Reproductive health and safe motherhood
Promoting the health of mothers and their children by reducing maternal deaths and injuries, preventing HIV and providing life-saving reproductive health supplies and services
Janice Banaag, 18, is a new mother. She resides in Tondo, a densely populated area of slums and industry in Manila in the Philippines. She, husband Joell and baby Janelle live in a small windowless room. They survive on Joell’s earnings as a pedicab driver. While most births in Tondo take place at home without a skilled attendant, Janelle was born safely at a mother-child clinic run by the Zone One Tondo Organization, supported by UNFPA. The clinic also offers prenatal and post-natal exams and family planning services. After Janelle’s birth, Janice returned to the clinic for an intrauterine device. Though she wants another child some day, she prefers to wait until she has saved more money.
Reproductive health is essential to the overall well-being of women, children and families. Reproductive health incorporates the protection and promotion of reproductive rights for individuals and couples through access to comprehensive health services and information to meet sexual and reproductive needs, relating to both physical and mental health.
Reproductive ill-health accounts for about one sixth of the worldwide burden of illness and premature death, and one third of illness and premature death among women of reproductive age. Unintended pregnancies, maternal deaths and injuries and sexually transmitted infections, including HIV, continue to plague people—particularly the poor—everywhere.
One of the main goals of the UNFPA Strategic Plan for 2008–2011 is to improve quality of life through universal access to reproductive health by 2015 and universal access to comprehensive HIV prevention by 2010.
Improving reproductive health, particularly reducing maternal mortality and morbidity, requires reliable, functioning health-care systems and adequate human resource planning and policies. In 2008, UNFPA developed a reproductive rights and sexual and reproductive health framework to provide overall guidance and cohesive UNFPA action to implement the reproductive health and rights elements of the UNFPA Strategic Plan. The framework builds on the goals of the International Conference on Population and Development of 1994, the Millennium Summit and the Millennium Development Goals in 2000, the 2005 World Summit and the addition in 2007 of the goal of universal access to reproductive health to Millennium Development Goal 5, which aims to improve maternal health. These high-level international agreements call on the international community to make greater efforts to improve maternal and child health and to make universal access to reproductive health a reality. The agreements also frame UNFPA’s response within the changing aid environment and within increased attention to and in the interest of strengthening health systems overall.
In 2008, UNFPA continued to support access to a package of sexual and reproductive health services through its integration into public policies, health plans and regulatory systems.
Because mental health has often been overlooked or marginalized in the field of reproductive health, UNFPA and the World Health Organization published a report, Mental Health Aspects of Women’s Reproductive Health: A Global Review of the Literature. The report, aimed at helping inform health professionals, policymakers and others about the links between mental and reproductive health, describes biological, psychological and social factors and explores options for an integrated approach to mental and reproductive health.
Saving the Lives of Mothers and Newborns
More than 500,000 women die during pregnancy or childbirth each year, with many more suffering from pregnancy-related injuries. One million newborns die within their first 24 hours of life. Ninety-nine per centof maternal deaths occur in developing countries. Most maternal and newborn deaths can be prevented through strategic, life-saving and cost-effective interventions, such as family planning, emergency obstetric care and the presence of skilled birth attendants during deliveries. The global momentum to prevent these deaths is building.
UNFPA, to achieve the goals set out in the organization’s Strategic Plan for 2008–2011, strives to increase access to and use of maternal health services to reduce maternal mortality and morbidity, and promotes a “continuum of maternal health care” as part of reproductive health and the right to health.
UNFPA is already helping countries upgrade clinics and hospitals that serve pregnant women, train midwives and other medical staff, provide family planning supplies and programmes to enable women to safely space their births, and promote local demand for reproductive health services and information. UNFPA also builds countries’ capacities to develop and implement national plans and strategies for reducing maternal death and improving reproductive health for all women.
