REPRODUCTIVE HEALTH AND SAFE MOTHERHOOD
A commitment to saving women’s lives.
Reproductive choice is a human right, but it cannot be exercised without access to relevant information and high-quality services.
To help individuals exercise this right, UNFPA supports projects and programmes that help meet the need for family planning, safer and healthier pregnancy and childbirth, and the prevention of sexually transmitted infections (STIs), including HIV/AIDS. Areas of particular concern are adolescent reproductive health, obstetric fistula and gender violence.
350 million women worldwide -one in six women of reproductive
age- are still in need of a full range of effective
family planning methods to be able to space their children
or limit the size of their families. More than half
the women in some countries say they would have preferred
to postpone or avoid their most recent birth. And more
than 50 million of the 190 million women who become
pregnant each year have abortions, many under unsafe
UNFPA supports voluntary family planning programmes that help couples plan the size of their families, protect the health of mothers and their children, enhance family well-being and increase men’s participation in family planning and reproductive health decisions.
- Young students in a military school in Ecuador now study reproductive health, including sexuality and gender equality, as part of the school curriculum. A related effort provides reproductive health services to armed forces personnel and their families.
- In Yemen, a new book for use by imams and preachers placed reproductive health and family planning in the context of Islam. It was produced with UNFPA support in cooperation with the Government.
- A culturally sensitive project in Peru’s Amazon region linked reproductive health and indigenous identity. Local trainers conducted workshops in the native language for community leaders, midwives and health promoters in the Condorcanqui province.
More than half a million women die every year from pregnancy-related complications. With access to emergency medical treatment, almost all of these women could be saved. UNFPA promotes safe motherhood by ensuring that skilled assistance and health services are available to all women during pregnancy and childbirth. We also make timely emergency obstetric care available to women with complications and provide supplies in response to the unmet need for family planning.
- UNFPA has supported the repair and renovation of 79 health care facilities in seven districts in the State of Rajasthan, India, as part of a project to improve access to, and the quality of, emergency obstetric services.
- Emergency obstetric care in West and Central Africa was the focus of needs assessments carried out by UNFPA in Cameroon, Côte d’Ivoire, Mauritania, Niger and Senegal. Published in November 2002, the results are being used to mobilize resources for projects that will make these services more widely available.
- In Morocco, a UNFPA-supported project has trained 700 health care providers and managers and contributed to a significant increase in the number of emergency obstetric care facilities. Monitoring and evaluation have focused on issues of access and quality.
- In the Sofala province in Mozambique, which has the highest rates of maternal mortality and the poorest facilities in the country, UNFPA is furnishing hospitals with staff and equipment to provide basic and comprehensive obstetric and neonatal care. Training has been provided to maternal and child health nurses, surgery technicians and medical doctors.
- To improve emergency obstetric care in Timor-Leste, UNFPA funded four specialized doctors through the United Nations Volunteers programme in 2002. These obstetrician/gynaecologists provide life-saving services and conduct on-the-job training for Timorese health workers in order to build local capacity.
- In Nicaragua, a comprehensive needs assessment of 138 public and private health-care facilities was completed in 2002. Special evaluation and assessment tools were developed to help identify regions with the highest rates of maternal mortality.
- A variety of reproductive health projects have benefited Somali refugees in Kenya and Ethiopia as well as Somalis residing within their own country. UNFPA helped rehabilitate the two main maternity health facilities in Garowe, Puntland (Northeast Somalia), train health staff, and obtain basic and essential medical supplies and equipment.
Obstetric fistula, the most severe of all pregnancy-related disabilities, is an injury caused by prolonged labour. It usually occurs when a young, poor woman has an obstructed labour and cannot obtain a needed Caesarean section. The baby usually dies and the mother suffers from extensive tissue damage to her birth canal, rendering her incontinent. Untreated women not only face a life of shame and isolation, but may also face a slow, premature death from infection and kidney failure. Obstetric fistula affects at least 50,000 to 100,000 women every year.
Fortunately, most of these cases can be corrected surgically, even after several years.
UNFPA is leading a global campaign to prevent and treat obstetric fistula, particularly in sub-Saharan Africa. Launched in Addis Ababa, Ethiopia, in October 2002, the campaign aims to educate communities about the causes and consequences of obstetric fistula, equip medical centres with essential supplies and train medical personnel to perform the needed surgery. The campaign also highlights the dangers associated with too-early marriage and childbearing and helps fistula victims reintegrate into their societies.
