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ñEnsuring€Reproductive€Rights€and€ImplementingÐ € ˆ ÐSexual€and€Reproductive€Health€Programmes€€€€ÏIncluding€Womenððs€Empowerment,€MaleÏInvolvement€and€Human€Rightsà @ àÔ#†XøXèè¹%#Ôó óÐ $,  ÐÌÔ‡îŠÄîXXøÔÌÌÌÌÌÌÌÔ#†XøXîîŠÄ‹#ÔÔ‡R‰z7RXXøÔÌÌÌÌÌÌò òExpert€Round€Table€Meetingó óÔ#†XøX7RR‰zÔ#ÔÔ‡îŠÄîXXøÔÐ ø# ÐÔ#†XøXîîŠÄ<#ÔÔ‡¼Þ¼XXøÔòòKampala,€UgandaÐ D%L Ð22-25€June€1998óóÔ#†XøX¼¼Þ“#ÔÐ P&X ÐÌò òTechnical€and€Policy€Division,€UNFPAó óÐ  H(P  ÐñI ñÔ#† XøX X X¤G#ÔñI ñѰøÑѰøÑÑ  ÑÑ5€°PP5ÑÔ‡ôhÞôXXøÔÑ€¼ÑÓ  ÓÌÌUNFPA€also€currently€publishes€reports€in€the€following€series:€Evaluation€Reports,€Programme€Advisory€Notes,ÏTechnical€and€Policy€Papers€and€Technical€Reports.€ÌÌÔh)h)¸$pÀÔNote:€à0  àThe€views€and€opinions€expressed€in€this€report€are€those€of€experts€who€attended€the€Expert€RoundÐ h)¸$ ÐTable€Meeting€on€Ensuring€Reproductive€Rights€and€Implementing€Sexual€and€Reproductive€HealthÏProgrammes,€Including€Womenððs€Empowerment,€Male€Involvement€and€Human€Rights€and€do€notÏnecessarily€reflect€those€of€the€United€Nations€Population€Fund€(UNFPA).Ð #¨+ø&(#(# – #ÐѼÑÑ7€ ù %%dÔXXdì7ÑÑ  ÑÌÔ#†XøXôôhÞî#ÔÙÙØØÑÀ°ÑÑ5€øÀ5Ññf ññh ññp ñÖ€6ÿÿÖñp ññp ñÖ€BÿÿÖñp ññh ññh ñÖ€ÿÿÖñh ññf ññf ñÖ€ÿÿÖñf ññi ññj ññl ñÖ€DÿÿÖñl ññl ñÖ€-ÿÿÖñl ññj ññj ñÖ€&ÿÿÖñj ññi ññi ñÖ€!ÿÿÖñi ñà@¸¸&ìàò òòòÔ‡îŠÄîXXøÔà@@íí&ìàForewordó óÔ#†XøXîîŠÄ¡ #ÔóóˆÐ øÀ ÐÌÌThe€Round€Table€on€Ensuring€Reproductive€Rights€and€Implementing€Sexual€andÏReproductive€Health€Programmes,€including€womenððs€empowerment,€male€involvementÏand€human€rights,€is€the€second€in€a€series€of€meetings€and€consultations€on€major€issuesÏbeing€organized€by€UNFPA€to€assess€progress€since€the€ICPD€and€to€identify€priorities€forÏfurther€action.€ÌÌEach€session€in€the€meeting€was€expected€to€recommend›€further€actions€needed€toÏachieve€the€goals€of€the€ICPD.€The€conclusions€will€be€consolidated€in€a€backgroundÏreport€to€be€reviewed€by€œmore›€than€100€countries€meeting€at€the€œICPD+5€International›ÏForum€scheduled€for€February€1999€œin€the€Hague€and›€as€inputs€to€the€Secretary„GeneralððsÏreport€for€the€Special€Session€of€the€General€Assembly€in€June€1999.ÌÌSome€fifty€international€experts€on€reproductive€health€and€rights€from€all€regions€of€theÏworld€representing€regional€and€international€non„governmental€organizations,€governmentÏand€the€United€Nations€system,€participated€in€the€Round€Table.€€The€meeting€was€heldÏœin›€Kampala,€Uganda,€from€22€to€25€June€1998.ÌÌThis€Round€Table€was€hosted€by€the€Government€of€Uganda,€and€was€organized€by€theÏTechnical€and€Policy€œDivision›€of€the€United€Nations€Population€Fund,€in€collaboration€withÏthe€United€Nations€Population€Division.ÌœÌI€would€like€to€thank€Dr.€Laura€Laski,€who€was€responsible€for€organizing€the€meeting€andÏpreparing€this€report,€as€well€as€her€colleague,€Ms.€Mette€Ostergaard,€for€helping€inÏdeveloping€the€background€paper€prepared€for€the€meeting€and€this€report.€I€would€alsoÏlike€to€thank€Ms.€Sunetra€Puri,€general€rapporteur;€Mr.€Peter€McCormick,€who€edited€thisÏreport;€and€Ms.€Victoria€Rector,€who€helped€in€the€organization€of€the€meeting.ÌÌ̛̛̜̜à€¸¸8(#àMohammad›€NizamuddinˆÌœà€d d C(#àDirector›ˆÌœà€èè.(#àTechnical›€and€Policy€DivisionˆÌœà€„ „ F(#àUNFPAˆÌà€˜˜>(#àNovember€1998›ˆÌ̜Р ,Ø%) ÐÑ  Ñò òòòÔ‡îŠÄîXXøÔ€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€€Table›€œof›€œContentsÔ#†XøXîîŠÄÌ#Ôóóó ó›Ð 8 ÐÌœForewordà‚ø"ø"J(#.àiˆÐ H ÐÌAcronymsà‚”"”"I(#.$$àvi›ˆÐ  è ÐÓ€:ÓÓ  ÓÝ‚=VmÿÝÌÝ  ÝÝ‚=Vm÷Ýà0  àà ° àÝ  ÝExecutive€Summaryà‚#d"d"H(#.˜ ˜ (#(##àœvii›Ýƒ=Vm÷ÝŒˆÐ ø À ÐŒÝ  ÝÝ‚=VmÿÝÌÝ  ÝÝ‚=Vm¼Ýà0  àà ° àÝ  ÝIntroductionà‚#¸"¸"J(#.ÐÐ(#(##à1݃=Vm¼ØÝŒˆÐ Ð ˜ ÐŒÝ  ÝÝ‚=VmÿÝÌÝ  ÝÓ€ÓÝ‚=VmxÝà0  àà ° àÝ  ÝChapter€I:€Openingà‚#¸"¸"J(#.X X (#(##àœ3›Ýƒ=Vmx¦ÝŒˆÐ ¨p  ÐŒÝ  ÝÝ‚>!ùÿÝÝ  ÝÝ‚>!ùNÝà0  àà0` (#(#àà  àÝ  ÝRemarks€by€Dr.€Nafis€Sadik,€Executive€Director€of€UNFPAà‚#¸"¸"J(#.44F` (#` (##àœ3›Ýƒ>!ùNiÝŒˆÐ  Ò  ÐŒÝ  ÝÝ‚>!ùÿÝÝ  ÝÝ‚>!ùJÝà0  àà0` (#(#àà  àÝ  ÝRemarks€of€the€Vice„President€of€Uganda,€Dr.€Specioza€Wandira„Kazibweà‚#¸"¸"J(#.à à T` (#` (##àœ5›Ýƒ>!ùJeÝŒˆÐ l4  ÐŒÝ  ÝÝ‚>!ùÿÝÝ  ÝÝ‚>!ùTÝà0  àà0` (#(#àà  àÝ  ÝThe€ICPD+5€Processà‚#¸"¸"J(#.hh!` (#` (##à5݃>!ùToÝŒˆÐ Ζ  ÐŒÝ  ÝÝ‚=VmÿÝÌÝ  ÝÝ‚=Vm)Ýà0  àà ° àÝ  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àSession›€2:€Designing€Quality€Sexual€and€Reproductive€Health€Servicesà‚H"H"I(#.ÜÜSàœ16›ˆÐ 8 ÐÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚V'Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝImplementing€and€Monitoring€Feasible€Standards€of€Careà‚#H"H"I(#.PPJ¸ (#¸ (##àœ16›Ýƒ?›‚V'q'ÝŒˆÐ šb ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚f(Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝœSexual€and€Reproductive€Health€and€Rights€in›€Ýƒ?›‚f((݌Р¸ (#¸ (# ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚I)Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  Ýà ¸ àIndia€Since€ICPDà‚#H"H"I(#.´´)¸ (#¸ (##àœ17›Ýƒ?›‚I)d)ÝŒˆÐ ^ & ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚?*Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝReducing€Maternal€Mortalityà‚#H"H"I(#.00/¸ (#¸ (##àœ18›Ýƒ?›‚?*Z*ÝŒˆÐ À ˆ ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚4+Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝBroadening€Constellation€of€Services€within€Existing€Systems:€Ýƒ?›‚4+O+݌Р¸ (#¸ (# ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚&,Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  Ýà ¸ àThe€Case€of€Bangladeshà‚#H"H"I(#.``/¸ (#¸ (##àœ19›Ýƒ?›‚&,A,ÝŒˆÐ „L  ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚"-Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  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ÝSession€3:€Access€to€RH/SH/FP€Servicesà‚#H"H"I(#.hh5` (#` (##àœ23›Ýƒ>!ùi4„4ÝŒˆÐ ”\ ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚U5Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝDiversifying€œA›€of€the€Private€Sector€Ýƒ?›‚U5p5݌Р¸ (#¸ (# ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚06Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  Ýà ¸ àIncluding€NGOs€in€the€Provision€of€Servicesà‚#H"H"I(#.D¸ (#¸ (##àœ23›Ýƒ?›‚06K6ÝŒˆÐ X   ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚A7Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝFindings€of€the€Working€Group€on€Access€to€RH/SH/FP€Servicesà‚#H"H"I(#.ììP¸ (#¸ (##àœ25›Ýƒ?›‚A7\7ÝŒˆÐ º‚" ÐŒÝ  ÝÝ‚'ÅþÿÝÝ  ÝÝ‚'ÅþW8Ýà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà ¸ àÝ  ÝA.€à  àProgress€toward€implementation€of€the€Ýƒ'ÅþW8r8ÝŒÐä$(#(# ÐŒÝ  ÝÝ‚'ÅþÿÝÝ  ÝÝ‚'Åþ\9Ýà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà ¸ àÝ  Ýà  àà h àICPD€Programme€of€Actionà‚#H"H"I(#.ÐÐ;(#(##àœ25›Ýƒ'Åþ\9w9ÝŒˆÐ ~ F& ÐŒÝ  ÝÝ‚'ÅþÿÝÝ  ÝÝ‚'Åþz:Ýà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà ¸ àÝ  ÝB.€à  àConstraints€in€improving€access€to€RH/SH/FP€Servicesà‚#H"H"I(#.$!$!R(#(##àœ25›Ýƒ'Åþz:•:ÝŒˆÐ à!¨( ÐŒÝ  ÝÝ‚'ÅþÿÝÝ  ÝÝ‚'Åþ«;Ýà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà ¸ àÝ  ÝC.€à  àActions€neededà‚#H"H"I(#.||,(#(##àœ26›Ýƒ'Åþ«;Æ;ÝŒˆÐ B# * ÐŒÝ  ÝÝ‚>!ùÿÝÝ  ÝÝ‚>!ù¶<Ýà0  àà0` (#(#àà  àÝ  ÝSession€4:€€Creating€Necessary€Conditions€for€Implementing€Sexual€and€Ýƒ>!ù¶<Ñ<݌Р` (#` (# ÐŒÝ  ÝÝ‚>!ùÿÝÝ  ÝÝ‚>!ùœ=Ýà0  àà0` (#(#àà  àÝ  Ýà ` àReproductive€Health€and€Rights€(Part€I)à‚#H"H"I(#.  ;` (#` (##àœ26›Ýƒ>!ùœ=·=ÝŒˆÐ &Î. ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚•>Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝFemale€Genital€Mutilation€in€Ugandaà‚#H"H"I(#.