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Regional and Interregional Overview |
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| LATIN AMERICA and the CARIBBEAN | |
| Introduction
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The year 1998 was significant for the Fund's work in Latin America and the Caribbean. Partnerships with other United Nations system agencies and organizations and with NGOs and other groups in civil society were expanded and strengthened; emerging issues such as gender equity and male responsibility in reproductive health were addressed; and innovative and replicable initiatives were supported. Within the context of the ICPD+5 review and appraisal process, a wide range of activities was pursued to consolidate the region's commitment to the ICPD Programme of Action. UNFPA also continued its participation in the UNDAF pilot exercise underway in Guatemala. Adolescent reproductive health and rights. The reproductive health and rights of adolescents, a key priority for the region, are the focus of various UNFPA initiatives. Poverty, unemployment, lack of training and educational opportunities, early pregnancy, unsafe abortion, high HIV/STD infection rates, and marked gender inequalities from an early age are some of the challenges faced by adolescents. Nearly all UNFPA-supported country programmes contain advocacy, IEC and service components to promote adolescent health and rights. In September, UNFPA participated in the Eighth First Ladies' Conference held in Santiago, Chile. Santiago was also the site for a regional parliamentary workshop held in March. UNFPA and UNESCO participated in the workshop, which aimed to strengthen support for sexual education. In Haiti, the Fund supported a campaign on HIV/AIDS awareness, including a peer counselling project. In Peru, an Interministerial Accord for the Promotion of Healthy Lifestyles of Adolescents and Youth was celebrated on Population Day. In Venezuela, UNFPA continued working with a network of NGOs to support legislation and awareness-raising on adolescent reproductive health. In an innovative endeavour in the Dominican Republic, UNFPA supported two youth-serving NGOs in the first-ever collaborative effort on adolescent reproductive health undertaken by the Ministry of Health and NGOs. The project seeks to build youth leadership and self-esteem by strengthening a peer counsellor programme in 36 poor urban neighbourhoods. Using teachers, health providers and Catholic priests, the project links counselling, IEC and referrals to public health services. As follow-up to the 1997 Regional Conference on Adolescent Reproductive Health, UNFPA is supporting a multi-country research project of the Ibero-American Youth Organization on integrating adolescent reproductive health in employment training programmes. UNFPA also secured additional resources for adolescent-friendly reproductive health care initiatives in Ecuador, Haiti, Honduras and Nicaragua. In Barbados, UNFPA convened an October Caribbean Youth Summit, bringing together youth leaders, youth-serving public and private agencies, and a number of United Nations agencies and institutions from throughout the subregion. The summit provided a unique forum for youth in the Caribbean to voice their own concerns and priorities. The summit, which opened with a keynote address by the UNFPA Executive Director, produced a regional action plan and a declaration negotiated by the youth on their sexual and reproductive health and rights. A UNFPA Youth Goodwill Ambassador scheme was also launched involving young people and NGOs from the Caribbean. In 1998, UNFPA served as chair of the regional Inter-Agency Coordination Committee for the Americas on Follow-Up to the World Summit for Children. An important lesson learned in the area of adolescent reproductive health is that even in a region where conservative and religious opposition is vocal and public, progress can be made if the right strategies are applied. The principal strategy is based on the knowledge that youth are their own best advocates and are effective in counteracting false charges and misrepresentations. A risk to keep in mind as programmes expand is that traditional and narrowly defined approaches may result in conceptual gaps and biases. Close monitoring will be needed to ensure the adoption of a rights-based, gender-sensitive programme strategy that truly corresponds to adolescent reproductive health and development needs. Quality of care. A central programming concern in 1998 was quality of care, with a focus on incorporating gender-related issues and on responding to the needs of poor and indigenous women. All UNFPA-supported programmes in the region focus on building national capacities to improve quality of care and to ensure that both services and service providers are gender-and age-responsive and respectful of clients from all social and cultural backgrounds. The programme in Bolivia, which addresses the needs of the country's indigenous population, is illustrative of this approach. In Ecuador, UNFPA continued to support an innovative project that combines traditional indigenous healing practices with modern medicine. In Bolivia and Peru, indigenous women were empowered through a unique methodology developed by the CST. It provides bilingual literacy (Quechua/Spanish), enabling the women to learn to read and write while simultaneously learning about sexual and reproductive health and rights and gender equality, with a view towards improving their