As of 2004, progress in reproductive health is evident in many countries, where family planning is the norm and fewer women are dying in childbirth. But much more needs to be done, especially in those countries with far to go in meeting development goals.
Three actions are central to saving women's lives: family planning, skilled attendance at birth, and access to emergency obstetric care. Ten years after the International Conference on Population and Development (ICPD) in Cairo, more than half a million women still die each year from complications of pregnancy and childbirth. Lack of care heightens the risk to mothers and babies: one third of all pregnant women worldwide receive no health care during pregnancy, and 60 per cent of all deliveries take place outside of health facilities. Poverty makes the dangers even greater: the lifetime risk of a woman dying in pregnancy or childbirth in sub-Saharan Africa is 1 in 16, compared to 1 in 2,800 in developed countries. The Cairo conference called for universal access to reproductive health care by 2015.
More than ever, women are making their own choices about childbearing - exercising their right to choose the number, timing and spacing of their children. As a result, families are smaller and more prosperous and children are healthier and better educated. A recent study in Africa shows that spacing births by three years or more could reduce infant deaths by 50 per cent and family planning could reduce maternal deaths by 20 per cent.
Current programmes provide contraceptives to 500 million women in developing countries, and 200 million more women would be using family planning if they had access to affordable, high-quality services. This would reduce dramatically the number of unintended pregnancies, abortions, infant deaths, maternal deaths and children losing their mothers. In 2004, UNFPA-supported programmes helped expand access to and improve the quality of reproductive health services, including family planning, especially in the poorest countries.
- In Manikganj, a farming community south of Dhaka, Bangladesh, women seek out the Mother and Child Welfare Centre for a complete array of maternal and health services, from family planning to emergency obstetric care. As one of only eight in the entire country, the UNFPA-supported clinic is a model for the nation, which plans to provide similarly comprehensive facilities in 64 districts by the end of 2005.
- Two guidelines on contraceptive use were published by the World Health Organization (WHO) with UNFPA support through the Strategic Partnership Programme. The two documents - Selected Practice Recommendations for Contraceptive Use and Medical Eligibility Criteria for Contraceptive Use - help policymakers, managers and the scientific community prepare service delivery guidelines for their national programmes.
- For the first time, Kazakhstan has allocated funds to buy contraceptives - $3 million in the 2005 budget - and initiated a draft law on reproductive rights. UNFPA has fully covered the needs of the population as the country's only supplier of contraceptives, and will continue to provide logistical support and training.
MAKING MOTHERHOOD SAFER
Much can happen in a single decade, as in the significant reductions of maternal mortality in Bolivia, China, Egypt, Honduras, Indonesia, Jamaica, Mongolia and Zimbabwe. Strong safe motherhood policies and the presence of skilled birth attendants and referrals for emergency obstetric care have made a tremendous difference in these countries. The goal of reducing maternal mortality, which is one of the MDGs as well as a key objective of the ICPD Programme of Action, cannot be achieved without universal access to reproductive health information and services. Of the estimated 529,000 maternal deaths each year, 99 per cent are in developing countries.
GLOBAL SURVEY TEN YEARS AFTER CAIRO
A global survey conducted by UNFPA to appraise national experiences concluded that the decade since the adoption of the ICPD Programme of Action has been one of significant progress. Since 1994, most governments have integrated population concerns into their development strategies. Almost all of the 151 developing countries surveyed have adopted laws or other measures to protect the rights of girls and women. Some 131 have changed national policies, laws or institutions to recognize reproductive rights. Results published in Investing in People: National Progress in Implementing the ICPD Programme of Action 1994-2004 will be used by UNFPA to ensure greater progress in the next decade.
- The UNFPA report Maternal Mortality Update for 2004 focuses on the role of skilled attendance in improving maternal health. A companion booklet, Into Good Hands: Progress Reports from the Field, provides examples of policies, research and activities aimed at improving skilled attendance.
- In Rajasthan, India, district-level emergency obstetric care projects have proven so successful that funding has multiplied tenfold and the UNFPA supported initiative has been expanded statewide and adopted as part of the nation's reproductive and child health programme.
- India, Morocco, Mozambique and Nicaragua are part of the Averting Maternal Death and Disability Programme of Columbia University with which UNFPA continues to carry out safe motherhood projects and needs assessments.
- Eight international organizations, including UNFPA, launched a safe motherhood initiative in Latin America and the Caribbean in February 2004. The aim is to improve national and municipal maternal health services, with skilled attendance at every birth along with drugs, equipment, supplies and referral services.
- UNFPA was among UN organizations that expressed concern about the living conditions of Palestinian women. The agencies cited an increase in home deliveries, a decrease in post-natal care, and 52 pregnant women having given birth at military checkpoints since 2002.
- A new regional and provincial safe motherhood initiative in Viet Nam is improving the quality of obstetric and newborn care through training for health service providers and by improving women's knowledge and understanding of pregnancy, delivery and the needs of infants.
