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 high—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 world’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 Mothers’ Lives
Saving lives—reducing maternal death and protecting women from serious health complications associated with pregnancy and childbirth—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)—the virus that causes cervical cancer—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 health care.
- In partnership with WHO, the United Nations Children’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 strategies—to be finalized and funded in 2007—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 year—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.
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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 pregnancy— 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 all—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 cent—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
fistula—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.
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Three mothers and their babies at the UNFPAsupported Al-Rimal clinic in Gaza, in the Occupied Palestinian Territory. |
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 “firsts”. 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 Darfur’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 —the London affiliate of Young & Rubicam advertising agency. Campaign spokesperson Natalie Imbruglia helped launch this remarkably successful campaign.
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 people’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 strategies—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 Care International.
- 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 and debates.
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 causes—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 “report cards” 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 Assembly’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 “Wake-Up”, 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 “48 Fest”, which bankrolled young filmmakers to produce a series of mini-documentaries focusing on HIV/AIDS. UNFPA also co-launched “Ready, Steady, Go”, a study examining the most effective ways of helping young people.
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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. |