$$7¸ (#¸ (##àœ26›Ýƒ?›‚•>°>ÝŒˆÐ h'0!0 ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚’?Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝViolence€Against€Women:€the€Role€of€the€Health€Ýƒ?›‚’?­?݌Р¸ (#¸ (# ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚u@Ýà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  Ýà ¸ àand€Education€œSectors›à‚#H"H"I(#.  .¸ (#¸ (##àœ27›Ýƒ?›‚u@@ÝŒˆÐ  ,*ô#4 ÐŒÝ  Ýœà  àSession›€5:€€Creating€Necessary€Conditions€for€Implementing€Sexual€and€Ìà  àà ` àReproductive€Health€and€Rights€(Part€II)à‚H"H"I(#.XX<àœ29ˆÐ šb Ðà  àà ` àReproductive›€Health€as€a€Human€Right:€Gender€Equality€ÌÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚‹BÝà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  Ýà ¸ àand€Womenððs€Empowermentà‚#H"H"I(#.¼¼0¸ (#¸ (##àœ29›Ýƒ?›‚‹B¦BÝŒˆÐ ^ & ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚‹CÝà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝLegislating€and€Implementing€Reproductive€Rights€in€South€Africaà‚#H"H"I(#.D D T¸ (#¸ (##àœ30›Ýƒ?›‚‹C¦CÝŒˆÐ À ˆ ÐŒÝ  ÝÝ‚?›‚ÿÝÝ  ÝÝ‚?›‚¥DÝà0  àà0` (#(#àà0¸ ` (#` (#àà ` àÝ  ÝFindings€of€the€Working€Group€on€Creating€Necessary€Conditionsà‚#H"H"I(#.L L R¸ (#¸ (##àœ32›Ýƒ?›‚¥DÀDÝŒˆÐ " ê  ÐŒÝ  ÝÝ‚'ÅþÿÝÝ  ÝÝ‚'Åþ½EÝà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà ¸ àÝ  ÝA.€à  àProgress€œtoward€implementation€of›€the€Ýƒ'Åþ½EØE݌ЄL (#(# ÐŒÝ  ÝÝ‚'ÅþÿÝÝ  ÝÝ‚'ÅþÄFÝà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà ¸ àÝ  Ýà  àà h àICPD€Programme€of€Actionà‚#H"H"I(#.ÐÐ;(#(##àœ32›Ýƒ'ÅþÄFßFÝŒˆÐ æ®  ÐŒÝ  ÝÝ‚'ÅþÿÝÝ  ÝÝ‚'ÅþâGÝà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà ¸ àÝ  ÝB.€à  àConstraints€in€creating€necessary€conditionsà‚#H"H"I(#.€€J(#(##àœ32›Ýƒ'ÅþâGýGÝŒˆÐ H  ÐŒÝ  ÝÝ‚'ÅþÿÝÝ  ÝÝ‚'Åþ IÝà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà ¸ àÝ  ÝC.€à  àActions€neededà‚#H"H"I(#.||,(#(##àœ32›Ýƒ'Åþ I&IÝŒˆÐ ªr  ÐŒÝ  ÝœConcluding›€Remarks€by€Mr.€œMohammad›€Nizamuddinà‚H"H"I(#.7àœ34›ˆÐ  Ô  МClosing›€Remarks€by€Mr.€Jotham€Musinguzi.à‚H"H"I(#.ÌÌ2àœ34›ˆÐ n6 МÌAnnexes:›Ìà  àRegional€Perspectives€on€Progress€Achieved€in€Ensuring€ReproductiveÌà  àà ` àRights€and€in€Implementing€Reproductive€HealthÌà  àà ` àSince€ICPDà‚H"H"I(#.l l àœ35›ˆÐ X   Ðà  àAgendaà‚H"H"I(#.¼ ¼ àœ37›ˆÐ º‚" Ðà0  àList€of€Participantsà‚#H"H"I(#.| | #(#(##àœ43›ˆÐ ä$ ÐÓ ëÓÐ  ~ F& Мò òÓ  ÓÔ‡îŠÄîXXøÔòòAcronymsó ó›óóÔ#†XøXîîŠÄ®L#ÔÐ 8 ÐÓ¢LÓÌAIDSà  àà ` àAcquired€immunodeficiency€syndromeÐ P  ÐCEDAWà ` àCommittee€on€the€Elimination€of€Discrimination€Against€WomenÐ ² z ÐFGMà  àà ` àFemale€genital€mutilationÐ  Ü ÐFPà  àà ` àFamily€planningÐ v >  ÐHIVà  àà ` àHuman€immunodeficiency€virusÐ Ø   ÐICPDà  àà ` àInternational€Conference€on€Population€and€DevelopmentÐ :  ÐIPPFà  àà ` àInternational€Planned€Parenthood€FederationÐ œd  ÐMCHà  àà ` àMaternal€Child€HealthÐ þÆ  ÐMISà  àà ` àManagement€information€systemÐ `( ÐMOHà  àà ` àMinistry€of€HealthРŠ ÐNGOsà ` àœNon„governmental›€organizationsÐ $ì ÐQOCà  àà ` àQuality€of€careÐ †N ÐREACHà ` àReproductive,€Education€and€Community€Health€programmeÐ è° ÐRHà  àà ` àReproductive€healthÐ J ÐRTIsà  àà ` àReproductive€tract€infectionsÐ ¬t  МSHà  àà ` àSexual€healthÐ Ö" ÐSTDs›à  àà ` àSexually€transmitted€diseasesÐ p8$ ÐTBAà  àà ` àTraditional€birth€attendantÐ Ò š& МUNAIDS›à ` àThe€Joint€United€Nations€Programme€on€HIV/AIDSÐ 4"ü( ÐUNDPà ` àœUnited›€Nations€Development€ProgrammeÐ –#^* ÐUNFPAà ` àUnited€Nations€Population€FundÐ ø$À, ÐUNICEFà ` àUnited€Nations€Childrenððs€FundÐ Z&" . ÐWHOà  àà ` àWorld€Health€OrganizationÐ ¼'„!0 МÌÐ  €*H$4 ÐÑ  Ñò òÔ‡¼Þ¼XXøÔÔ  ÔÓ€ÓÑ s Ñà@ZZ"ìàòòÔ#†XøX¼¼Þ+T#ÔÔ‡îŠÄîXXøÔExecutive›€œSummaryÔ#†XøXîîŠÄ®T#ÔóóÔ JTÔó ó›ˆÐ 8 М̛ÌThe€aims€of€the€Kampala€Round€Table€were€to€identify€strategies€that€have€emerged€sinceÏthe€œInternational€Conference€on€Population€and€Development€(ICPD)›€in€ensuringÏreproductive€rights€and€in€making€sexual€and€reproductive€health€programmes€operational;Ïto€identify€successes€and€constraints€in€policy,€legal,€administrative,€managerial,€strategicÏand€financial€aspects;€and€to€agree€on€actions€needed€to€accelerate€progress€towardsÏachieving€the€goals€of€the€ICPD.€ÌÌThe€Round€Table€recognized€that€sector„wide€progress€in€policy€formulation€has€occurredÏin€several€countries,€while€work€to€improve€specific€aspects€of€policies€and€ofÏimplementation€has€started€in€others.€Where€there€is€political€commitment€to€the€principlesÏof€sexual€and€reproductive€health€and€rights€and€gender€equality€and€empowerment€ofÏwomen,€progress€is€occurring€in€collaboration€between€governments€and€civil€society.€ÏEffective€and€empowered€womenððs€movements,€other€mass€movements€and€œnon„¼governmental€organization€(NGOs)›€are€proving€vital€to€ensuring€progress€in€policyÏdevelopment€and€implementation€in€areas€such€as€the€establishment€of€greaterÏunderstanding€and€will€for€developing€rights„based€policies.ÔUKUS.,ÔÌÔUS.,UK.,ãYÔÌWhile€various€elements€of€reproductive€health€care€are€available€in€many€countries,€theÏimplementation€of€comprehensive€integrated€services€has€advanced€slowly.€TraditionallyÏvertical€administrative€structures,€compartmentalized€budgets€and€personnel€preventÏintersectoral€collaboration€and€coordination€among€ministries€in€numerous€countries.€ÌÌWithin€integrated€and€comprehensive€reproductive€health,€three€central€issues€haveÏemerged€as€global€concerns€that€have€not€received€universal€and€balanced€investment:Ïmeeting€the€need€for€family€planning;€ensuring€maternal€health€(including€the€reduction€ofÏunsafe€œabortion);›€and€reducing€infant€mortality€and€morbidity;€and€preventing€and€treatingÏsexually„transmitted€diseases€(œSTDs›),€including€HIV/AIDS.€Although€much€remains€to€beÏdone€in€these€areas,€the€central€commitment€is€to€reduce€verticality€of€programmes€andÏintegrate€all€aspects€of€reproductive€health€in€the€context€of€primary€health€care€and€healthÏsector€reform.ÌÌTechnologies€are€seriously€inadequate€in€STDs,€including€HIV/AIDS.€€Few€women€canÏprotect€themselves€and€their€partners.€€Although€the€female€condom€exists€and€isÏbeginning€to€be€made€available,€simpler€diagnostic€tests€and€single€dose€treatmentsÏremain€unavailable.€ÌÌThe€challenge€of€Cairo€continues€to€be€the€integration€of€or€better€collaboration€betweenÏdifferent€institutional€structures,€transformation€of€existing€facilities,€improvement€of€logisticÏsystems€and€training€to€ensure€appropriate€and€effective€care.€The€means€to€meet€theÏchallenge€involve€the€structural€and€strategic€reorientation€of€health€systems€andÐ (-ð&* Ðfinancing.€Integration€is€not€just€a€matter€of€adding€services€to€family€planningÏprogrammes.€Another€challenge€is€to€overcome€social€barriers€to€access,€including€menððsÏunderstanding€of€their€roles€and€responsibilities€of€womenððs€health.ÌÌThe€Round€Table€experts€reached€consensus€on€the€following€actions€needed:ÌÌ„€In€òòhealth€sector€reformóó,€emphasis€must€be€given€to€ensuring€sexual€and€reproductiveÐ À ˆ Ðhealth€for€all€people€at€the€highest€achievable€standard€of€care,€and€to€mobilizing€theÏnecessary€resources.€òòEquityóó€is€a€necessary€prerequisite€to€achieving€the€right€to€health.€Ð ˜ ` ÐÌ„€òòContinue€and€promote€the€reorientation€of€the€health€systemóó€to€ensure€that€sexual€andÐ p8  Ðreproductive€health€policies,€strategic€plans€and€all€aspects€of€implementation€are€rights„¼based,€cover€the€life€cycle€and€serve€all.