For the women and girls affected, the most life-altering reproductive choice—whether or not to become pregnant—is no choice at all, explains the State of World Population 2022 report, released today by UNFPA, the United Nations sexual and reproductive health agency.

The groundbreaking report, "Seeing the Unseen: The case for action in the neglected crisis of unintended pregnancy," warns that this human rights crisis has profound consequences for societies, women and girls and global health.

Over 60 per cent of unintended pregnancies end in abortion and an estimated 45 per cent of all abortions are unsafe, causing 5 - 13 per cent of all maternal deaths, thereby having a major impact on the world's ability to reach the Sustainable Development Goals.

The war in Ukraine and other conflicts and crises around the world are expected to drive an increase in unintended pregnancies, as access to contraception is disrupted and sexual violence increases.

"This report is a wakeup call. The staggering number of unintended pregnancies represents a global failure to uphold women and girls' basic human rights," says UNFPA Executive Director Dr. Natalia Kanem.

"For the women affected, the most life-altering reproductive choice—whether or not to become pregnant—is no choice at all. By putting the power to make this most fundamental decision squarely in the hands of women and girls, societies can ensure that motherhood is an aspiration and not an inevitability."

Key findings

Gender inequality and stalled development drive high rates of unintended pregnancies.

Globally, an estimated 257 million women who want to avoid pregnancy are not using safe, modern methods of contraception, and where data is available, nearly a quarter of all women are not able to say no to sex. A range of other key factors also contribute to unintended pregnancies, including:

• Lack of sexual and reproductive health care and information
• Contraceptive options that don't suit women's bodies or circumstances
• Harmful norms and stigma surrounding women controlling their own fertility and bodies
• Sexual violence and reproductive coercion
• Judgmental attitudes or shaming in health services
• Poverty and stalled economic development
• Gender inequality

All of these factors reflect the pressure societies place on women and girls to become mothers. An unintended pregnancy is not necessarily a personal failure and may be due to the lack of autonomy society allows or the value placed on women's lives.

When crisis hits, unintended pregnancies climb

Crisis and conflict rob women of their agency at all levels, drastically increasing the risk of unintended pregnancy at the moment it is most threatening.

Women often lose access to contraceptives and sexual violence increases, with some studies showing that over 20 per cent of refugee women and girls will face sexual violence.

In Afghanistan, war and disruptions to health systems are expected to lead to an estimated 4.8 million unintended pregnancies by 2025, which will jeopardize the country's overall stability, peace, and recovery.

"If you had 15 minutes to leave your house, what would you take? Would you grab your passport? Food? Would you remember your contraception?" said UNFPA Executive Director Dr. Natalia Kanem.

"In the days, weeks and months after a crisis starts, sexual and reproductive health and protection services save lives, shield women and girls from harm and prevent unintended pregnancies. They are as vital as food, water and shelter."

The responsibility to act

The report shows how easily the most fundamental rights of women and girls are pushed to the back-burner in times of peace and in the midst of war.

It calls on decision-makers and health systems to prioritize the prevention of unintended pregnancies by improving the accessibility, acceptability, quality and variety of contraception and greatly expanding quality sexual and reproductive health care and information.

It urges policy makers, community leaders and all individuals to empower women and girls to make affirmative decisions about sex, contraception and motherhood, and to foster societies that recognize the full worth of women and girls.

If they do, women and girls will be able to contribute fully to society, and will have the tools, information and power to make this fundamental choice—to have children, or not—for themselves.

Five Key Facts from the 2022 SoWP

1. Every year, almost half of all pregnancies are unintended.

Between 2015 and 2019, there were roughly 121 million unintended pregnancies globally each year.

2. Globally, an estimated 257 million women who want to avoid pregnancy are not using safe, modern methods of contraception.

In 47 countries, about 40 per cent of sexually active women were not using any contraceptive methods to avoid pregnancy.

3. Nearly a quarter of all women are not able to say no to sex (where data is available).

Contraceptive use is 53 per cent lower among women who have experienced intimate partner violence.
Studies show that rape-related pregnancies are equally or more likely to occur than pregnancies from consensual sex.

4. Over 60 per cent of unintended pregnancies, and almost 30 per cent of all pregnancies, end in abortion.

45 per cent of all abortions performed globally are unsafe.

Unsafe abortions hospitalize about 7 million women a year globally and cause 5 to 13 per cent of all maternal deaths, one of the leading causes of maternal death.

In developing countries, unsafe abortions cost an estimated $553 million per year in treatment costs alone.

