WPC BrAT|2ʃT7Ȑق 6O p8w4GBO>=ԕ][fD_$7L躃.tnE(KK"_?I9#WaFneE|,C-)'K?_3m!N'=29:+:*fGkިBgԳᖀ:YB=f+wO09O^j*9&NsA{-.+mxQ"rMLTL hvJv ktO,*c-γQbT-_Rג^DIQee2v1;BA= JZ[V@,3Llcwp@Zn9-{;QUv)LXDh؏xF6Kr K??T(*|ϨJf(gU܍F;ٌ_}q/9)UDT# UN % 0(Uy:pY U>  U: D/A Bp  w@ 4  - U>5 fs fu 0Dw C f f U8 D3 fD :F U> 0.L U8 B B(fEfGU>I 08|maU>a;aOacwa]U>qaa D3 B*  D34 Bg:U>U: 06  DK BB( 0Aj 0 T 0AhU8gE:U>j 0DU> 0DU8I 0F h h h 0D h h# h) h// DM5Acrobat PDFWriterWINSPOOL((((((((0 (hH  Z 6Times New Roman RegularX($,rAZ"Arial RegularCEDAW FGM MCH MOH QOC RTIs STDs TBA '  XoXXX[+X7XoA"A)nxdEnxA (#RoundTableMeetingonReproductiveRightsandReproductiveHealth.L qZ &Univers Regular,  AZ"Arial Regular ' dxdP PdNafis a b Uc Ud Ef h i j l p %3|xp  ##  %d#/L qZ &Univers Regular(3$ !  d+OAZ Arial Italic""""'dxd 0 '  XoXXX[+X7XoA"A)nxdEnxA (# idG7[+RoundTableMeetingonReproductiveRightsandReproductiveHealth#[+Gid#/L qZ &Univers Regular>c$"Small Circle"0 +OAZ Arial Italic E(  %XjYXXX%~XFXjYA"A)axdEaxARoundTableMeetingonReproductiveRightsandReproductiveHealth d/L qZ &Univers Regular E(  )XjYXXX)~XFXjYA"A)axdEaxARoundTableMeetingonReproductiveRightsandReproductiveHealth(T$0  0` (#(#0 ` (#` (#0 (# (# TABLE A/L qZ &Univers RegularTABLE BTABLE CTABLE B E(  /XjYXXX/~XFXjYA"A)axdEaxARoundTableMeetingonReproductiveRightsandReproductiveHealthTABLE D/L qZ &Univers RegularTABLE ETABLE F3333'dxd&0 d d5555'dxd  d 0 '  7XoXXX7[+X7XoA"A)nxdEnxA (#idG7[+RoundTableMeetingonReproductiveRightsandReproductiveHealth#7[+Gid#/L qZ &Univers Regular+zAZ"Arial Regular(hJ$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#  =>?'9<<<<?Thick/Thin 2dxd>Thick/Thin 2[ d -d(Vm$0   (,!$0  0` (#(#  (@$0  0` (#(#0 ` (#` (# ` +OAZ Arial Italic 0 '  CXoXXXC[+X7XoA"A)nxdEnxA (#HidG7[+RoundTableMeetingonReproductiveRightsandReproductiveHealth#C[+Gid#/L qZ &Univers Regular ` E(  FXjYXXXF~XFXjYA"A)axdEaxA@idGF~RoundTableMeetingonReproductiveRightsandReproductiveHealth#F~G@id#8hF~#F~8h#(3$ !  /L qZ &Univers Regular(3$ !  +OAZ Arial Italic6k$Triangle0  (3$ !  #$""E"Thin Top/Bottom dxd !  I I I  XG XXXI I XX X XGI I  XXXXXVXX XI 5 5  XXI # V# ) I EnsuringReproductiveRightsandImplementing   SexualandReproductiveHealthProgrammesIncludingWomensEmpowerment,MaleInvolvementandHumanRights @ #XX%#  $,  XX#XXċ#Rz7RXX ExpertRoundTableMeeting #XX7RRz#XX # #XX<#XXKampala,Uganda D%L 22-25June1998#XX# P&X  TechnicalandPolicyDivision,UNFPA  H(P  I # XX X XG#I   5PP5hXX  UNFPAalsocurrentlypublishesreportsinthefollowingseries:EvaluationReports,ProgrammeAdvisoryNotes,TechnicalandPolicyPapersandTechnicalReports.h)h)$pNote:0  TheviewsandopinionsexpressedinthisreportarethoseofexpertswhoattendedtheExpertRound h)$ TableMeetingonEnsuringReproductiveRightsandImplementingSexualandReproductiveHealthProgrammes,IncludingWomensEmpowerment,MaleInvolvementandHumanRightsanddonotnecessarilyreflectthoseoftheUnitedNationsPopulationFund(UNFPA). #+&(#(#  #7  %%dXXd7  #XXh#55f h p 6p p Bp h h h f f f i j l Dl l -l j j &j i i !i @& XX@@&Foreword #XXġ #  TheRoundTableonEnsuringReproductiveRightsandImplementingSexualandReproductiveHealthProgrammes,includingwomensempowerment,maleinvolvementandhumanrights,isthesecondinaseriesofmeetingsandconsultationsonmajorissuesbeingorganizedbyUNFPAtoassessprogresssincetheICPDandtoidentifyprioritiesforfurtheraction.EachsessioninthemeetingwasexpectedtorecommendfurtheractionsneededtoachievethegoalsoftheICPD.Theconclusionswillbeconsolidatedinabackgroundreporttobereviewedbymorethan100countriesmeetingattheICPD+5InternationalForumscheduledforFebruary1999intheHagueandasinputstotheSecretaryGeneralsreportfortheSpecialSessionoftheGeneralAssemblyinJune1999.Somefiftyinternationalexpertsonreproductivehealthandrightsfromallregionsoftheworldrepresentingregionalandinternationalnongovernmentalorganizations,governmentandtheUnitedNationssystem,participatedintheRoundTable.ThemeetingwasheldϜinKampala,Uganda,from22to25June1998.ThisRoundTablewashostedbytheGovernmentofUganda,andwasorganizedbytheTechnicalandPolicyDivisionoftheUnitedNationsPopulationFund,incollaborationwiththeUnitedNationsPopulationDivision.̜IwouldliketothankDr.LauraLaski,whowasresponsiblefororganizingthemeetingandpreparingthisreport,aswellashercolleague,Ms.MetteOstergaard,forhelpingindevelopingthebackgroundpaperpreparedforthemeetingandthisreport.IwouldalsoliketothankMs.SunetraPuri,generalrapporteur;Mr.PeterMcCormick,whoeditedthisreport;andMs.VictoriaRector,whohelpedintheorganizationofthemeeting.̛̛̜̜8(#MohammadNizamuddin̜d d C(#Director̜.(#TechnicalandPolicyDivision̜ F(#UNFPA>(#November1998̜  ,%)   XXԀTableofContents#XX#  8 ̜Foreword""J(#.i H Acronyms""I(#.$$vi   :  =Vm  =Vm0     ExecutiveSummary#d"d"H(#. (#(##vii=Vm݌   Ќ  =Vm  =Vm0     Introduction#""J(#.(#(##1=Vm݌   Ќ  =Vm  =Vmx0     ChapterI:Opening#""J(#.X X (#(##3=Vmx݌ p  Ќ  >!  >!N0  0` (#(#    RemarksbyDr.NafisSadik,ExecutiveDirectorofUNFPA#""J(#.44F` (#` (##3>!Ni݌    Ќ  >!  >!J0  0` (#(#    RemarksoftheVicePresidentofUganda,Dr.SpeciozaWandiraKazibwe#""J(#. T` (#` (##5>!Je݌ l4  Ќ  >!  >!T0  0` (#(#    TheICPD+5Process#""J(#.hh!` (#` (##5>!To݌   Ќ  =Vm  =Vm)0     ChapterII:Background#""J(#. (#(##7=Vm)E݌ Z Ќ  >!  >!0  0` (#(#    ICPD:FourYearsLater.RecentTrendsandChallengesinMeeting>! ݌ ` (#` (# Ќ  >!  >!0  0` (#(#     ` ICPDGoalsinReproductiveRightsandHealth#""J(#.A` (#` (##7>!݌ V Ќ  >!  >!0  0` (#(#    ChallengesforFurtherProgress#H"H"I(#.@@.` (#` (##10>!݌  Ќ  =Vm  =Vm0     ChapterIII:ProceedingsofPlenarySessionsandWorkingGroups#H"H"I(#.I(#(##12=Vm݌ |D Ќ  >!  >!0  0` (#(#    Session1:PoliciesforSexualandReproductiveHealth#H"H"I(#.LLE` (#` (##12>!݌   Ќ  ?  ?0  0` (#(#0 ` (#` (# `   DevelopingaSexualandReproductiveHealthPolicy:?݌  (# (# Ќ  ?  ?0  0` (#(#0 ` (#` (# `    theCaseofZambia#H"H"I(#.+ (# (##12?݌ !j$ Ќ  ?  ?0  0` (#(#0 ` (#` (# `   FindingsoftheWorkingGrouponPoliciesfor?݌  (# (# Ќ  ?  ?e 0  0` (#(#0 ` (#` (# `    SexualandReproductiveHealth#H"H"I(#.7 (# (##13?e ݌ f$.( Ќ  '  'i!0  0` (#(#0 ` (#` (#0 (# (#   A.  Progresstowardimplementationofthe'i!!݌%*(#(# Ќ  '  'n"0  0` (#(#0 ` (#` (#0 (# (#      h ICPDProgrammeofAction#H"H"I(#.;(#(##13'n""݌ *' , Ќ  '  '#0  0` (#(#0 ` (#` (#0 (# (#   B.  MajorconstraintsinthedevelopmentofSexual'##݌(T".(#(# Ќ  '  '$0  0` (#(#0 ` (#` (#0 (# (#      h andReproductiveHealthPolicies#H"H"I(#.C(#(##14'$$݌ )#0 Ќ  '  '%0  0` (#(#0 ` (#` (#0 (# (#   C.  Actionsneeded#H"H"I(#.||,(#(##15'%%݌  P+%2 Ќ  ݜ  Session2:DesigningQualitySexualandReproductiveHealthServicesH"H"I(#.S16 8 ?  ?V'0  0` (#(#0 ` (#` (# `   ImplementingandMonitoringFeasibleStandardsofCare#H"H"I(#.PPJ (# (##16?V'q'݌ b Ќ  ?  ?f(0  0` (#(#0 ` (#` (# `   ݜSexualandReproductiveHealthandRightsin?f((݌  (# (# Ќ  ?  ?I)0  0` (#(#0 ` (#` (# `    IndiaSinceICPD#H"H"I(#.) (# (##17?I)d)݌ ^ & Ќ  ?  ??*0  0` (#(#0 ` (#` (# `   ReducingMaternalMortality#H"H"I(#.00/ (# (##18??*Z*݌   Ќ  ?  ?4+0  0` (#(#0 ` (#` (# `   BroadeningConstellationofServiceswithinExistingSystems:?4+O+݌  (# (# Ќ  ?  ?&,0  0` (#(#0 ` (#` (# `    TheCaseofBangladesh#H"H"I(#.``/ (# (##19?&,A,݌ L  Ќ  ?  ?"-0  0` (#(#0 ` (#` (# `   FindingsoftheWorkingGrouponDesigningHighQuality?"-=-݌  (# (# Ќ  ?  ?.0  0` (#(#0 ` (#` (# `    ReproductiveHealthProgrammes#H"H"I(#.7 (# (##21?.).݌ H  Ќ  '  '/0  0` (#(#0 ` (#` (#0 (# (#   A.  Progresstowardimplementationofthe'/-/݌r (#(# Ќ  '  '00  0` (#(#0 ` (#` (#0 (# (#      h ICPDProgrammeofAction#H"H"I(#.;(#(##21'020݌    Ќ  '  '510  0` (#(#0 ` (#` (#0 (# (#   B.  Constraintsindesigninghighqualityreproductive'51P1݌n6(#(# Ќ  '  'G20  0` (#(#0 ` (#` (#0 (# (#      h healthprogrammes#H"H"I(#.$$4(#(##22'G2b2݌  Ќ  '  '^30  0` (#(#0 ` (#` (#0 (# (#   C.  Actionsneeded#H"H"I(#.||,(#(##22'^3y3݌ 2 Ќ  >!  >!i40  0` (#(#    Session3:AccesstoRH/SH/FPServices#H"H"I(#.hh5` (#` (##23>!i44݌ \ Ќ  ?  ?U50  0` (#(#0 ` (#` (# `   DiversifyingAofthePrivateSector?U5p5݌  (# (# Ќ  ?  ?060  0` (#(#0 ` (#` (# `    IncludingNGOsintheProvisionofServices#H"H"I(#.D (# (##23?06K6݌ X   Ќ  ?  ?A70  0` (#(#0 ` (#` (# `   FindingsoftheWorkingGrouponAccesstoRH/SH/FPServices#H"H"I(#.P (# (##25?A7\7݌ " Ќ  '  'W80  0` (#(#0 ` (#` (#0 (# (#   A.  Progresstowardimplementationofthe'W8r8݌$(#(# Ќ  '  '\90  0` (#(#0 ` (#` (#0 (# (#      h ICPDProgrammeofAction#H"H"I(#.;(#(##25'\9w9݌ ~ F& Ќ  '  'z:0  0` (#(#0 ` (#` (#0 (# (#   B.  ConstraintsinimprovingaccesstoRH/SH/FPServices#H"H"I(#.$!$!R(#(##25'z::݌ !( Ќ  '  ';0  0` (#(#0 ` (#` (#0 (# (#   C.  Actionsneeded#H"H"I(#.||,(#(##26';;݌ B# * Ќ  >!  >!<0  0` (#(#    Session4:CreatingNecessaryConditionsforImplementingSexualand>!<<݌ ` (#` (# Ќ  >!  >!=0  0` (#(#     ` ReproductiveHealthandRights(PartI)#H"H"I(#.  ;` (#` (##26>!==݌ &. Ќ  ?  ?>0  0` (#(#0 ` (#` (# `   FemaleGenitalMutilationinUganda#H"H"I(#.$$7 (# (##26?>>݌ h'0!0 Ќ  ?  ??0  0` (#(#0 ` (#` (# `   ViolenceAgainstWomen:theRoleoftheHealth???݌  (# (# Ќ  ?  ?u@0  0` (#(#0 ` (#` (# `    andEducationSectors#H"H"I(#.. (# (##27?u@@݌  ,*#4 Ќ  ݜ  Session5:CreatingNecessaryConditionsforImplementingSexualand   ` ReproductiveHealthandRights(PartII)H"H"I(#.XX<29 b    ` ReproductiveHealthasaHumanRight:GenderEquality?  ?B0  0` (#(#0 ` (#` (# `    andWomensEmpowerment#H"H"I(#.0 (# (##29?BB݌ ^ & Ќ  ?  ?C0  0` (#(#0 ` (#` (# `   LegislatingandImplementingReproductiveRightsinSouthAfrica#H"H"I(#.D D T (# (##30?CC݌   Ќ  ?  ?D0  0` (#(#0 ` (#` (# `   FindingsoftheWorkingGrouponCreatingNecessaryConditions#H"H"I(#.L L R (# (##32?DD݌ "   Ќ  '  'E0  0` (#(#0 ` (#` (#0 (# (#   A.  Progresstowardimplementationofthe'EE݌L (#(# Ќ  '  'F0  0` (#(#0 ` (#` (#0 (# (#      h ICPDProgrammeofAction#H"H"I(#.;(#(##32'FF݌   Ќ  '  'G0  0` (#(#0 ` (#` (#0 (# (#   B.  Constraintsincreatingnecessaryconditions#H"H"I(#.J(#(##32'GG݌ H  Ќ  '  ' I0  0` (#(#0 ` (#` (#0 (# (#   C.  Actionsneeded#H"H"I(#.||,(#(##32' I&I݌ r  Ќ  ݜConcludingRemarksbyMr.MohammadNizamuddinH"H"I(#.734    МClosingRemarksbyMr.JothamMusinguzi.H"H"I(#.234 n6 МAnnexes:  RegionalPerspectivesonProgressAchievedinEnsuringReproductive   ` RightsandinImplementingReproductiveHealth   ` SinceICPDH"H"I(#.l l 35 X     AgendaH"H"I(#. 37 " 0  ListofParticipants#H"H"I(#.| | #(#(##43 $    ~ F& М   XXAcronyms #XXĮL# 8 LAIDS   ` Acquiredimmunodeficiencysyndrome P  CEDAW ` CommitteeontheEliminationofDiscriminationAgainstWomen  z FGM   ` Femalegenitalmutilation   FP   ` Familyplanning v >  HIV   ` Humanimmunodeficiencyvirus   ICPD   ` InternationalConferenceonPopulationandDevelopment :  IPPF   ` InternationalPlannedParenthoodFederation d  MCH   ` MaternalChildHealth   MIS   ` Managementinformationsystem `( MOH   ` MinistryofHealth  NGOs ` Nongovernmentalorganizations $ QOC   ` Qualityofcare N REACH ` Reproductive,EducationandCommunityHealthprogramme  RH   ` Reproductivehealth J RTIs   ` Reproductivetractinfections t  МSH   ` Sexualhealth " STDs   ` Sexuallytransmitteddiseases p8$ TBA   ` Traditionalbirthattendant  & МUNAIDS ` TheJointUnitedNationsProgrammeonHIV/AIDS 4"( UNDP ` UnitedNationsDevelopmentProgramme #^* UNFPA ` UnitedNationsPopulationFund $, UNICEF ` UnitedNationsChildrensFund Z&" . WHO   ` WorldHealthOrganization '!0 М  *H$4   XX   s @ZZ"#XX+T#XXExecutiveSummary#XXĮT# JT  8 М̛TheaimsoftheKampalaRoundTableweretoidentifystrategiesthathaveemergedsincetheInternationalConferenceonPopulationandDevelopment(ICPD)inensuringreproductiverightsandinmakingsexualandreproductivehealthprogrammesoperational;toidentifysuccessesandconstraintsinpolicy,legal,administrative,managerial,strategicandfinancialaspects;andtoagreeonactionsneededtoaccelerateprogresstowardsachievingthegoalsoftheICPD.TheRoundTablerecognizedthatsectorwideprogressinpolicyformulationhasoccurredinseveralcountries,whileworktoimprovespecificaspectsofpoliciesandofimplementationhasstartedinothers.Wherethereispoliticalcommitmenttotheprinciplesofsexualandreproductivehealthandrightsandgenderequalityandempowermentofwomen,progressisoccurringincollaborationbetweengovernmentsandcivilsociety.Effectiveandempoweredwomensmovements,othermassmovementsandnongovernmentalorganization(NGOs)areprovingvitaltoensuringprogressinpolicydevelopmentandimplementationinareassuchastheestablishmentofgreaterunderstandingandwillfordevelopingrightsbasedpolicies.UKUS.,US.,UK.,YWhilevariouselementsofreproductivehealthcareareavailableinmanycountries,theimplementationofcomprehensiveintegratedserviceshasadvancedslowly.Traditionallyverticaladministrativestructures,compartmentalizedbudgetsandpersonnelpreventintersectoralcollaborationandcoordinationamongministriesinnumerouscountries.Withinintegratedandcomprehensivereproductivehealth,threecentralissueshaveemergedasglobalconcernsthathavenotreceiveduniversalandbalancedinvestment:meetingtheneedforfamilyplanning;ensuringmaternalhealth(includingthereductionofunsafeabortion);andreducinginfantmortalityandmorbidity;andpreventingandtreatingsexuallytransmitteddiseases(STDs),includingHIV/AIDS.Althoughmuchremainstobedoneintheseareas,thecentralcommitmentistoreduceverticalityofprogrammesandintegrateallaspectsofreproductivehealthinthecontextofprimaryhealthcareandhealthsectorreform.TechnologiesareseriouslyinadequateinSTDs,includingHIV/AIDS.Fewwomencanprotectthemselvesandtheirpartners.Althoughthefemalecondomexistsandisbeginningtobemadeavailable,simplerdiagnostictestsandsingledosetreatmentsremainunavailable.ThechallengeofCairocontinuestobetheintegrationoforbettercollaborationbetweendifferentinstitutionalstructures,transformationofexistingfacilities,improvementoflogisticsystemsandtrainingtoensureappropriateandeffectivecare.Themeanstomeetthechallengeinvolvethestructuralandstrategicreorientationofhealthsystemsand (-&* financing.Integrationisnotjustamatterofaddingservicestofamilyplanningprogrammes.Anotherchallengeistoovercomesocialbarrierstoaccess,includingmensunderstandingoftheirrolesandresponsibilitiesofwomenshealth.TheRoundTableexpertsreachedconsensusonthefollowingactionsneeded:̄Inhealthsectorreform,emphasismustbegiventoensuringsexualandreproductive   healthforallpeopleatthehighestachievablestandardofcare,andtomobilizingthenecessaryresources.Equityisanecessaryprerequisitetoachievingtherighttohealth.  ` ̄Continueandpromotethereorientationofthehealthsystemtoensurethatsexualand p8  reproductivehealthpolicies,strategicplansandallaspectsofimplementationarerightsbased,coverthelifecycleandserveall.Thisrequiresthatthepublichealthsystembeopentoinputsfromcivilsocietyinthecontentanddeliveryofservicesandinformation.Thepublichealthsystemshouldmakepartnershipswithcivilsocietyinthespiritofcollaborationwithequals.̄Continueandpromotehealthsystemstructuralreforminvolvinginfrastructure,human  resourcedevelopment,financing,toachievebothcoverageandquality.Changesinsystemswillhavetobeincrementalandphasedaccordingtoresourceavailability.Theyshouldalsobedeterminedbyaparticipatoryconsultativeprocessanddesignedonthebasisofthelongertermstrategicplan.̄Increasedinvestmentsshouldbemadeinmanagementofserviceprovisionincluding: l4 c  cf"0    Structuralintegrationofreproductivehealthservicesorfunctionalintegration, D  includingeffectivereferralsystemsandtraininginsupervision.cf g݌ (#(# Ќ  c  c$h"0    Maximizeduseofexistingresourcestoprovidehighqualityservices,increase   resourcestoupgradestandardsofcareandperformcontinuingevaluation.Governmentsshouldestablishregulationsandqualityassurancemechanismsthatensurestandardsforhighqualityhealthservicesforthepublicandprivatesectors.c$h?h݌ (#(# Ќ  c  cj"0    Trainingserviceproviderstoimprovetheirtechnicalskills,interpersonal $l! communicationsandsupportivesupervision.Trainingshouldalsoprepareproviderstocommunicateclearlywithempathyandwithrespectforhumanrights,genderequality(includingviolenceagainstwomen)anddignityandtoprovidedignifiedcare.cjj݌T("%(#(# Ќ  Providemoreresourcesforgroupstonetwork:buildalliances,involvethemedia, ,*#' undertakeadvocacy,promotepubliceducationtocreateafavorableenvironmentforthe ICPDProgrammeofActionpolicydevelopmentandimplementation;developthecapacity ,%) ofgroupstoparticipateinpolicydevelopmentandimplementation;andensurethatgroupscanhelpinmonitoringpolicyimplementation. ̄Empowerpeopletoupholdtheirsexualandreproductiverightsandhealth.Information  providedshouldberelevantandeasilyunderstandable.Contentmustincludecommonhumanexperiencesuchassexualityandpowerrelationsbetweenmenandwomen,includingviolence.̀̄Createanenablingenvironmentthroughparticipatoryprocessesatalllevelsofsociety  ` forwomensempowermentandmaleinvolvementinpromotingsexualandreproductiverightsinahumanrightsframework.Thisrequirestheadoptionofagenderperspectivethataccountsforthedifferentrealitiesandconstraintswhichwomenandmenfaceintheirlives.Programmesforwomenareaninitialandessentialmeansthroughwhichgenderinequalitiesandinequitiescanbeaddressed.̜     ? f f        XXIntroduction 8qԛ#XXaq#XX  #XXq# RqӜ̛From22to25June1998,50internationalexpertsonreproductivehealth(RH)andrightsmetinKampala,UgandatoexaminewaystohastenprogresstowardsthegoalssetbytheICPDinCairoin1994.Thegathering,hostedbytheGovernmentofUgandaandorganizedbyUNFPA,wastheExpertRoundTableMeetingonEnsuringReproductiveRightsandImplementingSexualandReproductiveHealthProgrammes,IncludingWomensEmpowerment,MaleInvolvementandHumanRights.TheKampalaRoundTablewasoneofaseriesofRoundTables,TechnicalMeetingsandRegionalConsultationswhichUNFPAorganizedduringtheyearaspartofareviewofprogressachievedintheimplementationoftheICPDProgrammeofActionsince1994.TheoutcomeoftheKampalaRoundTablewillbeusedinthepreparationofreportsonthestatusofICPDimplementationtobepresentedattheInternationalForum,tobeheldinTheHagueinFebruaryof1999andtheSpecialSessionoftheGeneralAssemblythatwillmeettoreviewandappraiseprogressintheimplementationoftheProgrammeofActioninJuneJuly1999.DrawingfromChaptersVII(ReproductiveRightsandReproductiveHealth)andVIII(Health,MorbidityandMortality)intheICPDProgrammeofAction,theKampalaRoundTablesetouttoidentifystrategiessinceCairothatensurereproductiverightsandtheimplementationofsexualandRHprogrammes.Themeetingalsosoughttoidentifysuccessesandconstraintsinpolicy,law,administration,management,strategyandfinance.Last,theRoundTableparticipantswereaskedtodeviseactionsneededthatwouldaccelerateprogressatthenationalleveltoachievethegoalsofICPD.TheRoundTableaddressedfourissues:progressandconstraintsachievedafterICPDinthedevelopmentofpoliciesforensuringreproductiverightsandimplementingRH;theintegrationofsexualandRHservices,theimprovementofcareandaccess;andtheachievementofgenderequityandequality,womensempowerment,andmaleresponsibilityinthecontextofhumanrights.TheRoundTablehadfoursessionswhichtreatedthesethemes.Speakersamongtheparticipantsgavepresentations,followedbyquestionandanswerperiods.AllparticipantswereinvitedtojoinworkinggroupswhichdiscussedprogresssinceICPD,constraintsandactionsneeded.Thesubjectsofthefourworkinggroupswere:  '@#&   c  c{"0 `   PoliciesforSexualandReproductiveHealthc{{݌8` (#` (# Ќ    c  cr|"0 `   DesigningHighQualitySexualandReproductiveHealthProgrammescr||݌$` (#` (# Ќ    c  cJ}"0 `   AccesstoReproductiveHealth,SexualHealthandFamilyPlanningServices     cJ}e}݌ ` (#` (# Ќ    c  cP~"0 `   CreatingtheNecessaryConditionsfortheImplementationofSexualand   ReproductiveHealthandRights.cP~k~݌ ` (#` (# Ќ  Thisreportisdividedintothreechapters:(I)Opening;(II)Background;and(III)ProceedingsofPlenarySessionsandWorkingGroups,whichincludesworkinggroupreportsonprogress,constraintsandactionsneeded.XX  L   #XX(#  \$        XX @ ChapterI:Opening#XXǀ#     XX  RemarksbyDr.NafisSadik,ExecutiveDirectorofUNFPA b   #XXo# AttheopeningoftheRoundTable,Dr.NafisSadik,theUNFPAExecutiveDirector,addressedparticipantsandnotedthattheintentionofICPDwastoshiftemphasisfromfamilyplanningtoabroaderapproach,basedonreproductivehealthandrights.Parallelmovestowardsgenderequalityandtheempowermentofwomeninotherareasofsocialandeconomicdevelopmentwerealsoessentialfeaturesoftheapproach.TheICPDadoptedthepositionthatreproductiverightswerehumanrights,whichwasendorsedbytheSocialSummitinCopenhagenandfurtherendorsedandstrengthenedbytheFourthWorldConferenceforWomeninBeijingin1995.RealprogressinattainingRHliesintheenactmentofreproductiverightsaspartoflawandpolicy,andtheirrealizationaspartofhealthservices,Dr.Sadiknoted.TheprocessofmakingandcarryingoutRHpolicymustreachbeyondgovernmentministriesdirectlyresponsibleforhealth,andmustalsoinvolveabroadspectrumofNGOs.Eachcountryhastomakeafrankassessmentofitsstrengths,weaknessesandareasofgreatestneed,andmakepolicyaccordingly,shesaid.Amongcountrieswithcomprehensivefamilyplanningservices,somehavefocusedonlinkingorintegratingstructures,oronexpandingtherangeofservices.Dr.Sadiksuggestedthatfamilyplanningserviceswithlimitedresourceswouldfindthatincrementalimplementationwasappropriate.Inanycase,policyshouldmaintaincomprehensiveRHcareastheultimategoal:RHisnotachoicebutanecessityforcountrieswishingtosetafirmfoundationforeconomicandsocialdevelopment.Dr.SadikemphasizedfiveissuesfortheRoundTable:womensempowerment;theneedforchangeinmalebehavior;genderbasedviolence;RHcareinemergencysituations;andtheneedtoreversethetideofHIVandSTDs.Dr.SadikalsonotedtheApril1998RoundTableonadolescentsexualandRH.Sheremindedheraudiencetokeepinmindthefindingsofthatmeetingandtorememberthatyouthmadeuponefifthofhumanity.Alludingtothesepoints,Dr.Sadikdeclaredthatfreechoiceinthesizeandspacingofthefamilyrepresentedthecornerstoneofempowerment.Despiteprogress,morethanfourintenwomenindevelopingcountriesstilllackaccesstogoodRHservices.Manywomenalsoremainunawareoftherangeoffamilyplanningmethods,justasnotallfamilyplanningserviceprovidersareawareoftheneedtostresschoice.Educationisakeytoempowerment,Dr.Sadikstated.Womenremainlesseducatedthanmen.FewerthanhalfofallwomeninSubSaharanAfricadiscussfamilysizewiththeirspouses,comparedto60percentofcouplesinAsia,NorthAfricaandLatinAmerica/Caribbean.ThelowfigureforSubSaharanAfricaisconsistentwiththelowlevel ,(+  ofawarenessanduseofcontraceptivemethods.Dr.SadikaddedthatthecorrelationbetweenawomansplaceinsocietyandheraccesstoRHservicesisadirectone.SriLanka,forexample,althoughpoor,isneverthelessacountrywherewomenenjoyhighsocialstatus,andthematernalmortalityratethereisamongthelowestinthedevelopingworld.Changeinmalebehaviorisakeytotheempowermentofwomen.Behavioralchangeformenmeanstheiradoptionofresponsiblesexualandreproductivebehavior,andtheirsupportingnotonlywomensrighttomaketheirownreproductivechoicesbuttheirrighttotheinformationandmeanstodoso,Dr.Sadikexplained.Sheaddedthatpeopleshouldbecarefulofregardingmenaspartoftheproblem;manywouldliketobepartofthesolution,andtheyshouldbeencouragedtocommunicatebetter,totakeresponsibilityandtomakechangesinfavourofwomensempowerment.Notingthatpeopleintoomanycountriesacceptdomesticviolenceasafactoflife,Dr.SadiknotedincontrastthatsincetheICPD,manycountrieshavetakenuptheissueoffemalegenitalmutilation(FGM)atthehighestlevels.UgandahasshownthewaytosuccessinmakingmajorprogressintheeliminationofFGM,throughhighlevelleadershipfollowedbycommunityaction.Inemergencysituations,inwhichwomenareattheirmostvulnerable,UNFPAisworkingtobringessentialRHcare,includingthemeanstoavoidpregnancy.Besidesfacingthetaskofchangingmaleattitudesinregardtowomenassexualtargets,Dr.SadiksaidcolleaguesworkinginrefugeecampsandsimilarsituationsneededtobepersuadedthatRHandpreventivecareforwomenwereasessentialasdealingwithtraumaandinfection.STDs,includingHIV/AIDS,isapolicyissueextendingbeyondanyparticularagegroupandbeyondthehealthsector,DrSadiksaid.Itisasubjectthatdemandsbehavioralchangeamongmen,anditalsodemandsthatpolicymakersgiveitpriorityintheallocationofdevelopmentresources.ThefouryearssincetheICPDisarelativelyshorttimeinwhichtoseesubstantialchangeinreproductivehealthandreproductiverights,Dr.Sadikacknowledged.Sheaddedthatpeoplehadtoconfrontputtingideasintoactioninacontextofseverelylimitednationalbudgetsandaninternationalclimatethatdemandedproofoftheeffectivenessofoverseasassistance.Althoughmuchprogresshasbeenmade,thehardestpartliesahead.RHmustbeinstitutionalizedinthehealthsector,andoperationallinkshavetobeestablishedbetweenRHandotheraspectsofdevelopment.  @)#&  XX  &   RemarksoftheVicePresidentofUganda, 8 Dr.SpeciozaWandiraKazibwe #XX#DeliveredbyMr.SamKuteesa,MinisterofState, `( MinistryofFinanceandEconomicPlanning L  ϗOnbehalfofDr.WandiraKazibweandtheGovernmentofUganda,Mr.SamKuteesawelcomedparticipantsoftheRoundTable.Dr.WandiraKazibwerecognizedthatUgandawantedtobeassociatedwiththepostICPDparadigmshift.ThepostICPDerahaswitnessedunprecedentsupportbydevelopingcountriesforpopulationpoliciesandagreaterinvolvementofcivilsociety.SherecognizedthatNGOsareplayingacrucialroleinUgandaandsalutedtheirGovernmentpartnershipwithNGOs.TheroleoftheprivatesectorandtheparticipationofthecommunityaftertheimplementationofadecentralizationpolicyinUgandawasalsonoted.Thefactthatdecisionscannowbetakenatlowerlevel,closetothepeoplesothattheycandecideonmattersthataffecttheirdailylivesandprioritizethemisagreatopportunity.'8ۗSheexpectedthatthemeetingcouldhelplearnfromparticipantsexperiencesandevaluateprogresssince1994.InUgandaforexample,maternalmortalityratescontinuetobeveryhigh.MothersaredyingsoneedlesslyfrompreventableconditionsandtheGovernmentmadeacallforactiontodecreasematernalmortalitynow.HealthstatisticsinUgandashowamaternalmortalitylevelof506per100,000livebirthsandaninfantmortalityrateat97deathsper1,000livebirthsandfertilityratesareashighas6.9.However,evennationalstatisticsdonottellthefullstory,fortheyaremerelyaverages.Womenstillcontinuetobeputatadisadvantage.Populationanddevelopmentprogrammesneedtoputwomensstrategicconcernsatthecenteroftheirplansorareboundtoproducenegativeresults.AlthoughUgandahasmadesomemodestattemptstoemancipatewomen,sherecognizedthattheyneedtodomuchmore.Womenseducationisofstrategicimportanceandhasamultipliereffect.Finally,Dr.WandiraKazibwethankedtheorganizersofthemeetinganddeclaredthemeetingofficiallyopen.