The document summarizes reproductive health indicators and challenges in Latin America and the Caribbean. While average regional rates of fertility, contraceptive use and skilled birth attendance are better than other developing regions, there are huge gaps within and between countries. Maternal mortality rates vary widely from 31 deaths per 100,000 live births in Chile to 680 in Haiti. Poverty, access to services, and knowledge of contraception also differ greatly between urban and rural populations as well as indigenous and non-indigenous groups. Despite some government successes in reducing maternal mortality and HIV, funding for reproductive health has declined in the past decade. To improve reproductive rights, advocacy is needed to document needs, educate donors, and encourage regional support.

1. The Unfinished Sexual and Reproductive
Health Agenda
Repositioning Latin America and the
Caribbean
Women Deliver
London, October 2007

2. Latin America and the Caribbean:
Better off than other developing
regions?
Total
Fertility Rate
Contraceptive
prevalence
(modern
methods)
Skilled
Attendance of
Deliveries
HIV
Prevalence
Sub-
Saharan
Africa
5.7 20% 41% 7.2%
South and
East Asia 3.5 58% 37% .7%
LatinLatin
AmericaAmerica
and theand the
CaribbeanCaribbean
2.6 63% 86% .7%
Source: UNFPA, 2006

3. Deceiving regional indicators
• Regional average indicators mask
huge gaps
– Population living under
the poverty line: 24%
– Range: 6% in Uruguay -80% in Nicaragua
(Haiti a close second at 78%)

4. Deceiving regional reproductive health
indicators: Maternal mortality
• Although average regional rates are lower than other regions’,
some parts of LAC have higher MMR than some countries in
Africa.
• Wide range of MMR
– Chile: 31 deaths/100,000 live births
– Haiti: 680 deaths/100,000 live births (World Bank 2007)
• For example, Namibia’s MMR is 300/100,000 live births and
Botswana’s is 100 deaths/100,000 live births (World Bank, 2007)

5. Large inequalities
within countries
Average country indicators also
mask important differences
In Guatemala:
– Access to improved sanitation:
• 44% of rural populations
• 84% of urban populations
– Indigenous and non-indigenous peoples:
• 75% of Mayans vs. 27% of Ladinos live in poverty
• 30% of Mayans vs. 11% of Ladinos are illiterate

6. Assistance during delivery by place of
residency, Peru, DHS, 2000
0
10
20
30
40
50
60
Urban Rural
Doctor
Other health
professional
Traditional birth
attendant
Relative or other
No one

7. Knowledge and utilization of modern
contraceptive methods, Mayan vs. Ladino
women, Guatemala, 2002
Source: ENSMI 2002
0
20
40
60
80
100
Knows Used
Maya
Ladina

8. – In Honduras, multiple strategies led by national
commitment to address MM decreased it by 40%
from 1990-1997
– In Nicaragua abortion was banned even when a
woman’s life is threatened (2006)
Public policy and
reproductive health: safe motherhood

9. Public policy and sexual and
reproductive health: HIV and AIDS
–Government commitment to the fight
against HIV and AIDS:
• Brazil: with progressive policies and
widespread prevention efforts, AIDS
mortality dropped by 50% since 1996

10. Deceiving regional sexual and reproductive
health indicators: HIV and AIDS
• On average, the region has relatively low rates of HIV prevalence,
but the Caribbean has the second-highest HIV infection rate after
Sub-Saharan Africa
• Top 15 HIV and AIDS prevalence countries outside Africa (% of
population, 2005):
– Haiti (3.8)
– Bahamas (3.3)
– Trinidad and Tobago (2.6)
– Belize (2.5)
– Guyana (2.4)
– Suriname (1.9)
– Papua New Guinea
– Cambodia
– Barbados (1.5)
– Honduras (1.5)
– Jamaica (1.5)
– Thailand
– Ukraine
– Estonia
– Myanmar

11. Asymmetries in
international support

12. U.S. Government Support in LAC
• Resources for counter-narcotics
and security assistance increased
since 2002, especially in the
Andean region
• Aid levels to LAC did not
significantly change in 10 years:
8.2% (94) 9% (04) of worldwide aid
budget
• RH: Most LAC countries have
already “graduated” or will soon do
so

13. U.S. Foundation Support in LAC
• Peak of 18.3% in 1994 decreased to 5.9% in
2004
• Foundation’s giving priorities for LAC have
shifted from health to international development,
disaster relief, environment
and human rights
• Health grants : 8.3%;
Reproductive health: 4.5% (2004)

14. U.S. Foundation Support in LAC

15. U.S. Foundation Support in LAC
• Mexico and Brazil consistently
rank among top beneficiary
countries
• Ford and Kellogg foundations
provide biggest shares of support
• MacArthur Foundation, one of the
few with still a LAC country in
its priority list

16. Dwindling Support for Reproductive
Health
Funding for reproductive health and family planning has
decreased in the past decade with the exception of HIV/AIDS
Source: UNFPA. Financial resource flows for population activites in 2001 and UNFPA/NIDI Resource Flows
project database. New York, USA: UN Population Fund, 2003

17. LAC faces great challenges but also offers
unique opportunities!
• Commitment of governments with MDG
• Functional health systems
• Information on health
• Committed and vocal civil society organizations
• Robust health research institutions
• Strong private sector with nascent social
responsibility arms
• New philanthropic organizations
• General awareness of health as a
human right and importance of health
for development

18. What needs to be done to raise regional visibility and
attract more resources for SRHR?
• Advocate for Latin America and the Caribbean at the
global level
• Advocate for Sexual and Reproductive Health and Rights
globally and nationally
• Document needs and opportunities
• Educate donors about unmet needs, regional gaps and
inequities
• Encourage regional philanthropy
• Network with “friends of LAC” in influential positions
• Expand South-to-South collaboration in LAC and across
regions

19. Our goal:
Make the right to safe and voluntary
reproduction a reality in Latin America
and the Caribbean

20. Gracias!
www.engenderhealth.org