5. In humanitarian emergencies, such as the ongoing war in Ukraine, many women lose access to contraception and/or experience sexual violence.

Some studies have shown that over 20 per cent of refugee women and girls will face sexual violence.
An estimated 4.8 million unintended pregnancies will occur in Afghanistan by 2025 as a result of health system disruptions and gender inequality.

In the first 12 months of the COVID-19 pandemic, the estimated disruption in contraceptive supplies and services lasted an average of 3.6 months, leading to as many as 1.4 million unintended pregnancies.

Source

• Scoop
• Image: Futurity

Total sperm count in North America, Europe, Australia and New Zealand dropped by up to 60% in the 38 years between 1973 and 2011, the research found — an acceleration of a trend that began in the 1940s.

More recent studies show the trend is continuing.

At the same time, studies show a concurrent decline in testosterone levels — the hormone needed to build a man's muscle and bone mass and boost his sex drive.

Why? No one knows for sure.

Debate rages about the role of radiation, air pollution and chemicals in our food, clothes and water.

Smoking, alcohol consumption and obesity likely all play a role.

So could the lower nutritional quality of the typical Western diet, according to a new study published in JAMA Urology.

"This study is the largest study to date to examine the diet pattern with men's testicular function," said study author Feiby Nassan, a research fellow at Harvard's T.H. Chan School of Public Health.

The study found that, on average, men who typically ate a Westernized diet of pizza, snacks, sweets and processed foods produced around 68 million fewer sperm upon ejaculation than men who ate a more healthy, balanced diet.

A man is considered to have a low sperm count if he has less than 39 million sperm per ejaculation or fewer than 15 million sperm per milliliter.

A low sperm count can negatively impact a man's ability to get a partner pregnant, and it can be a key marker for overall male health.

"Fertility is not just important to make babies," Nassan said, adding that new research recently shows fertility is related to a man's general health and life expectancy.

A huge difference

The study looked at 2,935 Danish men of normal weight — with a median age of 19 — who were undergoing a physical to determine their fitness for military service (something all men in Denmark have to do after they turn 18).

Blood and semen samples were taken, and the men completed a questionnaire that asked how often they had eaten 136 food items in the prior three months.

The study looked at four food patterns:

• The "prudent," healthy pattern, in which fish, chicken, vegetables, fruit and water were mostly consumed.
• The "open-sandwich pattern," a more typically Danish diet with a greater intake of cold, processed meats, whole-grain breads, mayonnaise, cold fish, condiments and dairy.
• The vegetarian-like pattern, with a high intake of vegetables, soy milk and eggs, with little to no red meat or chicken.
• And the "unhealthy" Western pattern, with more pizza, snacks, french fries, sweets, sugar-sweetened drinks, processed and red meat, snacks and highly processed grains.

Men who closely followed the prudent pattern of eating — characterized by lots of fish, chicken, vegetables, fruit and water — were associated with the highest sperm counts.

This was followed by the semi-vegetarian and then the "smørrebrød," or Danish, eating style.

"The median sperm count of men who had the highest adherence to the 'prudent' pattern was 68 million higher than men who had the highest adherence to the 'Western' pattern," Nassan said, with 95 percent confidence intervals of 43 and 93.

In addition, the median sperm count of men who had the highest adherence to the vegetarian-like pattern was nearly 33 million higher than men who mostly ate the less nutritious Western diet. Continue reading

The research will be led by Dr John Shaver, University of Otago's Religion programme head, with Otago Research Fellow Dr Joseph Watts, who will conduct fieldwork in The Gambia.

The study will examine the impact of globalisation on practical support available to mothers and how this support impacts women's fertility and their children's health and development.

The Templeton Foundation notes that despite scholarly projections of the demise of religion, religious groups in many parts of the world are growing.

A great deal of this growth can be attributed to the higher fertility of religious people compared to their secular counterparts.

An unexplained paradox

Studies of diverse human populations demonstrate that parents in modern societies sacrifice the number of children they have for quality of children.

Even though children born to large families are expected to suffer physiological, psychological and social obstacles to flourishing, children born into religious communities appear buffered from the detrimental effects of high fertility.

Currently, this paradox of religious fertility is unexplained.

Shaver said preliminary work in New Zealand suggests co-operation in faith-based communities extends to childcare.

"What we don't know yet is whether shared childcare among co-religionists may help to mitigate the costs of high fertility, positively affecting both fertility and child health."

Over the next 30 months, a team of seven anthropologists and demographers will conduct cross-cultural studies of 6,050 Christian, Hindu, Jewish and Muslim participants in Bangladesh, India, Malawi, The Gambia and the United States.