well-being, health and income-earning potential. The success of the methodology has fostered interest in several other countries. A documentary on the methodology's field test in Peru won UNFPA its first-ever international film festival award in Havana, Cuba, in December. In June a regional seminar of indigenous women was convened in Peru by the Center for Amazonian Research and Promotion and UNFPA. The seminar produced a follow-up plan addressing integrated health issues and focusing on the sexual and reproductive health and rights of South American indigenous women. UNFPA has placed an increasing emphasis on working directly with municipalities to expand access of services to poor and hard-to-reach rural communities. Close collaboration with the ministries of health and education, women's health groups, universities and other institutions working in partnership at the local level has proved to be a difficult undertaking, but the longer-term prospects for sustainability of activities are promising. Under its regional programme, UNFPA supported the International Planned Parenthood Federation, Western Hemisphere Region, in preparing user-friendly self-assessment tools for reproductive health service organizations. The tools focus on quality of care; strategic planning; sustainability; and adolescents. Along with the Pan American Health Organization (PAHO), UNFPA continued to support a regional training programme on service management to improve service quality, access and coverage. The Fund's regional programme also supported maternal mortality prevention activities, including the safe motherhood advocacy and coalition-building efforts of Family Care International in Bolivia and Colombia. During the year, UNFPA was invited to join NGOs and regional academic institutions in launching an initiative and follow-up work in the area of male responsibility, gender equality, and reproductive health. In October, a landmark regional conference, supported by UNFPA and organized by IPPF and AVSC International in Mexico, brought together over 100 experts and programme professionals from throughout the region. UNFPA continued to support the formation of national networks and strategies to involve men in a positive way in reproductive health and in the gender equity agenda. In Bolivia, Ecuador, Nicaragua and Paraguay, UNFPA, in collaboration with the armed forces, collaborated on developing awareness-raising activities focusing on gender sensitivity, human rights and reproductive health. Messages were developed to reach the primarily male audiences of the armed forces. ICPD+5. Advocacy and other activities related to the ICPD+5 review and appraisal process were an important focus during the year. All UNFPA country offices mobilized to assist counterparts in preparing national reports and in responding to surveys undertaken for the ICPD+5 review and appraisal. The Fund provided support for the regional five-year review process undertaken by the Economic Commission for Latin America and the Caribbean, including meetings held in Aruba in May, in Trinidad and Tobago in November, and in Santiago, Chile, in December. Two regional events focusing on advocacy strategies for the ICPD+5 review and appraisal were supported in Mexico: a workshop on reproductive health and rights and on the broader issues of gender, population and development was organized bringing together journalists from the region; and a meeting of the regional representatives of the Latin American Council of Churches (Protestant denominations) was held. The meeting produced a declaration supportive of reproductive health and rights and the ICPD Programme of Action. UNFPA also continued to support a multi-country initiative developed by the Latin America and Caribbean Women's Health Network. The initiative focuses on monitoring the implementation of the ICPD Programme of Action. The monitoring is carried out by women's groups and includes the preparation of national progress reports. In Peru, the multi-country project led to the creation of the National Tripartite Commission on Population and Development, which brings together various ministries, United Nations agencies, universities and women's groups. UNFPA support at the country level played a key role in the establishment of the commission, which helped to forge a national consensus and monitor quality-of-care concerns in the wake of public outcry and media publicity over alleged forced sterilizations. The commission is considered a model for other countries as it brings together, on an equal footing, all necessary partners from government, civil society and multilateral organizations to promote quality of care and safeguard reproductive rights in the spirit of the ICPD Programme of Action. In 1998, Peru also finalized the National Population Plan 1998-2002. The United Nations Inter-Agency Campaign Against Violence Against Women. Coordinated by UNIFEM with a leadership role played by UNDP, UNFPA and UNICEF, the United Nations Inter-Agency Campaign Against Violence Against Women mobilized an impressive level of press coverage, sensitization activities, legislative initiatives and, most importantly, political commitment at all levels. The campaign, directly or indirectly, contributed to a series of important results: the Brazilian Government announced additional funds for safe houses; in Peru, a national multi-agency task force was established and developed a five-year action plan; in Nicaragua, forums were held in poor communities to raise women's