€This€requires€that€the€public€health€system€beÏopen€to€inputs€from€civil€society€in€the€content€and€delivery€of€services€and€information.ÏThe€public€health€system€should€make€partnerships€with€civil€society€in€the€spirit€ofÏcollaboration€with€equals.ÌÌ„€òòContinue€and€promote€health€system€structural€reformóó€involving€infrastructure,€humanÐ ä¬ Ðresource€development,€financing,€to€achieve€both€coverage€and€quality.€Changes€inÏsystems€will€have€to€be€incremental€and€phased€according€to€resource€availability.€TheyÏshould€also€be€determined€by€a€participatory€consultative€process€and€designed€on€theÏbasis€of€the€longer€term€strategic€plan.ÌÌ„€Increased€investments€should€be€made€in€òòmanagementóó€of€service€provision€including:Ð l4 ÐÌÝ‚cÿÝÝ  ÝÝ‚còfÝð"ðà0  àÝ  ÝòòStructural€integration€of€reproductive€health€servicesóó€or€functional€integration,Ð D  Ðincluding€effective€referral€systems€and€training€in€supervision.݃còf g݌Р(#(# ÐŒÝ  ÝÌÝ‚cÿÝÝ  ÝÝ‚c$hÝð"ðà0  àÝ  ÝòòMaximized€use€of€existing€resourcesóó€to€provide€high€quality€services,€increaseÐ  Ð Ðresources€to€upgrade€standards€of€care€and€perform€continuing€evaluation.ÏGovernments€should€establish€regulations€and€quality€assurance€mechanisms€thatÏensure€standards€for€high€quality€health€services€for€the€public€and€private€œsectors.›Ýƒc$h?h݌Р(#(# ÐŒÝ  ÝÌÝ‚cÿÝÝ  ÝÝ‚cjÝð"ðà0  àÝ  ÝòòTrainingóó€service€providers€to€improve€their€technical€skills,€interpersonalÐ ¤$l! Ðcommunications€and€supportive€supervision.€Training€should€also€prepare€providersÏto€communicate€clearly€with€empathy€and€with€respect€for€human€rights,€genderÏequality€(including€violence€against€women)€and€dignity€and€to€provide€dignifiedÏcare.òò݃cjjÝŒÐT("%(#(# ÐŒÝ  ÝÌóó„€òòProvide€more€resources€for€groups€to€network:óó€build€alliances,€involve€the€media,Ð ,*ô#' Ðundertake€advocacy,€promote€public€education€to€create€a€favorable€environment€for€theÏâ âICPD€Programme€of€Action€policy€development€and€implementation;€develop€the€capacityÐ ,Ì%) Ðof€groups€to€participate€in€policy€development€and€implementation;€and€ensure€that€groupsÏcan€help€in€monitoring€policy€implementation.Ìâ âÌ„€òòEmpower€peopleóó€to€uphold€their€sexual€and€reproductive€rights€and€health.€InformationÐ üÄ Ðprovided€should€be€relevant€and€easily€understandable.€Content€must€include€commonÏhuman€experience€such€as€sexuality€and€power€relations€between€men€and€women,Ïincluding€violence.̀̄€òòCreate€an€enabling€environment€through€participatory€processesóó€at€all€levels€of€societyÐ ˜ ` Ðfor€womenððs€empowerment€and€male€involvement€in€promoting€sexual€and€reproductiveÏrights€in€a€human€rights€framework.€This€requires€the€adoption€of€a€gender€perspective€thatÏaccounts€for€the€different€realities€and€constraints€œwhich›€women€and€men€face€in€theirÏlives.€€Programmes€for€women€are€an€initial€and€essential€means€through€which€genderÏinequalities€and€inequities€can€be€addressed.ÌÌ̜Р øÀ ÐÑ  ? Ññf ñ›ñf ñÙÙØ Øò òÔ  ÔÑ  ÑÓ  ÓòòÔ‡îŠÄîXXøÔIntroductionÔ 8qÔ›Ô#†XøXîîŠÄaq#ÔÔ‡¼Þ¼XXøÔóóÐ ° ÐÔ#†XøX¼¼ÞÁq#Ôó óÓRqӜ̛ÌFrom€22€to€25€June€1998,€50€international€experts€on€reproductive€health€œ(RH)€and›€rightsÏmet€in€Kampala,€Uganda€to€examine€ways€to€hasten€progress€towards€the€goals€set€by€œtheÏICPD›€in€Cairo€in€1994.€€ÌÌThe€gathering,€hosted€by€the€Government€of€Uganda€and€organized€by€UNFPA,€was€theÏExpert€Round€Table€Meeting€on€Ensuring€Reproductive€Rights€and€Implementing€SexualÏand€Reproductive€Health€Programmes,€Including€Womenððs€Empowerment,€MaleÏInvolvement€and€Human€Rights.€€The€Kampala€Round€Table€was€one€of€a€series€of€RoundÏTables,€Technical€Meetings€and€Regional€Consultations€which€UNFPA€organized€duringÏthe€year€as€part€of€a€review€of€progress€achieved€in€the€implementation€of€the€ICPDÏProgramme€of€Action€since€1994.€ÌÌThe€outcome€of€the€Kampala€Round€Table€will€be€used€in€the€preparation€of€reports€on€theÏstatus€of€ICPD€implementation€to€be€presented€at€the€International€Forum,€to€be€held€inÏThe€Hague€in€February€of€1999€and€the€Special€Session€of€the€General€Assembly€that€willÏmeet€to€review€and€appraise€progress€in€the€implementation€of€the€Programme€of€ActionÏin€June„July€1999.ÌÌDrawing€from€Chapters€VII€(Reproductive€Rights€and€Reproductive€Health)€and€VIIIÏ(Health,€Morbidity€and€Mortality)€in€the€ICPD€Programme€of€Action,€the€Kampala€RoundÏTable€set€out€to€identify€strategies€since€Cairo€that€ensure€reproductive€rights€and€theÏimplementation€of€sexual€and€œRH€programmes.€€The€meeting€also€sought€to€identifyÏsuccesses€and€constraints€in€policy,€law,€administration,€management,€strategy€andÏfinance.€€Last,€the€Round€Table€participants€were€asked€to€devise€actions€needed€thatÏwould€accelerate€progress€at€the€national€level€to€achieve€the€goals€of€ICPD.ÌÌThe€Round€Table€addressed€four€issues:€progress€and€constraints€achieved€after€ICPDÏin€the€development€of€policies€for€ensuring€reproductive€rights€and€implementing€RH;€theÏintegration€of€sexual€and€RH€services,€the€improvement€of€care€and€access;€and€€theÏachievement€of€gender€equity€and€equality,€womenððs€empowerment,€and€maleÏresponsibility€in€the€context€of€human€rights.ÌÌThe€Round€Table€had€four€sessions€which€treated€these€themes.€€Speakers€among€theÏparticipants€gave€presentations,€followed€by€question„and„answer€periods.€All€participantsÏwere€invited€to€join€working€groups€which€discussed€progress€since€ICPD,€constraints€andÏactions€needed.€€The€subjects€of€the€four€working€groups€were:Ð  ð'@#& Ðà  àÝ‚cÿÝÝ  ÝÝ‚c¯{Ýð"ðà0 ` àÝ  ÝPolicies€for€Sexual€and€Reproductive€Health݃c¯{Ê{ÝŒÐ8` (#` (# ÐŒÝ  Ýà  àÝ‚cÿÝÝ  ÝÝ‚cr|Ýð"ðà0 ` àÝ  ÝDesigning€High€Quality€Sexual€and€Reproductive€Health€Programmes݃cr||ÝŒÐ$ì` (#` (# ÐŒÝ  Ýà  àÝ‚cÿÝÝ  ÝÝ‚cJ}Ýð"ðà0 ` àÝ  ÝAccess€to€Reproductive€Health,€Sexual€Health€and€Family€Planning€ServicesÐ Ø Ðà ¸ àà  à݃cJ}e}݌Р` (#` (# ÐŒÝ  Ýà  àÝ‚cÿÝÝ  ÝÝ‚cP~Ýð"ðà0 ` àÝ  ÝCreating€the€Necessary€Conditions€for€the€Implementation€of€Sexual€andÐ è ° ÐReproductive€Health€and€Rights.݃cP~k~݌Р` (#` (# ÐŒÝ  ÝÌThis€report€is€divided€into€three€chapters:€(I)€Opening;€(II)€Background;€andÏ(III)Proceedings€of€Plenary€Sessions€and€Working€Groups,€which€includes€working€groupÏreports€on€progress,€constraints€and€actions€needed.Ô‡¼Þ¼XXøÔò òÐ „L  Ðó óÔ#†XøX¼¼Þ(€#ÔÌÐ  \$  ÐÑ  ÑÓ  ÓÔ  Ôòòò òÔ‡îŠÄîXXøÔà @ àChapter€I:€OpeningÔ#†XøXîîŠÄÇ€#ÔóóÔ ´€ÔÐ ° ÐÓ¨€ÓÌÌÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓRemarks€by€Dr.€Nafis€Sadik,€Executive€Director€of€UNFPAÔ bÔÐ ¼  ÐÔ#†XøX¼¼Þo#Ôó óÓŽÓÌAt€the€opening€of€the€Round€Table,€Dr.€Nafis€Sadik,€the€UNFPA€Executive€Director,Ïaddressed€participants€and€noted€that€the€intention€of€ICPD€was€to€shift€emphasis€fromÏfamily€planning€to€a€broader€approach,€based€on€reproductive€health€and€rights.€€ParallelÏmoves€towards€gender€equality€and€the€empowerment€of€women€in€other€areas€of€socialÏand€economic€development€were€also€essential€features€of€the€approach.€€The€ICPDÏadopted€the€position€that€reproductive€rights€were€human€rights,€which€was€endorsed€byÏthe€Social€Summit€in€Copenhagen€and€further€endorsed€and€strengthened€by€the€FourthÏWorld€Conference€for€Women€in€Beijing€in€1995.€ÌÌReal€progress€in€attaining€RH€lies€in€the€enactment€of€reproductive€rights€as€part€of€lawÏand€policy,€and€their€realization€as€part€of€health€services,€Dr.€Sadik€noted.€€The€processÏof€making€and€carrying€out€RH€policy€must€reach€beyond€government€ministries€directlyÏresponsible€for€health,€and€must€also€involve€a€broad€spectrum€of€NGOs.