderson, 2001). Moreover,among discordant couples—relationships inwhich one person is HIV positive and theother is not—the ways to safely pursue havingchildren vary. Artificial insemination canreduce the risk of infection when the woman isHIV-positive. When the male partner lives withHIV, pursuing pregnancy can be more complicated,problematic, and costly (Semprini, Fioreand Pardi, 1997).The poor. Although sexual and reproductivehealth outcomes have improved over thelast 20 years, they vary according to incomelevels (UNFPA, 2010). This widening gaphas increased the number of people who areunable to exercise the right to family planning.Moreover, research finds that a disproportionateamount of public spending on health andeducation is allocated towards wealthier sectorsof society, thereby exacerbating the likelihoodthat present-day inequalities will continue towiden among and within countries (Gwatkin,Wagstaff and Yazbeck, 2005).Demographic and Health Surveys from 24sub-Saharan African countries find that thepoorest and least educated women have “lostground,” with poor adolescent girls having thelowest levels of sustained contraceptive use andthe highest unmet need for family planning(UNFPA, 2010). For example, only 10 per centof those belonging to the poorest householdsuse contraception, compared to 38 per cent ofwomen belonging to the wealthiest households.Social exclusion makes it harder for poorpeople to access family planning informationand services, compared to individuals of highersocioeconomic status. These disparities compromisewomen’s health, men’s and women’s“Reproductive health eludes many of the world’s people becauseof such factors as: inadequate levels of knowledge abouthuman sexuality and inappropriate or poor-quality reproductivehealth information and services; the prevalence of high-risksexual behaviour; discriminatory social practices; negativeattitudes towards women and girls; and the limited power manywomen and girls have over their sexual and reproductive lives.Adolescents are particularly vulnerable because of their lack ofinformation and access to relevant services in most countries.Older women and men have distinct reproductive and sexualhealth issues which are often inadequately addressed.”— ICPD Programme of Action, 1994, paragraph 7.3rights, and undermine poverty reduction efforts(Greene and Merrick, 2005). For example,research finds that birth rates have increasedamong the least educated, poor adolescent girlswho often live in rural communities (UNFPA,2010). In contrast, more educated adolescentgirls who live in the wealthiest 60 per cent ofhouseholds in urban areas have experienced lowand declining birth rates since 2000.Hard-to-reach persons in rural or urbancommunities. In most developing countries,national measures of poverty are highly correlatedwith place of residence; urban householdstend to be weathier than rural households(Bloom and Canning, 2003a). Hard-to-reachcommunities vary across countries, but wherepeople live influences their ability to accessfamily planning.In some settings, women and men in ruralareas are unable to routinely access qualityfamily planning information and services. Onaverage, for example, poor women in ruralsub-Saharan Africa have a contraceptive prevalencerate of 17 per cent, compared to 34per cent for their urban peers (United NationsPopulation Fund, 2010). Relative differencesTHE STATE OF WORLD POPULATION 201261