As part of the campaign, UNFPA is supporting the first-ever needs assessment reports on the prevalence of obstetric fistula in 11 of these countries, namely Benin, Chad, Ethiopia, Malawi, Mali, Mozambique, Niger, Nigeria, the United Republic of Tanzania, Uganda and Zambia. The fistula initiative is being financed by an initial contribution of $200,000 from the Government of Finland.
than 150 women in Chad received surgical treatment
for fistula during the first year of a UNFPA-supported
programme to expand services and raise awareness.
Needs assessments guided the expansion of treatment
capacity, including training of doctors and nurses
and equipping and supplying hospitals. After surgery,
women receive seed money to start small income-generating
activities as part of their return to a more normal
life in their villages.
In its newly launched campaign to end fistula, UNFPA cooperates with the Addis Ababa Fistula hospital, where these women have been successfully treated.
Photo: Kristin Hetle/UNFPA
ADOLESCENT REPRODUCTIVE HEALTH
With limited knowledge about their bodies, young people are vulnerable to unwanted pregnancies, unsafe abortions, sexually transmitted infections, substance abuse, exploitation and violence.
Adolescents are even more vulnerable than their older peers.
UNFPA supports initiatives in family life education, sexuality education in schools, peer education, youth-friendly health centres and services, and youth participation. The Fund gives special attention to girls, whose health, education and life opportunities are often curtailed by gender discrimination, early marriage and early childbearing.
- In Cambodia, more than 300 Buddhist monks participated in UNFPA-supported training on reproductive health issues, including HIV prevention. These well-respected religious leaders then conveyed the information to young people through sermons, workshops and informal meetings.
In another project, young people too shy or embarrassed to seek reproductive health services or information at a clinic can go to a karaoke club or a library-two of the new “drop in ” centres supported by the European Commission/UNFPA Initiative for Reproductive Health in Asia.
- Street dramas and mobile video shows in Nepal brought reproductive health messages to rural adolescents and youth. The UNFPA-supported project featured performances in local languages, followed by question and answer sessions.
- Urban gangs in Lima, Peru, were among the targets of a UNFPA-supported project to provide information on sexual and reproductive health, gender and violence issues. Outside the city, radio broadcasts reached out-of-school youth in the Amazon region.
- In Egypt, manuals produced by UNFPA introduce young people to reproductive health issues, and to the physical, psychological and social changes of adolescence. The manuals complement a national campaign addressing youth-related issues such as shisha (water pipe) smoking, nutrition, family relations, gender equity, anger, violence and, for married adolescents, family planning.
- In Viet Nam, adolescent reproductive health issues have been integrated within the secondary education system, with assistance from UNFPA.
- Grass-roots activities and advocacy campaigns gained the attention of adolescents in Bosnia and Herzogovina. The UNFPA-supported project aims to boost youth participation in decision-making on sexual and reproductive health issues, and to improve their access to related services through peer-mediated networks.
Cuba,UNFPA education and information campaigns
targeted adolescents and youth, with a view towards
delaying first pregnancies and reducing the country’s
rate of abortion. Reproductive health messages
were conveyed via the mass media and through promotional
materials such as calendars, pens and T-shirts,
like the one worn by this Havana teenager.
Johnette Iris Stubbs
Violence against women is strongly associated with poor reproductive health, including reduced demand for, and access to, reproductive health services. UNFPA works with governments to establish national mechanisms to monitor and reduce gender violence, and monitors their commitment. In 2002, 26 countries had a monitoring mechanism in place, and 25 more were reported to be developing such mechanisms.
- Trafficking in women and girls was the topic of an international workshop in Bratislava, Slovak Republic, organized by UNFPA in October 2002. More than 60 parliamentarians, government officials and NGO representatives from 25 countries attested to the detrimental effects of trafficking on their populations and agreed that its elimination should be a matter of national policy.
- Health care workers in Chimaltenango, Guatemala, received training on how to screen female patients for gender-based violence and refer victims to an on-site psychologist. In addition to this training, UNFPA supported awareness sessions for community leaders in this poor urban community.
- In Somali refugee camps in northeastern Kenya and eastern Ethiopia, counselling for rape
victims is part of an initiative carried out by UNFPA with funding from the Danish Government.
Victims are provided with emergency reproductive health and family planning services. The initiative emphasizes the prevention and treatment of sexually transmitted infections, including HIV/AIDS, and raises awareness of female genital cutting.