›€€Each€countryÏhas€to€make€a€frank€assessment€of€its€strengths,€weaknesses€and€areas€of€greatest€need,Ïand€make€policy€accordingly,€she€said.€€ÌÌAmong€countries€with€comprehensive€family€planning€services,€some€have€focused€onÏlinking€or€integrating€structures,€or€on€expanding€the€range€of€services.€€Dr.€SadikÏsuggested€that€family€planning€services€with€limited€resources€would€find€that€incrementalÏimplementation€was€appropriate.€€In€any€case,€policy€should€maintain€comprehensive€œRHÏcare€as€the€ultimate€goal:€RH€is€not€a€choice€but€a€necessity€for€countries€wishing€to€setÏa€firm€foundation€for€economic€and€social€development.ÌÌDr.€Sadik€emphasized€five€issues€for€the€Round€Table:€womenððs€empowerment;€the€needÏfor€change€in€male€behavior;€gender„based€violence;€RH€care€in€emergency€situations;Ïand€the€need€to€reverse€the€tide€of€HIV€and€STDs.›€€Dr.€Sadik€also€noted€the€April€1998ÏRound€Table€on€adolescent€sexual€and€œRH.›€€She€reminded€her€audience€to€keep€in€mindÏthe€findings€of€that€meeting€and€to€remember€that€youth€made€up€one„fifth€of€humanity.ÌÌAlluding€to€these€points,€Dr.€Sadik€declared€that€free€choice€in€the€size€and€spacing€of€theÏfamily€represented€the€cornerstone€of€empowerment.€€Despite€progress,€more€than€fourÏin€ten€women€in€developing€countries€still€lack€access€to€good€œRH€services.€€Many€womenÏalso€remain€unaware€of€the€range€of€family€planning€methods,€just€as€not€all€familyÏplanning€service€providers€are€aware€of€the€need€to€stress€choice.ÌÌEducation€is€a€key€to€empowerment,€Dr.€Sadik€stated.€€Women€remain€less€educated€thanÏmen.€€Fewer€than€half€of€all€women€in€Sub„Saharan€Africa€discuss€family€size€with€theirÏspouses,€compared€to€60€per€cent›€of€couples€in€Asia,€North€Africa€and€LatinÏAmerica/Caribbean.€€The€low€figure€for€Sub„Saharan€Africa€is€consistent€with€the€low€levelÐ Ä,(+  Ðof€awareness€and€use€of€contraceptive€methods.€€Dr.€Sadik€added€that€the€correlationÏbetween€a€womanððs€place€in€society€and€her€access€to€œRH€services€is€a€direct€one.€€SriÏLanka,€for€example,€although€poor,€is€nevertheless€a€country€where€women€enjoy€highÏsocial€status,€and€the€maternal€mortality€rate€there€is€among€the€lowest€in€the€developingÏworld.ÌÌChange€in€male€behavior€is€a€key€to€the€empowerment€of€women.€€Behavioral€change€forÏmen€means€their€adoption€of€responsible€sexual€and€reproductive€behavior,€and€theirÏsupporting€not€only€womenððs€right€to€make€their€own€reproductive€choices€but€their€rightÏto€the€information€and€means€to€do€so,€Dr.€Sadik€explained.€€She€added€that€people€shouldÏbe€careful€of€regarding€men€as€part€of€the€problem;€many€would€like€to€be€part€of€theÏsolution,€and€they€should€be€encouraged€to€communicate€better,€to€take€responsibility€andÏto€make€changes€in€favour€of€womenððs€empowerment.ÌÌNoting€that€people€in€too€many€countries€accept€domestic€violence€as€a€fact€of€life,ÏDr.Sadik€noted€in€contrast€that€since€the€ICPD,€many€countries€have€taken€up€the€issueÏof€female€genital€mutilation€(FGM)€at€the€highest€levels.€€Uganda€has€shown€the€way€toÏsuccess€in€making€major€progress€in€the€elimination€of€FGM,€through€high„level€leadershipÏfollowed€by€community€action.ÌÌIn€emergency€situations,€in€which€women€are€at€their€most€vulnerable,€UNFPA€is€workingÏto€bring€essential€RH€care,€including€the€means€to€avoid€pregnancy.€€Besides€facing€theÏtask€of€changing€male€attitudes€in€regard€to€women€as€sexual€targets,€Dr.€Sadik€saidÏcolleagues€working€in€refugee€camps€and€similar€situations€needed€to€be€persuaded€thatÏRH€and€preventive€care€for€women€were€as€essential€as€dealing€with€trauma€and€infection.ÌÌSTDs,€including€HIV/AIDS,€is€a€policy€issue€extending€beyond€any€particular€age€groupÏand€beyond€the€health€sector,€Dr€Sadik€said.€€It€is€a€subject€that€demands€behavioralÏchange€among€men,€and€it€also€demands€that€policy€makers€give€it€priority€in€the€allocationÏof€development€resources.ÌÌThe€four€years€since€the€ICPD€is€a€relatively€short€time€in€which€to€see€substantial€changeÏin€reproductive€health€and€reproductive€rights,€Dr.€Sadik€acknowledged.€€She€added€thatÏpeople€had€to€confront€putting€ideas€into€action€in€a€context€of€severely€limited€nationalÏbudgets€and€an€international€climate€that€demanded€proof€of€the€effectiveness€of€overseasÏassistance.€€Although€much€progress€has€been€made,€the€hardest€part€lies€ahead.€€RHÏmust€be€institutionalized€in€the€health€sector,€and€operational€links€have€to€be€establishedÏbetween€RH€and€other€aspects€of€development.Ìâ âÐ @)#& Ðò òÔ‡¼Þ¼XXøÔÓ  ÓÔ&  Ôâ âRemarks€of€the€Vice„President€of€Uganda,€Ð 8 ÐDr.€Specioza€Wandira›„œKazibwe›Ìòòó óÔ#†XøX¼¼Þ°—#ÔDelivered€by€Mr.SamKuteesa,€Minister€of€State,€Ð `( ÐMinistry€of€Finance€and€Economic€PlanningóóÐ L  ÐÓÏ—ÓÌOn€behalf€of€Dr.€Wandira„Kazibwe€and€the€Government€of€Uganda,€Mr.€Sam€KuteesaÏwelcomed€participants€of€the€Round€Table.€€Dr.€Wandira„Kazibwe€recognized€that€UgandaÏwanted€to€be€associated€with€the€post„ICPD€paradigm€shift.€The€post„ICPD€era€hasÏwitnessed€unprecedent€support€by€developing€countries€for€population€policies€and€aÏgreater€involvement€of€civil€society.€She€recognized€that€NGOs€are€playing€a€crucial€roleÏin€Uganda€and€saluted€their€Government€partnership€with€NGOs.€The€role€of€the€privateÏsector€and€the€participation€of€the€community€after€the€implementation€of€a€decentralizationÏpolicy€in€Uganda€was€also€noted.€€The€fact€that€decisions€can€now€be€taken€at€lower€level,Ïclose€to€the€people€so€that€they€can€decide€on€matters€that€affect€their€daily€lives€andÏprioritize€them€is€a€great€opportunity.€ÌÔ'8Û—ÔÌShe€expected€€that€the€meeting€could€help€learn€from€participantsðð€experiences€andÏevaluate€progress€since€1994.€In€Uganda€for€example,€maternal€mortality€rates€continueÏto€be€very€œhigh.€€Mothers€are›€dying€so€needlessly€from€preventable€conditions€and€œtheÏGovernment€made€a€call›€for€action€to€decrease€€maternal€mortality€now.€Health€statisticsÏin€Uganda€show€a€maternal€mortality€level€of€506€per€100,000€live€births€and€an€infantÏmortality€rate€at€97€deaths€per€1,000€live€births€and€fertility€rates€are€as€high€as€6.9.€ÌÌHowever,€even€national€statistics€do€not€tell€the€full€story,€for€they€are€merely€averages.ÏWomen€still€continue€to€be€put€at€a€disadvantage.€Population€and€developmentÏprogrammes€need€to€put€womenððs€strategic€concerns€at€the€center€of€their€plans€or€areÏbound€to€produce€negative€results.€Although€Uganda€has€made€some€modest€attempts€toÏemancipate€women,€she€recognized€that€they€need€to€do€much€more.€Womenððs€educationÏis€of€strategic€importance€and€has€a€multiplier€effect.€Finally,€Dr.€Wandira„Kazibwe€thankedÏthe€organizers€of€the€meeting€and€declared€the€meeting€officially€open.Ìœò òÌÔ‡¼Þ¼XXøÔÔ  Ô›Ó  ÓThe€ICPD+5€ProcessÔ à Ôó óÔ#†XøX¼¼ÞÁ #ÔÐ $#ì МòòMr.€Mohammad›€Nizamuddin,€Director,€Technical€and€Policy€Division,€UNFPAóóò òÐ 8$  Ðó óÓî ÓÌMr.€Nizamuddin€outlined€how€the€present€round€table€meeting€is€a€component€of€theÏICPD+5€process.€It€was€initiated€in€response€to€the€decision€of€the€General€Assembly€toÏhold€a€special€session€in€1999€to€mark€the€progress€made€in€the€implementation€of€theÏICPD€Programme€of€Action.€In€explaining€the€different€activities,€actors€and€expectedÏoutcomes€of€the€ICPD+5€œprocess,›€Mr.