Reproductive health, including family planning and
sexual health
Adolescent reproductive health
Reducing maternal mortality
Emergency assistance in refugee situations
HIV/AIDS
Population and development strategies
Advocacy
Women's empowerment and gender issues
Strengthening programme effectiveness
Decentralization
National capacity-building
Monitoring and evaluation
Training
Contraceptive requirements and logistics management needs
Partnership with NGOs and civil society
ICPD+5 |
A key objective of UNFPA assistance is to reduce maternal mortality. This requires close
collaboration with many development partners, particularly WHO and UNICEF, as well as
national and international NGOs. UNFPA has worked closely with WHO and UNICEF in defining
guidelines for monitoring maternal health programmes and with WHO in conducting
epidemiological research on the causes of maternal mortality. Moreover, technical
specialists from WHO, UNICEF and the World Bank, among others, participated in the
regional consultations organized by the Fund on operationalizing reproductive health.
UNFPA also participated in the Safe Motherhood Technical Consultation sponsored by the
Inter-Agency Group for Safe Motherhood, which was held in Colombo, Sri Lanka, 18-23
October. Over 250 delegates from 65 countries and various organizations, including the
World Bank, UNICEF, WHO, Ministries of Health, and a number of NGOs, participated in the
consultation. The participants acknowledged that reducing maternal mortality had proven
much more difficult than had been thought at the Nairobi conference that launched the Safe
Motherhood Initiative 10 years earlier. This was due in part to the multi-faceted nature
of the problem and, consequently, the need for a multidimensional programme approach to
deal with it. Nonetheless, participants identified lessons learned in implementing safe
motherhood activities that could be used to guide future programming in this area.
In general, high levels of maternal mortality indicate weak-nesses in the coverage and
quality of reproductive health services, including family planning. Improving access to
and availability of quality family planning information and services, particularly among
high-risk groups such as teenagers, women over age 39 and those of high parity, help to
reduce maternal mortality. The lack of services, both human and physical, results in many
readily avoidable maternal deaths, particularly among the rural poor. This unmet need
requires that emergency obstetric services be extended and that the quality of services be
improved.
In order to help mobilize such obstetric and gynaecological services, UNFPA is providing
assistance to an innovative project being executed by the International Federation of
Gynaecology and Obstetrics. The project, appropriately called "Save the
Mothers", is being implemented in seven countries that have high maternal mortality
rates, the existence of an active obstetric/gynaecological society, and a demonstrated
government commitment to improving women's health. The aim is to define how maternity
services can best be organized and extended within available resources to handle
efficiently early detection, referral and management of
life-threatening complications in pregnancy and childbirth. The project will develop,
execute and test a demonstration project at the district level in each country.
Most UNFPA country programmes employ multidimensional approaches to meet the reproductive
health needs of the people they serve. The programme in the Islamic Republic of Iran, for
example, is assisting the Government in integrating more aspects of reproductive health
and family planning information and services into its primary health care network. The
emphasis is on improving quality of care. Hundreds of training courses have been conducted
at the district level for health-care and family planning workers, many of them women, to
improve their knowledge and skill in providing integrated reproductive health care,
including family planning. The programme is also emphasizing male participation, holding a
workshop on this topic for the first time. This was accompanied by the development of
special reproductive health IEC programmes for military bases in order to target a large
group of young men. The Government also conducted a workshop to discuss reproductive and
sexual health issues with young married couples. It was decided to prepare special IEC
materials for this group and to include sex education in compulsory premarital counselling
classes that are held throughout the country.
An activity in Bolivia supports a national strategy to accelerate the reduction of
maternal mortality. It focuses on quality of care of obstetric emergencies. The programme
aims to develop service delivery norms; train medical, nursing and auxiliary staff;
provide medical equipment; and develop appropriate management and organization systems. A
national maternity insurance has been created to reduce economic barriers to services, and
options are being explored to expand this insurance to include family planning. UNFPA is
also supporting related activities, linking with NGOs to improve the quality of services,
conduct research and implement pilot activities. The Fund has also provided assistance for
a sensitization campaign for national and community leaders in support of a national
commission for safe motherhood. A National System for Monitoring Maternal Mortality has
been established to review and analyse causes of maternal mortality.
An activity in Morocco provides another useful example. It seeks to strengthen national
capacities to coordinate the implementation of the national safe motherhood strategy and
to improve the performance, quality and accessibility of reproductive health services in
six provinces. It has three strategic orientations: upgrade existing health centres and
rural hospitals to be able to deliver reproductive health services; strengthen management
capacities at the periphery; and promote social mobilization. The activity provides
equipment, medical supplies and contraceptives. It also has a strong training component,
providing training in interpersonal communication, risk-management, post-partum
counseling, and contraceptive use to heads of health clinics, doctors, midwives and
nurses; in safe delivery practices to doctors, midwives and nurses; and in management and
medical audit to supervisors.
Similar integrated approaches are found in Gabon, Cote d'Ivoire, Niger, Nigeria and
Uganda. The programmes make use of traditional and popular media to create awareness of
the importance of family planning and of ante- and postnatal care and attended deliveries
as essential means of improving reproductive health. They each also train health care
providers to distribute contraceptives and act as pregnancy monitors so that they can
refer pregnant women with complications to health care facilities. Doctors and nurses are
trained with the necessary skills to cope with obstetric emergencies, and traditional
births attendants (TBAs) are trained in basic hygiene to prevent infection. The programmes
provide assistance to renovate health facilities as well as to supply the clinical
equipment needed to integrate reproductive health within existing primary health care
facilities. |