̜ XX  ԛ  TheICPD+5Process  #XX# $# МMr.MohammadNizamuddin,Director,TechnicalandPolicyDivision,UNFPA  8$   Mr.NizamuddinoutlinedhowthepresentroundtablemeetingisacomponentoftheICPD+5process.ItwasinitiatedinresponsetothedecisionoftheGeneralAssemblytoholdaspecialsessionin1999tomarktheprogressmadeintheimplementationoftheICPDProgrammeofAction.Inexplainingthedifferentactivities,actorsandexpectedoutcomesoftheICPD+5process,Mr.NizamuddinputspecialemphasisontheimportanceofthisparticularRoundTable,becauseRHconstitutesthecornerstoneoftheICPDProgrammeofAction.a Heencouragedtheparticipantstodevisespecifickeyfuture^  +`%( ^ actionsonRHandrights,andonwomenshealthandrightsandmensrolesandresponsibilities.a a  $ a  +`%(    t  XXChapterII:Background#XX#  8 XX    ICPDFourYearsLater:RecentTrendsandChallengesinMeeting D  ICPDGoalsinReproductiveRightsandHealth#XX# ǥ X  ԥThissectionisbasedonthepresentationmadebyDr.NicholasDodd,Chief,TechnicalBranch,TechnicalandPolicyDivision,UNFPAandontheBackgroundpaperpreparedfortheRoundTablebytheTechnicalandPolicyDivisionofUNFPA. 0 TheconsensusreachedatCairoraisedexpectationstowardsestablishingtrulycomprehensivesexualandRHservicesthroughouttheworld.Fouryearslater,thereisgrowingrecognitionthatprogresshasindeedoccurred.Examplesofchangesinpolicieshaveoccurred,andmanycountriesarebuildingconsensusontheneedtorevisepolicyandredesignprogrammes.Althoughthefullimplementationofthisconceptrequiresmorethanpolicydevelopment,consensusbuildingrepresentsafirststepintheroadtouniversalaccesstocomprehensiveRHservices.Countriesthatdefinedpriorityareasforimplementation,allocatedresourcesandinvolvedstakeholdersinthedecisionmakingprocess,andinvestedtimeandresourcesintheprocess,showsignsofadvancingtheimplementationoftheCairoagenda.Manynationalpoliciessince1994reaffirmthereproductiverightsprincipleoftheProgrammeofAction,namely,therightofallcouplesandindividualstodecidefreelyandresponsiblethenumber,spacingandtimingoftheirchildrenandtohavetheinformationandmeanstodoso.Mostpoliciesalsorecognizetheequalrightsofwomenandmenandthatthestatusofwomenmustbeimprovedtoreachthisgoal.Adolescentneeds,includingsexualandRH,havealsogainedrecognition.Policiesandpracticesthatlimitaccesstofamilyplanningservicesarebeingchanging,particularlyspousalauthorization,maritalstatusandagelimitations.Inthepast,restrictivepoliciesoftendeniedservicestounmarriedwomen,adolescents,thedivorcedandwidowed,andwomenwhowantedtodelayorspacepregnancies.Muchremainstobedonebeyondpolicyformulation,however.WhilevariouselementsofRHcareareavailableinmanycountries,progresshasyettobemadeinimplementingcomprehensive,integratedservices.Whethercountriesintheiroverallprogrammedesignhavepursuedtheintegrationofservices,broadenedthescopeofavailableservices,orfocussedonlyonprovidingafewcomponentsofRH,amorecomprehensiveRHapproachcanbedistinguishedbylookingbrieflyatitskeycomponents.  *$' &   Meetingtheneedforfamilyplanning 8 Familyplanningremainsthecentralfocusofmostprogrammes.ARHapproachtofamilyplanninghasbeenthefirststeptakeninthemajorityofcountrieswhere'87Ԁimplementationhasbegun.Thismeansthateffortsarenowmorefocussedonmeetingthebroaderneedsofclients.Theeffortsincludereviewingtherangeofcontraceptivemethodsavailable,andstrengtheninginformationandcounsellingservicestoenablemoreinformedandappropriatecontraceptivechoices.Whileabout56percentofcouplesintheworldareusingamethodoffamilyplanning,contraceptivesremaininaccessibleto120to150millioncoupleswhowantthem.Newcontraceptiveshaveappearedinthemarketsince1994,mainlyonceamonthinjectables,femalecondomsandrevitalizationofemergencycontraception.However,highcostandqualityofcarecontinuetoposeseriousconstraintsintheprovisionoffamilyplanning.&  Improvingmaternalhealth    Maternalhealthhasimprovedinselectedcountries.Forexample,inSriLankathematernalmortalityrate,whichdeclinedfrom500deathsper100,000livebirthsinthe1950stoabout50per100,000in1994,isoneofthelowestinthedevelopingworld' ).SriLankafocusedontheexpansionofmidwiferyskillsandnow95percentofallbirthsoccurininstitutions.Factorsbehindsuchprogressincludetherelativelyhighstatusthatwomenenjoy,theexistenceofageneralhealthinfrastructureandagoodroadnetworktofacilitateaccesstohealthservices.InUganda,acountrywithlimitedresources,asystemhasbeendevelopedtoidentifyandtransportpregnantwomenwithcomplicationstodistricthospitals.Asaresult,Caesareansectionratesareincreasinginsomedistricthospitalsandthiscouldbetakenasaproxyindexofreducedmaternalmortality.Incontrast,theexperienceofpregnancyanddeliveryformillionsofwomenworldwideremainsoneofpainandsuffering.WHOestimatedthataround600,000womencontinuetodieeachyearfromcomplicationsarisingfrompregnancyand99percentofthesedeathsoccurindevelopingcountries.LittleoverallprogressappearstohaveoccurredsincetheSafeMotherhoodinitiativeinNairobiin1987.Thelifetimeriskofmaternaldeathis1per48ofwomenlivingindevelopingcountries,incontrastto1per1,800forwomeninthedevelopedworld.In1997,areviewoftheSafeMotherhoodInitiativeconcludedthatthetrainingoftraditionalbirthattendants(TBAs),antenatalscreeningforhighriskpregnantwomenandtheprovisionofsimplebirthkits,wasinsufficient.Womenmusthaveaccesstoskilledpersonnelatdelivery,postpartumcareandeffectivereferralandtransporttowellstaffedandequippedfirstreferrallevelhospitalsandwaitinghomes.Achallengetomaternalhealthservices,asinotheraspectsofsexualandRHcare,ishowtoalterexistingfacilities,andtraining,toensureeffectivecare.Anotherchallengeistoovercomesocialbarrierstoaccess.Thisincludestheensuringofeducation,nutrition,healthcare,employmentopportunitiesforgirlsandwomen,andthechangingofmensunderstanding ,&* oftheirrolesandresponsibilitiesinwomenshealth.UKUS.,ԀTheinternationalhealthanddevelopmentcommunityneedtocontinuetohelpcountriesensurethatreproductiveservicesareavailable,affordableandacceptabletoallwomen.US.,UK.,rԀPreventingunsafeabortion   Withtwentyfivemillionlegalabortionstakingplaceeachyearintheworldand1outof6birthsendinginabortion,thisissuecannotbeignored.WHOestimatesthatabout20millionunsafeabortionsoccureveryyearworldwideandbetween60,000and80,000womendieofunsafeabortions.Since1994,fourcountrieshavepassednewlawsregulatingabortion.PreventingandtreatingSTDs(IncludingHIV/AIDS) \$  ThereiswidespreadagreementthatthepreventionandcontrolofSTDs,including H  HIV/AIDS,shouldbeanintegralcomponentofRHprogrammes.SinceICPD,programmeshavetriedtodevelopandteststrategies.Whiletheimmediatesuccessofinitiativeshasvariedwidely,suchapproacheshavegenerallyconfirmedthefeasibilityanddesirabilityofintegration.Approximately330millionnewSTDsoccureveryyear.UNAIDSestimatesthattenmillionpeoplewerelivingwithHIV/AIDSin1991.Thenumberreached31millionin1997anditisexpectedtoincreaseto40millionin2000.Althoughsometechnologiesareavailable,methodsthatwomencanusetoprotectthemselvesandtheirpartners,suchasthefemalecondomareexpensiveandnotyetwidelyavailable.Progresshasneverthelessoccurredinsomecountries.ThesuccessofThailandinreducingreportedSTDcasesfrom400,000in1989tofewerthan50,000in1995camefromafirmpoliticalcommitment,sufficientresources,andstrongprogrammeleadership.UgandahasalsoreducedHIVinfectionasevidencedbydatafromsentinelsurveillancesitesbetween1996and1997,particularlyamongyoungadults.̜ThereductionofSTDsandtheconsequencesinhealthandsocialwellbeingrequiresnotonlyservicesbutmajorchangesinthemostintimateaspectsofhumanrelationships,invaluesandnormsregardinggenderrolesandpowerimbalancesbetweenthesexes,andinmassmediaandotherinformationsources.Thesechangesinturnwillrequirepoliticalwill,informationandeducationforpeopleofallages.ItisclearbynowthatideasarechangingfavorablyinsupportofRHinalmostallregionsintheworld.ThechallengeisnowhowtoputtheseideasintoactionsothattheICPD becomesmeaningfultoall,eventowomenandmeninthemostremoteareasoftheworld.XX @)#& #XX#  XX&     ChallengesforFurtherProgress#XX#  L  AdrienneGermain,InternationalWomensHealthCoalition  `(  1Ms.GermaindiscussedthreemajorissuestoberesolvedforfurtherprogressintheimplementationoftheCairoagenda.Theyarespecificlimitationsandconstraints;sensitiveissuesandpolitical'8Ԁopposition.Shecalledforconsultations,partnerships,broadalliances,andinvestmentsinadvocacyskillsinordertobuildthestrategiccapacityofinterestedactors.Ms.Germainidentifiedlimitationsandconstraints,whichinclude(1)Humanresources,   particularlyskilledandproperlyequippedhealthprovidersatalllevelsofcareandcommittedpolicymakers,includingthepeoplewhodecideontheallocationofbudgetsandthecontentofprogrammes;(2)Institutionalcapacityfromtheprimaryhealthcarelevel L  totheparliamentandthecabinet;(3)Financialresources;(4)GapsinTechnologies, p8  specifically,inSTDs,includingHIV/AIDS.Thegapsincludebarriermethodsthatwomencancontrol,simpleandbetterdiagnostictherapiesfortheprimaryhealthcarelevelandaffordablesingledosetherapiesforthosewithcurableinfections;and(5)Lackof 4 consumerknowledge,whichlimitspeoplesabilitytoprotecttheirownhealth,particularly   thosepeoplewholackthestatustoexercisetheirownrightsintheircommunities,familiesorwiththeirpartners.Ms.GermainrecognizedthreeimportantsensitiveissuesintheCairoagreement.First,  thehealth,safetyandlivesofpregnantwomenrequirepoliticalwillandcommitmentby  governmentstoinvestinservicesandtechnologiesneededbywomenwishingtobecomepregnant,andtothepoliticaldynamicandargumentsconcerningaccesstosafeabortionforwomenwithunwantedpregnancies.Thisisaquintessentialwomenshealthissueresultingfromsexdiscriminationandmaledominance.Second,sexualityandgender l4 powerrelationships underlieconcernsaboutsexualandRHandarereflectedin X  inadequateservicesandinformation.Itisimportantforallwomenandmenbutisparticularlypertinenttoyoungpeople.Third,shenotedthatequalityandequityofwomen 8" andmenremainsafundamentalissueinmostsocieties. $# ThethirdchallengeishowtoorganizeandmobilizetoconfrontwellorganizedandwellfundedpoliticaloppositiontoICPDgoals.PoliticaloppositionalsoarisesintheformofbureaucraticlethargyorlackofinterestbypoliticiansfortheCairoagreements.Forpoliticiansconcernedwithreelectioninashortperiod,undertakingnewactivitiesinvolvesmorerisksthanbydoinglittle.Ms.Germainpointedoutthatthesechallengescanbemetbycreatingthepoliticalwilltomakehumanandfinancialresourcesavailableandovercomesensitivities.Shesuggestedabasicsetoforganizingprincipleswhichincludes:(1)Consultationofstakeholdersatalllevelsofsociety;(2)EqualpartnershipsbetweenNGOsandgovernments;governments H-'* donorsandNGOsthatensurestheirautonomyandaccountability,particularlyofNGOs;and(3)Buildingalliances,whichrequiresdevelopingconsensusandreachingcompromisesamonginterestgroups.Underlyingallthisistheneedtodevelopadvocacyskillsforbuildingastrategiccapacityofvariousinterestgroupstointeractwiththosewhocontrolbudgetsandpoliciesandfocusonlegislationthatneedstochange,monitoringandaccountability.Finally,Ms.Germaincalledforthedevelopmentofcoordinationtoworkacrossallministriesandsectorsincludingnotonlytheministryofhealthbuteducation,finance,labor,thecabinetlevelandcivilsocietyitself.  \$         . XXChapterIII : ProceedingsofPlenarySessionsandWorkingGroups#XXh#XX B  #XX#O  XX  Session1:PoliciesforSexualandReproductiveHealth    #XXx#l Chair: ` MoniqueEssedFernandes    Presenter:  ` Dr.DeanPhiri,Director,ReproductiveHealthUnit,Zambia     XX  DevelopingaSexualandReproductiveHealthPolicy:theCaseof   Zambia#XX#      Presenter:Dr.DeanPhiri,Director,ReproductiveHealthUnit,Zambia   ZambiaundertookamultisectoralanddecentralizedapproachinvolvingcivilsocietyinformulatinganewRHpolicywhichaddressedgenderissues,includingmaleinvolvement,andtheallocationofresourcesforimplementation.TheICPDandtheBeijingConferencemadethegovernmentawareoftheneedtobroadenfamilyplanningtoincludeRH.AninteragencyTechnicalCommitteeonPopulationwasformedtointegratepopulationissuesintheplanningandimplementationacrossallgovernmentministries,agenciesandNGOs.ThisperiodcoincidedwithhealthcarereforminitiatedbytheGovernment,whichincludedRHasoneofitsmajorcomponentsofprimaryhealthcare.̀ThedevelopmentofthenationalRHprogrammewasbasedonanextensiveneedsassessment.Surveyswereusedtodeterminepriorities.Theseincludedthedemographicandhealthsurveysof1992and1996,assessmentsofcontraceptiveneedsassessmentandtraditionalbirthattendants,asituationanalysisofRHservicesandamaleinvolvementstudy.Withtheinformationprovidedbytheneedsassessment,theMinistryofHealthdevelopedaRHpolicywhichincludedstandardsfortheprovisionofservicestobeutilizedbythedistrictsinplanningandimplementingtheirownhealthstrategies.Togainnationalconsensus,theMinistryofHealthhostedtwoworkshopswhichinvolvedhealthdistricts,NGOs,donoragencies,privateandindustrialinstitutionsandtraditionalpractitioners.Teamsthatworkedonspecificissuessuchassafemotherhood,adolescentsandSTDs,includingHIV/AIDS,providedinputstoamultidisciplinarygroupfromtheMinistryofHealth,NGOsandtheprivatesector,whichwereresponsibleforformulatingtheZambianϜRHpolicy.ThelawschoolincollaborationwithagenderdivisionintheGovernmentwasinvolvedindevelopingthehumanrightsframeworkoftheRHpolicy.eThesuccessofZambiainformulatinganRHpolicyemergedfromtheGovernmentsidentificationofneedsandtheinvolvementofstakeholdersinamultisectoralapproach,makingthepublicaware,includingmanagers,political,andlocalreligiousleadersatthedistrictlevel,andplacingRHatthecenterofhealthcarereform.  (-x(+  Discussion  8 ThediscussioncenteredontheconstraintsfacedwhendevelopingRHpolicies,thetypeofNGOsthatshouldbeinvolvedintheprocessandthenatureoftheparticipatoryprocess.Constraintsinthedevelopmentofpolicies   ParticipantsagreedthatsomeoftheconstraintsinthedevelopmentofRHpoliciesweretheoftenrigidstructuresofministriesandthelackofinterestandcommitmentofpoliticianswhowereinterestedinimplementingpolicieswithonlytemporaryeffectiveness.  Ensuringalongtermparticipatoryprocess H  Thequestionwasraisedonwhetheraparticipatorypolicymakingprocesshasservedasafoundationforcontinuedparticipationandcooperation.Theanswerwasaffirmative.ItwasnotedthattheconsultativeprocessresultedinanexpandedpartnershipwithgroupsthatwerenotpreviouslyinvolvedinRH.Throughthispartnershipthedivisionoflabourforimplementingthepolicywasestablished.Thegovernmentcontinues,furthermore,tocallonthevariouspartnersandstakeholdersastheirexpertiseandinputisneeded.  WhichNGOsshouldbeinvolved?  ItwaspointedoutthatgovernmentstendtoinvolveonlythoseNGOswhichtoethelineorinvolveNGOsasatokengesture.Thusorganizationswithoutpowertendtobeuninvolved.ThechallengeremainstoinvolvethoseNGOswhichreallyrepresentcommunityinterestsandneeds.̜  XX@ FindingsoftheWorkingGrouponPolicies p8 @. . forSexualandReproductiveHealth#XX#   L    A.  ProgresstowardimplementationoftheICPDProgrammeofAction  L  SectorwideprogressinpolicyformulationhasoccurredincountriessuchasZambia,BangladeshandSouthAfrica.Othercountrieshavebegunworkonspecificaspectsofpoliciesandimplementation.Inmanycountries,civilsocietyorganizationsexertconsiderableinfluenceonpolicydevelopment.Aneffectivewomen'smovement,othermassmovements,andNGOsareprovingfundamentaltoprogressinpolicydevelopmentandimplementationinplacessuchasBrazilandBangladesh. ̜  b   +H%( b B.  Majorconstraintsinthedevelopmentofsexualandreproductivehealth 8  policies `  $ PoliciesforRHandrightsareevolvingamidincreasingglobalpovertyandinequality,weakandunderfinancedsocialsectors(healthandeducation),persistentgenderinequality,andlimitedprogressintheinvolvementofcivilsocietyinpolicydevelopment.Constraintsinclude:c  c\"0    Inadequateknowledgeandunderstandingofreproductiverightsandhealthas  ` describedintheICPDProgrammeofAction.TheProgrammeandtheconceptsitdescribeshavenotbeendisseminatedwidelyandpublicly.Consequently,aspectsoftheRHandrightshavereceivedonlyhesitantsupport.c\w݌ (#(# Ќ  c  c"0    FundamentalistoppositiontoaspectsoftheICPDpersists.c2݌4 (#(# Ќ  c  c"0    Inmanycountries,lawssuchastheprohibitionofsexeducationinschoolsorof    adolescentsaccesstocontraceptiveshamperimplementationoftheProgrammeofAction.c݌ (#(# Ќ  WheregeneralsupportfortheICPDProgrammeofActionexists,policiesoftenlackahumanrightsapproachandcommitment.FullsupportisstilllackingforlegislationtoensurereproductiverightsandRHandgenderequityandequality.Policydevelopmentandimplementationarelimitedbyinadequateunderstandingofthestructuralandstrategicimplicationsofashiftfromverticalmaternalandchildhealth/familyplanningstructurestoarightsbasedsexualandRHstrategy.RHpolicyhastendedtobeshapedprimarilybyhealthsectororganizationsandprofessionals,totheexclusionofothersectorsanddisciplines.Thismeansnotenoughattentionisgiventothesocial,economicandpoliticaldimensionsofsexualhealthandreproductiverights.Similarly,littleattentionispaidtothepsychosocial,genderandemotionalaspectsofthehealthandwellbeingofindividuals.GovernmentsrestrictionsonNGOsandothercivilsocietyorganizationslimittheirfullparticipationinpolicydevelopmentandimplementation.Politicalinstabilityandthefrequentturnoverofcivilservantsunderminethecontinuityofpolicydevelopment,implementationandmonitoring.    @)#& &   C.  Actionsneeded   8 Political/Legislativelevel   Inhealthsectorreform,sexualandRHforallatthehighestachievablestandardofcare  mustbeensured,andthenecessaryresourcesshouldbemobilized.'8EnactandimplementlegislationrequiredtomeetthecommitmentsmadeinCairo,using   allnecessaryandappropriatemeans,suchasremovingrestrictivelaws.FinancegroupsthattranslatetheProgrammeofActionintolegislativeterms,thatlobby T  forProgrammeofActionimplementationandbuildpoliticalwill.Investintrainingparliamentarians,legislators,andmediaintheimportanceofthe P  ProgrammeofAction.Ministry/ExecutiveLevel   Continueandpromotereorientationofthehealthsystemtoensurethatpolicies,strategic  plans,andallaspectsofimplementationarerightsbased,coverthelifecycleandserveeveryone.Thisrequireschangingtheattitudesofpolicymakers,healthcareproviders,andusers/clientssothatthepublichealthsystemisopentocontributionsonthecontentanddeliveryofpublichealthservicesandinformationfromcivilsociety.ThehealthsystemmustbeopentoinnovationsfromothersectorsincludingcivilsocietyorganizationsandNGOs,enablingthesystemtoestablishpartnershipswithcivilsocietyorganizationsasameetingofequals. Promotesystemicstructuralreforminhealth󀄄infrastructure,humanresource L development,financingtoachievebothcoverageandquality.Realistically,changesinsystemswillhavetobeincrementalandphasedaccordingtoresourceavailability(organizationalcapacity,personnel,finances).Prioritiesforincrementalchangesandprojectstotestnewapproaches,mustbedeterminedbyaconsultativeprocessandbedesignedonthebasisofthelongertermstrategicplan.AkeyelementneededisinvestmentindevelopingmanagerialcapacityatalllevelstoimplementrightbasedRHpolicies.Thisrequiresnotonlytechnicaltrainingbutalsosensitizationtogenderissues,humanrights,andreductionofhierarchicalbarriers. Involvemiddlelevelmanagersatallstages,toensurecontinuityintheimplementationof &T # planningandpolicy. Engageallrelevantsectors,notonlyhealth,inpolicydevelopmentandimplementation. X) #&   L*$' &   CivilSocietyOrganizations 8   Providemoreresourcesforgroups,buildalliances,involvethemedia,undertake $ advocacy,promotepubliceducationtocreateafavorableenvironmentfortheICPDProgrammeofActionpolicydevelopmentandimplementation.Promotethe'8ԀdevelopmentanddisseminationofmaterialstoincreaseunderstandingoftheconceptsanddevelopstrategiestoimplementtheProgramme. Provideresourcestoinitiateinnovativeactivitiesthatdemonstratetogovernmentwhatcan  | bedonetoimplementtheProgrammeofAction. Investindevelopingthecapacityofgroupstoparticipateinpolicydevelopmentand H  implementation.Easetheiraccesstoinformation. t<   Ensurethatgroupsparticipateinmonitoringpolicyimplementation. L  &  Donorsandinternationalagencies ,  ЄDonorsandinternationalagenciesshouldmaketheirpoliciesandbudgetallocations  consistentwiththeICPDProgrammeofAction.',P  ̄Donorsandagenciesshouldsupportanationallydrivenpolicydevelopmentprocessand  implementation,keepinginmindtheimportanceofspecificnationalconditionsandthe  ultimateobjectiveofsustainablenationallyfinancedhealthservices.̄Encouragegovernmentstoconsultwithcivilsocietyinpolicydevelopmentand T implementation.  x@   XX  &  Session2:DesigningHighQualitySexualandReproductiveHealth X  Services > #XX #Ԁ l4  Chair:  Dr.AdepejuOlukoya t!<  Presenters:  Dr.SaumyaRamaRao,PopulationCouncil h"0     Dr.SharadIyengar,ActionResearchandTrainingforHealth,India    Dr.KhamaRogo,UniversityofNairobi,Kenya Panel: 0  Mr.MohammadNizamuddin,Director,TechnicalandPolicyDivision,UNFPA4%! (# (#     Ms.AdrienneGermain,InternationalWomensHealthCoalition,USA' XK   XX  c  P,&( c ImplementingandMonitoringFeasibleStandardsofCare 7  #XXD # 8 Dr.SaumyaRamaRao,PopulationCouncil L c Dr.RamaRaodefinedQualityofCare(QOC)as thewayclientsaretreatedbytheservicedeliverysystem.Thedefinitionfocusesontheprocessofservicedelivery,includingcommunicationandinformationsharing;criteriaforminimalstandardsforproceduresandexaminations;andwhetherclientsreceivetheserviceappropriatetotheirneeds.Withfindingsfromsituationanalyses,Dr.RamaRaoshowedthatevenwherearangeofcontraceptivemethods,water,informationmaterial,andtimewereavailable,QOCdoesnotnecessarilyresult.Clientsoftenreceiveonlylimitedinformationoncontraceptivemethods,andoften,serviceprovidersdonotwashtheirhandsbeforeundertakingexams.HerfindingsalsoillustratedthatwhereQOCisprovided,theoutcomeispositive.Greateruseracceptance,satisfactionandcontinuationofcontraceptiveuseareachievedwhenclientsreceivecomprehensiveinformationonmethods,theiruseandsideeffects.Thesefindingsindicatethatimprovementsinqualityandgreaterusersatisfactionandempowermentcanbeachievedwithexistingresources.TheinformationisparticularlyimportantbecausemuchofthepostCairodebatehascentered,directlyorindirectly,onthefeasibilityofofferingsexualandRHservicesamiddiminishingresources.Dr.RamaRaoidentifiedthemainconstraintstogoodQOCasperceptionsofirrelevanceandexpense;scepticismregardingoutcomes;andlackofspecifiedprocesses.WhilethepresentedstudiescontradictthevalidityofsomeoftheseperceptionsDr.RamaRaoidentifiedthefollowingactionstoovercometheremainingconstraints:developclearprotocolsforandtraininginhighqualityserviceprovision;institutionalizesupportivesupervisionandperformanceevaluation,whichwouldalsoincludetheperformanceofsupervisors;andconductstudiesforassessmentandtrainingdevelopment.  XX  SexualandReproductiveHealthandRights#XX#XX ! inIndiaSinceICPD#XXV#   0" Dr.SharadIyengar,ActionResearchandTrainingforHealth,India D#  ӀICPDgaveanimpetustoIndiastargetriddenfamilyplanningprogrammetomoveawayfromthepredominantlyclinicbasedpickandchooseapproach,whichinthelatenineteensixtiessawtheintroductionofdemographictargetsforcontraception.FollowingICPD,the TargetFreeApproachwasintroducedin1995.Itdiscardeddemographiccontraceptivegoalsandinstead,the1998 CommunityNeedsAssessmentapproachwasinstituted.Itprovidesforannualprimaryhealthcareplansbasedonneedsassessmentandencompassescontraception,maternalcare,immunization,tobepreparedlocallywiththeinvolvementofthecommunity.Identifiedconstraintsincludetheworkculture |,D&) ofhealthstaffnottraditionallyinvolvedinplanningorcalculatinglocalneeds.Thestafffoundworkingwithouttargetsdifficultandthereforelosttouchwithclients.Keyexperiencesfromtheprocessinclude:Indicators:TheCommunityNeedsAssessmentapproachintroducedamodified   managementinformationsystem(MIS)thatreflectsconcernforQOCandmanagementbytheserviceproviders.Duetotheworkculturementionedabove,thekeyfutureactionistodevelopmiddlelevelmanagement,leadership,andsupervisorycapabilitieswithintheadministrationandtocontinuetounderscorecommitmenttothenewsetofindicators.Privatesectorinvolvement:TheRHprogramcollaborateswithserviceprovidersofthe p8  NGO,private,andtraditionalsectors.QualityAssuranceMeasures:Institutionalqualityassuranceinthehealthsystem,including 4  theprivatesector,shouldbepursued,accordingtotheguidelinesdisseminatedbythecentralgovernment.Forthispurposeaselfregulationmechanismneedstobedeveloped.Simultaneously,communitygroupsshouldbeequippedwithsimpleindicatorsofQOCtoallowthemtoundertakesurveillance.Involvementofstatelegislaturesandparliament:Electedrepresentativeshavebeen  sensitizedtodemographicconcernsandnowneedtobesensitizedtotherightsandgenderdimensionsofRH.Akeyactionistoadvocateamonglegislatorsforrecentpolicychangestobetranslatedintoaction.  XX  &  ReducingMaternalMortality#XXI # <  X   Dr.KhamaRogo,UniversityofNairobi,Kenya  l4 h  Dr.RogostatedthatinlightofthelowGovernmentspendingonhealth,poorgeneral L infrastructureandpoorhealthinfrastructureinAfrica,maternalmortalityisclosely'Xt Ԁrelatedtopoverty.Delaysoccurinobtainingtheessentialobstetricservicesforcomplicationsofpregnancy.However,Dr.Rogoalsopointedoutalackofinitiativeinaddressingtherootcausesofmaternalmortality.Forinstance,consequencesofunsafeabortionaremanagedbuttheunderlyingreasonsforunwantedpregnanciesarenot.Keyactivitiesinreversingthistrendwereidentifiedas:Participation:Communityinvolvementtomakematernalmortalityacommonissueshould &t # beachievedthroughadvocacy,serviceandinformationprovision(includingaccesstoemergencyobstetriccare),andcommunitylevelfunding.PrivateandNGOsectorinvolvementshouldincludethemajorityofnurses,midwivesanddoctorswhodonotworkinthepublicsystemandtoenhancecompetition.Providersshouldbegearedtoproviderelevantservicesthroughnetworkingreferralsystems.Governmentsshouldformulateappropriatepoliciesandlaws,undertakerealhealthsectorreform,providesufficientfunding,andencourageintersectoralcollaboration.  -&* ЇProgramming:Processindicatorsshouldbereviewed.Dr.RogorecommendedtheUNICEF 8 indicators,whichdescribetheminimumacceptablenumberoffacilitiesandservicesperpopulation,andemergencyobstetricandbirthfacilitiesavailabletowomen.Marginalizedgroupslikeadolescentsshouldbeurgentlyaddressed.Thisgrouprepresents30percentofthepopulationandsuffersfromthreetofourtimeshigherthanaveragematernalmortality.Inmanycasestheyaredeniedservices.Dialoguewithprovidersisalsoanimportantissueanditshouldbeimproved.ProvidersarewelltrainedbuttheenvironmentisnotconduciveforprovidingQOC.Providershavetobeinvolvedindecisionstoprovidequalityservices.  