€Nizamuddin€put€special€emphasis€on€the€importanceÏof€this€particular€Round€Table,€because€œRH€constitutes€the€cornerstone€of€theÏICPDProgramme€of€Action.€ña ñ€He€encouraged€the€participants€to€devise€specific€key€futureñ^ ñÐ ˜+`%( Ðñ^ ñactions€on€RH€and€rights,€and€on€womenððs€health€and€rights€and€mensðð€roles€andÏresponsibilities.ña ñò òña ñÐ $ì Ðña ñÐ  ˜+`%( ÐòòÓ  ÓÑ t ÑÔ  ÔÔ‡îŠÄîXXøÔChapter€II:€BackgroundÔ#†XøXîîŠÄ¥#ÔÔ ¥ÔóóÐ 8 ÐÓï¤ÓÌÌÔ‡¼Þ¼XXøÔÔ  ÔÓ  ÓICPD€Four€Years€Later:€€Recent€Trends€and€Challenges€in€MeetingÐ D  ÐICPD€Goals€in€Reproductive€Rights€and€HealthÔ#†XøX¼¼Þ¨¥#Ôó ó€Ô Ç¥ÔòòÐ X  ÐÓÔ¥ÓÌThis€section€is€based€on€the€presentation€made€by€Dr.€Nicholas€Dodd,€Chief,€TechnicalÏBranch,€Technical€and€Policy€Division,€UNFPA€and€on€the€Background€paper€prepared€for€Ïthe€Round€Table€by€the€Technical€and€Policy€Division€of€UNFPA.óó€Ð 0ø ÐÌThe€consensus€reached€at€Cairo€raised€expectations€towards€establishing€trulyÏcomprehensive€sexual€and€RH€services€throughout€the€world.€Four€years€later,€there€isÏgrowing€recognition€that€progress€has€indeed€occurred.€€ÌÌExamples€of€changes€in€policies€have€occurred,€and€many€countries€are€buildingÏconsensus€on€the€need€to€revise€policy€and€redesign€programmes.€€Although€the€fullÏimplementation€of€this€concept€requires€more€than€policy€development,€consensus„buildingÏrepresents€a€first€step€in€the€road€to€universal€access€to€comprehensive€RH€services.€ÏCountries€that€defined€priority€areas€for€implementation,€allocated€resources€and€involvedÏstakeholders€in€the€decision„making€process,€and€invested€time€and€resources€in€theÏprocess,€show€signs€of€advancing€the€implementation€of€the€Cairo€agenda.€€ÌÌMany€national€policies€since€1994€reaffirm€the€reproductive€rights€principle€of€theÏProgramme€of€Action,€namely,€the€right€of€all€couples€and€individuals€to€decide€freely€andÏresponsible€the€number,€spacing€and€timing€of€their€children€and€to€have€the€informationÏand€means€to€do€so.€Most€policies€also€recognize€the€equal€rights€of€women€and€men€andÏthat€the€status€of€women€€must€be€improved€to€reach€this€goal.€Adolescent€needs,€includingÏsexual€and€RH,€have€also€gained€recognition.€Policies€and€practices€that€limit€access€toÏfamily€planning€services€are€being€changing,€particularly€spousal€authorization,€maritalÏstatus€and€age€limitations.€€In€the€past,€restrictive€policies€often€denied€services€toÏunmarried€women,€adolescents,€the€divorced€and€widowed,€and€women€who€wanted€toÏdelay€or€space€pregnancies.ÌÌMuch€remains€to€be€done€beyond€policy€formulation,€however.€While€various€elements€ofÏRH€care€are€available€in€many€countries,€progress€has€yet€to€be€made€in€implementingÏcomprehensive,€integrated€services.€€Whether€countries€in€their€overall€programme€designÏhave€pursued€the€integration€of€services,€broadened€the€scope€of€available€services,€orÏfocussed€only€on€providing€a€few€components€of€RH,€a€more€comprehensive€RH€approachÏcan€be€distinguished€by€looking€briefly€at€its€key€components.Ìâ âòòÐ Ä*Œ$'Ä ÐÔ& Ä Ôâ âMeeting€the€need€for€family€planningóóÐ 8 ÐFamily€planning€remains€the€central€focus€of€most€programmes.€A€RH€approach€to€familyÏplanning€has€been€the€first€step€taken€in€the€majority€of€countries€whereÔ'Ä87°Ô€implementationÏhas€begun.€This€means€that€efforts€are€now€more€focussed€on€meeting€the€broader€needsÏof€clients.€The€efforts€include€reviewing€the€range€of€contraceptive€methods€available,€andÏstrengthening€information€and€counselling€services€to€enable€more€informed€andÏappropriate€contraceptive€choices.ÌÌWhile€about€56€per€cent€of€couples€in€the€world€are€using€a€method€of€family€planning,Ïcontraceptives€remain€inaccessible€to€120€to€150€million€couples€who€want€them.€€NewÏcontraceptives€have€appeared€in€the€market€since€1994,€mainly€once„a„month€injectables,Ïfemale€condoms€and€revitalization€of€emergency€contraception.€€€However,€high€cost€andÏquality€of€care€continue€to€pose€serious€constraints€in€the€provision€of€family€planning.ÌÌòòÔ& ° ÔImproving€maternal€healthóóÐ  è  ÐMaternal€health€has€improved€in€selected€countries.€€For€example,€in€Sri€Lanka€theÏmaternal€mortality€rate,€which€declined€from€500€deaths€per€100,000€live€births€in€theÏ1950s€to€about€50€per€100,000€in€1994,€is€one€of€the€lowest€in€the€developing€worldÔ'° )´Ô.€€SriÏLanka€focused€on€the€expansion€of€midwifery€skills€and€now€95€per€cent€of€all€births€occurÏin€institutions.€Factors€behind€such€progress€include€the€relatively€high€status€that€womenÏenjoy,€the€existence€of€a€general€health€infrastructure€and€a€good€road€network€to€facilitateÏaccess€to€health€services.€€In€Uganda,€a€country€with€limited€resources,€a€system€has€beenÏdeveloped€to€identify€and€transport€pregnant€women€with€complications€to€districtÏhospitals.€As€a€result,€Caesarean€section€rates€are€increasing€in€some€district€€hospitalsÏand€€this€could€be€taken€as€a€proxy€index€of€reduced€maternal€mortality.ÌÌIn€contrast,€the€experience€of€pregnancy€and€delivery€for€millions€of€women€worldwideÏremains€one€of€pain€and€suffering.€WHO€estimated€that€around€600,000€women€continueÏto€die€each€year€from€complications€arising€from€pregnancy€and€99€per€cent€of€theseÏdeaths€occur€in€developing€countries.€Little€overall€progress€appears€to€have€occurredÏsince€the€Safe€Motherhood€initiative€in€Nairobi€in€1987.€The€lifetime€risk€of€maternal€deathÏis€1€per€48€of€women€living€in€developing€countries,€in€contrast€to€1€per€1,800€for€womenÏin€the€developed€world.ÌÌIn€1997,€a€review€of€the€Safe€Motherhood€Initiative€concluded€that€the€training€of€traditionalÏbirth€attendants€(TBAs›),€antenatal€screening€for€high€risk€pregnant€women€and€theÏprovision€of€simple€birth€kits,€was€insufficient.€Women€must€have€access€to€skilledÏpersonnel€at€delivery,€postpartum€care€and€effective€referral€and€transport€to€well€staffedÏand€equipped€first€referral€level€hospitals€and€waiting€homes.€A€challenge€to€maternal„¼health€services,€as€in€other€aspects€of€sexual€and€œRH€care,€€is€how€to€alter€existingÏfacilities,€and€training,€to€ensure€effective€care.€Another€challenge€is€to€overcome€socialÏbarriers€to€access.€€This€includes€the€ensuring€of€education,€nutrition,€health€care,Ïemployment€opportunities€for€girls€and€women,€and€the€changing€of€menððs€understandingÐ ð,¸&* Ðof€their€roles€and€responsibilities€in€womenððs€health.ÔUKUS.,Ô€The€international€health€andÏdevelopment€community€need€to€continue€to€help€countries€ensure€that€reproductiveÏservices€are€available,€affordable€and€acceptable€to€all€women.ÔUS.,UK.,r½Ô€ÌÌòòPreventing€unsafe€abortionóóÐ è ° ÐWith€twenty€five€million€legal€abortions€taking€place€each€year€in€the€world€and€1€out€of€6Ïbirths€ending€in€abortion,€this€issue€cannot€be€ignored.€€WHO€estimates€that€about€20Ïmillion€unsafe€abortions€occur€every€year€worldwide€and€between€60,000€and€80,000Ïwomen€die€of€unsafe€abortions.€€Since€1994,€four€countries€have€passed€new€lawsÏregulating€abortion.ÌÌòòPreventing€and€treating€STDs›€(Including€HIV/AIDS)Ð \$  ÐóóThere€is€widespread€agreement€that€the€prevention€and€control€of€œSTDs›,€includingÐ H  ÐHIV/AIDS,€should€be€an€integral€component€of€œRH€programmes.€€Since€ICPD,€programmesÏhave€tried€to€develop€and€test€strategies.€While€the€immediate€success€of€initiatives€hasÏvaried€widely,€such€approaches€have€generally€confirmed€the€feasibility€and€desirabilityÏof€integration.ÌÌApproximately€330€million€new€STDs›€occur€every€year.