UNFPAUNFPA Annual Report 2003
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REPRODUCTIVE HEALTH AND SAFE MOTHERHOOD

The difference between life and death, health and disability. From family planning to obstetric care that saves lives.

Gaps in reproductive health care account for nearly one fifth of the worldwide burden of illness and premature death, and one third of the illness and death among women of reproductive age. These gaps could be closed and millions of lives saved with highly cost-effective investments in this area, including contraceptive services and supplies now in severe global shortage.

Reproductive health yields a high return on investment. Reproductive health services, especially for the poorest with the greatest need, not only improve quality of life for individuals and families but also contribute to economic growth, societal and gender equity, and democratic governance. In particular, adequate funding of programmes enabling young people to avoid unwanted pregnancy, unsafe childbirth and sexually transmitted infections (STIs) would produce a significant benefit to development and slow the spread of HIV/AIDS.

Key areas of UNFPA support are featured below in examples of action in family planning, safe motherhood, obstetric fistula, adolescent reproductive health, gender violence, commodity security and access and quality.

FAMILY PLANNING

Greater access to family planning is a sign of progress: 60 per cent of married couples in developing countries now use modern methods of contraception, compared to 10-15 per cent in 1960. Even so, more than 200 million women worldwide are still in need of access to a full range of effective, modern 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 conditions.

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. In addition, UNFPA provides contraceptive commodities to support these programmes and to fill requests from the international donor community.

  • In Nigeria, UNFPA maintained the continuous availability of at least five contraceptive methods at 540 service delivery points in 2003. In the 12 States covered by the Country Programme, at least 80 per cent of facilities offered a combination of family planning and efforts, including HIV/AIDS counselling, to stem STIs. With special support from Canada, these efforts are being expanded to improve contraceptive logistics and the supply of other reproductive health essentials.
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  • UNFPA works with the military in many countries to reach men with information, education and services for family planning, HIV prevention, reduction of gender-based violence and other reproductive health concerns. A new digital document, Enlisting the Armed Forces to Protect Reproductive Health and Rights: Lessons from Nine Countries, offers "lessons learned" from projects in nine military organizations.

Adding It Up

A new report makes the case for increased funding for reproductive health services — particularly in poor countries — by illustrating the unusually broad societal and individual impact of investments in reproductive health. The Alan Guttmacher Institute and UNFPA have jointly published Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care.

Potential health benefits are tremendous, the report says. Each year current programmes providing contraceptives to the 500 million women in developing countries who do not wish to become pregnant already prevent: 187 million unintended pregnancies; 60 million unplanned births; 105 million abortions; 22 million miscarriages; 2.7 million infant deaths; 215,000 pregnancy-related deaths; and 685,000 children from losing their mothers.

SAFE MOTHERHOOD

Saving women’s lives is the most fundamental of UNFPA goals. One woman dies every minute from pregnancy-related complications, yet most of these deaths are preventable. Worldwide, the disparity in maternal health between rich and poor countries is the widest of all health indicators.

The Programme of Action of the International Conference on Population and Development (ICPD) and the Millennium Development Goals (MDGs) call for nations to significantly reduce maternal deaths by 2015. Our strategy is to provide voluntary family planning to reduce unwanted pregnancies and to ensure that all women have the assistance of a skilled health worker during pregnancy and delivery, and access to emergency medical care if complications arise.

  • Access to timely emergency obstetric care for pregnant women was the focus of a three-day conference on reducing maternal mortality that was attended by 300 participants from 50 countries. The event was part of the Averting Maternal Death and Disability (AMDD) programme, a partnership of Columbia University and UNFPA along with UNICEF, CARE and Save the Children.
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  • Following assessments of emergency obstetric care in Nicaragua, the UNFPA/AMDD programme rehabilitated health facilities, published a book of standards and protocols, conducted training for obstetrical staff, and developed a referral system.
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  • A tiny health clinic in the remote rural village of Goudiry, Senegal, was expanded into a much larger and well-equipped obstetric care centre with support from UNFPA. Services include care for complicated pregnancies, antenatal check-ups, ultrasounds, contraceptive supplies, HIV prevention and information about reproductive health.

OBSTETRIC FISTULA

Obstetric fistula is a debilitating pregnancyrelated condition caused by prolonged obstructed labour. The woman, often very young, suffers chronic incontinence and, in most cases, her baby dies.

UNFPA has launched a global campaign to prevent and treat fistula, and in 2003 provided targeted support to some 20 countries in sub-Saharan Africa, South Asia and the Arab region. Strategies include delaying marriage and pregnancy for young girls, increasing access to family planning, providing access to medical care for all pregnant women, ensuring emergency obstetric care (including Caesarean sections) for all who develop complications, and repairing physical damage through medical treatment with reconstructive surgery and emotional damage through counselling.

