Introduction

Africa (Sub-Saharan)

Arab States

Europe

Asia and the Pacific

Latin America and the Caribbean

Interregional Programmes

Children waiting for a school bus in Afghanistan,
where UNFPA helped provide emergency reproductive health services
to earthquake victims

In keeping with their commitment to implement the ICPD  Programme of Action, in 1998 the Asian and Pacific countries  worked on reorienting their population and development policies  and programmes along the lines of the Programme of  Action, according to their own particular demographic, socio-economic  and political situations. Political commitment to ICPD goals was maintained, and efforts to gain the support of  NGOs and civil society, especially in the area of reproductive  health, were strengthened. Operationally, 1998 witnessed approval of new UNFPA country programmes and the development  of subprogrammes and projects for Bangladesh, Bhutan, China, the Democratic People's Republic of Korea, India,  Maldives, Papua New Guinea, the Pacific subregion and  Thailand, as well as approval of programme extensions for the Central Asian Republics, Azerbaijan, Kazakhstan, Pakistan and the Philippines. Furthermore, mid-term reviews were conducted in the Philippines and in countries in Central Asia, and  Country Population Assessments were finalized for the Islamic Republic of Iran and the Philippines. As part of the ICPD+5 process, technical and operational reviews on the implementation  of the ICPD Programme of Action were conducted in  several countries. 

As in the past, UNFPA assistance in Asia and the Pacific  focused on the operationalization of reproductive health services,  including ones for adolescents, with an emphasis on  national capacity-building. In 1998 UNFPA continued to help  countries revise or develop population and reproductive health  policies, operational guidelines and reproductive health clinic  and protocol standards and to integrate their reproductive  health services. 

For example, in Bangladesh, operations research was used in  the development of an essential package of services as part of a comprehensive approach to reproductive health services.  Forty-seven health centres were renovated, with UNFPA assistance,  to provide these services. A similar exercise was  undertaken in India.

In Nepal, operational guidelines on reproductive health were  prepared, and a new strategy is being developed to tackle maternal morbidity and maternal mortality. The strategy is  based on the findings of a 1998 survey. 

In the Philippines, an integrated package of 10 components of  reproductive health services is being piloted in Nueva Vizcaya  province. One of the lessons learned was that even focusing on  one province was still very ambitious. 

Service integration was a priority in Thailand and the Islamic Republic of Iran. In Thailand, the Government recently  announced the integration of reproductive health components  into one package of services. The Islamic Republic of Iran has  integrated a number of health services, including family planning,  prevention of STDs and pre-marriage counselling, into its  health network system. 

Expansion of reproductive health services to remote, under-served  areas was a key feature of programmes in Bangladesh,  Cambodia, the Islamic Republic of Iran, the Lao People’s  Democratic Republic, Papua New Guinea, the South Pacific subregion and Viet Nam. The reproductive health subprogramme  in Viet Nam has improved considerably with direct  funding to eight provinces, while continuing to strengthen capacity at central levels. UNFPA also helped provide emergency  reproductive health services in parts of Afghanistan that  were affected by the May earthquake. 

Several countries reported encountering obstacles during the course of shifting to a holistic reproductive health approach.  These obstacles included a shortage of appropriately trained  staff, limited human resources at the local level, inadequate  understanding of client needs, and difficulties in operationalizing  reproductive health services within the limited existing  health infrastructure.

To overcome such barriers, the Fund's support has focused on capacity-building through the training of health professionals.  Consequently, extensive training programmes in  reproductive health, IEC and counselling skills were mounted  in Cambodia, Bangladesh, India, Indonesia, the Islamic  Republic of Iran, Mongolia, Nepal and Pakistan. For example,  in Cambodia over 2,000 health workers were trained; in  Mongolia, following a training programme and upgrading of  health centres, services were provided to over 5,000 clients  during a six-month period; in the Islamic Republic of Iran,  services were extended to remote provinces; and in Bangladesh, 75 per cent of the health centres in 64 districts were renovated. 