- UNFPA presented 12 tractor ambulances to the Ghana Ministry of Health in May to provide fast access to medical help in emergencies. The locally produced ambulances (tractors hitched to small trailers) can reach people in rural areas with rough and hilly terrain, particularly in the northern regions.
ENDING OBSTETRIC FISTULA
Obstetric fistula is a tragic childbirth injury that affects at least 2 million women in developing countries. UNFPA's global Campaign to End Fistula focuses on prevention and treatment in 30 countries in sub- Saharan Africa, South Asia and the Arab States. A website for the campaign (www.endfistula.org) was launched in 2004.
- Uganda launched a national campaign to end fistula, providing 12 regional hospitals with equipment and supplies for fistula surgery, training for local doctors, and advocacy to raise awareness.
- In Chad, UNFPA has helped to establish and equip fistula repair centres at the Hôpital de la Liberté in Ndjamena, the Hôpital Abeche in the Ouadai region, and in Mongo and Kelo. Surgeons received training at the Addis Ababa Hospital, and a referral system has been implemented.
- In northern Nigeria, four fistula repair centres were renovated by UNFPA in partnership with the Government, and will be staffed by 10 doctors and 40 nurses that completed fistula repair training in early 2005. Plans are underway to similarly enhance fistula treatment services in seven other Nigerian states.
- The Human Security Trust Fund approved fistula activities in Mali, Nigeria and Pakistan, funding them with $3.54 million to be spread over five years. The Islamic Development Bank pledged $1 million to establish a fistula repair centre in Bangladesh.
- The London office of the award-winning advertising agency Young & Rubicam donated its creative services to UNFPA for the Campaign to End Fistula. The agency is working with UNFPA to raise awareness of obstetric fistula in the United Kingdom through broadcast, print and electronic materials.
Adolescent girls in a literacy class in Yemen. Literacy programmes have been shown to increase the use of health services. Access to relevant information and services can protect and improve the health of both women and girls, and can help them to know their rights.
SUPPORTING ADOLESCENTS AND YOUTH
Nearly half of all people are under the age of 25 - the largest youth generation in history. Facing many challenges and risks, young people need information and services that enable them to lead healthy and productive lives. The ICPD gave unprecedented attention to adolescents' diverse needs with regard to reproductive health, as both a human rights priority and a practical necessity. In UNFPA's global survey on ICPD progress, a large number of countries reported progress in adolescent reproductive health through policies, laws, health and life skills education, and youth-friendly services. Most endeavours have been small-scale, however, and a major challenge is to secure the resources and commitment needed to scale up these programmes.
In 2004, UNFPA formed a Youth Advisory Panel of young people from all parts of the world to help the organization promote the rights and needs of youth within UNFPA programming and national development plans. UNFPA also established the Special Youth Programme Internship to host interns from developing countries at UNFPA headquarters in New York for six-month assignments. The Global Youth Partnership continued its work against HIV/AIDS.
- Married girls from Bangladesh, Burkina Faso and Yemen talk about child marriage in Too Brief a Child: Voices of Married Adolescents, a video produced by UNFPA that documents how the practice threatens girls' health, restricts their education and limits their social, economic and political growth.
- In Cotonou, Benin, a dynamic multimedia centre with its own television and radio stations provides job training for hundreds of young people, along with lessons in preventing HIV/AIDS and unwanted pregnancies, with support from UNFPA.
- A youth centre opened in Rwanda's Kibuye province in January, next to a health clinic that provides free HIV testing. The UNFPA-supported centre offers information, counselling, film screenings, cultural and sports activities, and training in income-generating skills.
- In the city parks of Caracas, Venezuela, young visitors learned how to handle peer pressure and delay sexual activity through UNFPA-supported plays and informational materials about their reproductive health and rights.
- A youth summit attended by 70 young people from Asia and Europe identified ways to increase youth participation in reproductive health programming. Held in November in Sri Lanka, the event was part of the Reproductive Health Initiative for Youth in Asia (RHIYA), supported by the European Union and UNFPA.
- The UNFPA-supported African Youth Alliance (AYA) reached more than 100,000 young people in four countries in 2004 with training in life skills. In Uganda, the AYA network of faith-based organizations raised $2 million for HIV prevention.
- Universities in Tunisia joined UNFPA in 2004 to produce materials on adolescent sexual and reproductive health. The new partnerships produced a workshop and training manuals addressing research, training and South-South cooperation, along with a reference manual on quality assurance.
- In Cambodia, more than 200 young people met in February at the Fourth Annual Youth Camp to address the theme: "Young people together eliminate shyness for better understanding of sexual and reproductive health and HIV/AIDS." The camp was co-funded by UNFPA, the European Union and the United States Agency for International Development.
- UNFPA continued to support the Youth Peer Education Electronic Resource network (Y-PEER), which links over 1,000 members from 27 countries in Central and Eastern Europe and Central Asia. YPEER helps local and national NGOs work together to implement programmes that promote safer and more responsible behaviour among adolescents. In 2004, the network organized 246 events in 15 countries attended by 220,000 participants, and later reached 1.7 million young people through rollout activities in the region.