In addition to Otago University, the project involves researchers from the London School of Hygiene and Tropical Medicine, Pennsylvania State University and the University of Connecticut.

The John Templeton Foundation supports independent research on subjects ranging from complexity, evolution and emergence to creativity, forgiveness and free will.

Source

• templeton.org
• voxy.co.nz
• odt.co.nz
• Image: ecovis.com

An average of 1.71 children per woman in New Zealand is well below population replacement level and threatens economic growth and the country's social balance and structure.

Population replacement and growth is only coming by way of immigration.

The claims come in "Families: Ever Fewer or No Children, How Worried Should We Be?" - a discussion paper from Family First NZ.

The report's author is Lindsay Mitchell, and in the report she looks at the reasons behind falling fertility, and discusses what might influence future trends.

In the report she attributes the reduction in fertility to

• Government policy
• Better educated females
• Increased female participation in the work force
• Economic pressure
• Pressure from environmentalists to have fewer children
• Ineffective policy interventions to incourage fertility.

As well as looking at the historical context of family size in New Zealand, the report also examines also reviews other countries' efforts to incentivise fertility.

"To date, New Zealand has been complacent about its total fertility rate.

"Firstly because it fluctuated around replacement rate for a long period, and secondly, it was higher than most other OECD countries.'

The report shows that New Zealand's fertility trend is beginning to resemble many other European and Asian nations struggling to boost their fertility rates.

"As New Zealand's fertility rate falls progressively further below population replacement level, the need to address the issue becomes more urgent," Mitchell points out.

"Without population replacement or growth, economies decline," she writes.

Mitchell point sout that a nation's strength lies in its young: their energy, innovation, risk-taking and entrepreneurship and that new blood drives the exchange of ideas and experimentation.

"If these attributes aren't home-grown, they have to be imported," she says.

Looking at the big picture Mitchell sounds a warning, saying that single person households are the fastest growing household type in New Zealand.

"I increasingly people are facing old-age with few or no family support," she writes.

Mitchell says the matter of fertility is critical to New Zealand's future and she encourages people to feature the topic in public and private conversations.

"Ultimately, whether or not people choose to have a child or children is a highly personal matter, but they shouldn't be denied balanced information to help them decide."

• Source: Family First

But behind the public face of infertility is the more hidden face of the altruistic dream-maker; the young woman egg donor. Easily forgotten in the ‘dreams lost and found' world of the fertility industry, she is taking inordinate risks that need to be spelled out.

According to Jennifer Lahl, the founder for The Center for Bioethics and Culture Network in the USA, there should be serious concerns for women donors who have suffered through losing their own fertility, suffered strokes or torsioned ovaries due to severe ovarian hyperstimulation syndrome.

She has met mothers whose daughters have died due to complications associated with egg donation. The experiences of several women feature in her award winning film ‘Eggsploitation'.

Lahl has been researching the health issues around egg donation for more than a decade and what she found seriously concerns her. Apart from the immediate risks of chemically forcing a young fertile woman's body into a menopausal state in order to prepare for the desired effect if possible of an unnaturally large harvest of eggs; an action totally foreign to the body's natural expectations.

The important question here is what is known about the long term risks? Well nothing concrete at all; there are no long term studies (which would be unethical anyway) and no follow up of actual donors or even a donor register.

In California in 2013, Governor Brown vetoed a bill that would have allowed scientific researchers to pay women for eggs for research. Lahl reports that Governor Brown cited the lack of studies, the real risks and unknown risks to women's health along with the exploitation of the poor seeking financial benefit.

In the final analysis egg donation is all risk and no benefit to the donor. The fertility industry can give no assurances as to the long term risks for egg donors.

It is worth noting that the fertility industry in the USA where Jennifer Lahl works is unregulated; donors are enticed by financial reward.

New Zealand is currently regulated and relies on the altruism of donors who might be within the family network of those needing their assistance or respondents to advertisements in specialty media sites.

New Zealand is under pressure to change due to the growing demand from a burgeoning fertility client market and insufficient donors to meet that demand. One expert has said he has had to send clients offshore for this reason.

We need to be aware of the threats to our daughters, sisters and friends who at some time might be approached personally or enticed financially; they need to be warned off taking such a risk as far as their immediate health is concerned and can never be assured in any concrete way as to the status of their long term health.'

• Lynda Stack graduated as a distance student with a BTh from Good Shepherd College. She is now studying a Masters at the JPII Institute in Melbourne. Lynda is married. She and her husband have two adult children who are living overseas.