  • The first report ever to map obstetric fistula in sub-Saharan Africa, published in June 2003 by UNFPA and EngenderHealth, contends that current figures on the number of women living with fistula — estimated at 2 million — are too low, since they are based on patients who seek treatment in medical facilities. In Nigeria alone, there could be as many as 1 million women living with fistula, the report says.
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  • UNFPA worked with the Government of Bangladesh, where an estimated 70,000 women are living with fistula, to establish a fistula centre at the Dhaka Medical College that will manage cases and train service providers in South Asia.
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  • The fistula repair unit at Monze Mission Hospital in Zambia has increased awareness of the condition, increased referrals and improved quality of care with support from UNFPA.
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  • UNFPA purchased medical equipment and supplies for Sudan’s only fistula centre, where eight volunteer doctors manage one operating room. Between 1994 and 2000, the centre in Khartoum treated more than 700 women suffering from fistula.

A fistula patient, after her treatment at the UNFPA-supported National Hospital in Niamey, Niger, relaxing with the children of other patients in the hospital compound..

 

Photo: Carrie Svingen

ADOLESCENT REPRODUCTIVE HEALTH

More than 1 billion people are between the ages of 10 and 19, the largest number of adolescents in history. Half of them are poor; one in four lives in extreme poverty on less than $1 a day. In developing countries, some 82 million girls now between the ages of 10 and 17 will marry before their 18th birthday, disrupting their education, limiting their opportunities and increasing the danger of tooearly childbearing.

Unmet need for family planning among adolescents is twice as high as among the adult population, despite undeniable risks: young women aged 15 to 19 are twice as likely as women in their twenties to die in childbirth, and of the 14 million teenagers who give birth each year, many face serious pregnancy-related illnesses and at least 5 million undergo unsafe abortion.

  • The African Youth Alliance (AYA), with support from UNFPA and other partners, is scaling up comprehensive adolescent development programmes that include behaviour change communication activities and capacitybuilding of youth groups and national institutions in Botswana, Ghana, Uganda and the United Republic of Tanzania.
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  • The Adolescent Girls Initiative promoted policy dialogues on adolescent issues in 11 countries with governments, NGOs, community action groups and adolescents. The initiative is a joint effort of UNFPA, UNICEF and WHO funded by the United Nations Foundation.
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  • The European Commission/UNFPA Initiative for Reproductive Health in Asia has worked with 19 European NGOs and more than 60 local partners to improve reproductive health in Bangladesh, Cambodia, the Lao People’s Democratic Republic, Pakistan, Nepal, Sri Lanka and Viet Nam.
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  • A booklet to guide communications between parents and youth on sensitive matters was launched in November by UNFPA and Action Health Incorporated, a Nigerian NGO. The booklet, "Can’t We Talk About It? A Self-help Guide for Talking with Your Adolescent," was produced in an effort to save adolescents’ lives by helping them avoid dangers such as HIV/AIDS.
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  • In Angola, UNFPA supported pilot programmes on population and family life education in schools and teacher training in three provinces. Information on adolescent reproductive health, gender, STIs and HIV/AIDS was shared with students in 20 schools who later acted as peer educators.
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  • Meeting adolescents’ reproductive health needs is an urgent priority in the global fight against poverty and HIV/AIDS, emphasized UNFPA’s report The State of World Population 2003. Countries that invest in education and health on a priority basis will be repaid many times over in progress towards development, said the report. It featured examples of UNFPA-supported projects that combine life skills and sexuality education as well as peer counselling with access to youth-friendly services, and often offer job skills training.

GENDER VIOLENCE

Violence against women perpetuates poverty by reducing women’s capacity to work outside the home, their mobility and access to information, and children’s school attendance. It is also a violation of human rights. UNFPA works with partners to help minimize and provide treatment for cases of sexual violence, to provide life-saving medical supplies and assistance to pregnant women, and to halt the spread of HIV/AIDS.

