state state of world population 2017 state of world population 2017 Delivering a world where every pregnancy is wanted every childbirth is safe and every young person’s potential is fulfilled WORLDS Worlds apart Worlds : Reproductive health Reproductive and rights in an age of inequality ReproductiveAPART health and rights in an age of inequality United Nations Population Fund 605 Third Avenue New York, NY 10158 Tel. +1 212 297 5000 www.unfpa.org @UNFPA ISSN 1020-5195 ISBN 978-1-61800-019-4 Sales No. E.17.III.H.1 E/4,268/2017 Printed on recycled paper. The State of World Population 2017 This report was developed under the auspices of the UNFPA ACKNOWLEDGMENTS Division of Communications and Strategic Partnerships Aluisio Barros, Janaina Costa, Inacio Silva and Cesar Victora of the International Center for Equity in Health at the Federal EDITOR-IN-CHIEF University of Pelotas Brazil analysed and plotted data showing Arthur Erken, Director, UNFPA Division of Communications and correlations between wealth inequality and inequalities in Strategic Partnerships maternal, neonatal and reproductive health. David Alejandro Huertas Erazo and Zoe Colgin provided research assistance. SENIOR RESEARCH ADVISER Melanie Kruvelis, Mariam K. Chamberlain Fellow at the Institute Raquel Fernández for Women’s Policy Research, provided research and writing assistance. A.K. Shiva Kumar also contributed to the report. LEAD CHAPTER RESEARCHERS AND AUTHORS Mercedes Mateo Diaz Rachel Snow, chief of the UNFPA Population and Development Robert Engelman Branch, and her colleagues, contributed substantive content, Jeni Klugman commented on numerous drafts and guided research. The branch Gretchen Luchsinger also aggregated regional data in the indicators section of this report. Elyse Shaw Source data for the report’s indicators were provided by the UNFPA TECHNICAL ADVISER Population Division of the United Nations Department of Economic Howard Friedman and Social Affairs, the United Nations Educational, Scientific and Cultural Organization and the World Health Organization. EDITORIAL TEAM Editor: Richard Kollodge MAPS AND DESIGNATIONS Editorial associate and digital edition manager: The designations employed and the presentation of material in Katheline Ruiz maps in this report do not imply the expression of any opinion Digital developer: Hanno Ranck whatsoever on the part of UNFPA concerning the legal status of any Publication and web design and production: Prographics, Inc. country, territory, city or area or its authorities, or concerning the delimitation of its frontiers or boundaries. © UNFPA 2017 Front cover photo credit: © Andrew McConnell/IRC/Panos Pictures Back cover photo credit: © Igor Alecsander/www.igoralecsander.com Delivering a world where every pregnancy is wanted every childbirth is safe and every young person’s potential is fulfilled WORLDS ReproductiveAPART health and rights in an age of inequality state of world population 2017 STATE OF WORLD POPULATION 2017 FOREWORD OVERVIEW 1 2 The case Inequality The intersection of for a more in health inequalities in women’s equal world and rights health and rights and economic inequality page 4 page 8 page 16 page 34 “Economic disparities are only part of the inequality story.” — Dr. Babatunde Osotimehin © Gianluca Colla EQUIPLOTS AND 3 4 5 INDICATORS The costs Towards equality Inclusion within of inequality by reaching the reach: actions furthest behind for a more first equal world page 60 page 74 page 92 page 104 © Frank Heuer/laif/Redux While some privileged … many hundreds of millions households budget barely scrape by on less than for billions … $1.25 a day. © Mark Tuschman 4 FOREWORD FOREWORD In today’s world, gaps in wealth have grown shockingly wide. Billions of people linger at the bottom, denied their human rights and prospects for a better life. At the top, resources and privileges accrue at explosive rates, pushing the world ever further from the vision of equality embodied in the Universal Declaration of Human Rights. Right now, the combined wealth of the world’s Inequality is often understood in terms of income 2,473 billionaires, as calculated by Wealth-X, or wealth—the dividing line between the rich exceeds $7.7 trillion. That’s equivalent to and poor. But, in reality, economic disparities the combined gross domestic product of an are only one part of the inequality story. Many astonishing four fifths of the world’s countries other social, racial, political and institutional in 2015. It means that while some privileged dimensions feed on each other, and together households budget for billions, many hundreds block hope for progress among people on of millions of families barely scrape by on less the margins. than $1.25 a day. Two critical dimensions are gender inequality, This is a path that we pursue at our peril. and inequalities in realizing sexual and The yawning gap between the richest and reproductive health and rights; the latter, in the poorest is not only unfair, but a risk to particular, still