In 2004, the Human Assisted Reproductive Technology Act was passed governing the practice of fertility treatment.

In 2010 the legislation was amended allowing the retrospective 10-year storage period for eggs, sperm and embryos.

Families can apply to have the time lengthened.

One fertility clinic, Fertility Associates, says it has not been able to contact everyone who has frozen samples.

Fertility Associates has spent the past year trying to track down 1700 people with samples 10 years or older that are frozen in liquid nitrogen banks.

"This is urgent, this is within the week they need to make the decision," says Richard Fisher, the co-founder of Fertility Associates.

Around 300 people cannot be reached and another 650 have not replied to letters.

There are fears that the unclaimed samples may be the only chance some have at raising children.

"What we don't want to do is for someone turn up on our doorstep in a year's time and say: 'I've come to collect my sperm' or 'I've come to collect my embryos' and we'll have to say: 'Sorry, they've been disposed of'," Mr Fisher says.

At least two other clinics, Fertility Plus at Auckland's Greenlane Hospital and Otago Fertility Services in Dunedin, also hold embryos which may be affected by the deadline.

Sex could become purely recreational by 2050 with large numbers of babies in the Western world born through IVF, the professor who invented the contraceptive pill says.

Professor Carl Djerassi, an Austrian-American chemist and author, said the pill would become obsolete because men and women would choose to freeze their eggs and sperm when young before being sterilised.

He also claims it would end abortions, as no pregnancies would be unplanned.

Djerassi said advances in fertility treatment made it much safer for prospective parents who do not have fertility problems to consider IVF.

Djerassi, 91, is an emeritus professor of chemistry at Stanford University.

Watch Video clip TVNZ news item

Source

• TVNZ News
• Herald on Sunday
• New Zealand Herald
• Image: tupbebek-genetik.com

But Olivier and Xristilla Roussy said their experience with contraception was not a good one.

After their third child was born, Mr Roussy said, Xristilla was exhausted; they thought that using the pill for a few months would help their marriage, "but it had the opposite effect".

He said his wife was always "in a bad mood, desire was absent and her joy disappeared".

In addition, he said, they both "understood we closed the door to the Lord in our conjugal life".

So they resorted back to Natural Family Planning, but this too, was not always easy, Mr Roussy explained.

Sexual desire increases during a woman's fertile period, but talking to one another and exercising discipline teaches trust and tenderness, he said.

"We have found these methods are reliable," he said, "even though we must admit that when we did not contain our desire, an infant came nine months later."

At the synod, Brazilians Arturo and Hermelinda As Zamberline asked that the Church stop giving "contradictory advice" on contraception, which only aggravates confusion.

The Zamberlines, married for 41 years and with three children, admitted that many Catholic couples in Brazil don't feel troubled by using artificial contraception.

The couple said natural methods of family planning had an "unjust reputation of being unreliable".

But they said such methods were often badly explained and thus badly practised.

Introducing the couple to the assembly, Cardinal Andre Vingt-Trois of Paris warned of the demographic consequences of a widespread "contraceptive mentality".

In the first week of the synod, a married couple would give an address to start each new session of the gathering.

Sources

• National Catholic Reporter
• National Catholic Reporter
• Image: Eglise Catholique en France

A highlight of the visit was two interactive broadcasts Lord Winston held for Year 7-10 and Year 12-13 students throughout New Zealand and the Pacific on the 13th March.

The focus of the Year 7-10 broadcast was "Puberty: Let's Talk About it with the Experts", and the Year 12-13 broadcast: "Reproductive Technologies: An Issue for our time".

The Lord Winston TALKFEST 2014 took place on Thursday. It was broadcast live with a selected student panel and student audience from the Fale Pasifika, the University of Auckland.

The Best Student Bloggers from the Pacific made up the selected panel, and had been identified from the winner of Blog BLAST entries

Lord Winston is patron of Gravida and a Professor of Science and Society and Emeritus Professor of Fertility Studies at Imperial College, London.

Source

• Gravida
• Image: l.yimg.com

The reason given for the recommendation is that it will encourage more people to donate eggs, and sperm.

Acart chairman John Angus said increasing payments would allow donors fair compensation for their efforts.

"There's a real shortage of eggs, in particular, in New Zealand, and overseas couples are able to access eggs of younger women."

The Human Assisted Reproductive Technology Act says eggs and sperm have to be given charitably, unlike in the United States and Britain, where sums of up to $10,000 are paid. In New Zealand, donations have to be open, so the child can find its origin.

