The 2019 State of the World Population Report reflects on the current state of sexual and reproductive health and rights 50 years after the United Nations Population Fund (UNFPA) was established.

While progress has been made over the past five decades, “hundreds of millions of women today still face economic, social, institutional and other barriers that prevent them from making their own decisions about whether, when, how often and with whom to become pregnant.”

The report offers a look at the key moments for sexual and reproductive rights across five decades, from the discovery of the HIV to the Commission on the Status of Women’s call to end child marriage. It highlights political changes around population policy, such a shift in focus from controlling population to expanding human rights and reproductive choices.

“Any form of coercion in population policies and programmes is unacceptable. Women and men have the right to choose the size and spacing of their families, and to the information and the means to do so.” – Nafis Sadik, former Executive Director, UNFPA. 

The report includes the stories of six women, all 60 years old, who reflect on how sexual and reproductive health and rights and gender inequality has shaped their personal and professional lives. 

The report identifies major barriers to achieving sexual and reproductive health and rights for all in 2019, including a lack of access to modern contraceptives and sexual and reproductive health services, and struggles with gender inequality which diminishes power to make choices about our lives and future.

Availability but no access

The report recognises that while we have a broad range of highly effective contraceptives, safe and effective methods of abortion, and evidence of the effectiveness of sexuality education, there is significant inequality both within and between countries in access to quality health care, information and education. For example, the report notes the significant relationship between income and access to services.

“Contraceptive prevalence rates are generally lower among the poorest 20% of the population and highest among the richest 20%.”

Access to necessary supplies, adequate facilities and trained health workers also presents a challenge to people getting the sexual and reproductive health care they need. Legal barriers also still exist for people across the globe, including restrictive abortion laws, criminalisation of same-sex relationships, and parental or spousal consent to access services.

“To ensure rights and choices in people’s lives, all people need and deserve a comprehensive suite of information and services related to sexual and reproductive health.”

Lack of power

“Of all the obstacles to the achievement and exercise of human rights, including reproductive "rights, few have proven to be as challenging to overcome as those based on gender.”

The report makes it clear that one of the greatest challenges to achieving sexual and reproductive health and rights for all is gender inequality. 

“Gender inequality limits the ability of women to freely make fundamental decisions about when and with whom to have sex…”

The report notes that while traditional gender stereotypes limit women’s ability to make choices about their lives, they also negatively impact men who face social pressure to engage in risky behaviour and prove their fertility. Sexuality and gender diverse communities face additional barriers to sexual and reproductive health and rights including persistent stigma and discrimination.

Humanitarian and environmental disasters

The State of the World Population Report emphasises the influence of social, political, economic and environmental pressures and upheaval on sexual and reproductive health and rights. The report reflects on the impact of war, climate change, migration and disasters and how systems and access to service break down during these crises leaving women and girls, in particular, extremely vulnerable.

Pushing forward

“Realising rights and choices for all – if not now, when?”

“[We are] embracing a new energy and a new language that brings more and more people, from all walks of life, on board.”

The report ends positively by focusing on how to move forward. It highlights that adequate funding for sexual and reproductive health services is essential, and that initiatives to promote universal access to health care presents opportunities for universal access to sexual and reproductive health services.

“All health systems should define and deliver an essential package of universally available, integrated, high-quality sexual and reproductive health care services, at primary and referral levels.”

The report advocates for attention to a range of issues which continue to impact sexual and reproductive health and rights for all including: focusing on adolescents in efforts to ensure access to sexual and reproductive health and rights, recognising growing concerns around fertility and reproductive cancers, challenging gender norms, ending harmful practices and engaging men.

The report advocates for “Getting to three zeros –  NO unmet need for contraception, NO preventable maternal deaths and NO violence or harmful practices against women and girls –but notes that this will require ambition and commitment.

Read the full report here.