XX  BroadeningConstellationofServiceswithinExistingSystems#XXY)#XX: p8  TheCaseofBangladesh#XX)# L)  L  Mr.MohammadNizamuddin,Director,TechnicalandPolicyDivision,UNFPA `   @ Ms.AdrienneGermain,InternationalWomensHealthCoalition,USA L  x)ImmediatelyfollowingtheICPD,theGovernmentofBangladesh,togetherwithadonorconsortiumandUNagencies,decidedtodevelopforthefirsttimeanationalhealthandpopulationsectorstrategy.ItwasagreedthattheICPDProgrammeofActionwouldbeusedasthecoresubstantiveframeworkandthatthedesignprocesswouldincludetheparticipationofrepresentativesofallstakeholdersateverystage.Agreatdealhasbeenlearnedfromthisexperienceonsuchmattersasthefollowing:̄  HowtodesignanapproachtoRHservicesreflectiveoftheICPDcommitment,while  takingintoaccountthehumanandinstitutionalconstraintsthecountryfaces.InthecaseofBangladesh,thenational(vertical)familyplanningprogrammehasa25yearhistoryofinvestmentandpoliticalsupport,andtheMinistryofHealthandFamilyWelfareisitselfdividedintotwowings.Thus,developingRHpolicyandprogrammesrequiresnotsimplyintegrationofhealthandfamilyplanningservices,butalsoreorganizationofbureaucraticstructuresatalllevels.Whatisthebestprocessforachievingthis?̄  WhichofthemanyelementsofsexualandRHcarecanthecurrenthuman 0" resourcesandinstitutionsdeliver?Whatexactstepsneedtobetaken,inwhatorder,tobuildthenecessaryhumanandinstitutionalcapacitytoprovidesexualandRHservices,monitorprogress,educatethepublic,developpartnershipwithNGOsandcivilsociety,andensureaccountability?̀  Whichservicesshouldhavepriorityintheallocationofscarceresources?Howcan '!$ allstakeholdersparticipateinthedecision-makingprocess?Whatareappropriatemeanstouseexistingresourcesmoreefficiently,andtogenerateincreasedresources,includingcollaborationwiththeprivatesector,costrecoverythroughfeesforservices,andpartnershipswithNGOs?Howcanasocialsafetynetbemaintainedtoensureaccessto servicesfortheverypoor,keepinginmind,especially,thefactthatwomenhaveless T,&) accesstocashthanmenandtheirhealthcareisoftenlessvaluedthanmensinBangladeshandothercountries. ̀  Whatarefeasibleandeffectivemeanstoimprovebothaccesstoservicesandthe  qualityofservices,especiallytechnicalqualityandclient-providerinteraction?̀  Oncethosesortsofquestionshavebeenaddressed,whatarefeasiblemeans,   throughaparticipatoryprocesstodesign,implementandmonitordetailedimplementationplans?TheBangladeshexperiencemakesclearthat"stakeholderparticipation"requiresinvestmentofbothtimeandmoneybyallactors.Thisinvestmentpaysoffinastrategyfirmlyrootedinrealityand"owned"byallthosewhoparticipate. &  Discussion     Clientperspectiveandempowerment  TheRoundTablepointedoutthattheQOCprovidedoftendependsonthesocioeconomicstatusandliteracyofclients.Groupssuchascommercialsexworkers' 6,unmarriedwomen,youth,andwomenseekingabortion(whereitisnotagainstthelaw)arevulnerabletohostiletreatmentfromprejudicedhealthcareproviders.TheimportanceofempoweringclientstodemandQOCbyraisingawarenessoftheirrightsandonQOCwasstressed.Informationtocreatesuchawarenessanddemandshouldbeprovidedoutsidetheservicedeliverysystem,forinstance,throughthemedia.Itwasnotedthatclientsarewillingtopayforservicestheyhavedemanded.Infact,thefirststopformanyclientsisthetraditionalhealer,whomtheywillinglypay.CompetitionshouldbeconsideredasameanstoimproveQOC.Ifthereisachoiceofservicedeliverypoints,clientscanusetheservicesthatbestliveuptotheclientsdemandforQOC. ! ProviderperspectiveTheneedtoassessthereasonsforserviceprovidersunderuseofresourcesillustrated $t! inDr.RamaRaospresentationwasstressed.Providersareoftendemoralizedbytheirworkingenvironmentandbystructurallyflawedpublichealthsystems.Infact,thesamepersonintheprivatesectorperformsmuchbetter.ProvidersshouldthereforenotbeconsideredtheenemybutessentialtoimprovingQOC. \($"% &  Training 4*#' ThePopulationCouncilisimplementingaprogrammeinwhichfamilyplanningprovidersandsupervisorsarebeingtrainedtoimproveQOC.Suchtrainingcreatesthecommitmenttosolveproblemsastheyarise.InSouthAfrica,apilotschemeis'4*<Ԁunderwayinwhich ,&* traininghealthworkersinhospitalsareinstructedtoprovidegreaterunderstandinginpostabortioncare.ThecurriculumwasdrawnupbyanNGO.SouthAfricahasalsoeffectivelyusedthetrainingmethodologyofHealthWorkersforChange,aprogrammethatenableshealthworkerstoselfidentifyproblemsinthecaretheyprovide.ThishashelpedtobuildmoralewhichwasmentionedseveraltimesasbeingatthecoreofimprovingQOC.MinimumstandardsinQOC  ` TheRoundTableparticipantsagreedthatthefamilyplanningQOCframeworkisgenerallyapplicabletoRH.Manytechniquesandskillsneededarethesame.Issuesofqualitysuchasconfidentiality,privacy,counsellingandinterpersonalrelations,remain.Thekeyquestionis,howtodefineminimumstandardsforQOC,andhowtoimproveQOCcontinuouslyasmoreresourcesbecomeavailable.ThedebatecenteredontheneedtointerpretinternationalQOCstandardsaccordingtolocalneedsandperceptions.Itwasunderlinedthatminimumstandardsshouldalsoapplytotheprivatesectorjustasspecialattentionshouldbegiventosettingminimumstandardsforunfamiliarornewservices,andforservicesprovidedinemergencysituations.TheRoundTableunderscoredthatQOCishumanrightsinaction.Ifclientsarenotprovidedwithsufficientinformationtomakefullyinformedchoicestheirhumanrightsareviolated.Thisisthecase,forinstance,withsterilizationclientsarenotmadeawareofthepermanenceoftheprocedure.  XX  FindingsoftheWorkingGrouponDesigning D  HighQualityReproductiveHealthProgrammes D  X  #XX#D#BD   A.  ProgresstowardimplementationoftheICPDProgrammeofAction E  X  SomeprogresssinceICPDhasoccurredinintegration,suchastheprovisionofmoreservicesatthefirstpointofcontactandintheestablishmentofreferralsystems.ThishasbeenachievedinprojectsconductedbyNGOs.Countrieshavealsomadeprogresswithinitiatives,oftenbegunbefore1994,forintegratingMCHandFPservices.SinceICPD,thefocushasbeentofurtherintegratetheseserviceswithSTD/HIV/AIDSprevention,screeningandtreatment.Integrationmay,however,onlyinvolvethatservicesareofferedatthesameservicedeliveryplacewhiledifferentproviderscontinuetoaddressindividualaspectsofRH.Manycountrieshaveadoptedthequalityofcarelanguageandhavefocusedonprovidingthedetermingfactorsforqualityofcare.Someprogresshasbeenmadeinexpandingcontraceptivechoice,andmanycountries(Bangladesh,somestatesofIndiaandMexico)areconcernedwithprovidinginformationandcounsellingandensuringinformedconsent @-'* andconfidentiality.NGOsareincreasinglyinvolvedindefiningandimplementingQOCandqualityassurancesystemsareinplaceinmanycountries.Takingnoteofthehealthsectorreforminmanycountries,thegrouppointedoutthatthisprocesscanbothbeafacilitatorandanimpedimenttocomprehensiveandintegratedsexualandreproductivehealthQOC.Theprocessmayfacilitateintegration,collaborationbetweensectors,anddecentralizationbuttherearetherisksthatsexualandRHdoesnotreceiveenoughpriorityintheprocessandthatthecapacitytomanagethenewsystemisnotpresentatthedecentralizedlevel.InintegratedandcomprehensiveRH,threeissueshaveemergedasglobalconcerns:meetingtheneedforfamilyplanning,ensuringmaternalhealth(includingreducingunsafeabortion)andreducinginfantmortality;andpreventingandtreatingSTDs,includingHIV/AIDS.   B.  ConstraintsindesigningqualityRHprogrammes M     Theverticalorganizationstructureofhealthcaresystemsconstitutesthemaininstitutionalbarriertoamoreintegratedapproach.Separatebudgetallocations,administrativestructuresandpersonnelpreventthecoordinationandintegrationservices.LackofpoliticalcommitmenttoimproveQOCenduresbecausechangeisseenastoocostly.Thegroupfoundthatimprovingthequalityofservicesrequiresnotonlyexpandedchoicesbutalsoinformationandcounsellingtotakeadvantagesofexpandedchoicesandstrictadherencetoatleastminimumtechnicalstandardsofcare.Studiesrevealthatimprovementsinserviceprovisioncanbemadeatreasonablecost.TechnologiesareseriouslyinadequateinSTDs,includingHIV/AIDS.Thefemalecondomisexpensive.Fewwomenhaveamethodthattheycanusetoprotectthemselvesandtheirpartners;simplerdiagnostictestsandsingledosetreatmentsarenotavailable.   C.  Actionsneeded 1Q  " MinistryLevel/ServiceDelivery $l! ЄIncreaseinvestmentinthemanagementofserviceprovision,including: %X" c  c-R"0    StructuralintegrationofRHservicesoratleastfunctionalintegration,including h'0!$ effectivereferralsystemsandtraininginsupervisionisrequiredtomoveverticalservicesandmanagementsystemstointegratedcomprehensivecare.c-RHR݌ (#(# Ќ  c  cS"0    Makethemostofexistingresourcestoprovidegoodservices,improveresources +$( toupgradestandardsofcareandperformcontinuingevaluations.Governmentsshouldestablishregulationsthatensurestandardsforhighqualityhealthservices.cSS݌,&*(#(# Ќ  c  cNU"0    ݀Trainingserviceproviderstoimprovetheirtechnicalskills,communicationsand $ supervision.Trainingshouldalsoprepareproviderstocommunicateclearlywithempathyandwithrespectforhumanrights,genderequality(includingviolenceagainstwomen)andtheprovisionofdignifiedcare.cNUiU݌ (#(# Ќ  c  cW"0    DevelopindicatorstomonitorQOCprovisionandtrainmanagersandsupervisors   inusingMISforQOCimprovement.cW,W݌ t(#(# Ќ  c  c/X"0     Institutionalizequalityassurancemeasures,towhichboththepublicandprivate L  sectorshouldbeheldaccountable.ThereisalsoaneedtodevelopandapplycommunitydrivenqualityassurancebyapplyingasimpleQOCframework.c/XMX݌d, (#(# Ќ  Donorsandinternationalagencies <  ЄInSTDandHIV/AIDS,increasedsubsidiesareneededtobroadenaccesstofemalecondoms.Investmentsareurgentlyrequiredforresearchanddevelopmentofmicrobicides,   simplediagnostictestsandsingledosetreatments.  ̄Developasystemformonitoringtheimplementationoftheparagraph8.25oftheICPDProgrammeofActionregardingsafeabortion.     XX  Session3:AccesstoRH/SH/FPServices [#XX[#  [Chair:  Dr.MawahebElMouehly   Presenter:   Ms.MariaIsabelPlata,ExecutiveDirector,PROFAMILIA,Colombia    XX  DiversifyingServiceProviders:TheParticipationofthePrivateSector h IncludingNGOsintheProvisionofServices#XX)]# ]  | H]  Ms.MariaIsabelPlata,ExecutiveDirector,PROFAMILIA,Colombia    :^ PROFAMILIA,afinanciallyselfsufficientNGOinColombia,providesmorethan60percent "p ofnationalfamilyplanningandlegalservicesspecializinginfamilylaw.Ms.PlatachartedtheprogressofPROFAMILIA,whichstarteddistributingcondoms30yearsago,tothecurrentorganization,whichhasa$28millionannualbudgetandmorethan1,000staffmembers.Mindfulofwomensautonomy,PROFAMILIAlaunchedalegalservicein1986whichexpandedintoanofficeforSexualandReproductiveRightsandGenderin1995.WhenPROFAMILIAstartedoperationsitmetoppositionfromthemedicalprofessionandtheCatholicChurch,butthegovernmentletPROFAMILIAconductitswork.TheprogrammegrewbymeetingpublicdemandwithhighqualityservicesandagrowingnumberofColombiansnowacceptfamilyplanning.Today,familyplanningisaconstitutionalrightandisapartofnewpublicandprivatehealthplans. ,&) ЇInitiallydonorsupportwascriticalforincreasingoutreach,butthroughitscostrecoveryprogramme,PROFAMILIAcannowsubsidizeservicesinpoorandremotecommunitiesandforteenagers.Costrecoveryhashelpedensurevoluntaryandinformedchoiceaswellasmaintainhighqualityofcare.Relianceoncostrecoverypreventsabuse: Wesleepbetterknowingpeoplehavetopayforatuballigationorvasectomy,Ms.Platasaid. Nooneisgoingtopayforsomethingtheydonotwant.Ms.PlataunderscoredtheimportanceofNGOsbeingpoliticallyindependentandconstantlycorrectingmistakes.WhilegovernmentsneversupportedPROFAMILIAthepoliticalindependencewasimportantforgovernmentsneverthelesstoallowittoconductitswork.ShealsostressedtheimportanceofMIStoimproveQOCtomeettheneedsofthecommunityisessential,especiallyinaprogramthatdependsoncostrecovery. Discussion 4   ThediscussionfocusedontherelationbetweenPROFAMILIAandthegovernment,andthesustainabilityofPROFAMILIA.&  NGOsandgovernment  ThelessonofthePROFAMILIAshowsthattheflexibilityofNGOsenablesthemtopromoteRHthroughtheirownserviceswithoutabsolvinggovernmentsoftheirresponsibilitytoprovideafull'fԀpackageofservices.PROFAMILIAshowedhowanNGOcancollaboratecloselywithagovernment.PROFAMILIAprovidesauniqueexampleofhowpublicfundscanbeusedforpayingforprivatesectorservices.Itsapplicabilityinallpoorcountriesisquestionable,however,becauseoftheabsenceofnationalhealthinsurance.Sustainability 8 Ms.PlatanotesthatlevelsofselfsufficiencycanbeduplicatedbyNGOsthathavesupportoftheinternationalcommunity.Selfsufficiencyrequirestheefficientmanagementoffinancesandplanning.InColombia,userfeesarefoundtoempowerclientstodemandbetterservices.Thiseffectwasnotedbyconferenceparticipantswithexperiencefromotherregions.Healthreformcancreatehealthycompetitionbetweenthepublic,privateandNGOsectors.OncefeesarestandardizedclientswillbeattractedtotheclinicwhichoffersthebestQOC.  &L #   XX  & `  FindingsoftheWorkingGrouponAccesstoRH/SH/FPServices#XXk# uk  8 k   A.  