Kouboura Moutari of Niger married when she was only 15 years old. Soon after,
she gave birth to her first child, who was stillborn. During her second pregnancy,
she laboured for two days before her family brought her by horse-drawn cart
to the hospital for an emergency Caesarean section. Unfortunately, it was too
late, and she not only lost the baby, but also suffered obstetric fistula. With the
help of UNFPA, however, she was able to obtain treatment and today works with
a UNFPA-supported non-governmental organization (NGO) to inform village
women of the importance of prenatal care and timely obstetric intervention.
Promoting reproductive health and rights is central to
the UNFPA mission. The Fund strives to contribute to
the Millennium Development Goals (MDGs) by focusing
on maternal mortality, adolescents, gender equality,
HIV prevalence (particularly among women), under-5
child mortality and unmet family planning needs.
In many developing countries, maternal mortality
remains unacceptably highâ€”a stinging indictment
of inadequate national priorities that fail to address a
global tragedy that is as easily preventable as it is seemingly
intransigent. According to the 2006 MDG progress
report, advancement on maternal health has stagnated
and, in some instances, has even deteriorated.
Although many countries have established reproductive
health programmes, millions of pregnancies are still
unwanted or mistimed. Furthermore, modern family
planning methods remain out of reach for the worldâ€™s
poorest and, in particular, for unmarried young people.
In 2006, UNFPA strengthened efforts to guarantee
the right to sexual and reproductive health, to help
girls at risk of acquiring HIV and to support young
people, who hold the key to a healthy future.
Saving Mothersâ€™ Lives
Saving livesâ€”reducing maternal death and protecting
women from serious health complications
associated with pregnancy and childbirthâ€”is not
only a leading international development priority,
but is also a human rights imperative. UNFPA helps
families and individuals to gain access to reliable
family planning, and developing countries to build
capacity so they can provide women with skilled
attendance at birth and emergency obstetric care in
case of complications. In 2006:
- UNFPA raised awareness of the critical shortage
of midwives in developing countries, where
an estimated 529,000 women die in pregnancy and
childbirth each year. Key partners included the
International Confederation of Midwives and the
World Health Organization (WHO). In December,
UNFPA and partners organized a groundbreaking
forum in Tunisia that focused exclusively on midwifery.
Participants from 23 countries signed the
Hammamet Call to Action, which recommends that
donors and national governments strengthen midwifery
services throughout the developing world.
- UNFPA helped launch two new vaccines against
the human papillomavirus (HPV)â€”the virus that
causes cervical cancerâ€”by working with donors, governments
and multilateral organizations to establish
how national immunization, sexual and reproductive
health services, and cancer control programmes could
make the vaccines rapidly available to women in the
developing world. UNFPA also contributed to a policy
and programme guide after a March 2006 technical
consultation. Delivery of HPV vaccines may offer an
opportunity to reach pre-adolescent girls and their
mothers with HIV prevention and other reproductive
- In partnership with WHO, the United Nations
Childrenâ€™s Fund (UNICEF) and the World Bank,
UNFPA supported the development of national maternal
and newborn health strategies to help countries
realize MDG 5 (improve maternal health). The new
strategiesâ€”to be finalized and funded in 2007â€”will
enable partners to rapidly scale up interventions,
contribute to the prevention of mother-to-child
transmission, and integrate good practices into
maternal health programmes.
Family Planning: So that Every Pregnancy is Wanted
Improving access to voluntary family planning services
lies at the heart of the UNFPA mandate. Despite
the lack of up-to-date data on global or regional contraceptive
prevalence rates, improvement is evident:
An increasing number of countries report that service
delivery points now stock at least three modern
methods of contraception. Nevertheless, millions of
people still lack access to contraceptives. Today, an
estimated 201 million women worldwide are unable
to acquire safe and effective contraceptive services. in 2006:
- UNFPA worked with more than 50 countries to
increase contraceptive prevalence and to prevent, control
and treat sexually transmitted infections (STIs),
including HIV. The Fund promotes family planning as
a means to reduce unsafe abortion, which claims the
lives of some 78,000 women each yearâ€”99 per cent of
whom live in developing countries.
- UNFPA and the Program for Appropriate Technology
in Health published and launched Meeting the Need:
Strengthening Family Planning Programs. The document is
intended to help practitioners strengthen their programmes
and meet growing family planning needs.
It offers a broad overview of key programmatic
considerations, practical specialized resources and
hands-on online tools.
- UNFPA continued to work with the Islamic Republic
of Iran to reduce fertility rates. The initiative demonstrates
how a supportive environment can rapidly
change these rates. A review revealed that success
was largely the result of the establishment of
a strong national consensus forged with the help
of Islamic clergy; the development of policies that
reflected the needs of the population; and access to a
range of family planning methods.
||UNFPA Executive Director Thoraya Ahmed Obaid
with a 16-year-old patient at the Fistula Repair Centre
at Dhaka Medical College Hospital in Bangladesh.