- In Nicaragua, gender equality and the prevention of violence against women are the focus of innovative communication methods that promote behaviour change and bring information to underserved areas. The UNFPA-supported project has helped to improve relations between the military and local communities.
- In Ghana, UNFPA continued to support the Joint UN Gender Programme in collaboration with UNDP and UNIFEM. In 2002, six national organizations carried out a nationwide “16 Days of Activism Against Gender Violence ”. Among the advocacy materials produced this year was a made-for-television video, “Speak Out Against Gender Violence ”, featuring high-profile government and community leaders.
The quest to improve health and prevent sexually transmitted infections depends largely on the availability of essential reproductive health commodities, including contraceptives. In 2002, UNFPA supplied $150 million in commodities to 73 developing countries, at their request.
The cost of these supplies was met in part by $25 million in financing from the Governments of Canada, the Netherlands and the United Kingdom. A number of countries have signed cost-sharing agreements with UNFPA for the provision of contraceptive commodities.
In response to urgent requests from 33 emergency situations in 2002, UNFPA dispatched reproductive health supplies valued at about $1.5 million. International aid organizations have also made use of the Fund’s procurement services to obtain emergency reproductive health supplies for their own relief efforts.
UNFPA’s global strategy for reproductive health commodity security ensures that there are enough quality contraceptives and other commodities to meet the needs of people at the right time and in the right place. In 2002, the strategy was introduced to nearly 200 UNFPA representatives and national counterparts during regional workshops in China, Côte d’Ivoire and the Slovak Republic. The workshops also laid the foundation for national plans to monitor and evaluate steps taken by countries to secure sustainable supplies of quality reproductive health commodities at affordable prices.
UNFPA launched an initiative with the United States Agency for International Development to engage country partners, technical agencies and other donors in an effort to further promote reproductive health commodity security at the country and global levels. Through a series ofconferences and working groups, the initiative came to be called the Strategic Pathway to Reproductive Health Commodity Security (SPARCHS). The purpose of SPARCHS is to support countries in developing a strategic commitment and funded action plan for ensuring an adequate supply and range of choice of quality contraceptives and other reproductive health commodities.
- In Brazil, a UNFPA-supported study found that national systems to purchase and distribute contraceptives were insufficiently developed, with inadequate tracking and control mechanisms. UNFPA helped the Ministry of Health analyse national legislation and regulations affecting procurement, importation, tariffs, distribution and logistics.
- At a workshop in Norway in 2002, the United Nations Department of Peacekeeping Operations and UNFPA developed guidelines on condom programming for peacekeeping missions and signed a memorandum of understanding on the provision of reproductive health supplies, including condoms, essential drugs and HIV testing kits.
in Timor-Leste try out their new motorbikes, purchased
with UNFPA assistance. The 80 new motorbikes enable
the midwives to expand their outreach, in particular
to women in remote rural communities. To further
improve access to the limited number of trained
midwives, UNFPA is pilot-testing maternity “waiting
houses ” where a woman can stay near a midwife
as her delivery date approaches. Timor-Leste,
the newest member of the United Nations, became
an independent nation on 20 May 2002. It has the
highest number of maternal deaths in Asia (860
per 100,000 live births).
ACCESS AND QUALITY
Far from being a luxury, improving quality of care can be a cost-effective means to achieve the ultimate goal of better reproductive health. Treating clients with respect is one important aspect of care, as otherwise they may not use the available services or may end up with poor results.
Quality of care encompasses access to services, adequate supplies and equipment, and high standards of technical, managerial and interpersonal skills among health staff. UNFPA has been active in all of these areas from the start, largely through providing technical support, equipment and training for health care providers.
UNFPA-led global initiative, Stronger Voices for Reproductive
Health, is fostering partnerships between governments
and civil society to improve the quality of sexual and
reproductive health in six countries: India, Kyrgyzstan,
Mauritania, Nepal, Peru and the United Republic of Tanzania.
Community-based mechanisms, such as mobilization and
advocacy, savings and credit programmes and micro-insurance
schemes, are helping communities, particularly women,
have a stronger say in the quality of reproductive health
care they receive. The project has enabled communities
to publicly discuss and address their reproductive health
concerns, which often had been deemed too “private
” for the public domain. The initiative is being
carried out in cooperation with the UN and other agencies,
with funding from the United Nations Foundation.