ProgresstowardimplementationoftheICPDProgrammeofAction bl 8  Education   InformationandtheconfidencetotakeactioninpersonalandinstitutionalrelationshipsareapreconditionforsexualandRH.NGOshavebeensuccessfulinbuildingtheknowledgebaseandconfidenceofwomen,menandadolescentstoclaimtheirsexualandreproductiverightsandpromotetheirsexualandRHincludingtheeffectiveuseofhealthservices.'` 8kInnovativemethodologiesandmaterialshavebeendevelopedtohelppeoplerealizetheirsexualandRHandrights.Theseincludedrama,massmediaandpeereducation.ServiceDelivery H  ThediversificationofserviceprovisionforselectedRHservicessuchasfamilyplanninghasimprovedaccessinsomecountries.Communitybaseddistributionprogrammesandsocialmarketingareproventobeeffectiveandcosteffective.   B.  ConstraintsinimprovingaccesstoRH/SH/FPServices Gp   Prevailingeconomicconditionsandtheresultingpoorhealthcareinfrastructurecontinuetoobstructaccesstoservices.Barrierstoserviceincludedistance,cost,ignoranceandthepoorattitudeofproviders.Theseparationofbasicprimaryhealthcareservicesplacesanexceptionalburdenonwomentomeettheirdiverseneedsandthoseoftheirchildren.Italsoleadstoduplicationofinfrastructural,management,informationandothersystems.MenoftencanpreventwomensaccesstosexualandRHcareandendangertheirhealthandlives.d  " d   C.  Actionsneeded sԀ  " Government/Legislative #  ЄEquityisapreconditiontoachievingtherighttohealth.Healthsectorreformsmustbe $! designedtoeasepeoplesaccesstoservices.Investmentsmustbemadetohealth %" financingsystemstosafeguardequityofaccess,whilefacilitatingtheuseofdiverseprovidersincludingNGOs,theprivateandthepublicsectors.  |(D"% &   Ministry/Executive 8 ЄBecausehealthservicescannotfunctionwithoutinfrastructure,governmentsmustmake $ apriorityofdevelopingandmaintainingservicessuchaswatersupply,power,sanitation,  roads,transport,andcommunications.Healthservicesshouldgiveprioritytowomenshealthneeds.'89uServiceproviders   Empoweringpeopletoupholdtheirsexualandreproductiverightsandhealthrequiresthat  t informationbeavailableandthatitberelevantandeasilyunderstandable.GovernmentsandNGOsshouldincreaseeffortstoevaluatetheeffectivenessofcommunicationstechniquesandmaterialsandsharethemwidely.Contentmustincludecommonhumanexperiencesuchassexualityandpowerrelationsbetweenmenandwomen,includingviolence.   XX  & x Session4:CreatingNecessaryConditionsforImplementingSexual    ЀandReproductiveHealthandRights (PartI) x#XXx#XX  4  #XXy#x     m    Chair:   m Dr.MawahebElMouehly 4  Presenters:   m Mr.JacksonChekweko,Reproductive,EducationandCommunity (      m  HealthProgramme(REACH),Uganda    0 m Ms.WandaNowicka,FederationforWomenandFamilyPlanning,Poland m (#m (#  Discussants:  m Ms.YlvaSormanNath,WomensForum,Sweden  Ѐ0 m Ms.AnikaRahman,CenterforReproductiveLawandPolicy,USAm (#m (# 'x   y  XX  FemaleGenitalMutilationinUganda#XX}#  }  t 6}  Mr.JacksonChekweko,Reproductive,EducationandCommunityHealth  Programme(REACH),Uganda t }Mr.ChekwekosetthesceneforthediscussiononviolencebydescribingtheREACHprogramme,auniqueUNFPAfundedprojectwhichhasgreatlyreducedFGMintheKapchorwaareaofUganda,oneof30Africancountrieswherethepracticetakesplace.FGMposesseverephysicalandpsychologicalrisks.Nonetheless,thedistrictresistedeffortsbygovernmentandNGOstoeradicatethepracticebecauseresentedwhatitsawasoutsideinterference.Atonepoint,KapchorwaDistricthadpassedalawrequiringthecircumcisionofallwomen.TheREACHprojectbeganin1995.Itinvolvedallowingpeopletodetermineandbringaboutchangeontheirown.REACHsucceededbyseparatingFGMfromtheculturalvaluesitwassupposedtosave,proposingalternativeactivitiestosustainthoseideals,andbyconsultingthecustodiansofcommunityethics.Theprocessofacceptanceinvolved ,\&) awarenessworkshopsandseminarsheldatalllevelsinthedistrictforallsectorsofthecommunity;peereducationbothatschoolandruralareas;extensionofRHservicesintegratedwithFGM;sensitizationthroughthetrainingofhealthworkers;participationinalleventsandfunctions;trainingofcircumciserstobeTBAs;andundertakingoperationalresearch.TheprojectfoundopportunitiestoenablefreediscussionofFGMespeciallyamongyoungmales,empoweringwomenthrougheducation,andestablishingaNGOlink.In1996FGMdroppedby36percent.AccordingtoMr.Chekweko,localcommunitiesshouldoccupyacentralpositionintheimplementationoftheprogramme,andgovernmentsinconsultationwithcommunitiesshoulddesignlawstoprotectwomenfromallformsofviolence.DiscussionsofFGMshouldbeincludedinschoolcurricula,girlchildeducationshouldbeencouragedandresearchthatissensitivetoculturebeundertaken.Thosewhoearntheirincomebyperformingthepracticemustbeshownalternativewaystosupportthemselves.Interagencycollaborationisneededatalllevelstodeliverthesamemessagetothecommunity.  XX  ViolenceAgainstWomen:theRoleoftheHealthandEducationSectors#XX# ~     WandaNowicka,FederationforWomenandFamilyPlanning,Poland   YMs.Nowickadescribedactsofgenderbasedviolenceduringthewomanslife.Beforegivingbirth,womensuffergenderbasedviolence,includingsexselectiveabortion,batteringduringpregnancyandcoercedpregnancy.Duringinfancy,violenceincludesfemaleinfanticide,emotionalandphysicalabuse,andtherelegationofinferiorfoodandmedicinetofemales.Genderbasedviolenceamongchildrenincludeschildmarriage,FGM,sexualabuseandchildprostitution.Inadolescence,girlsfacesexualabuseandharassment,forcedprostitutionandtrafficking.Duringwomensreproductivespan,theyfacemaritalrape,dowrydeaths,psychologicalandsexualabuse.Inaddition,theabuseofelderlywidowsisincreasing.Topreventviolencetowardswomen,Ms.Nowickarecommendedsexeducationthatpromotesgenderequality,humanrightsandtrainingforthepoliceandotherlawenforcementinstitutionssuchasthejudiciary.Healthcaresystemsshouldrecognizetheconsequencesofviolenceandaddressboththepreventionandtheconsequencesofviolence.Mostofall,providefullinformationtowomenandfacilitatetheiraccesstoreproductivehealthservicesincludingabortion(whereitisnotagainstthelaw)andfamilyplanning.Itisimportanttoincludecommunicationskillsandeducationonviolenceinthecurriculaofmedicalandnursingschools.Counselingandreferralsystemsshouldbedevelopedinthehealthcaresystemandhealthcareservicesshouldbeimprovedtoidentifyandtreatcasualtiesofviolence.Theissueofviolence,includingtheidentificationofchildabuse,shouldalsobeincludedinteacherstraining.Allthisshouldbesupplementedbytheprovisionofsheltersforvictimsofgenderbasedviolence.Finally,MsNowickaurgedenergeticeffortstopersuadethemediatoendtheirindifferencetogenderbasedviolence. -&*  Discussion Ms.YlvaSormanNathdiscussedherworkintryingtoeliminateFGMinSweden,whereitispracticedamongsomeSomalimigrants.SwedendevelopedguidelinesaboutFGMforhealthworkersandincorporatedtheseintowomensrightsworkandintoeducationandmaternalandchildhealthprograms.ThemediawaseducatedonFGMandcarriedresponsiblestoriesthatraisedawarenessamongSwedesandSomalis.TheFGMprojectinGothenburginvolvesSomalidoctors,menandreligiousleaders,nursesandschoolsindiscouragingFGM.Theseeffortshavesucceededincurbingthepractice,althoughsomeSomaliwomenstillfeelitisnecessarytokeeptheirdaughterseligibleformarriagebymakingthemundergoFGM.Ms.NathrecommendsusingSomaliprofessionals,encouragingreligiousleaderstoemphasizethatthepracticeisnotrequiredbyanyfaith,involvingSomalimentoseethedisadvantagesofFGMandeducatingthemediaontheissue.Humanrights  Genderbasedviolenceshouldbeseenasahumanrightsissue.Educationandtrainingofthehealth,educationandlawenforcementsectorsisessential.Strategiestopreventgenderbasedviolenceshouldencouragemaleparticipation.Communityapproach X Itwassuggestedthatanyprojectinitiallyreflectgenderbasedviolenceasaglobalproblemandthenfocusontheproblemsinthecommunity.Interagencycollaboration @ ItwasrecommendedthatthesuccessoftheWHO/UNICEF/UNFPAeffortinFGMshouldbebroadenedtogenderbasedviolence.Successfulprogrammesneedtobeanalyzedandbestpracticeresultsdisseminatedwidely.  " &   XX   Session5:CreatingNecessaryConditionsforImplementingSexual 8 andReproductiveHealthandRights(PartII) ?#XX# L 3Chair:  Dr.IsaiahNdong T   Presenters:   Ms.AnikaRahman,CenterforReproductiveLawandPolicy,USA H      Ms.BarbaraKlugman,WomensHealthProject,SouthAfrica  XX  ReproductiveHealthasaHumanRight:GenderEqualityandWomens   Empowerment#XX7# *  ( Ms.AnikaRahman,CenterforReproductiveLawandPolicy,USA <  VMs.RahmanreviewedthelegalfoundationforreproductiverightsintheUniversalDeclarationonHumanRightsandotherhumanrightsinstrumentsadoptedbytheinternationalcommunitysince' 8Ԁ1945.Therighttothehighestattainablestandardofhealth,andsexualandreproductiverights arebasedonUNconventions,signedbygovernments,   whichincludetheInternationalCovenantonEconomic,SocialandCivilRights,TheConventiononEliminationofAllFormsofDiscriminationAgainstWomen(CEDAW),andtheConventionontheRightsoftheChildandtheInternationalConventionagainstRacialDiscrimination.Theycanbeusedasinstrumentsofadvocacyandasframeworksforactivism.Therealizationsofreproductiverightscallsforthedisseminationofinformationaboutthoserights,establishingacultureofrightsineachcountry,anddevelopingindicatorsformonitoringtheirimplementation.Reproductiverightsincludereproductiveselfdetermination,whichinturnincluderightsexplicitlyguaranteedininternationalconventions:therighttodecidethenumberandspacingofchildren,therighttomarryandtohaveafamily,therighttofreedomfromtortureorothercruelordegradingformsoftreatmentorpunishment;therighttomodifycustomsthatdiscriminateagainstwomen,andtherighttofreedomfromsexualassaultandexploitation.Advocacymethodsusefulinadvancingreproductiverightsincludelobbyingforlegalandorpolicyreforms,institutinglegalproceedings;educatingpolicymakersandthepublic,buildingcoalitionsandglobalnetworks;andnegotiatingwithpublicinstitutions,includingdonors.Advocates,beforeembarkingonlobbyingorcourtactions,mustfirstexamineexistinglaws,especiallythosedealingwithsterilizationandabortion,andhowtheyareinterpretedorenforced,andconsiderwhetherthepublicisawareofthem.Whenfurtheractionisrequired,itisofteneasiertopushforchangesinpolicyratherthanlaws,becauseefforts toalterlawsinvolvemoretime. )"% &    XX  LegislatingandImplementingReproductiveRightsinSouthAfrica#XX# ԡ 8  Ms.BarbaraKlugman,WomensHealthProject,SouthAfrica L Ms.KlugmanreportedonthegainsmadeinlegislatingandimplementingreproductiverightsinSouthAfricasincetheendofapartheid.Thenewconstitutionprovidesforhealthcareandsexualandreproductiverights.SouthAfricarecentlyadoptedapopulationpolicyanditsparliamentpassedtheTerminationofPregnancyActin1997.'8SouthAfricaisuniqueamongcountriesdealingwithreproductiverightsissuesbecausetheAfricanNationalCongresswonthenationalelectiononahumanrightsplatform.Thereisalsoapowerfulmoralimperativetoenddiscrimination,includingthatagainstwomen,andtoendfamilyplanningforpopulationcontrolreasons.Theministerandgovernmentleadershiparecommittedtosexualandreproductivehealth.Theyfavortheinvolvementofcivilsocietyinpolicy,throughtheuseofgreenpapersanddraftwhitepapersforpublicscrutinyandpublichearings.Therealsoexistsoftboundariesbetweenpoliticians,governmentandpolicyactivity,whichcancreateopportunitiesfordiscussion.TheWomensHealthProjectidentifiedabortionasapublichealthissueduringthenumerousseminarsandmeetingsatalllevels.Itdevelopedastrategicadvocacyplanwhichincludedalliances,influencingpoliticiansandeducatingthemedia.TheProjectformedanalliancewithallgroupsinterestedinRH.Itthenpromotedapublicdiscussiononthepopulationpolicy,encouragedNGOsandmembersofthecivilsocietytorespondtothegovernmentsdraftWhitePaperonthepopulationpolicy,thusstrengtheningthedemocraticprocess.TobringpoliticianstosupporttheTerminationofPregnancyAct,theProjectcollaboratedwiththerenownedMedicalResearchCounciltoconductresearchanddisseminateitsfindingsonnumbersandcostofunsafeabortions.Twopublichearingswereorganizedonabortion:ontheissueitselfandonlegislation.TheProjectinvitedamaleblackdoctorwhoworkedintheruralareaandknewfirsthandtheresultsofbotchedillegalabortions.Younggirlswhohadundergoneillegalabortionsalsotestified.Thenewsmedia,uncommittedatfirst,wasgalvanizedintosupportinglegalabortionwhenagirlwhowasmadepregnantbyaCatholicpriesttestifiedthatthepriesthadencouragedhertohaveanabortion.TheexampleofSouthAfricaoffersvaluablelessons.Itisimportanttounderstandpoliticiansconcernsandtoconvincethemthattheirsupportforthedesiredchangewillhelptheircareersandconstituents.Forthispurposeresearchanddataunderscorethevalidityoftheproblemandthepotentialsolution.Thestrategicuseofthenewsmediatocreatepublicawarenessandpoliticalsupportisalsorecommended.Inaddition,itisusefultofindresearchtoanswertheperspectivesputbyopponents,whethercivilsocietylobbyistsorpoliticians.  ,,%) Themobilizationofmassorganizationsandtheinclusionofimportantmembersofthe publicwhospeakontheissuestrengthenadvocatescampaigns.Itisalsousefultopreparepotentiallegislation,andtopublicizeindividualtestimonies,remindingpoliticiansthatthequestionsathandaffecttheirconstituents.Becausethecivilserviceisinfluencedbyconcernsaboutthecostsofnewlegislation,andadvocatescanwintheirsupportbyshowingthecosteffectivenessofintervention,includingsocialcosts.Itisalsoimportanttoassessthecapacityandwillingnessofbureaucracytoimplementaconsultativeprocess. &  Discussion Opposition H  Indealingwithreligiousoppositionwithoutconfrontation,itwasnotedthatanalliancewasformedofprochoicereligiousleaderswhowereusedasspokespeoplewiththemedia.' ߰Alliances 0  TheSouthAfricanexampleshowedthatwhiletheconsultativeprocesswasdemocratic,adivisionoflabourwasestablished:urbanNGOsundertookpracticalcampaigningandlobbyingwhileruralNGOsofferedfirsthandtestimonytopublicopinion.TheAllianceofNGOsforRHandRRnowrunsasexualrightscampaignatalllevelstoensurethatthepolicyisimplemented.Maleinvolvement l TheneedformaleinvolvementinempoweringwomeniscrucialinSouthAfrica.Duringpeereducationprogrammes,couplesarenotonlygivencontraceptivesbutaredrawnintodiscussionsonpowerrelationships.Toinvolvemen,theleadershipmustbecommitted.NoministerinSouthAfricacanmakeaspeechwithoutmentioningHIV/AIDS,andmostMinistersaremen.Humanrightsandsexeducationinschoolsshouldaddressbothmenandwomen.Theissueofmalereproductiverightsprovokedagreatdealofdiscussionduringthissession,withsomeparticipantsarguingthatmenandwomenshouldhaveequalrights.Itwaspointedoutbyothers,however,thatoneofthepointsisthatwomenmustobtainandbeabletoexercisethereproductiverightsduetothemwhichhavetraditionallybeendeniedthem.Onlywhenwomencanfreelyexercisetheserightscanbothsexessaythattheyareenjoyingequalrights.Genderequityandnotonlygenderequalityshouldbeachieved.̀&  ̜  XX@ FindingsoftheWorkingGrouponCreatingNecessaryConditions#XX#   x'@!$    A.  ProgresstowardimplementingtheICPDProgrammeofAction Z  x)@#& SeveralcountrieshavedevelopedpoliciesbanningFGM,havefollowedupwith programmesandhavedevelopedlawsorpoliciesonsexualandgenderviolence,which'&x <,&) havereceivedfarmoreattentionsincetheICPD.Somecountrieshaveabolishedspousalconsentfortheprovisionofcontraceptiveservices. PioneeringprojectsarebeingdevelopedbyNGOsworkingwithyoungpeople,withthepoliceandhealthcareprovidersintrainingthejudiciarytodealwithviolenceagainstwomen.   B.  Constraintsincreatingnecessaryconditions    t Duetolackofpoliticalwillatthenationallevel,genderconcernsintheformulationandimplementationofpoliciesandprogrammesarenotarticulated.Thisisfurthercomplicatedbypoorfundingfornationalwomensorganizations.Also,thereisrelativelylittleoperationalandqualitativeresearchontheseissues.Thisfactcontributestoinconsistenciesbetweenpolicyframeworksandimplementationstrategies.Appropriateindicatorsformonitoringarelargelyabsent.Manysocial,culturalandreligiousattitudesandbeliefsstillputwomenschildbearingfunctionsbeforeotherroles,restrictwomensdecisionmakingintheprivateandthepublicdomain.Restrictiveattitudesalsolimitwomenseconomic,politicalandeducational,restricttheiraccesstoandcontroloflandandcreditaswellasinformationandknowledge,andexcludetheirviewsasimportantstakeholdersinpolicyformulation,planningandimplementation.Therestrictionsperpetuategendergaps,hindereffortstoempowerwomen,thwartstrategiestointegrateahumanrightsperspectiveandnullifylegalandrelatedinterventionstopromotegenderequality.Oneofthemostperniciousobstaclestogenderequalityandequityisgenderbasedviolence.Littleheadwayhasbeenmadeinaddressingviolenceagainstgirlsandwomenasahumanrightsandpublichealthissue.Sexualcoercion,abuseandviolenceremainspervasiveinthelivesofmanygirlsandwomen.   &  C.  Actionsneeded >  ! Political/Legislative/Ministrylevel #  ЄCreateanenablingenvironmentthroughparticipatoryprocessesatalllevelsofsociety $l! forwomensempowerment,maleinvolvementinpromotingsexualandreproductive'!KԀrightsinahumanrightsframework.Thisrequirestheadoptionofagenderperspectivethataccountsforthedifferentrealitiesandconstraintsthatconfrontmenandwomen.Programmesspecificallyforwomenareessentialmeansforaddressinggenderinequalitiesandinequities.̄Reviseandensuretherepealofrestrictiveandpunitivelawsandpoliciestoadvancethe +$( sexualandreproductivehealthandrightsofgirlsandwomen. ,&* ЄIntroducemechanismstoprovidehumanrightsbasedimplementationoftheICPD 8 ProgrammeofActionbyallactors(UNFPAandotherUNagencies,Governments,NGOs, $ civilsocietypartnersandhumanrightstreatybodies)whichareaccountable,transparent,andevaluatedonregularbasis,by:(a)increasingNGOinvolvementinstatepartiesimplementationtohumanrightstreatybodies;(b)establishinghumanrightscommissionsincountrieswhichaddresssexualandreproductiverights;and(c)promotinginvolvementofcivilsocietyinpreparationofshadowreportstohumanrighttreatybodies.̄Investmentsareneededtosupportmenscontributiontothesexualandreproductive  ` healthoftheirpartners,suchaspartnersaccesstoreproductivehealthcareandmens L  involvementinchildcare.Informationandservicesforboysandmenthemselvesneedtobeincreasedtoenablethemtotakeresponsibilityfortheirownreproductiveandsexualbehaviour(suchasinformationonandaccesstocontraceptivemethodsthatprovideprotectionagainstSTDs/HIV),takingresponsibilityforavoidingunwantedpregnancy.Theseinvestments,however,mustnotdetractprogrammesandservicesforwomen.̜     e   XX ConcludingRemarksbyMr.MohammadNizamuddin #XX#  Mr.Nizamuddin,afterthankingtheGovernmentofUgandaforhostingthemeetingandtheparticipantsfortheirvariedcontributions,notedseveralissuesthatweredebatedduringtheRoundTable.Someattentionneededtobegiventomensrolesandresponsibilityinreproductivehealthincludingsupportforpartnersaccesstoreproductivehealthcareaswellasinformationonandaccesstoservices.Concerningresources,Mr.Nizamuddinaddedthatmoreattentionneededtobeaddressedtoresourceshortages,andthatconcretesuggestionsforbothdevelopinganddevelopedcountrieswereneeded.Hehopedthattheresourcesituationwouldbecomeclearer,aswoulddataaboutresources,bynextyear,enablingUNFPAtoestablishtowhereitstoodfiveyearsafterCairo.XX @ ClosingRemarksbyMr.JothamMusinguzi #XX#Ԉ X  Mr.JothamMusinguzi,DirectorofthePopulationSecretariatoftheGovernmentofUganda,statedthatsinceICPDin1994,theUgandanGovernmenthadattemptedinnovativewaysofimplementingtheProgrammeofActionbyidentifyingareasofpriority,whichpreviouslyhadnotbeenadequatelyaddressed:adolescentneeds;womensempowerment,reproductivehealthandrights.Mr.MusinguziconcludedthattheGovernmentcouldpointtosomesuccessinitsefforts,andcouldpointtoachievementsintheempowermentofwomen,theinvolvementofmen,andrespectforhumanrights.AlthoughtheGovernmenthadtakenaction,Mr.Musinguziaddedthat ourbestisnotenough,andheassuredthechairmanofthefinalsessionthatUgandawouldtaketheReportontheRoundTablewithgreatseriousness.  (x  М    Annex1 z  XX  RegionalPerspectivesonProgressAchievedinEnsuringReproductive  RightsandinImplementingReproductiveHealthSinceICPD#XX#   AmongAsiancountries,theBangladeshinationalfamilyplanningprogrammehadfor   decadesmadegreatprogressinthepromotionofcontraception.Butbythemid1990s,thestatusofwomenshealthremainedlow.Halfthepopulationwasyoungerthan15,whichunderscoredtheneedtoensureopportunitiesforadolescentstodelaymarriageandreproduction.Furthermore,theriskofHIV/AIDSandSTDepidemicsloomed.ThebroaderRHframeworkthereforehadimmediaterelevanceandtheICPDrecommendationswerewidelydiscussedamongthegovernment,NGOsanddonors.ThepostICPDconsultationsresultedfromgovernmentinterest,vibrantNGOsandanunusuallypositiveatmosphereofdonorcooperation.BangladeshalsooffersauniqueexampleofNGOsengagedinconsortiumandofdonorsworkingtogethertowardsacommongoal.TheintentionofmovingtowardRHinthehealthsectorisreflectedinthe1997 HealthandPopulationSectorStrategy,whichaffirmstheprinciplesofICPDandrecognizestheneedforaclientcenteredapproachandforgoodservicedelivery.In1997,aNationalReproductiveHealthStrategywasformulatedwiththeinvolvementofNGOs,professionalgroupsandconsultants.Fourserviceareashavepriority:safemotherhood,familyplanning,menstrualregulationandcareofpostabortioncomplicationsandthemanagementofRTIs/STDs.Itisbasedonalifecycleapproach,inwhichwomenaretheobjectsofspecificservicesandpeoplearetreatedholistically.InAfricasincetheadoptionoftheICPDProgrammeofAction,headsofstatesinGhana, P Kenya,UgandaandSenegalhavemadepublicstatementsofsupportespeciallyforreproductivehealthingeneralorforspecificaspectssuchasbirthspacing,AIDS,orFGMandotherharmfultraditionalpractices,suchasexpectedearlychildbearingandfemalereligiousbondage.Althoughthesestatementshavenotbeenfollowedbyfurtherlegislativeprovisionsorothermeansofenforcement,theyhaveprovidedadefactovisaforaction ! especiallyforsexualandreproductivehealthandreproductiverights.Insomecountries,populationpoliciesadoptedbefore1994havebeenorareintheprocessofbeingrevisedinaccordancewiththeProgrammeofAction.PostICPDpopulationpolicieshavebeendevelopedinlinewiththeProgrammeofActioninGhana,Mauritania,Uganda,ChadandtheCentralAfricanRepublic.Othercountriesareintheprocessofmovingtowardsareproductivehealthapproach.LatinAmericanandtheCaribbeanisnoteworthyfortherelationshipestablishedinmany )8%( policiesbetweenreproductivehealthandprimaryhealthcareandthebroadercontextofsustainabledevelopment.TheGovernmentofPeru,forexample,approvedin1996thenewRHandFamilyPlanningProgramme,whichrecognizesabortionasapublichealthproblem, ,'+  proposesanemergencyplantoreducematernalmortalityandconsidersFPasastrategytoreducepoverty.InBrazil,aCommissiononPopulationandDevelopmentwascreatedafterICPDwithabroadparticipationofthecivilsociety.Reproductivehealthiscentraltoitsagendaamongotherdevelopmentissuesandin1997,theCongressapprovedaNationalFamilyPlanningLaw.Alltemporarycontraceptivemethodsarecoveredbythelaw,thatalsorecognizessterilizationasanacceptableprocedureforreimbursementbytheUnifiedHealthSystem.AmongArabStates,aMinistryofPopulationhasbeenestablishedinMorocco.IntheMOH,  ` theMCHdivisionhasbeenchangedtotheDivisiononReproductiveHealth,wherereproductivehealthisdefinedastakinganintegratedapproachtowomenshealth.Consequently,MCHandFParenowunderthesameroof,whilelinkagesarebeingstrengthenedtothedivisionresponsibleforSTD/AIDS.Populationcommissionshavebeenreactivatedatnationalandregionallevels.TheyinvolvevariousministriesandtheirregionaladministrationsintheplanningandimplementationofRHservicesandrelatedissuessuchasgirlseducation.InEasternEurope,countriesofferdifferentexperiences.TheRHapproachiswellreceived  inLatvia,whileinRussia,thereiswarinessbasedonthebeliefthatRHserviceswillfurtherdecreasethealreadynegativenaturalpopulationrate.ItisinterestingtonotethatthisconcerndiffersfromthatinAsia,wherepeoplefearthattheRHapproachwillincreasethefertilityrateduetotargetfreeFPprovision.Polandistheonlycountryintheworldwhichhasenactedamorerestrictiveabortionlawinrecentyears.  D  М  i Annex2   *y$4"(ddd Xdd Xdd Xe(#e(#y,dd"+    XXICPD+5: 8 ЀEXPERTROUNDTABLEMEETINGONENSURINGREPRODUCTIVERIGHTS,ANDIMPLEMENTINGSEXUALANDREPRODUCTIVEHEALTHPROGRAMMES,INCLUDINGWOMENSEMPOWERMENT,MALEINVOLVEMENTANDHUMANRIGHTS 8  #XX_#Kampala,Uganda2225June1998 $t   @'  Rz7RXXAgenda  #XX7RRz#Ԉ T  Sunday,21June1998  $t 17:0019:00 m  Registration.LobbyofNileInternationalHotel L  Day1 : Monday,22June $  @d d NileHotelInternationalConferenceCentre  @\\"CommitteeRoomB  9:009:15   m  WelcomeRemarks  p      m 0 Mr.EmmanuelTumusiimeMutebile PermanentSecretary, \ MinistryofFinance,PlanningandEconomicDevelopment(deliveredbyMs.NaomiKibaaju,PrincipalAssistantSecretary/FinanceandAdministration,MinistryofFinanceandEconomicPlanning)#d (# (#       m PurposeandOrganizationoftheRoundTable  $< !      m  MohammadNizamuddin,Director,     m  TechnicalandPolicyDivision,UNFPA  '#$  @  Chair:MoniqueEssedFernandes   *W4"*dddd"$4"(e(#e(#W,dd +      @UU+U@&U=XXBackground #XX=#Ԉ      9:1510:30  0 m  ICPD:FourYearsLater . RecentTrendsandChallengesinMeeting   ICPDGoalsinReproductiveRightsandReproductiveHealth  m (#m (#      m  Dr.NicholasDodd,Chief,TechnicalBranch     m  TechnicalandPolicyDivision,UNFPA&       m  Discussants : l      m  0  Ms.AdrienneGermaine,InternationalWomensHealthCoalition,andMs.KarenNewman,IPPF (#(#        m  Discussion'10:3011:00 m  CoffeeBreak 4     *W#4"+dddd 4"*e(#e(#W,xdd"+    @@   =XXSession1.PoliciesforSexualandReproductiveHealth#XX=݉#  H  D  11:0012:00  m  DevelopingaSexualandReproductiveHealthPolicy L"      m 0 Dr.DeanPhiri,Director,ReproductiveHealthUnit,Republicof 8# Zambia  (# (#      m    Discussion  %! *W4",ddxdd"#4"+e(#e(#W,xdd +   $  @)@&=XXOpening#XX=i#  |D  x @ 12:001:00   WelcomeAddress:  H      m Dr.NafisSadik,ExecutiveDirector,UNFPA  l 4     0 m VicePresidentofUganda,Dr.SpeciozaWandiraKazibwe ` (  (deliveredbyHonourableMr.SamKuteesa,MinisterofState,Ministry T ofFinanceandEconomicPlanning)@ m (#m (# ?JA?XX1:002:00   m Lunch   2:002:15   m PlenarySession.BriefingontheWorkingGroups   2:003:30   m WorkingGroups x@ 3:304:00   m CoffeeBreak 0 4:005:30   m WorkingGroups,continued  6:30     m Reception h  Day2:Tuesday,23June  X  @D D Chair:Dr.AdepejuOlukoya,WomensHealthOrganization*W4".ddxdd 4",e(#e(#W,xdd"+    @@  #XXA??J#=XXSession2.DesigningHighQualitySexualandReproductiveHealth   Services#XX=#   !  " 9:0010:30  Qualityofhealthservices $      0 m  Implementingandmonitoringfeasiblestandardsofcare %" (experiencesfromIndia,thePhilippinesandZambia) & #m (#m (#       m 0 Ms.SaumyaRamaRao,ThePopulationCouncil'!