The ICPD Programme of Action called on governments and  international agencies to promote effective partnerships with  civil society. Exemplifying such partnerships is the Initiative for  Reproductive Health in Asia (RHI), the largest cooperation  arrangement between the European Commission, UNFPA and  the non-governmental sector. The RHI was launched in 1997 and began its activities in 1998 in Bangladesh, Cambodia, Lao  People's Democratic Republic, Nepal, Pakistan, Sri Lanka and  Viet Nam. Twenty-one European NGOs and over 60 national  NGOs and other organizations have been involved in the programme development of 38 country projects. During 1998, 20  projects were started, mostly in the area of adolescent reproductive health and in promoting inter-linkages and collaboration  at the national level. 

Successful partnerships with NGOs are exemplified by the  activities undertaken in the Philippines, where 34 per cent of  UNFPA funding was provided to an umbrella project of 30  NGOs working in 18 provinces to complement services provided by the Government. NGOs worked to provide services to hard-to-reach target groups like commercial sex workers,  unmarried women and adolescents. They also included services  for poor and marginalized populations that are not adequately served by public or commercial services. By offering gender-sensitive services and IEC activities, NGOs have promoted women's empowerment, increased male participation and  addressed adolescent reproductive health concerns.

The Fund continued to promote male involvement and male  responsibility. In this context, UNFPA and the Economic Cooperation Organization (ECO) jointly organized a conference on the role of men in population and reproductive health programmes.  The conference, hosted in Baku by the Government of Azerbaijan, concluded with a series of country reviews that  discussed the prevailing situation in each of the 10 ECO member  states and proposed national operational responses that  would enhance men's rights and responsibilities vis-à-vis reproductive  health. 

Another major focus of UNFPA assistance in Asia and the  Pacific was in the area of adolescent reproductive health. High  levels of unprotected sexual activity both within and outside  marriage were reported in most countries, leaving adolescents  at high risk of unwanted pregnancy as well as STDs/AIDS. The  prevalence of unsafe abortions has been reported in Asia. In  some countries, the belief that sex education and access to services  lead to promiscuity is a major obstacle to promoting  adolescent reproductive health. The situation is aggravated by  the poor quality of adolescent reproductive health services in  many countries. Several countries, including Malaysia, the  Philippines and Thailand, have started the process of developing  pilot activities by conducting an adolescent reproductive  health needs assessment. Others, such as Indonesia, Mongolia,  the Republic of Korea and Sri Lanka, have established a policy  framework for dealing with adolescent reproductive health concerns.  However, most countries have no such policy and, even  among those countries with adolescent reproductive health  policies, services are often not easily accessible for adolescents. 

In an effort to create wider awareness of adolescent reproductive  health issues among policy makers — and to overcome  misconceptions in this area — advocacy efforts were intensified  at the country and regional levels. In 1998, a series of high-level  international conferences was organized with UNFPA assistance.  At the regional level, technical workshops and conferences were organized to assist in the formulation of specific policy and programme strategies for adolescent reproductive health in Bangkok, Thailand, and New Delhi, India. Strategies were formulated to guide planners and policy  makers in developing policies and implementing programmes for adolescents, especially for adolescent girls.

At the country level, particularly in Bangladesh, Mongolia,  Nepal, Papua New Guinea, the South Pacific subregion and Viet  Nam, the Fund supported efforts aimed at strengthening  national capacity to advocate on behalf of adolescent reproductive  health issues. Influential people, including policy makers, religious leaders and parents, were the targeted audience for sensitization efforts. Among the innovative approaches used to  reach adolescents were telephone hotlines in India, Mongolia  and Viet Nam, peer education in the Philippines, cooperative  efforts with religious groups and parents in Papua New Guinea  and Sri Lanka, and sexuality education in Bhutan, India and  Indonesia. In Pakistan, a "girl-child programme" focused on  training in leadership qualities, health and nutrition, women's  rights and family life education. 

Over the past decade, the Mekong Delta region of South-East Asia has seen significant social transformations brought about  in part by rapid and uneven economic and political developments.  Governments have become increasingly aware of the complex reality of sexual abuse and youth exploitation through  prostitution and the trafficking of women and children. The  recent Asian economic crisis has aggravated the situation. In  response to the concern expressed by several governments,  UNFPA, in collaboration with the Economic and Social Commission for Asia and the Pacific and the Governments of  Japan and Sweden, formulated a pilot project in 1998 for six countries of the Mekong Delta region. A training package for social service and health personnel is being developed that  would serve as a model for application in other subregions of Asia and the Pacific and could be made available to interested  training institutions. 