The centre was established with UNFPA support.
Coming through with Commodities
Every minute, 190 women are forced to confront the
possibility of an unplanned or unwanted pregnancyâ€”
one that could have been easily prevented if only
they had access to contraceptives. Every minute, 650
people contract an STI and nearly 10 are newly infected
with HIV because they could not obtain condoms.
Government allocation of funds for contraceptives is
key to the sustainability of reproductive health services.
To improve access to reproductive health services,
UNFPA Country Offices have focused on: (a) undertaking
advocacy to increase national investments in family
planning services; (b) promoting reproductive health
commodity security; (c) expanding the choice of methods;
(d) improving the quality of services; (e) increasing
the number of service delivery points; (f) increasing
capacity in areas such as protocol development, logistics,
forecasting, costing, monitoring and evaluation;
and (g) undertaking advocacy and capacity-building to
expand services to adolescents.
With UNFPA support, some governments are fundraising
for their five-year condom strategies. Others
are allocating funds from other sources, such as the
Global Fund to Fight AIDS, Tuberculosis and Malaria, to
support commodities and programme costs. Moreover,
female condoms are now being integrated into the
National Essential Drug List for HIV and for reproductive
health in some countries. In 2006:
- The number of countries allocating their own
funds for contraceptive purchases increased to 66,
up from 34 in 2004. A total of 13 UNFPA Country
Offices reported increases in the national budgets
for contraceptives over the same period.
- Ministers of health and delegates from 48 African
countries met in September in Maputo, Mozambique,
and agreed that poor sexual and reproductive health
was a leading killer. They subsequently adopted a
plan of action to ensure universal access to comprehensive
sexual and reproductive health services.
During the meeting, health ministers reiterated
the urgent need for reproductive health commodity
security to help reduce maternal mortality and to
contain the continental tragedy of HIV/AIDS.
- UNFPA helped overcome reproductive health commodity
shortages in more than 60 countries. European
governments and the Government of Canada financed
the programme and established a thematic trust fund
of $63.8 million.
- Under the umbrella of the Joint United Nations
Programme on HIV/AIDS (UNAIDS), UNFPA took the lead in securing male and female condom supplies and
is now the largest procurer of condoms in the public
sector. At the XVI International AIDS Conference in
Toronto, UNFPA highlighted the fact that millions of
people still lack access to the most basic prevention
method of allâ€”the male and female condom.
- In 23 countries, the political and technical
endorsement of female condom programming moved
to the implementation stage. Procurement of female
condoms increased by 40 per centâ€”from 13.5 million
in 2005 to almost 20 million in 2006.
- UNFPA helped commodity vendors to pre-qualify
in order to widen the worldwide supplier base.
In addition to enabling countries to obtain international
accreditation for their national product
testing facilities, UNFPA advises participating manufacturers
on how to deliver products that comply
with WHO and UNAIDS specifications.
- In May, the Secretariat of the African, Caribbean and
the Pacific Group of States, the European Commission
and UNFPA approved a budget of 15 million euros to
supply 17 conflict and post-conflict countries with reproductive
health commodities and to develop capacity.
Restoring Hope and Dignity to Women and Girls
Galvanizing support for maternal health is the goal
of the UNFPA-led Campaign to End Fistula, which in
2006 worked in 40 countries in sub-Saharan Africa,
South Asia and the Arab States. The aim is to prevent
and treat a terrible childbirth injury called
fistulaâ€”a rupture in the birth canal that occurs during
prolonged, obstructed labour and leaves women
incontinent, isolated and ashamed. Most victims are
poor, young and malnourished. Nine out of ten fistulas
can be successfully repaired.
||Three mothers and their babies at the UNFPAsupported
Al-Rimal clinic in Gaza, in the Occupied
Only three years after launching the campaign in
2003, UNFPA has assisted 30 countries to complete
needs assessments. More than 20 countries have
moved from assessment and planning to implementation.
Eleven governments, as well as private-sector
supporters such as Johnson & Johnson, One by One,
the 34 Million Friends of UNFPA and Virgin Unite,
donated to the campaign in 2006.
The year saw several â€œfirstsâ€�. In 2006:
- Pakistan launched its own national campaign to
end fistula. With the help of UNFPA, seven regional
centres are being established to provide surgical treatment
free of charge. Local imams and the media are
now alerting the population to the dangers of early
childbearing and the availability of fistula repair.