€UNAIDS€estimates€that€ten€millionÏpeople€were€living€with€HIV/AIDS€in€1991.€€The€number€reached€31€million€in€1997€and€itÏis€expected€to€increase€to€40€million€in€2000.€Although€some€technologies€are€available,Ïmethods€that€women€can€use€to€protect€themselves€and€their€partners,€such€as€the€femaleÏcondom€are€expensive€and€not€yet€widely€available.ÌÌProgress€has€nevertheless€occurred€in€some€countries.€The€success€of€Thailand€inÏreducing€reported€STD€cases€from€400,000€in€1989€to€fewer€than€50,000€in€1995€cameÏfrom€a€firm€political€commitment,€sufficient€resources,€and€strong€programme€leadership.ÏUganda€has€also€reduced€HIV€infection€as€evidenced€by€data€from€sentinel€surveillanceÏsites€between€1996€and€1997,€particularly€among€young€adults.ÌÌœThe›€reduction€of€STDs€and€the€consequences€in€€health€and€social€well„being€requires€notÏonly€services€but€major€changes€in€the€most€intimate€aspects€of€human€relationships,€inÏvalues€and€norms€regarding€gender€roles€and€power€imbalances€between€the€sexes,€andÏin€mass€media€and€other€information€sources.€These€changes€in€turn€will€require€politicalÏwill,€information€and€education€for€people€of€all€ages.€€ÌÌIt€is€clear€by€now€that€ideas€are€changing€favorably€in€support€of€œRH€in€almost€all€regionsÏin€the€world.€€The€challenge€is€now€how€to€put€these€ideas€into€action€so€that€the€ICPDÏâ âbecomes€meaningful€to€all,€even€to€women€and€men€in€the€most€remote€areas€of€the€world.Ô‡¼Þ¼XXøÔÐ @)#& ÐÔ#†XøX¼¼Þ•Ç#Ôò òÔ  ÔÔ‡¼Þ¼XXøÔÔ& Ä Ôâ âÓ  ÓÌChallenges€for€Further€ProgressÔ#†XøX¼¼ÞüÇ#ÔÔ ïÇÔÐ L Ðó óòòAdrienne€Germain,€International€Womenððs€Health€Coalitionóóò òÐ `( Ðó óÓ1ÈÓÌMs.€Germain€discussed€three€major€issues€to€be€resolved€for€further€progress€in€theÏimplementation€of€the€Cairo€agenda.€They€are€specific€limitations€and€constraints;Ïsensitive€issues€and€politicalÔ'Ä8ÈÔ€opposition.€€She€called€for€consultations,€partnerships,€broadÏalliances,€and€investments€in€advocacy€skills€in€order€to€build€the€strategic€capacity€ofÏinterested€actors.ÌÌMs.€Germain€identified€limitations€and€constraints,€which€include€(1)€òòHuman€resourcesóó,Ð Àˆ  Ðparticularly€skilled€and€properly€equipped€health€providers€at€all€levels€of€care€andÏcommitted€policy€makers,€including€the€people€who€decide€on€the€allocation€of€budgetsÏand€the€content€of€programmes;€(2)€òòInstitutional€capacityóó€from€the€primary€health€care€levelÐ „L  Ðto€the€parliament€and€the€cabinet;€(3)òò€Financial€resourcesóó;€(4)€òòGaps€in€Technologiesóó,Ð p8  Ðspecifically,€in€STDs›,€including€HIV/AIDS.€€The€gaps€include€barrier€methods€that€womenÏcan€control,€simple€and€better€diagnostic€therapies€for€the€primary€health€care€level€andÏaffordable€single€dose€therapies€for€those€with€curable€infections;€and€(5)òò€Lack€ofÐ 4ü Ðconsumer€knowledgeóó,€which€limits€peopleððs€ability€to€protect€their€own€health,€particularlyÐ  è Ðthose€people€who€lack€the€status€to€exercise€their€own€rights€in€their€communities,€familiesÏor€with€their€partners.ÌÌMs.€Germain€recognized€three€important€sensitive€issues€in€the€Cairo€agreement.€€First,РИ Ðòòthe€health,€safety€and€lives€of€pregnant€womenóó€require€political€will€and€commitment€byÐ ¼„ Ðgovernments€to€invest€in€services€and€technologies€needed€by€women€wishing€to€becomeÏpregnant,€and€to€the€political€dynamic€and€arguments€concerning€access€to€safe€abortionÏfor€women€with€unwanted€pregnancies.€This€is€a€quintessential€womenððs€health€issueÏresulting€from€sex€discrimination€and€male€dominance.€€Second,€òòsexuality€and€genderÐ l4 Ðpower€relationshipsóóò ò€ó óunderlie€concerns€about€sexual€and€œRH€and€€are€reflected€inÐ X  Ðinadequate€services€and€information.€It€is€important€for€all€women€and€men€but€isÏparticularly€pertinent€to€young€people.€Third,€she€noted€that€òòequality€and€equity€of€womenóóÐ 8" Ðòòand€menóó€remains€a€fundamental€issue€in€most€societies.Ð $#ì ÐÌThe€third€challenge€is€how€to€organize€and€mobilize€to€confront€well„organized€and€well„¼funded€political€opposition€to€ICPD€goals.€Political€opposition€also€arises€in€the€form€ofÏbureaucratic€lethargy€or€lack€of€interest€by€politicians€for€the€Cairo€agreements.€ForÏpoliticians€concerned€with€re„election€in€a€short€period,€undertaking€new€activities€involvesÏmore€risks€than€by€doing€little.€ÌÌMs.€Germain€pointed€out€that€these€challenges€can€be€met€by€creating€the€political€will€toÏmake€human€and€financial€resources€available€and€overcome€sensitivities.€She€suggestedÏa€basic€set€of€organizing€principles€which€includes:€(1)€Consultation€of€stakeholders€at€allÏlevels€of€society;€(2)€Equal€partnerships€between€NGOs€and€governments;€governments„Ð H-'* Ðdonors€and€NGOs€that€ensures€their€autonomy€and€accountability,€particularly€of€NGOs;Ïand€(3)€Building€alliances,€which€requires€developing€consensus€and€reachingÏcompromises€among€interest€groups.€ÌÌUnderlying€all€this€is€the€need€to€develop€advocacy€skills€for€building€a€strategic€capacityÏof€various€interest€groups€to€interact€with€those€who€control€budgets€and€policies€and€focusÏon€legislation€that€needs€to€change,€monitoring€and€accountability.€Finally,€Ms.€GermainÏcalled€for€the€development€of€co„ordination€to€work€across€all€ministries€and€sectorsÏincluding€not€only€the€ministry€of€health€but€education,€finance,€labor,€the€cabinet€level€andÏcivil€society€itself.ÌÌÐ  \$  Ðò òòòÔ  ÔÓ  ÓÑ  . ÑÔ‡îŠÄîXXøÔChapter€IIIóóó ó:€ò òProceedings€of€Plenary€Sessions€and€Working€GroupsÔ#†XøXîîŠÄhØ#ÔÔ‡¼Þ¼XXøÔÔ BØÔÐ ° ÐÔ#†XøX¼¼ÞòØ#ÔÓOØÓÌÌÓ  ÓÔ‡¼Þ¼XXøÔÔ  ÔSession€1:€Policies€for€Sexual€and€Reproductive€Healthó óÐ À ÐÔ —ÙÔÔ#†XøX¼¼ÞxÙ#ÔÓlÙÓÌò òChair:à ` àó óMonique€Essed€FernandesÐ À  Ðò òPresenter:ó óà ` àDr.€Dean€Phiri,€Director,€Reproductive€Health€Unit,€ZambiaÐ ´  ÐÌò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓDeveloping€a€Sexual€and€Reproductive€Health€Policy:€the€Case€ofÐ ” ä ÐZambiaÔ#†XøX¼¼Þ÷Ú#ÔÔ êÚÔó óÐ ¨ ø  ÐòòPresenter:€Dr.€Dean€Phiri,€Director,€Reproductive€Health€Unit,€ZambiaóóÐ ¼  ÐÓÛÓÌZambia€undertook€a€multi„sectoral€and€decentralized€approach€involving€civil€society€inÏformulating€a€new€RH€policy€which€addressed€gender€issues,€including€male€involvement,Ïand€the€allocation€of€resources€for€implementation.€ÌÌThe€ICPD€and€the€Beijing€Conference€made€€the€government€aware€of€the€need€to€broadenÏfamily€planning€to€include€RH.€An€inter„agency€Technical€Committee€on€Population€wasÏformed€to€integrate€population€issues€in€the€planning€and€implementation€across€allÏgovernment€ministries,€agencies€and€NGOs.€This€period€coincided€with€health€care€reformÏinitiated€by€the€Government,€which€included€RH€as€one€of€its€major€components€of€primaryÏhealth€care.Ì€ÌThe€development€of€the€national€RH€programme€was€based€on€an€extensive€needsÏassessment.€Surveys€were€used€to€determine€priorities.€€These€included€the€demographicÏand€health€surveys€of€1992€and€1996,€assessments€of€contraceptive€needs€assessmentÏand€traditional€birth€attendants,€a€situation€analysis€of€RH€services€and€a€male€involvementÏstudy.€With€the€information€provided€by€the€needs€assessment,€the€Ministry€of€HealthÏdeveloped€a€RH€policy€which€included€standards€for€the€provision€of€services€to€be€utilizedÏby€the€districts€in€planning€and€implementing€their€own€health€strategies.€To€gain€nationalÏconsensus,€the€Ministry€of€Health€hosted€two€workshops€which€involved€health€districts,ÏNGOs,›€donor€agencies,€private€and€industrial€institutions€and€traditional€practitioners.