STOP VIOLENCE AGAINST WOMEN! This was the message of a national campaign launched in November in Istanbul by the Turkish Government using the mass media, sports activities, celebrity appearances and religious sermons. The campaign was organized by UNFPA, which worked with a local advertising agency on shaping the campaign concept.
ENDING GENDER VIOLENCE
Speaking before the UN Security Council in October, the Executive Director of UNFPA, Thoraya Ahmed Obaid, urged world leaders to condemn and act against systematic rape and all forms of degrading treatment of women during conflicts and to help rehabilitate victims physically and mentally. Ten years earlier, the ICPD called on countries to "take full measure" to end violence against women, yet progress has been mixed despite high-level promises throughout the past decade. UNFPA works with partners to prevent and treat cases of sexual violence, whether in times of crisis or its ongoing occurrence.
- Influential representatives of government, NGOs, UN agencies and the media focused on the trafficking and sexual exploitation of women from Russia at an April round table organized by UNFPA with the Russian Central House of Journalists. Recent research documented the adverse impact of trafficking on victims' reproductive health, social status and economic situation.
- Some of the most powerful women from more than 40 African countries called for ratification of an African protocol on women's rights during a regional conference on ending gender-based violence and achieving the MDGs. More than 200 African women ministers and parliamentarians attended the November event in Gabon, which was organized by UNFPA, WHO and the United Nations Development Fund for Women (UNIFEM).
- Combating discrimination at its most extreme, UNFPA supported efforts to raise awareness of female infanticide and prenatal sex selection. A workshop on sex ratio disparities at birth was sponsored by UNFPA in China, bringing together countries experiencing the same problem. In India, the Government launched a research and advocacy campaign on "missing girls" that focuses on districts with the most extreme differences in the numbers of girls compared to boys.
SECURING ESSENTIAL SUPPLIES
As the world's largest multilateral source of reproductive health commodities, UNFPA is committed to meeting the need, with measurable impact: each $1 million of commodities could prevent 800 maternal deaths, 150,000 abortions or 360,000 unwanted pregnancies. Commodity security has improved since the ICPD called for a reliable and adequate supply of a range of contraceptive methods and other reproductive health essentials. In many developing countries, however, the shortage of condoms and contraceptives continues to be severe.
- The European Union pledged $75 million to UNFPA to meet the supply requirements of 49 developing countries that largely depend on external assistance for contraceptives and condoms to meet their reproductive health needs and prevent HIV/ AIDS. The decision was announced in October at the United Nations General Assembly meeting marking the ICPD's 10th anniversary. Hans van den Broek of the Netherlands, Special Envoy of the European Union Presidency, told the meeting that the Union's 25 member States and the European Commission would collectively "fill the entire reproductive health commodities gap of $75 million in 2004 through a special contribution to UNFPA's Reproductive Health Commodity Fund".
- Pacific countries agreed on a plan to secure reproductive health commodities through UNFPA as part of efforts to save lives and improve health. Health ministers of the Cook Islands, Fiji, Kiribati, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu endorsed the plan in May.
- Computer software developed by UNFPA provides country-specific data on stock levels that helped 69 countries replenish supplies and avoid shortages in 2004, an increase of 20 countries over the previous year. Country Commodity Manager is enhancing national capacity to collect, analyse and report data and to secure, store and distribute supplies.
- UNFPA launched the Female Condom Initiative in 2004 to promote and facilitate female condom programming in more than 20 countries. The female condom was also promoted through the UN's programme addressing HIV/AIDS in the workplace. Female condoms are an important addition to the fight against sexually transmitted infections (STIs) and HIV/AIDS and the only female-controlled total barrier method.
- UNFPA finalized a large study on the contraceptives, drugs and supplies required to meet needs through 2015 in family planning, reproductive health and HIV prevention. Also, a costing model was developed for UNFPA country offices, enabling countries to cost and budget for reproductive health interventions in their national policies and poverty-reduction strategies. In addition, major advances were made in the costing of obstetric fistula and emergency obstetric care.
CULTURAL SENSITIVITY TO ENHANCE PROGRAMMING
Development efforts stand greater chances of succeeding when they are presented to beneficiaries in a culturally sensitive manner and built on open dialogue and community involvement, says the 2004 report Working from Within: Culturally Sensitive Approaches in UNFPA Programming. The aim is to create an environment that makes programmes for human rights more acceptable and sustainable, which is accomplished by recognizing local social and cultural realities and actively supporting a process of local ownership. Nine case studies presented in this publication are drawn from a longer UNFPA report, Culture Matters: Working with Communities and Faith-based Organizations. The companion booklet, 24 Tips for Culturally Sensitive Programming, presents recommendations based on UNFPA research. Culture and human rights were also the focus of a conference attended by more than 100 experts from around the world, "Cairo and Beyond: Reproducti ve Rights and Culture", which was organized by the Government of the Netherlands and UNFPA on the occasion of International Women's Day, 8 March.