In September 2008, UNFPA united with the World Bank, the World Health Organization and the United Nations Children’s Fund (UNICEF) to accelerate action to improve maternal and newborn health in 60 countries with the highest rates of maternal mortality. “We will support countries in strengthening their health systems to achieve the two Millennium Development Goal 5 targets of reducing the maternal mortality ratio by 75 per cent and achieving universal access to reproductive health by 2015,” the organizations pledged in a statement issued jointly at the start of a high-level event on the Millennium Development Goals in New York. “Maternal mortality is the largest health inequity in the world,” the statement added. “Ninety-nine per cent of maternal deaths occur in developing countries—half of them in Africa.”
At its annual meeting, the Group of Eight industrialized nations renewed their endorsement of the Millennium Development Goals, with a particular commitment to improving maternal and reproductive health. The Group of Eight issued a joint statement vowing to make reproductive health “widely accessible” through actions such as improving access to health care and preventing mother-to-child transmission of HIV.
The Countdown to 2015 for Maternal, Newborn and Child Survival conference, in Cape Town, South Africa, concluded with a commitment by global health experts, policymakers and parliamentarians to increase investments to reduce maternal and child mortality. Tracking Progress in Maternal, Newborn and Child Survival, a report released at the conference, revealed that few of the 68 developing countries that account for 97 per cent of maternal and child deaths worldwide are making fast enough progress to prevent maternal, infant and child deaths. The UNFPA-backed report offered a wake-up call to governments and others, with information on the latest trends in life-saving interventions to reduce maternal and child deaths.
UNFPA and the International Confederation of Midwives launched a programme to increase the number of births attended by midwives in developing countries. The initiative will focus on developing a sustainable midwifery workforce and strengthening midwifery education and standards as part of broader efforts to strengthen health-care systems in 11 countries.
UNFPA launched its Thematic Fund for Maternal Health to raise nearly $500 million to reduce maternal mortality and morbidity in 68 countries. In 2007 and 2008, the fund raised $25 million in pledges and contributions, including $5 million for the midwifery programme. The fund began operating in 11 countries with rapid reviews of each country’s plans for improving maternal and newborn health, identification of gaps and challenges, and consultations with national stakeholders to determine a course of action.
To strengthen national health systems, UNFPA, UNICEF and Columbia University’s Averting Maternal Death and Disability Programme agreed to jointly establish a network of institutions and experts to build national and regional capacity in emergency obstetric and newborn care.
Family planning is a key component to reaching Millennium Development Goal 5 for the improvement of maternal health. Access to basic family planning can reduce maternal deaths by as much as one third and child deaths by as much as one fifth. Despite the critical need for family planning, funding for supplies has virtually stagnated since 2001, according to a UNFPA report issued in 2008: Donor Support for Contraceptives and Condoms for STI/HIV Prevention 2007. In addition, family planning is usually left out of the planning, budgeting and implementing of maternal health programmes.
Secretary-General Ban Ki-moon, in his statement on World Population Day 2008, urged the world to “focus on the critical importance of family planning if we are to successfully achieve the Millennium Development Goals.”
In 2008, UNFPA continued efforts to ensure universal access to reproductive health and the right of all people to decide the number and timing of their children. UNFPA has family planning programmes in 140 countries and works with governments, civil society and United Nations partners to forecast needs, provide and coordinate the distribution of contraceptives and maternal health supplies and build each country’s logistical capacities.
UNFPA provided family planning supplies and services in emergency situations, where access to such services is often compromised. UNFPA supported refugees and internally displaced populations by providing nearly 7 million male condoms and 440,000 female condoms to 26 conflict or post-conflict countries through the Office of the United Nations High Commissioner for Refugees.
In Nicaragua, government funds covered 1 per cent of contraceptives used in 2006, about 10 per cent in 2007 and about 36 per cent in 2008.
Reducing Unmet Need for Family Planning: Evidence-Based Strategies and Approaches offered brief, clear suggestions that programme managers, policymakers and others may use to address the unmet need for family planning. The joint UNFPA-PATH publication draws on the latest scientific research and evidence on reproductive health programming.