ÌÌTeams€that€worked€on€specific€issues€such€as€safe€motherhood,€adolescents€and€œSTDs›,Ïincluding€€HIV/AIDS,€provided€inputs€to€a€multi„disciplinary€group€from€the€Ministry€ofÏHealth,€NGOs€and€the€private€sector,€which€were€responsible€for€formulating€the€ZambianÏœRH€policy.€The€law€school€in€collaboration€with€a€gender€division€in€the€Government€wasÏinvolved€in€developing€the€human€rights€framework€of€the€RH€policy.ÌÌÒe°ÒThe€success€of€Zambia€in€formulating€an€RH€policy€emerged€from€the€GovernmentððsÏidentification€of€needs€and€the€involvement€of€stakeholders€in€a€multi€sectoral€approach,Ïmaking€€the€public€aware,€€including€managers,€political,€and€local€religious€leaders€at€theÏdistrict€level,€and€placing€RH€at€the€center€of€health€care€reform.€Ìò òÐ (-x(+  ÐDiscussionó óÐ 8 ÐÌThe€discussion€centered€on€the€constraints€faced€when€developing€RH€policies,€the€typeÏof€NGOs€that€should€be€involved€in€the€process€and€the€nature€of€the€participatory€process.ÌÌòòConstraints€in€the€development€of€policiesóóÐ Ü ¤ ÐParticipants€agreed€that€some€of€the€constraints€in€the€development€of€RH€policies€were€theÏoften€rigid€structures€of€ministries€and€the€lack€of€interest€and€commitment€of€politicians€whoÏwere€interested€in€implementing€policies€with€only€temporary€effectiveness.Ìò òÌòòó óEnsuring€a€long€term€participatory€processóóÐ €H  ÐThe€question€was€raised€on€whether€a€participatory€policy„making€process€has€served€asÏa€foundation€for€continued€participation€and€cooperation.€The€answer€was€affirmative.€It€wasÏnoted€that€the€consultative€process€resulted€in€an€expanded€partnership€with€groups€thatÏwere€not€previously€involved€in€RH.€Through€this€partnership€the€division€of€labour€forÏimplementing€the€policy€was€established.€€The€government€continues,€furthermore,€to€callÏon€the€various€partners€and€stakeholders€as€their€expertise€and€input€is€needed.Ìò òÌòòó óWhich€NGOs€should€be€involved?óóÐ è° ÐIt€was€pointed€out€that€governments€tend€to€involve€only€those€NGOs€which€toe€the€line€orÏinvolve€NGOs€as€a€token€gesture.€Thus€organizations€without€power€tend€to€be€uninvolved.€ÏThe€challenge€remains€to€involve€those€NGOs›€which€really€represent€community€interestsÏand€needs.€ÌÌœò òÔ  ÔÔ‡¼Þ¼XXøÔà@ˆ ˆ ÆàFindings›€of€the€Working€Group€on€Policies€œˆÐ p8 Ðà@. . Æàfor›€Sexual€and€Reproductive€HealthÔ#†XøX¼¼Þ÷ê#ÔÔ êêÔó óˆÐ „L ÐÌò òòòÔ  ÔA.€à ½ àProgress€toward€implementation€of€the€ICPD€Programme€of€Actionóóó óÐ „L ÐÔ óëÔÌSector„wide€progress€in€policy€formulation€has€occurred€in€countries€such€as€Zambia,ÏBangladesh€and€South€Africa.€Other€countries€have€begun€work€on€specific€aspects€ofÏpolicies€and€implementation.ÌÌIn€many€countries,€civil€society€organizations€exert€considerable€influence€on€policyÏdevelopment.€An€effective€women's€movement,€other€mass€movements,€and€NGOs€areÏproving€fundamental€to€progress€in€policy€development€and€implementation€in€places€suchÏas€Brazil€and€Bangladesh.Ìòòò òÌœÔ  Ôñb ñÌÌâ âÐ €+H%( Ðñb ñB.›€à ½ àMajor€constraints€in€the€development€of€sexual€and€reproductive€healthÐ 8 Ðâ âpoliciesÔ `îÔóóó óÐ $ì ÐÌPolicies€for€œRH€and€rights€are€evolving€amid€increasing€global€poverty€and€inequality,€weakÏand€underfinanced€social€sectors€(health€and€education),€persistent€gender€inequality,€andÏlimited€progress€in€the€involvement€of€civil€society€in€policy€development.€ConstraintsÏinclude:ÌÌÝ‚cÿÝÝ  ÝÝ‚c\ðÝð"ðà0 ½ àÝ  ÝInadequate€knowledge€and€understanding€of€reproductive€rights€and€health€asÐ ˜ ` Ðdescribed€in€the€ICPD€Programme€of€Action.€The€Programme€and€the€concepts€itÏdescribes€have€not€been€disseminated€widely€and€publicly.€Consequently,€aspectsÏof€the€RH€and€rights€have€received€only€hesitant€support.݃c\ðwð݌Р½(#½(# ÐŒÝ  ÝÌÝ‚cÿÝÝ  ÝÝ‚còÝð"ðà0 ½ àÝ  ÝFundamentalist€opposition€to€aspects€of€the€ICPD€persists.݃cò2òÝŒÐ4ü ½(#½(# ÐŒÝ  ÝÌÝ‚cÿÝÝ  ÝÝ‚cÞòÝð"ðà0 ½ àÝ  ÝIn€many€countries,€laws€such€as€the€prohibition€of€sex€education€in€schools€or€ofÐ  Ô  Ðadolescentsðð€access€to€contraceptives€hamper€implementation€of€the€Programme€ofÏAction.݃cÞòùò݌Р½(#½(# ÐŒÝ  ÝÌWhere€general€support€for€the€ICPD€Programme€of€Action€exists,€policies€often€lack€aÏhuman€rights€approach€and€commitment.€Full€support€is€still€lacking€for€legislation€to€ensureÏreproductive€rights€and€RH€and€gender€equity€and€equality.ÌÌPolicy€development€and€implementation€are€limited€by€inadequate€understanding€of€theÏstructural€and€strategic€implications€of€a€shift€from€vertical€maternal€and€child€health/familyÏplanning€structures€to€a€rights„based€sexual€and€RH€strategy.ÌÌRH€policy€has€tended€to€be€shaped€primarily€by€health€sector€organizations€andÏprofessionals,€to€the€exclusion€of€other€sectors€and€disciplines.€This€means€not€enoughÏattention€is€given€to€the€social,€economic€and€political€dimensions€of€sexual€health€andÏreproductive€rights.€€Similarly,€little€attention€is€paid€to€the€psycho„social,€gender€andÏemotional€aspects€of€the€health€and€well„being€of€individuals.ÌÌGovernments€restrictions€on€NGOs€and€other€civil€society€organizations€limit€their€fullÏparticipation€in€policy€development€and€implementation.ÌÌPolitical€instability€and€the€frequent€turnover€of€civil€servants€undermine€the€continuity€ofÏpolicy€development,€implementation€and€monitoring.Ìâ âò òòòÔ  ÔÐ @)#& ÐÔ&  Ôâ âC.€à ½ àActions€neededÔ ÓøÔóóó óÐ 8 ÐÌòòPolitical/Legislative€levelóóÐ Ø Ðò ò„€ó óIn€òòhealth€sector€reformóó,€sexual€and€RH€for€all€at€the€highest€achievable€standard€of€careÐ üÄ Ðmust€be€ensured,€and€the€necessary€resources€should€be€mobilized.ÌÔ'8õøÔÌòò„€òòóóEnact€and€implement€legislationóó€required€to€meet€the€commitments€made€in€Cairo,€usingÐ È  Ðall€necessary€and€appropriate€means,€such€as€removing€restrictive€laws.ÌÌòò„€òòóóFinance€groups€that€translate€the€Programme€of€Action€into€legislative€termsóó,€that€lobbyÐ ŒT  Ðfor€Programme€of€Action€implementation€and€build€political€will.ÌÌòò„€òòóóInvest€in€training€parliamentarians,€legislators,€and€mediaóó€in€the€importance€of€theÐ P  ÐProgramme€of€Action.ÌÌòòMinistry/Executive€LevelóóÐ Ü  Ðòò„€òòóóContinue€and€promote€re„orientation€of€the€health€system€óóto€ensure€that€policies,€strategicÐ È Ðplans,€and€all€aspects€of€implementation€are€rights„based,€cover€the€life€cycle€and€serveÏeveryone.€€This€requires€changing€the€attitudes€of€policy€makers,€health€care€providers,€andÏusers/clients€so€that€the€public€health€system€is€open€to€contributions€on€the€content€andÏdelivery€of€public€health€services€and€information€from€civil€society.€The€health€system€mustÏbe€open€to€innovations€from€other€sectors€including€civil€society€organizations€and€NGOs,Ïenabling€the€system€to€establish€€partnerships€with€civil€society€organizations€as€a€meetingÏof€equals.ÌÌò ò„ó ó€òòPromote€systemic€structural€reform€in€healthó󀄄€infrastructure,€human€resourceÐ L Ðdevelopment,€financing€„„€to€achieve€both€coverage€and€quality.€Realistically,€changes€inÏsystems€will€have€to€be€incremental€and€phased€according€to€resource€availabilityÏ(organizational€capacity,€personnel,€finances).€Priorities€for€incremental€changes€andÏprojects€to€test€new€approaches,€must€be€determined€by€a€consultative€process€and€beÏdesigned€on€the€basis€of€the€longer€term€strategic€plan.€€A€key€element€needed€isÏinvestment€in€developing€managerial€capacity€at€all€levels€to€implement€right„based€RHÏpolicies.