China. In January 1998, the UNDP/UNFPA Executive Board  approved the Fund's fourth programme of assistance (1997-  2000) for the People's Republic of China. The $20 million  programme consists of four different components, focusing on  the areas of reproductive health, women's empowerment, advocacy  and South-South collaboration.

A major project under the programme is the $14 million  reproductive health and family planning project, which was  approved by all concerned parties in September 1998. Activities completed so far include a baseline reproductive health survey, needs assessments, orientation meetings and study tours. The  main part of the project is being implemented throughout 32 counties in 22 provinces. The Chinese Government has agreed to lift acceptor targets and birth quotas within these areas,  while still pursuing overall national demographic targets. The  project seeks to establish a client-oriented reproductive health  approach that will provide a wide range of quality health services,  encompassing maternal health care, treatment for  reproductive tract infections and STDs, and extensive family planning services that make available a broad range of contraceptive  methods. This project also includes two urban-based  pilot projects that promote adolescent reproductive health and social marketing efforts. 

As confirmation that the acceptor targets and birth quotas have  been lifted, IEC materials addressing the qualitative approach  towards reproductive health and family planning that was set out  at ICPD are to be distributed to households and clinics throughout the project sites. Due to the sensitive nature of these issues in China, considerable time was taken to develop appropriate materials. This slowed down project activities at local levels. It is  hoped that the successful experiences from the 32 counties will contribute to the formulation of the Government's reproductive  health and family planning strategies for the future. 

With regard to the women's empowerment project, which is  focusing on 15 counties, progress is being made in the finalization of the project document. The advocacy project will focus on client-centred reproductive health, esteem of the girl child,  male involvement and adolescent reproductive health. It will be implemented in the same 15 counties as the women's empowerment  project. Some pre-project activities have been approved  while the project is being finalized. A South-South project is  also in the process of being developed, and discussions are  ongoing as to the most appropriate focus. 

Pacific subregion. Because the Pacific subregion displays  considerable socio-economic and cultural differences, the  responses of various countries to the ICPD Programme of  Action have varied considerably. Most governments, however,  have adopted the reproductive health approach and have  accepted the main principles of the Programme of Action. In  spite of this, in some countries there are still high levels ofmaternal mortality and morbidity, as well as high total fertility  rates and population growth rates. Furthermore, new reproductive health problems have emerged, such as increasing rates  of adolescent pregnancies and a rise in the incidence of STDs,  including HIV/AIDS. A major challenge identified by the Pacific  island countries is to improve access to quality reproductive  health and family planning services, particularly to underserved  groups such as adolescents and men and to populations living  in rural outer islands. 

In 1998, a regional meeting in Fiji afforded Pacific island  countries the opportunity to take stock of their experiences in  implementing the ICPD Programme of Action. UNFPA assisted  countries in identifying the major population-related  issues and challenges facing each country and the Pacific sub-region  as a whole. 

UNFPA is assisting a number of new initiatives that have  been started by Pacific island governments and civil society  groups. In the Solomon Islands, for example, an integrated  reproductive health programme was introduced. In the  Marshall Islands, a youth-to-youth health programme is addressing the needs of adolescents in a youth-friendly environment.  In Vanuatu, the Wan Smol Bag Theatre Group is  using drama to convey reproductive health messages to out-of-school  youth and people living in remote rural areas. And in  Fiji, non-governmental organizations, such as the Fiji Women's  Rights Movement and the Fiji AIDS Task Force, are playing a  key advocacy and programming role by addressing women's  rights and gender issues and by helping forge a community  response to the HIV/AIDS epidemic.

The second cycle of the Fund's programme of assistance in  the Pacific subregion for the period 1998-2001 is addressing  many of these issues by focusing on improving national and  regional capacities in the delivery of reproductive health services;  strengthening national and regional capacities in the  planning, management and delivery of reproductive health IEC  interventions; contributing to the establishment of an updated and reliable reproductive health database; and expanding  reproductive health services to youth and adolescents.