Bodily autonomy and reproductive health

We still have a long way to go before all people are able to exercise their human rights in relation to reproductive health, sex and sexuality, and family planning. Deficits particularly affect women, girls and LGBTIQ+ people.

• According to World Health Organization (WHO) estimates, nearly 800 women die every day due to complications during pregnancy and childbirth. That is about 290,000 a year – and more than 90 per cent of these deaths occur in countries in the Global South.
• According to a scientific study, some 40 per cent of all pregnancies worldwide are unplanned. Six in ten unplanned pregnancies end in abortion – and nearly half of all abortions are unsafe. A significant proportion of maternal mortality is linked to unsafe abortion.
• An estimated 270 million women worldwide who would like to avoid getting pregnant have no access to modern methods of family planning.
• The World Health Organization estimates that over 200 million girls and women in Asia, the Middle East and Africa are affected by genital mutilation.
• Many girls and women are subjected to sexual or physical violence. According to WHO estimates, nearly one third of all women worldwide experience such violence in the course of their lives.
• In 67 countries, homosexual partnerships are a criminal offence. In 11 of these countries, homosexual acts can be punished by death.
• Worldwide, some 12 million girls under the age of 18 are married every year. For most of them, this means the end of their schooling. Early pregnancies have a negative impact on their health, and on that of their children.
• In 2021, some 1.5 million people were newly infected with HIV. This particularly affects young women, men who have sex with men, drug users, sex workers and their clients, incarcerated people, and transgender people.
• In many countries, access to vaccines against sexually transmitted infections with human papillomavirus (HPV) and Hepatitis B virus is very limited.

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Waiting patients in the maternity ward of Nkhoma Hospital in Malawi

Together with its partners, the German government campaigned strongly for making the right to bodily autonomy and the improvement of sexual and reproductive health part of the 17 Sustainable Development Goals (SDGs) of the 2030 Agenda. These efforts largely succeeded. The topic was included in SDG 3 (Health and well-being) and SDG 5 (Gender equality).

One important focus of SDG 3 (Health) is the further reduction of maternal, newborn and child mortality. SDG 3 also includes a target for ending the HIV epidemic.

SDG 5 comprises ambitious targets on gender equality and on reducing gender-based violence. This includes the eradication of practices such as female genital mutilation and child marriage.

The German government also addresses aspects of sexual and reproductive health that have not been included in the SDGs, such as young people's access to comprehensive sexuality education and the elimination of all forms of discrimination based on sexual orientation.

Partnerships

At the international level, Germany is involved in various fora and partnerships. They include the Partnership for Maternal, Newborn and Child Health (External link) (PMNCH), the Family Planning 2030 initiative (External link), and the Every Woman Every Child campaign of the UN Secretary-General.

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Even though numerous challenges remain, significant progress has been made in many areas of sexual and reproductive health. Here are some examples.

• The number of maternal deaths related to pregnancy and childbirth dropped by 34 per cent between 2000 and 2020. This has mainly been achieved through improved access to health services and to skilled attendance at birth.
• More and more people have access to information on methods of family planning and to comprehensive sexuality education. The number of women using modern family planning methods nearly doubled between 1990 and 2021 – from 467 million to 874 million.
• By combining various prevention methods and expanding antiretroviral therapy for people infected with HIV, new HIV infections and deaths from AIDS have been reduced significantly.

The combination of a variety of factors has facilitated this progress on sexual and reproductive health. They include the development of new and more effective drugs and prevention, diagnostics and treatment methods, and the dissemination of these new developments, as well as efforts to train staff or strengthen health systems in other ways.

Good and active governance is also important. This means fostering the right to bodily autonomy, minimising corruption and inefficiency, facilitating citizen and patient participation, and defining the right goals and pursuing them systematically. Such efforts must not be limited to the health sector; they need to address other areas as well. For instance, girls' access to education is a particularly powerful factor that has multiple positive impacts on their sexual and reproductive health, and simultaneously strengthens their rights and participation.

Protecting the right to bodily autonomy, fostering sexual and reproductive health, and providing access to family planning information and services are important goals of Germany's development policy.

The Initiative on Rights-based Family Planning and Reproductive Health for All brings together many programmes under Germany's development cooperation. Between 2011 and 2021, the BMZ committed more than 1.2 billion euros as part of this effort, especially for activities to prevent unwanted pregnancies and support safe pregnancy and childbirth.

Under the Initiative, support is currently being provided to over 20 partner countries in Africa and Asia. Further countries are reached through regional programmes and through the work of faith-based and other non-governmental organisations. For example, in the period up to 2020, the Initiative enabled some 37 million couples to get access to modern contraceptives and thus prevent unwanted pregnancies. The Initiative will continue until 2025.

The BMZ also supports important international partners in the sector. One of them is the United Nations Population Fund (UNFPA). It works to reduce maternal mortality and to end gender-based violence, and to facilitate universal access to family planning. In 2022, German support for UNFPA totalled about 60 million euros.

The BMZ also supports the International Planned Parenthood Federation (External link) (IPPF). The Federation's member organisations give people in 170 countries direct access to family planning methods and health services. IPPF is an important voice for sexual and reproductive health and rights.

Moreover, Germany is an important donor to major health funds such as the Global Financing Facility (External link) (GFF); Gavi, the Vaccine Alliance (External link); and the Global Fund to Fight AIDS, Tuberculosis and Malaria (External link).

From 2002 to 2022, Germany provided about 5.1 billion US dollars in support of the Global Fund, making it the Fund's fourth-largest official donor. And since 2006, Germany has provided over 1.36 billion euros to support Gavi's work on basic immunisation and health systems strengthening. It is the Alliance's fourth-largest official donor.