awareness of their rights; in Venezuela, the pending bill against domestic violence was finally approved after two years of inaction; in Ecuador, schoolchildren's lunch bags and public transportation carried the campaign's logo and slogan; and in Haiti, UNFPA supported advocacy for legislation on rape. The key lesson learned was that the United Nations, speaking in one voice while reaching out to national partners, can be highly effective in making progress on critical human rights and gender issues. The United Nations Inter-Agency group held several meetings, including with PAHO, to develop follow-up activities and related initiatives for 1999 and 2000. These included fundraising strategies to capitalize on the commitment mobilized and to put programmes and services in place. Hurricane Mitch. Responding to Hurricane Mitch became a top priority for UNFPA in the last quarter of 1998. UNFPA Representatives from countries in Central America and the Director of the Latin America and the Caribbean Division participated in inter-agency initiatives in Guatemala, Honduras and Nicaragua; attended a consultative meeting convened by the Inter-American Development Bank focusing on reconstruction; and contributed to the United Nations Inter-Agency Transitional Appeal for Hurricane Mitch, as well as to the development of medium-term reconstruction projects that rebuild health infrastructure and address reproductive health and gender concerns. In Honduras and Nicaragua, UNFPA supported needs assessments in reproductive health among the displaced population, provided emergency kits on sexual and reproductive health and supported counselling efforts. The counselling, primarily for female adolescents in shelters, included information on preventing gender-based violence. Nicaragua. UNFPA provided technical assistance for the development of subprogrammes focusing on reproductive health and adolescents and on the integration of population dynamics into national development strategies. UNFPA supported the Ministry of Health's adolescent programme, as well as services for youth in 17 priority municipalities. In coordination with PAHO, the Fund supported the Ministry of Health in developing norms for the provision of adolescent health services and also continued support to the Bertha Calderon Hospital's Center for Adolescents in the capital. An agreement with the Ministry of Health and the United States Agency for International Development was reached to improve logistics management. In July, the Government formulated a national population policy and a corresponding action plan. The lack of human resources in the area of population is being addressed through UNFPA-supported training and higher education in the relevant disciplines. For example, UNFPA supported 35 nationals from Nicaragua and other Central American countries who graduated in 1998 with a Master's Degree in reproductive health from the School of Medicine of Nicaragua. In November 1998, following Hurricane Mitch, the UNFPA country office accorded top priority to rehabilitation efforts. Work plans were revised to focus on the most vulnerable groups and to establish alliances with community representatives close to the affected population. In the area of reproductive health, UNFPA efforts focused on strengthening the primary health care system, including through re-equipping units and training service providers. Mobile information units (two vans) were provided to promote preventive care and health education. Special attention was focused on promoting the sexual and reproductive health and rights of adolescents. UNFPA has been instrumental in developing an innovative inter-agency emergency project with UNDP to meet the most pressing needs, including those of adolescent girls and women, in the 25 most affected municipalities of the northern provinces. Paraguay. During 1998, the programme in Paraguay focused attention on adolescent reproductive health. Activities included the establishment of specialized clinics providing integrated reproductive health services to adolescents and undertaking education initiatives on sexual and reproductive health. Special clinics, run by NGOs with support from UNFPA, are functioning in the metropolitan area of Asuncion and in the department of Guaira. A sex education project was also initiated in collaboration with Paraguay's armed forces. Every year 12,000 young males, mainly adolescents from the rural areas, are recruited for their mandatory military service. Education on sexual and reproductive health issues has been integrated in their training. In addition, the armed forces are providing selected reproductive health services, including the supply of contraceptives and services for the prevention of HIV/AIDS and other sexually transmitted diseases. It is believed that the combined effort of educating adolescents and offering them sexual and reproductive health services will bring down the high rate of adolescent pregnancies. Under the subprogramme on population and development strategies, training was provided at the local level to civil servants and government officials to enable them to integrate population concerns into policy formulation and decision-making. A regional workshop was organized in Paraguay to prepare for the 2000 round of censuses. Efforts are also underway to create a regional network of population and development experts from Argentina, Bolivia, Brazil, Chile and Uruguay to support upcoming activities.
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