- UNFPA helped open western Darfurâ€™s first comprehensive
fistula centre in the town of Zalingei,
Sudan. The 16-bed repair facility is expected to serve
nearly 300 girls and women a year, offering a range
of care that includes repair, rehabilitation, social
reintegration and psychosocial counselling.
- UNFPA and WHO collaborated with Averting
Maternal Death and Disability and the International
Federation of Gynecology and Obstetrics to produce a
manual on obstetric fistula, the first of its kind. The
publication provides guiding principles for clinical
care and programme development.
- Senegalese President Abdoulaye Wade stated his commitment
to provide free obstetric fistula treatment after
viewing a documentary produced by CNN and UNFPA.
- UNFPA launched a major United Kingdom-based
awareness-raising campaign in June targeting the
public as well as policymakers. The Renew initiative
included press and London transit advertisements
and a public service announcement developed free of
charge by RKCR/Y&R â€”the London affiliate of Young
& Rubicam advertising agency. Campaign spokesperson
Natalie Imbruglia helped launch this remarkably
Investing in Youth,Investing in the Future
With the support of UNFPA, young people in every
region took action in 2006 to protect their health,
education and future opportunities. The Fund
championed young peopleâ€™s rights and promoted
youth issues as a priority for human development
and social and economic growth. Among the major
achievements in 2006:
- UNFPA developed its organizational strategic
framework on young people, which outlines how
investing in young people can reduce poverty. It
describes four key policy development areas: population,
poverty and policy; sexual and reproductive
health services; life skills-based sexuality education;
and youth participation. The framework is consistent
with an international focus on poverty reduction and
United Nations reform. It advances ongoing UNFPA
action to help girls stay in school, build life skills,
delay marriage and pregnancy until adulthood, and
prevent HIV infection.
- UNFPA produced the first-ever youth companion
to its flagship report, The State of World Population.
Moving Young highlights the social, economic and
demographic aspects of youth migration through
first-hand accounts of young people themselves. The
supplement will be published every year and will
offer an added dimension to our in-depth presentation
of population and development issues.
- Youth-friendly centres help young people, both
married and unmarried, to obtain information and
services that keep them healthy. In Uzbekistan,
vocational training in carpet weaving and computer
technology added extra value to UNFPA-supported
centres; in Mongolia, they provided safe places to
discuss issues rarely mentioned at home or in public;
and in Pakistan, more than 54,000 youth visited 80
centres supported by UNFPA and the European Union
as part of the Reproductive Health Initiative for
Youth in Asia.
- Education and training empowered young women
with information and skills, with a special focus on
adolescent sexual and reproductive health (ASRH)
in countries such as Bolivia, where UNFPA helped
train 12,000 teachers and reached 67,000 adolescents
and 3,500 parents through the Adolescent Project.
In Malawi, 350 new Community Based Distribution
Agents received ASRH training. In Liberia, young
women affected by civil war participated in HIV
prevention and vocational training provided with
UNFPA support by the Organization for Children and
Adolescent Mothers. Young women developed a training
manual with UNFPA and the World YWCA to bring
leadership skills to their peers worldwide.
- In every region, an increasing number of countries
adopted adolescent and youth reproductive health
strategiesâ€”recent examples include Bangladesh,
China, Ethiopia and India. Morocco and Mozambique
scaled up youth health services nationwide. In July,
with support from UNFPA, the African Union Summit
in Gambia adopted the first African Youth Charter
since 1964. The Fund also provided technical support
to the League of Arab States strategy for youth.
- Sixteen countries in Latin America and the
Caribbean signed the Convention on the Rights of
Youth in November. UNFPA helped establish a favourable
policy environment through a pilot programme
for adolescents and youth in Bolivia, Panama
and the Dominican Republic, conducted with the
Iberomerican Organization of Youth and Family
- In response to a recommendation by its Global
Youth Advisory Panel, UNFPA established national
youth panels in more than 20 countries to advise
the Fund on how to improve youth programmes,
and to provide a platform for young people to voice
their opinions and promote their needs within
international and national development policies
Intensifying HIV Prevention
Prevention offers the best hope of reversing the HIV
epidemic. Sustained political commitment through
intensive programmes in diverse settings has reduced
HIV incidence. Advances in treatment are reinforcing
prevention efforts by encouraging voluntary
testing and reducing the stigma associated with
AIDS. Nevertheless, the pandemic is outstripping
efforts to contain it and is gaining ground globally.
The overarching strategy of UNFPA is to link HIV/
AIDS and sexual and reproductive health to optimize
prevention, care, treatment and support.
The majority of HIV infections are sexually transmitted
or associated with pregnancy, childbirth
and breastfeeding. Both HIV/AIDS and poor sexual
and reproductive health are driven by common root
causesâ€”poverty, gender inequality and social marginalization.