Reproductive Health Commodities
Commodities, such as contraceptives and medicines for emergency obstetric care, prevent unintended pregnancies, facilitate reproductive health and avert the spread of HIV. Lack of access to affordable commodities has been one major obstacle to universal access to reproductive health and HIV prevention, according to the UNFPA Strategic Plan for 2008–2011. UNFPA is the lead United Nations agency working with the private and public sectors to ensure that the right quantities of commodities reach the right people, at affordable prices. UNFPA also chairs two of the three working groups of the Reproductive Health Supply Coalition, a global partnership ofmore than 70 multilateral and bilateral organizations, private foundations, national governments, civil society groups and private companies, to ensure that all people in low- and middle-income countries can access supplies. As of 2008, 80 countries had national budget lines for contraceptives and other reproductive health supplies.
In 2008, UNFPA continued to ensure that national commodity systems and plans were strengthened. To meet urgent reproductive health commodity needs and avoid supply “stock outs” in 2008, UNFPA provided technical assistance for logistics and information systems and about $20 million of reproductive health commodities to some 60 countries. These commodities included about 196 million male condoms and 2.9 million female condoms, along with other contraceptives and drugs to protect maternal health.
Continued funding from the Global Programme to Enhance Reproductive Health Commodity Security enabled UNFPA to expand its support to governments to mainstream reproductive health commodity security into national health policies, programmes, budgets and plans in four more countries: Haiti, the Lao People’s Democratic Republic, Madagascar and Niger. The programme acts as a catalyst for national action and the prioritization and mainstreaming of reproductive health commodity security into national health policies, programmes, budgets and plans.
In Ethiopia, Global Programme funds are covering reproductive health commodity security to complement a $110 million, five-year Ministry of Health initiative to implement a new nationwide health commodity supply system. In Nicaragua, Global Programme funds were used to integrate reproductive health and commodity security into the Ministry of Health’s National Sexual and Reproductive Health Strategy.
Global Programme funds are also helping build the capacity of regional institutions that can provide technical support for national reproductive health and commodity security.
UNFPA used its “RHCS Dashboard” tool to monitor and track global progress towards reproductive health commodity security, giving countries scores that measure their overall progress in six key categories. The Fund’s Country Commodity Manager software, used in 89 countries, helps manage and report data on supplies at warehouses.
UNFPA worked with parliamentarians, regional communities and other key stakeholders to increase support for reproductive health commodity security. UNFPA and the Eastern Africa Community organized a meeting of the East Africa Inter-Parliamentary Forum on Health, Population and Development during which five countries developed detailed action plans.
At the global level, the Thematic Fund for Reproductive Health Commodity Security helped UNFPA work with national governments and development partners to promote reproductive health commodity security. In 2008, targeted advocacy work was car-ried out at the regional and country levels, leading to increased government funding of budget lines for reproductive health commodities. In Burkina Faso, for example, the national budget contribution for contraceptives rose to 32 per cent in 2007 and to 89 per cent in 2008.
Leading the Fight Against Fistula
The Global Campaign to End Fistula, created by UNFPA and other partners, aspires to eliminate obstetric fistula by 2015. Obstetric fistula is a preventable and treatable childbearing injury that leaves women incontinent and often socially isolated. In 2008, the Campaign to End Fistula reached an important milestone when it announced that it had quadrupled in size. The campaign now reaches more than 45 countries in Africa, Asia and the Arab States, compared to 12 countries when it was launched in 2003. Since 2003, the campaign has helped more than 12,000 women receive fistula treatments, and more than 20 countries have integrated fistula into their national strategies, policies and plans. These efforts reinforce actions to achieve Millennium Development Goal 5 to improve maternal health.
In 2008, as a result of the campaign, about 4,000 women received fistula treatment with support from UNFPA; more than 2,000 professionals received training to provide fistula prevention, treatment and reintegration services; and the capacity to manage and treat fistula was strengthened in 104 health facilities in 20 countries.
The campaign’s achievements were recognized in 2008 with an award from the United Nations Development Programme. The award cited the campaign’s innovative and outstanding efforts to facilitate collaboration and the sharing of knowledge and expertise among developing countries.
Secretary-General Ban Ki-moon released the first-ever report by a Secretary-General on fistula. Issued in response to a General Assembly resolution, the report, which UNFPA contributed to, described efforts to end fistula worldwide. The report concluded with recommendations for intensifying efforts to make fistula obsolete, including the strengthening of health systems and increasing funding.
