As a Japanese citizen, I read with great interest the speech US President Barack Obama gave during his recent historic visit to Hiroshima and one sentence struck me like no other: "Those who died, they are like us." With these few simple words, he quietly called on people around the world to exercise their empathy to bridge the distance, however great, in time and space, to see those 200,000 people killed by the atomic bombs in Japan -- indeed all those we see as "others" -- as fellow human beings.
The 2030 Agenda for Sustainable Development, recently adopted by the member states of the United Nations, echoes this challenge by calling on nations to overcome inequalities and exclusions to ensure a life of dignity for all people, leaving no one behind. The United Nations Population Fund where I serve as the regional director for Asia and the Pacific, seeks to contribute to this objective by helping countries to achieve universal access to sexual and reproductive health.
Given our mandate, we are happy to see that the World Economic Forum on Asean 2016 is focusing on how to achieve economic integration with social inclusion and, particularly, universal health coverage. Because without all people having access to good healthcare that includes sexual and reproductive health services, it is impossible to achieve that goal of a life of dignity for all human beings.
Sexual and reproductive health, at heart, has to do with ensuring that people can enjoy that most intimate and delicate part of our lives -- how and with whom we share our bodies and our hearts, and whether and when to have children -- in safety and in freedom. It includes, among other services, the provision of family planning methods and counselling and skilled professional assistance when women give birth.
Whether women have access to good sexual and reproductive health services is a matter of life and death. Every year, close to 13,000 women die of causes related to pregnancy and child birth in the Asean region. We estimate that a quarter of those deaths can be prevented if women are provided with effective contraceptive methods. Almost half are a result of women not having proper care before, during and after giving birth. One way to save women's lives is by ensuring access to skilled birth attendance. This varies widely within the Asean region, from 41.5% in Lao PDR to 100% in Brunei Darussalam.
Another measure is the rate of utilisation of modern family planning methods. Here too, the levels vary greatly within Asean: from about 46% in Myanmar to close to 80% in Thailand. Within the same country as well there are large inequalities -- between women living in rural areas and those living in cities, between ethnic majorities and minorities and between the poor and the rich. For example, in Indonesia, the province of Papua in the east has extremely high maternal mortality ratios compared with the west of the country, towards the capital, Jakarta. In Vietnam, higher maternal mortality ratios are reported in the central and northern highlands and the remote mountainous region where ethnic minority communities live.
In Cambodia, out-of-pocket health expenditures for urban residents are 18.7% compared with 72.2% for rural dwellers. And in Asia, as a whole, only 32% of the poorest women have access to delivery in a health facility versus 92% of the richest.
To eliminate these inequities and ensure that all people have access to sexual and reproductive health, countries must invest more in these services to provide sufficient and properly trained health professionals, adequate infrastructure for them to work in and also essential equipment and medicines. On average, the Asean countries spend 4% of their GDP on health, which contrasts with the 12% average of the OECD countries. Of course, the OECD countries are wealthier than Asean but this is about countries placing the greatest possible priority on health in using the wealth that is available to them. And on this front, most Asean countries can and must do more. Thailand, for example, started its journey towards universal health coverage almost four decades ago when its GDP per capita was only US$400 -- a significant and visionary effort. In particular, it is critically important to reduce out-of-pocket expenditures, which hit the poorer people the hardest. These stand at 40% of total health expenditures among Asean countries but only 14% in the OECD.
People have a right to receive decent healthcare without impoverishing themselves in the process. Governments must guarantee that right through prepayment schemes that do not place an excessive burden on the people, in particular, protecting the poor and the vulnerable. Countries must also give priority to basic and essential services and ensure that all people have access to them -- regardless of who they are, where they live, whether they are rich or poor. Family planning is one such service. In Cambodia, the $2.5 million the government is investing in contraceptives in 2016 is expected to save $18 million in maternal, newborn and child healthcare costs this year alone
And finally, to ensure that universal health coverage is truly universal, countries must take those services to those communities and people who have so far been excluded -- the rural poor, ethnic and religious minorities, the disabled, migrants and refugees, the LGBT community.
One important group of people who desperately need services and information are the adolescents. A number of countries in the Asean region prohibit government facilities from providing sexual and reproductive health services to unmarried young people or require parental consent for adolescents. This is especially worrying given that in some parts of Asean teenage pregnancies are on the rise. As a result, many young people, especially girls, are being prevented from realising their full potential as productive citizens and as human beings.
This is no easy endeavour, but UNFPA is confident that with strong and sustained political will, the Asean region can achieve the goal of Universal Health Coverage and universal access to sexual and reproductive health by 2030. And to muster that will, let us remember that the mother from an ethnic minority who died from bleeding in childbirth because she could not reach a clinic in time, the teenage girl in an urban slum who dropped out of school because her pregnancy started to show, the young gay man who contracted HIV from ignorance about the virus and a lack of access to protection -- they are like us.
Yoriko Yasukawa is the United Nations Population Fund's Regional Director for Asia and the Pacific. She is part of the panel on Universal Health Coverage at the World Economic Forum on Asean 2016 (June 1-2, Kuala Lumpur, Malaysia).