  • Police officers in Timor-Leste participated in training to protect victims of domestic violence and deal with offenders. UNFPA also supported a drama group engaged in community awareness-raising and worked with representatives from the Government, local communities, the church and women’s groups.
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  • UNFPA launched a webfilm entitled "Women, War, Health" to mark the Day for the Elimination of Violence against Women, 25 November. Translated into nine languages, this three-minute clip highlights the urgent need to protect women’s health in war and refugee settings.
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  • A new UNFPA programming guide on gender-based violence for health care providers was reviewed at a September conference in Rome following pilot tests in 10 countries. In Lebanon, the pilot project established referral resources, developed information and advocacy materials, designed monitoring tools and translated the guide into Arabic. In Romania, the project conducted training to sensitize medical staff, developed brochures and flyers, established a referral resource, and supported the creation of a national strategy on domestic violence.
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  • In Kenya in 2003, UNFPA supported advocacy and counselling services for rescued girls at the Waa School in Kwale and in Narok, inspiring financial support from the Ministry of Education. The services help runaway girls return to their homes without risking genital cutting or forced marriages.
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  • A shocking decline in the number of girls compared to boys in India during the last decade was publicized in a booklet that consolidates data on the impact of sex-selective abortion and infanticide. The booklet, Missing: Mapping the Adverse Child Sex Ratio in India, was compiled in 2003 by the Office of India's Registrar-General and Census Commissioner, the Ministry of Health and Family Welfare, and UNFPA.

COMMODITY SECURITY

The severe global shortage of contraceptive services and supplies not only contributes to unintended pregnancy but is costing lives lost to pregnancy-related illness and unsafe abortion. UNFPA, the world’s largest multilateral source of reproductive health commodities, works to ensure a secure supply and choice of quality contraceptives and other reproductive health commodities to meet the needs of people at the right time and in the right place.

  • New software was introduced in more than 50 countries to help track stocks and shipments of contraceptives, condoms and other reproductive health commodities. Country Commodity Manager (CCM) enables users to identify potential shortages, replenish stockpiles when needed and "swap" commodities from a country with plentiful supplies to a country in urgent need.
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  • UNFPA and WHO issued a list of supplies to aid in the planning and management of reproductive health programmes, Essential Drugs and Other Commodities for Reproductive Health Services.
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  • Pakistan signed an agreement with UNFPA in 2003 to significantly expand the delivery of reproductive health commodities and services over the next five years. Contraceptive use is increasing in Pakistan, which has one of the highest population growth rates in the world as well as high levels of maternal mortality.
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  • A series of regional workshops on UNFPA’s Reproductive Health Commodity Security (RHCS) strategy was completed in 2003, preparing UNFPA representatives and national government counterparts to integrate the strategy within national health programmes.
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  • The introduction of female condoms continued to expand in 2003, in particular for HIV prevention. UNFPA endeavored to link condom promotion with gender-sensitive initiatives to empower women with negotiation skills. Since 1999, more than 19 million female condoms have been supplied in Africa, Asia and Latin America through joint efforts with UNAIDS, WHO and the Female Health Company.

Partnerships are pivotal in promoting commodity security. In 2003, UNFPA cooperated closely with development partners including WHO, the World Bank, the International Planned Parenthood Federation (IPPF), the United States Agency for International Development (USAID), John Snow, Inc. (JSI), The Management Sciences for Health (MSH) and the Program for Appropriate Technology in Health (PATH).

In a UNFPA poster campaign, messages aimed at preventing domestic violence, teen pregnancies and HIV infections were displayed in metro stations in Caracas, Venezuela.







Photo: Marianella Cardenas/UNFPA

ACCESS AND QUALITY

Women’s empowerment, reproductive rights, gender and community mobilization are key aspects of UNFPA-supported efforts to expand access to and improve the quality of reproductive health services, especially in the poorest countries.

  • The successful Stronger Voices for Reproductive Health initiative added a "lessons learned" dimension to its web site in 2003, describing quality of care issues in six countries: India, Kyrgyzstan, Mauritania, Nepal, Peru and the United Republic of Tanzania. The initiative is a partnership of UNFPA, the International Labour Organization, WHO and UNICEF that was started in 2001 with funding from the United Nations Foundation.
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  • In March 2003, UNFPA provided the Government of Sudan with six new four-wheel drive vehicles equipped as ambulances. The vehicles ensure access to emergency care, particularly for pregnant women in need of prompt medical attention. Maternal mortality rates in Sudan are among the highest in the world.

WORLD POPULATION DAY

"1,000,000,000 adolescents are about to enter their reproductive years," announced the poster campaign for World Population Day, 11 July 2003. The annual event, which has raised awareness about population issues for the past 14 years, emphasized the right of young people to have access to the information and services they need to enjoy healthy and productive lives.

  • In Afghanistan, girls from Al Fatah High School attended a forum for World Population Day at which government leaders said that early marriage limits girls’ educational prospects and threatens their health.
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  • Tunisia’s observance of World Population Day included a conference organized by UNFPA and the National Office of Family and Population at which several partnership conventions with local NGOs were signed. The partnerships are to implement a new UNFPA-supported project in adolescent reproductive health.
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  • For young people in Turkmenistan, World Population Day activities included a televised quiz show and an essay contest on population issues. Media coverage featured an award for best service in reproductive health care, along with musical and sporting events that marked the Day, which was celebrated jointly by UNFPA and partners in government ministries.