With support from UNFPA, fistula survivors spoke out to promote maternal health. Thirteen countries are now engaged in efforts to support fistula survivors as advocates for maternal health in communities and at the national level. UNFPA and the United Nations Foundation sponsored two fistula survivors to speak at events on Capitol Hill in Washington, D.C. The advocates outlined recommendations for improving maternal health and urged members of Congress to support a proposed resolution to reduce maternal mortality in the United States and globally. The day after these visits, the United States House of Representatives passed the resolution.
The campaign focused on addressing fistula in conflict and post-conflict settings through expanded programmes in Afghanistan, the Democratic Republic of the Congo, Liberia, Sudan and Somalia.
UNFPA and the Ministry of Health and Public Hygiene in Côte d’Ivoire held a subregional conference on obstetric fistula that resulted in the creation of the Africa Network for Fistula Elimination.
UNFPA and others partnered with Engel Entertainment to produce an award-winning film on fistula survivors. A Walk to Beautiful follows the journey of several women in Ethiopia who seek treatment for fistula.
Promoting the Rights of Adolescents and Youth
About 1.5 billion people are between the ages of 10 and 25. Given young people’s potential contribution as the future leaders of families, communities and nations, UNFPA prioritizes youth, including adolescents, in all of its programming and activities. UNFPA’s Framework for Action on Adolescents and Youth guides its efforts to promote and protect the rights of young people by advocating for their issues within national development strategies, sexual and reproductive health and HIV prevention programmes. UNFPA pays close attention to the needs of adolescent girls and, in particular, those who are marginalized and may not be served by other development programmes. Investing in young people, especially adolescent girls, with regard to sexual and reproductive health, HIV prevention and social participation is essential to break the intergenerational transmission of poverty.
Generation of Change: Youth and Culture, the “Youth Supplement” to The State of World Population 2008, highlighted the value of young people to protecting the cultures in which they grew up. It also stated that young people can help transform their cultures and ready their societies to meet new challenges.
UNFPA supported activities that led seven countries to ratify the Ibero-American Convention on the Rights of Youth, the world’s only legally binding instrument that recognizes young people’s rights as citizens.
UNFPA, as co-chair of the United Nations Interagency Task Force on Adolescent Girls, promoted the rights of adolescent girls and advocated for strategic investments for girls in national policies and programmes. The task force developed the first-ever United Nations joint programming framework targeting marginalized adolescent girls.
UNFPA organized a study tour of Ethiopia’s programme to address child marriage. Participants included representatives from the Nike Foundation, the United Nations Foundation, the Government of Finland and the United Nations Educational, Scientific and Cultural Organization.
UNFPA country offices in Guatemala, Liberia and Malawi are leading an inter-agency process to draw attention to the needs of marginalized adolescent girls within national policies and programmes, focusing on their education, health, livelihoods and security.
UNFPA hosted its fifth Global Youth Advisory Panel in December. The panel, consisting of 21 youth from around the world, developed 14 recommendations for increasing youth participation in UNFPA programming at country and regional levels.
To facilitate an open dialogue with youth and to involve them in development, UNFPA continued to provide technical and financial support to 25 country-level Youth Advisory Panels. In 2008, Nepal became the latest country to launch a panel.
In 2008, a report on the global AIDS epidemic released by UNAIDS, the Joint United Nations Programme on HIV/AIDS, contained more positive news than in previous years. However, it also revealed that while the number of new HIV infections had fallen in several countries, HIV infections continue to rise in many others. Research by UNAIDS shows that 33 million people were living with HIV as of 2007, with 2.7 million new infections occurring that year.
HIV/AIDS continues to spread, and the impact continues to intensify among women. This is due in part to deep underlying factors of gender inequality, persistent stigma and discrimination and a lack of empowerment to reduce vulnerabilities to infection.
Because the overwhelming majority of HIV infections are sexually transmitted or associated with pregnancy, childbirth and breastfeeding, UNFPA seeks an integrated approach to the delivery of sexual and reproductive health services and HIV/AIDS interventions. Strengthening these linkages is widely acknowledged to be critical to achieving Millennium Development Goals. UNFPA concentrates on preventing HIV infection, especially among women and young people. UNFPA also supports countries to ensure access to sexual and reproductive health services for those living with HIV.