$ (# (#   0  0m  (# (# Discussion m (#m (#   *L$'      m Broadeningconstellationofserviceswithinexistingsystems.  8 0  0 (#(#0m  (# (#0 m (#m (#Panel: u Mr.M.Nizamuddin,andMs.AdrienneGermain$ (# (#      m Discussion10:3011:00 m Coffeebreak   &  11:001:30  Scopeofhealthservices  t      m ' `      m ExperiencesfromImprovingQualityofCareinIndia  L       m 0 Dr.SharadIyengar,ExecutiveDirector,ActionResearchandTrainingforHealth \$  (# (#      m Reducingmaternalmortality  4       m 0 Dr.KhamaRogo,UniversityofNairobi  (# (#      m  Discussion1:302:30   m Lunch  2:304:00   m WorkingGroups p     4:004:30   m CoffeeBreak H 4:305:300  0m  (# (#WorkingGroups,continuedX m (#m (#  & 8 Day3:Wednesday,24June 0 @" " Chair:Dr.MawahebElMouelhy,AVSCInternational    9:0010:30   m Genderbasedviolence !       m Femalegenitalmutilation #       m  0 Mr.JacksonChekweko,Reproductive,Educationand $l! CommunityHealthProgramme,Uganda %X" (# (# '8 0V    0 m &  Violenceagainstwomen:theroleofthehealthandeducationsectors. m (#m (#      m  0 Ms.WandaNowicka,FederationforWomenandFamily @)#& Planning,Poland'h' ,*#' (# (# 0  0 (#(#  (# (#      m Discussion ,%)  ,&* Ї10:3011:00 m  CoffeeBreak $ *W4"0ddxdd"4".e(#e(#W,xdd"+      @@=XXSession3.AccessibilitytoRH/SH/FPService  @,  @  @ #XX=K# ,   ,  11:001:00   KeyIssuesinimprovingaccesstosexualandreproductivehealth "          m  services:     m Ik  Ik 0   LinkingreproductivehealthinformationandservicesIk  ݌  (# (# Ќ       m Ik  Ik 0   Diversifyinghealthproviders:theparticipationofthe   privatesectorincludingNGOsandtheexpansionofsocialmarketing Ik  ݌p (# (# Ќ       m 0 Ms.MariaIsabelPlata,ExecutiveDirector,PROFAMILIA,Colombia  (# (#      m    Discussion@*1:002:00   m LunchConferenceCenterDiningRoom 0     0 m Videopresentationon ReproductiveHealthinRefugeeSituations  inEmergencyPlan--theIFRC/UNFPA/UNHCRproject m (#m (#      m  Dr.DanielPierotti,EmergencyReliefOperations,UNFPA/ERO2:004:00   m WorkingGroups   @*4:004:30   m Coffeebreak "X      m   Chair:KarenNewman,IPPF  h$0  4:306:300  0m  (# (#ReportfromWorkingGroups@& "m (#m (#   ,' # М8HDay4:Thursday,25June  @ Chair:KarenNewman   *W4"1ddxdd"4"0e(#e(#W,xdd"+   p   =XXSession4. CreatingNecessaryConditions forImplementingSexualand   ReproductiveHealthandRights    #XX=.#   8:3010:30  Legislationandregulations       0 m  Reproductivehealthasahumanright;genderequalityand   womens   u   empowerment  m (#m (#      m  &F&XXMs.AnikaRahman,CenterforReproductiveLawandPolicy,USA#XXF&&y# |       m  Legislatingandimplementingreproductiverights  4t      m  Ms.BarbaraKlugman,WomensHealthProject,SouthAfrica     m Discussion10:3011:00 m CoffeeBreak  11:001:00  PresentationofWorkingGroups1and4       m  1:002:00   m Lunch  2:004:00   m WorkingGroups X 4:004:30   m CoffeeBreak 0 p 5:00     0 m FinalPlenarySession:ActionsNeeded "Hm (#m (#      m  Chair:KarenNewman     m PresentationofReportsof4WorkingGroups     m ClosingRemarks     m 0 Mr.JothamMusinguzi,Director,PopulationSecretariat  (# (#      m  GovernmentofUganda     m 0 Mr.JamesKuriah,UNFPARepresentative,Uganda  (# (# 0     m  Mr.M.Nizamuddin,Director,TechnicalandPolicyDivision (#(#      m  UNFPA,NewYork  ,,l&) М88H  e Annex3   XX  RoundTableonReproductiveRightsandImplementationof  ReproductiveHealthProgrammes,includingwomensempowerment,maleinvolvementandhumanrights#XXL#   Kampala,Uganda,June2225,1998    LISTOFPARTICIPANTS    k(e(#e(#( AFRICA       Mr.AmadouLamineGueyePopulationAffairsOfficerUNEconomicCommissionforAfricaP.O.Box3005AddisAbaba, Ethiopia  `  Tel:    2511517200 T  Fax:    2511514416   @ Email:  gueyel@eca.org , Dr.PapeSyrDiagneDirectorCenterforAfricanFamilyStudiesBox60054Nairobi, Kenya  `  Tel:   f 2542448618 T Fax:   f 2542448621 @ Email: f psdiagne@cafs.org , Dr.KhamaRogoSeniorLecturerUniversityofNairobiP.O.Box19329Nairobi, Kenya  d Tel:    2542570254   X Fax:    2542562901   D Email:  rogo@formnet.com 0 Dr.AdepejuOlukoyaCoordinatorWomensHealthOrganization1IkoroduRd.,MarylandPMB21178Ikeja, Nigeria  d! Tel/Fax: f 23414937937 X"    f 23414962463Email: f whon@infoweb.abs.net 0$ Ms.BarbaraKlugmanDirectorWomensHealthProjectUniversityoftheWitwatersrandP.O.Bo1038Johannesburg2000, SouthAfrica  $* Tel:    27114899917/4899905 % + Fax:    27114899922 p&!, Email:  bklugman@wn.apc.org \'"-  H(#. Hon.SamKuteesaMinisterofStateMinistryofFinanceandEconomicPlanningKampala, Uganda  "2 Tel:25641242292 Fax:25641243116$4  Hon.RobertSsebunnyaMinisterofHealthBugandaGovernment    Mengo,BulangeP.O.Box7451Kampala, Uganda    Tel:    25641271820   Fax:    25641344169    | Email:  buganda@informa.com  h Mr.JothamMusinguziDirectorPopulationSecretariatMinistryofPlanningandEconomicDevelopmentKampala, Uganda     Tel:25641242292Fax:25641243116  | Mr.JacksonChekwekoProjectManagerReproductive,EducationandCommunityHealthProgramme Uganda    (  Tel/Fax.:  2564551190     Dr.DeanPhiriDirectorReproductiveHealthUnitMinistryofHealthP.O.Box30205Lusaka, Zambia    Tel/Fax: f 2601227513  (ee( ASIAANDPACIFIC   (Xe(#e(#(Dr.ZhangKainingDirectorYunnanReproductiveHealthAssociationKunmingMedicalCollegeKunming650031 China  T" Tel:    868715339612 H# Fax:    868715311542 4$ Email:  yrhra@km.col.com.cn  % Dr.SharadIyengarExecutiveSecretaryActionResearchandTrainingforHealth(ARTH)67,AdinathNagar,FatehpuraUdaipur331004 India  @+ Tel/Fax:  91-11-0294-561150 4, Ms.HildaSaeedShirkatGahF25ABlock9Clifton,Karachi Pakistan 75600 %p0 Tel:    9221570619/579211 &d 1 Fax:    92215832754 'P!2 Email:   sgah@sgah.khi.sdnpk.undp.org t(<"3 hilda@imajics.khi.sdnpk.undp.org `)(#4 Dr.JuniceLirzaD.MelgarExecutiveDirectorLIKHAAN   #6  Philippines  $7 Tel/Fax:  6324112151 %x8 Email:  likhaan@phil.gn.apc.org &d 9  8+%9  8+%9 Dr.WiputPhoolcharoenDirectorDivisionofAIDSDepartmentofCommunicableDiseaseControlMinistryofPublicHealth88/21Moo4,TivanontRoadAmphurMuangNonthaburi11000 Thailand   ` Tel:    66259184112 T  Fax:    6625918413 x@  Email:  wiput@health.moph.go.th d,   P   8  (Xee( LATINAMERICAANDCARIBBEAN  (  (Xe(#e(#(Ms.MarthaRosenbergPresidentForumforReproductiveRightsLasHeras4095BuenosAires1425 Argentina  d Tel:    5418049824 X Fax:    5418047722 |D Email:  foroddrr@abaconet.com.ar h0 Ms.AngelaMariaCaldeiraTeixeiradeFreitasSeniorProgramOfficerCEPIARuadoRussel,694/Apto.201RiodeJaneiro,RI22210010 Brazil  P Tel: J   550215586115 |D Fax: J   550212052136 h0 Email:  cepia@ax.apc.org T Ms.MariaIsabelPlataExecutiveDirectorPROFAMILIA Colombia  !" Tel:    5713383159/2872100 "# Fax:    5713383160/2875530 #$ Email:  profamil@colomsat.net.co $% Mr.JavierAlatorreProgramaUniversitariodeEstudiosdeGenero/UniversidadNacionalAutonomadeMexico(PUEG/UNAM)Copilco30012504Mexico,D.F.CopilcoUniversidadCP04360 Mexico  &T - Tel: J   526230020 'H!. Fax: J   526230019 l(4"/ Email:  jarico@servidor.unam.mx X) #0  0+$0  0+$0 Ms.MoniqueEssedFernandesCoordinatingDirectorFoundationProjektaTweedeRijweg4Paramaribo, Suriname    Tel:    597433802    Email:  projekta@sr.net   Ms.GraceTalmaChairmanFamilyPlanningAssociatioǹofTrinidadandTobago(FPATT)79OxfordStreetPortofSpain, TrinidadandTobago     Tel: J   8686234764    Fax: J   8686252256  |  Email:  gta@wow.net  h (Xee( ARABSTATES  x@  (Xe(#e(#(Dr.MawahebElMouehlyProgrammeOfficerAccesstovoluntaryandsafecontraception(AVSC)P.O.Box56,ManialElRodaCairo11553 Egypt   Tel:    2023555473  Fax:    2023629525  Mme.NouzhaSkalliDemocraticAssociationofMoroccanWomen30,RueSidiBelyont,Apt.54Casablanca, Morocco   Tel: J   2122267410  Fax: J   2122209992  Email:  bennis@casanet.net.ma  Dr.MohammadShaheenDirectorCenterforDevelopmentinPrimaryHealthCare   T" P.O.Box3523Ramallah, Palestine  ,$ Tel/Fax:  97229952767  %     97229981526Email:  cdphc@planet.edu !'  X' (Xee( EUROPE  #' (Xe(#e(#(Ms.LiseKaalundViceChairmanDanidaBoardMinistryofForeignAffairs2,AsiatiskPlads1448CopenhagenK Denmark  D* $. Tel:    4533921408 8+%/ Fax:    4533921421 $,%0 Dr.BeritAustvegNorwegianBoardofHealthP.O.Box8128Dep0032Oslo, Norway  l(4"4 Tel: J   4722249077 `)(#5 Fax: J   4722248868 L*$6 Email:+(#berit.austveg@helsetilsynet.dep. 8+%7 telemax.no $,%8 Ms.WandaNowickaFederationforWomenandFamilyPlanningUl.Rabsztynska801140Warsaw, Poland    Tel:    48226320882   Fax:    48226320882   Email:  polfedwo@waw.pdi.net  | Ms.YlvaSormanNathChiefofDivision,WomensForumStockholmQlaraManagementAB,Kungsgatan65S11122Stockholm, Sweden     Tel: J   468200800/6057009    Fax: J   4686049470/200380    Email:  ylvna@kvinnoforum.se  | (Xee( INTERNATIONALNGOs  T (Xe(#e(#(Ms.KarenNewmanPolicyUnit IPPF  <  RegentsCollegeInnerCircle,RegentsParkLondonNW14NS, UK   Tel:  441714877900/4877854  Fax:  441714877823/4877964  Email:  knewman@ippf.org  Mr.KodjoEfuAfricaRegionalDirector IPPF  <  MadisonInsuranceHouseP.O.Box30234Nairobi, Kenya   Tel: J   2542720280  Fax: J   2542714968  Email:  kodjo@ippfaro.org   Ms.PatriciaHepkerHindmarsh MarieStopesInternational/ `! ReproductiveHealthforRefugeeConsortium  H# 153157ClevelandStreetLondonW1P5PG, UK  `(% Tel:    441715747347 T& Fax:    441715747418 @ ' Email:patricia.hindmarsh@stopes.org.uk ,!( Dr.IsaiahNdongMedicalAssociate AVSCInternational  L* 79MadisonAve.NewYork,NY10016, USA  d,, Tel: J   2125618000 X - Fax: J   2127799439 D . Email:  indong@avsc.org 0 / Ms.AnikaRahmanDirectorInternationalProgram CenterforReproductiveLawand %2 Policy  & 3 120WallStreetNewYork,NY10005, USA  (d"5 Tel:    2125145534 )X#6 Fax:    2125145538 |*D$7 Email:  anika.rahman@crlp.org h+0%8 Ms.AdrienneGermainPresident InternationalWomensHealthCoalition  $: 24East21StreetNewYork,NY,10010, USA  & < Tel: J   2129798500 'x!= Fax: J   2129799009 (d"> Email:  agermain@iwhc.org )P#?  8  8 Ms.SaumyaRamaRaoProgrammeAssociateInternationalProgramme PopulationCouncil    OneDagHammarskjoldPlazaNewYork,NY10017, USA   | Tel:    2123390603  p Fax:    2127556052 \ Email:  sramarao@popcouncil.org H    (Xee( UNITEDNATIONSAGENCIESANDORGANIZATIONS  X  (Xe(#e(#(Ms.ArletteCampbellWhiteSeniorPopulationandReproductiveHealthSpecialist TheWorldBank    1818 HStreet,NWWashington,DC20433, USA   Tel:    2024733301  Fax:    2026760961 | Email:  awhite1@worldbank.org h Dr.MalikaLadjaliTSSAdviseronReproductiveHealth/FamilyPlanning WHO   Geneva, Switzerland   Tel: J   41227913355  Fax: J   41227910746  Email:  mladjali@who.ch | Ms.SreeGururajaSeniorAdviserGenderandDevelopment UNICEF  < NewYork, USA  0  Tel:    2128246671 $! Fax:    2128246486 "  Email:  sgururaja@unicef.org "! Ms.EllenBrennanChief,PopulationPolicySection UNPopulationDivision/DESA  P# NewYork, USA  D $ Tel: J   2129633227 8 % Fax: J   2129632147 $!& Email:  rennan@un.org "'  "( (Xee( OBSERVERS  $( (Xe(#e(#(Ms.CharlotteE.HordDeputyDirector,Policy IPAS  (L", 303EastMainStreetCarrboro,NC27510 USA  P+%/ Tel:    919-967-7052 D, &0 Fax: J   919-929-0258 &t 0 Email:  hordce@ipas.org '`!1 Dr.JoseDavidOrtizMariscalMedicalAdviser IPAS LatinAmerica  AmacuzacNo.1204,ColoniadelValleOriente,GarzaGarcia,NuevoLeonC.P.66250 Mexico    Tel:    5283469299   Fax:    5283568977   Email:  ortizm@intercable.net  p Dr.PierreHoupikianMedicalAttacheFrenchEmbassyP.O.Box7212Kampala, Uganda     Tel: J   25641342344/5    Fax: J   25641341252/348328   Email:  culturel@imul.com  | Ms.EuniceMathuJournalistParentsMagazineofKenya Kenya    D  Tel:    2542448804 8      2542441781/4Fax:    2542448806  Email:  kmathu@africaonline.co.ke  Ms.BarbaraBitangaroEditorTheNewVision Uganda  D  (Xee( UNFPA   (Xe(#e(#(Dr.NafisSadikExecutiveDirectorUNFPA220East42StreetNewYork,NY10017Tel:    2122975111 P  Fax:    2122974915 <! Mr.M.NizamuddinDirectorTechnicalandPolicyDivisionUNFPA,NYTel: J   2122975211 d,% Fax: J   2122974915  P& Dr.NicholasDoddChiefTechnicalBranch,TPDUNFPA,NYTel:    2122975221 $* Fax:    2122974915 %x+ Ms.MitraVasishtChiefExternalRelationsBranch,IERDUNFPA,NYTel: J   2122975016  $/ Fax: J   2125576416 %x0 Dr.LauraLaskiTechnicalOfficerTechnicalBranchUNFPA,NYTel:    2122975224 8+%4 Fax:    2122974915 $,%5 Ї 'P!5 Dr.LukaMonojaReproductiveHealthAdviserUNFPACST/EthiopiaP.O.Box871AAddisAbaba,EthiopiaTel:    2511511288   Fax:    2511517133   Email:  monoja@unfpa.org  t  8  L Dr.DanielPierottiUNFPA/ERO,GenevaEmergencyReliefOperationsTel: J   41229799314 H  Fax: J   41229799049 4  Email:  unfpaero@undp.org      Ms.SunetraPuriConsultant/GeneralRapporteur35AlbyfieldBickley,BromleyKentBR12HY,UKTel:    441814675645 l4 Fax:    441814678060 X  Email:  SpuriUK@aol.com D  Ms.MetteOstergaardJPOTechnicalBranchUNFPA,NYTel: J   2122975256 H Fax: J   2122974915 l4 Ms.VictoriaRectorSecretaryTechnicalBranch m    UNFPA,NY   ! Tel:    2122975258 " Fax:    2122974915 #   (Xee( MEDIARELATIONS  %X (Xe(#e(#(Mr.AbubakarDungusInformationOfficer,IERDUNFPA,NYTel:    2122975031 ,*#$ Fax:    2125576416 +$% Mr.WilliamRyanWriter/Editor,IERDUNFPA,NYTel: J   2122975279 ,*#( Fax: J   2125576416 +$) Mr.PeterMcCormickInformationAdvisorUNFPA,NYTel:    2122975240   u   Fax:    2125576416   # XG XXXS#