Responses to both health issues need to
be closely linked and mutually reinforcing.
As one of 10 co-sponsors of UNAIDS, UNFPA works
to intensify and scale up HIV prevention efforts by
using rights- and evidence-based strategies. Within
UNAIDS, the Fund focuses on condom programming
and HIV prevention. In 2006:
- UNFPA supported national efforts to undertake
country-level discussions relating to universal access
to prevention, treatment, care and support with
governments, civil society, the private sector and
development partners in more than 100 countries.
- In June, UNFPA, UNAIDS and the Brazil Ministry
of Health organized a global consultation on HIV and
commercial sex work in Rio de Janeiro. Participants
included government ministers, faith-based groups
and networks of commercial sex workers.
- In collaboration with International Planned
Parenthood, the Global Coalition on Women and
AIDS, and Young Positives, UNFPA issued a series of
national eight-page â€œreport cardsâ€� focusing on HIV
prevention for girls and young women. The reports
are designed as an advocacy tool for policymakers
and service providers. UNFPA also collaborated with
the Global Coalition on Keeping the Promise: An Agenda
for Action on Women and AIDS, which calls for a massive
scale-up of AIDS responses for women and girls.
- In Latin America and the Caribbean, UNFPA
mobilized and sensitized decision makers throughout
the year about the need for condom programming
and urged more than 20 ministers from the region to
strengthen HIV prevention services for women and
vulnerable groups during meetings in June at the
United Nations. Also, UNFPA and the OPEC Fund for
International Development continued to undertake
peer education activities in six countries.
- The Maputo Plan of Action commits African
governments to work towards the goal of universal
access to sexual and reproductive health services by
2015 and the integration of HIV programming into
such services. UNFPA supported the African Union
in developing and adopting the plan, recommending
two immediate actions: Linking HIV prevention
and family planning, and integrating HIV/AIDS into
maternal and newborn health programmes.
- UNFPA participated in World AIDS Day events,
such as those in the Occupied Palestinian Territory,
where more than 1,000 university students attended
HIV/AIDS prevention and awareness-raising activities
conducted at five universities and colleges in the
West Bank and Gaza.
- UNFPA highlighted the plight of women and
youth at the United Nations General Assemblyâ€™s
High-Level Meeting on AIDS in June. At the meeting,
UNFPA also hosted a Youth Summit, which drew
over 60 youth representatives from 28 countries and
prepared input for the progress review. The Fund
also co-financed and launched â€œWake-Upâ€�, a documentary
film focusing on young people and HIV
in Mozambique, which was subsequently broadcast
around the world; and organized a Youth Caucus to
review meeting outcomes.
- At the same June meeting, UNFPA Executive
Director Thoraya Ahmed Obaid moderated a panel
discussion to highlight the disproportionate impact
of HIV/AIDS on women and girls. To reverse the
spread of HIV, she said, women must have greater
control of their bodies and their lives, as well as
greater influence on public policy and budgets.
Ms. Obaid also co-launched the 2006 Report on the
global AIDS epidemic.
- The Fund scored a triumph when delegates to the
High-Level Meeting endorsed linking HIV prevention
with sexual and reproductive health. World leaders
also pledged to eliminate gender inequalities and to
provide evidence-based prevention, education and
services to young people.
- In August, UNFPA joined 24,000 participants at the
XVI International AIDS Conference in Toronto, Canada.
The Fund participated in a number of panels and sessions
to promote evidence-informed interventions that
work, including programmes focusing on pregnant
women, who are often overlooked when it comes to
prevention, treatment and care. The Fund also emphasized
the necessity of preventing infection among
girls and women; preventing unintended pregnancies
among women living with HIV; reducing mother-tochild
transmission through antiretroviral drugs; and
promoting safer deliveries and infant feeding.
- The Government of Canada, UNFPA, UNAIDS and
other partners gathered together 250 young people from
all over the world to take part in the Toronto conference.
The Fund also teamed up with MTV for the â€œ48 Festâ€�,
which bankrolled young filmmakers to produce a series
of mini-documentaries focusing on HIV/AIDS. UNFPA
also co-launched â€œReady, Steady, Goâ€�, a study examining
the most effective ways of helping young people.
||The AIDS clock, created by UNFPA in 1997 to record
the rising human toll of the epidemic, was re-launched
in 2006 using new epidemiological data from the
Joint United Nations Programme on HIV/AIDS
(UNAIDS). The Web-based clock was unveiled during
the High-level Meeting on AIDS, held at United
Nations headquarters from 31 May-2 June. In addition
to showing estimates of the number of people living
with HIV, the clock offers links to regional figures, fact
sheets, and major campaigns targeting the disease.
The clock is accessible at www.unfpa.org/aids_clock.