As a co-sponsor of UNAIDS, UNFPA leads diverse, innovative initiatives to curb the spread of HIV.
A 2008 external review of UNFPA’s efforts to support national responses to HIV/AIDS concluded that the scope, intensity and quality of UNFPA’s contribution to HIV prevention had made a positive shift in the previous three years, resulting in greater credibility with national, international and United Nations partners.
UNFPA continued working with partners in 2008 to support the scaling-up of HIV-prevention programmes. UNFPA’s support for institutional strengthening and technical capacity-building among United Nations country teams and in regional and national organizations in 2008 resulted in the recruitment of more than 120 national HIV focal points in 65 countries as well as regional and subregional advisers.
UNFPA played a key role in the 17th International AIDS Conference in Mexico City and the 15th International Conference on AIDS and Sexually Transmitted Diseases in Dakar. UNFPA Executive Director Thoraya Ahmed Obaid participated in several events, including a session on the links between gender-based violence and HIV/AIDS, and the first-ever meeting of Latin and Caribbean ministers of health and education to discuss the prevention of HIV and other sexually transmitted infections. UNFPA supported the participation of more than 600 young people from 41 countries in both conferences.
UNFPA encouraged world leaders attending the United Nations General Assembly High-Level Meeting on AIDS to increase their efforts to meet the needs of women and youth with HIV/AIDS and to more effectively integrate responses to AIDS and sexual reproductive health.
UNFPA provided support for the development, publication and dissemination of several materials and tools on the linkages between sexual and reproductive health and HIV. The Rapid Assessment Tool for Sexual and Reproductive Health and HIV Linkages: A Generic Guide has already been used to develop country-specific plans in Uruguay and countries of the Pacific Islands.
UNFPA contributed to Linkages: Evidence Review and Recommendations, a review of literature confirming the links between sexual and reproductive healthand HIV/AIDS. UNFPA also helped develop Linking Sexual and Reproductive Health and HIV: Gateways to Integration in Haiti and Kenya. The study provided in-depth examples for linking sexual and reproductive health and HIV/AIDS prevention.
To better link sexual and reproductive health and HIV services and interventions, UNFPA and its partners reached 66 countries through five regional training workshops.
As part of its strategic response to HIV, UNFPA participated in several efforts to increase the global supply and demand for male and female condoms. The UNFPA-led Global Condom Initiative, an effort to prevent HIV and unintended pregnancies, continued its work in 55 countries. With UNFPA’s assistance, 20 countries drafted National Condom Strategies.
For the third consecutive year, distribution of female condoms expanded, totalling 33 million in 2008. With UNFPA’s help, Zimbabwe receives more female condoms per capita than any other country.
Under UNFPA’s leadership, the Inter-Agency Task Team on HIV and Young People expanded its global role in HIV prevention and its membership beyond the United Nations to include selected youth networks or associations, bilateral and multilateral donors, civil society and foundations. The task team also published seven Global Guidance Briefs on HIV and Young People, which outline specific actions for an effective response to HIV among young people in education, the workplace and humanitarian emergencies.
The Fund contributed to the publication of national report cards on HIV prevention for girls and young women. The report cards—25 of them so far—address the progress that has been made on meeting global commitments on HIV/AIDS and offer recommendations that stakeholders may use to enhance HIV prevention and services for young women and girls.
The Fund continued to support Y-Peer, the Youth Peer Education Network, which operates in 39 countries. An evaluation of Y-Peer in eight of these countries concluded that the project has successfully established youth networks to improve young people’s knowledge of sexual and reproductive health issues and strengthen the capacity of country-level services for youth.
UNFPA’s technical support helped scale up the implementation of the Global Strategy for Accelerating Prevention of Mother-to-Child Transmission of HIV, with a focus on a basic package of HIV/AIDS services in maternal health-care settings, sexual and reproductive health services for women living with HIV and links between maternal, sexual and reproductive health.
UNFPA organized workshops in 11 countries to help integrate better data collection, monitoring and evaluation into health care for the prevention of mother-to-child transmission.