receives inadequate attention. economies, communities and nations. In Neither explains the totality of inequality in 2015, in recognition of this risk, the world’s the world today, but both are essential pieces governments agreed that the path to sustainable that demand much more action. Without such development for the next 15 years must be built action, many women and girls will remain on a foundation of equality, inclusiveness and caught in a vicious cycle of poverty, diminished universal enjoyment of rights. capabilities, unfulfilled human rights and THE STATE OF WORLD POPULATION 2017 5 © Mark Tuschman © UNFPA/Nicolas Axelrod unrealized potential—especially in developing repercussions. The lack of power to decide countries, where gaps are widest. whether, when or how often to become pregnant can limit education, delay entry into the paid The unmet demand for family planning labour force and reduce earnings. in developing countries, for example, is generally greatest among women in the poorest Making information and services more widely 20 per cent of households. Without access to available and accessible will lead to better contraception, poor women, particularly those reproductive health outcomes. But this is only part who are less educated and live in rural areas, are of the solution. Unless we start addressing the at heightened risk of unintended pregnancy. This structural and multidimensional inequalities within may result in health risks and lifelong economic our societies, we will never attain the highest © Pep Bonet/NOOR © UNFPA/Nicolas Axelrod 6 FOREWORD © Fernando Moleres/Panos Pictures © Tommy Trenchard/Panos Pictures standard of sexual and reproductive health objectives of the ICPD—and the new 2030 Agenda for all. This standard was envisaged by the for Sustainable Development—are met, humanity 179 governments that endorsed the Programme will be well on its way to a more equal world, of Action of the 1994 International Conference with more inclusive and vibrant economies. Most on Population and Development (ICPD), which important of all, this is the path to human dignity guides the work of UNFPA, the United Nations for every woman and every girl, everywhere. Population Fund. The ICPD affirmed that closing disparities for women and girls in income, The late Dr. Babatunde Osotimehin (1949–2017) education, employment and other areas will United Nations Under-Secretary-General and largely depend on enabling women and girls Executive Director to fully realize their reproductive rights. If the UNFPA, the United Nations Population Fund © Trygve Bolstad/Panos Pictures © Kadir Van Lohuizen/NOOR THE STATE OF WORLD POPULATION 2017 7 She was born to a poor family, in a rural community, in a poor country. Unlike her brother or her more affluent relatives in the city, she is poised to be left behind by a world that is surging forward. As her life unfolds, she may go to school, but probably for fewer years than boys her age. Schooling may end prematurely because she is married young or expected to care for younger siblings. By the time she is an adolescent, she may know how to perform household tasks and cultivate a field, but little else that might help her one day join the paid labour force. If her brother can hope to travel to a city to find decent work, she is more likely to stay home and start bearing children before she even exits her teens. Giving birth at an early age is already risky, and the dangers will be compounded because her rural community lacks quality maternal health services. Looking ahead in her life, she can expect that at least some of the disparities she suffers will be transmitted to her children, particularly her daughters. Caught in a tangled web of inequalities, at some point she may get a glimpse of another world, one that is both better off and out of reach. It may make her wonder why she has so little, and so little opportunity for gaining anything more. 8 OVERVIEW OVERVIEW The case for a more equal world © Abbie Trayler-Smith/Panos Pictures THE STATE OF WORLD POPULATION 2017 9 Unrealized rights, unequal prospects No country today—even those considered that individual rights and dignity—including the the wealthiest and most developed—can equal rights of women and girls, and universal access claim to be fully inclusive, where all people to sexual and reproductive health and rights— have equal opportunities and protections, are necessary for the achievement of sustainable and fully enjoy their human rights. development. Among the internationally agreed human rights Many gaps remain in meeting these commitments, central to human well-being is the right to sexual however. Some of the worst are among women and reproductive health. This right was endorsed by and girls already marginalized by other forms of 179 governments in the 1994 Programme of Action exclusion—most notably, poverty. In many developing of the International Conference on Population and countries, women who are poor, in the bottom Development.