Source

• Stuff.co.nz
• Image: i.telegraph.co.uk

Stuart says the way the news was delivered added to the blow. His doctor walked into the room and bluntly declared: "You've got big troubles. You basically have one good sperm." Stuart says this "made me feel about an inch tall".

Like most illnesses, infertility does not discriminate. But somehow it makes people feel they are part of a brutal natural selection process that prevents the weakest from reproducing their inferior genes. It also has a cruel way of making well-matched couples feel they may not be truly compatible. Says Rachel, "I often think, in a way, that, as hard as it has been, I'm glad it was both of us that had problems because if it was just me, I would have felt as though Stu should go and find someone else."

The Maloneys borrowed most of the $30,000 they have spent on IVF to become pregnant with Nate. While they don't regret a cent of it and believe they have received good care, they still wonder why the often repetitive procedures cost so much. "The thing that always pulls me up is the embryo transfer," Rachel says. "It costs about $3000 and it's a bit like a pap smear. They basically pop a speculum in and use a catheter to squirt the embryo in with some sterile water. It takes about 15 minutes. The doctor is there, so we're obviously paying for his time, but the embryo has already been created and we pay storage fees of about $160 every six months to keep them frozen. A scientist obviously has to prepare the embryos, but $3000 for a 15-minute procedure? That really gets me." Continue reading

Sources

• The Sydney Morning Herald
• Image: The Guardian

These Asian giants have not been alone. In much of Europe, North America, East Asia and elsewhere, the average number of children born to women during the course of their childbearing years has fallen to unprecedentedly low levels.

Our new book, The Global Spread of Fertility Decline: Population, Fear, and Uncertainty (Yale University Press, 2013) analyzes these trends and the demographic, political and economic consequences and uncertainties as low fertility has become a global phenomenon. Like other facets of globalization, low fertility rates are by no means universal: High fertility persists in sub-Saharan Africa and in parts of the Middle East, but elsewhere low fertility is more the rule than the exception. These underlying trends in childbearing mean that in the near future the rate of population growth both in Europe and Asia are likely to decline. The world is not on a path of unrestrained demographic growth, as some believe. People all over the world have hit the brakes.

Thirty years ago only a small fraction of the world's population lived in the few countries with fertility rates substantially below the "replacement level" - the rate at which the fertility of a hypothetical cohort of women would exactly replace itself in the next generation - normally set at 2.1 children per woman for populations with low mortality conditions. Fast forward to 2013, with roughly 60 percent of the world's population living in countries with such below-replacement fertility rates. Continue reading

Sources

• YaleGlobal Online
• Image: The Economist

Speaking at the end of a three-day Vatican conference on diagnosing and treating infertility, Benedict also reiterated Church teaching that marriage is the only permissible place to conceive children. Matrimony "constitutes the only 'place' worthy of the call to existence of a new human being," he said.

New Zealand-born Shamus Husheer, founder of the company Cambridge Temperature Concepts, told the Wall Street Journal that six months' use of his DuoFertility monitor has the same success rate as a round of IVF, according to a peer-reviewed study his company has published.

"From a woman's perspective, IVF is pretty awful. With us, all they have to do is wear a patch," Husheer said.

The monitor system uses a small temperature sensor which a woman tapes under her arm and wears all night and preferably during the day.

The monitor is synchronized with a base station connected to a PC to record a woman's body basal temperature, which is lower before ovulation than after.

A small increase in temperature of about 0.78 degrees Fahrenheit takes place within 48 hours of ovulation and will remain elevated until a woman's next period.

Recording the body basal temperature has historically been difficult and depends on taking temperature with regularity upon waking each morning.

The monitor uses the data to identify the day of a woman's ovulation and to suggest the ideal three-day window to try to conceive. A woman can also use the base station to report other events such as the beginning of her menstrual cycle, interrupted sleep, or illness.

The DuoFertility website characterizes the product as a "personal fertility coach" and as an alternative to lengthy waits to see fertility experts.

The device has been licensed by the British National Health Service and is undergoing approval by the U.S. Food and Drug Administration. The NHS is considering using the system for its patients with unexplained fertility, who number 4,000 per year.

In the U.K. an IVF cycle costs $7,200, while the DuoFertility system costs about $800.

IVF has also faced ethical objections. The procedure often creates "leftover" human embryos whose lives are at risk. Catholic ethicists also object to IVF's separation of procreation from marital sex.

Sources

• EWTN
• Duo Fertility