€This€requires€not€only€technical€training€but€also€sensitization€to€gender€issues,Ïhuman€rights,€and€reduction€of€hierarchical€barriers.ÌÌò ò„€ó óòòInvolve€middle€level€managersóó€at€all€stages,€to€ensure€continuity€in€the€implementation€ofÐ Œ&T # Ðplanning€and€policy.ÌÌò ò„€ó óòòEngage€all€relevant€sectorsóó,€not€only€health,€in€policy€development€and€implementation.Ð X) #& Ðâ âÐ L*$' ÐòòÔ& ¸ Ôâ âCivil€Society€OrganizationsòòóóÐ 8 Ðò òóó„€òòó óProvide€more€resources€for€groupsóó,€build€alliances,€involve€the€media,€undertakeÐ $ì Ðadvocacy,€promote€public€education€to€create€a€favorable€environment€for€the€ICPDÏProgramme€of€Action€policy€development€and€implementation.€Promote€theÔ'¸8Ô€developmentÏand€dissemination€of€materials€to€increase€understanding€of€the€concepts€and€developÏstrategies€to€implement€the€Programme.€ÌÌò ò„€ó óòòProvide€resources€to€initiate€innovative€activities€óóthat€demonstrate€to€government€what€canÐ ´ | Ðbe€done€to€implement€the€Programme€of€Action.ÌÌò ò„€ó óòòInvest€in€developing€the€capacity€of€groups€to€participate€in€policy€development€andÐ €H  Ðimplementationóó.€€Ease€their€access€to€information.€Ð t<  ÐÌò ò„ó ó€òòEnsure€that€groups€participate€in€monitoringóó€policy€implementation.Ð L  ÐÌòòÔ& Ä ÔDonors€and€international€agenciesóóÐ ,ô  Є€Donors€and€international€agencies€òòshould€make€their€policies€and€budget€allocationsÐ à Ðconsistent€with€the€ICPD€Programme€of€Action.Ô'Ä,PÔóóÐ Ì ÐÌ„€Donors€and€agencies€should€support€aòò€nationally€driven€policy€development€process€andРܤ Ðimplementationóó,€keeping€in€mind€the€importance€of€specific€national€conditions€and€theÐ È Ðultimate€objective€of€sustainable€nationally€financed€health€services.€ÌÌ„€Encourage€governments€to€òòconsult€with€civil€societyóó€in€policy€development€andÐ ŒT Ðimplementation.ò òÐ x@ ÐÌÓ  ÓÔ‡¼Þ¼XXøÔÔ  ÔÔ& ” ÔSession€2:€Designing€High€Quality€Sexual€and€Reproductive€HealthÐ X  ÐServicesÔ > ÔÔ#†XøX¼¼Þ #ԀРl4 ÐÓ ÓÌChair:à  àó óDr.€Adepeju€OlukoyaÐ t!< Ðò òPresenters:à  àó óDr.€Saumya€RamaRao,€Population€CouncilÐ h"0 Ðà ½ àà  àDr.€Sharad€Iyengar,€Action€Research€and€Training€for€Health,€IndiaÌà ½ àà  àDr.€Khama€Rogo,€University€of€Nairobi,€Kenya€Ìò òPanel:ó óà0  àMr.€Mohammad€Nizamuddin,€Director,€Technical€and€Policy€Division,€UNFPAÐ4%ü! (# (# Ðà ½ àà  àMs.€Adrienne€Germain,€International€Womenððs€Health€Coalition,€USAÌÌÔ'” XK Ôò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  Óñc ñÌÌÌÌÐ P,&( Ðñc ñImplementing€and€Monitoring€Feasible€Standards€of€CareÔ 7 Ôó ó€Ô#†XøX¼¼ÞD #ÔòòÐ 8 ÐDr.€Saumya€RamaRao,€Population€CouncilóóÐ L ÐÓc ÓÌDr.€RamaRao€defined€Quality€of€Care€(QOC)€as€ð ðthe€way€clients€are€treated€by€the€serviceÏdelivery€system.ðð€The€definition€focuses€on€the€process€of€service€delivery,€€includingÏcommunication€and€information€sharing;€criteria€for€minimal€standards€for€procedures€andÏexaminations;€and€whether€clients€receive€the€service€appropriate€to€their€needs.ÌÌWith€findings€from€situation€analyses,€Dr.€RamaRao€showed€that€even€where€a€range€ofÏcontraceptive€methods,€water,€information€material,€and€time€were€available,€QOC€does€notÏnecessarily€result.€€Clients€often€receive€only€limited€information€on€contraceptive€methods,Ïand€often,€service€providers€do€not€wash€their€hands€before€undertaking€exams.€HerÏfindings€also€illustrated€that€where€QOC€is€provided,€the€outcome€is€positive.€Greater€userÏacceptance,€satisfaction€and€continuation€of€contraceptive€use€are€achieved€when€clientsÏreceive€comprehensive€information€on€methods,€their€use€and€side€effects.€ÌÌThese€findings€indicate€that€improvements€in€quality€and€greater€user€satisfaction€andÏempowerment€can€be€achieved€with€existing€resources.€The€information€is€particularlyÏimportant€because€much€of€the€post„Cairo€debate€has€centered,€directly€or€indirectly,€onÏthe€feasibility€of€offering€sexual€and€RH€services€amid€diminishing€resources.ÌÌDr.€RamaRao€identified€the€main€constraints€to€good€QOC€as€perceptions€of€irrelevanceÏand€expense;€scepticism€regarding€outcomes;€and€lack€of€specified€processes.€While€theÏpresented€studies€contradict€the€validity€of€some€of€these€perceptions€Dr.€RamaRaoÏidentified€the€following€actions€to€overcome€the€remaining€constraints:€develop€clearÏprotocols€for€and€training€in€high€quality€service€provision;€institutionalize€supportiveÏsupervision€and€performance€evaluation,€which€would€also€include€the€performance€ofÏsupervisors;€and€conduct€studies€for€assessment€and€training€development.ÌÌò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓSexual€and€Reproductive€Health€and€RightsÔ#†XøX¼¼Þß#ÔÔ‡¼Þ¼XXøÔÐ !ä Ðin€India€Since€ICPDÔ#†XøX¼¼ÞV#ÔÔ ÒÔó óÐ 0"ø ÐòòDr.€Sharad€Iyengar,€Action€Research€and€Training€for€Health,€IndiaóóÐ D#  ÐÓþÓ€ÌICPD€gave€an€impetus€to€Indiaððs€target„ridden€family€planning€programme€to€move€awayÏfrom€the€predominantly€clinic„based€pick€and€choose€approach,€which€in€the€late€nineteenÏsixties€saw€the€introduction€of€demographic€targets€for€contraception.€€ÌÌFollowing€ICPD,€the€ð ðTarget„Free€Approachðð€was€introduced€in€1995.€€It€discardedÏdemographic€contraceptive€goals€and€instead,€the€1998€ð ðCommunity€Needs€AssessmentððÏapproach€was€instituted.€€It€provides€for€annual€primary€health€care€plans€based€on€needsÏassessment€and€encompasses€contraception,€maternal€care,€immunization,€to€be€preparedÏlocally€with€the€involvement€of€the€community.€Identified€constraints€include€the€work€cultureÐ |,D&) Ðof€health€staff€not€traditionally€involved€in€planning€or€calculating€local€needs.€The€staffÏfound€working€without€targets€difficult€and€therefore€lost€touch€with€clients.€Key€experiencesÏfrom€the€process€include:ÌÌòòIndicatorsóó:€The€Community€Needs€Assessment€approach€introduced€a€modifiedÐ è ° Ðmanagement€information€system€(MIS)€that€reflects€concern€for€QOC€and€management€byÏthe€service€providers.€Due€to€the€work€culture€mentioned€above,€the€key€future€action€is€toÏdevelop€middle€level€management,€leadership,€and€supervisory€capabilities€within€theÏadministration€and€to€continue€to€underscore€commitment€to€the€new€set€of€indicators.ÌÌòòPrivate€sector€involvementóó:€The€RH€program€collaborates€with€service€providers€of€theÐ p8  ÐNGO,€private,€and€€traditional€sectors.ÌÌòòQuality€Assurance€Measuresóó:€Institutional€quality€assurance€in€the€health€system,€includingÐ 4ü  Ðthe€private€sector,€should€be€pursued,€according€to€the€guidelines€disseminated€by€theÏcentral€government.€For€this€purpose€a€self„regulation€mechanism€needs€to€be€developed.ÏSimultaneously,€community€groups€should€be€equipped€with€simple€indicators€of€QOC€toÏallow€them€to€undertake€surveillance.ÌÌòòInvolvement€of€state€legislatures€and€parliamentóó:€Elected€representatives€have€beenÐ ¼„ Ðsensitized€to€demographic€concerns€and€now€need€to€be€sensitized€to€the€rights€and€genderÏdimensions€of€RH.€€A€key€action€is€to€advocate€among€legislators€for€recent€policy€changesÏto€be€translated€into€action.ÌÌò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓÔ& Ì ÔReducing€Maternal€MortalityÔ#†XøX¼¼ÞI #ÔÔ < ÔÐ X  Ðó óòòDr.€Khama€Rogo,€University€of€Nairobi,€Kenya€óóò òÐ l4 ÐÓh ÓÌó óDr.€Rogo€stated€that€in€light€of€the€low€Government€spending€on€health,€poor€generalÐ L Ðinfrastructure€and€poor€health€infrastructure€in€Africa,€maternal€mortality€is€closelyÔ'ÌXt Ô€relatedÏto€poverty.€Delays€occur€in€obtaining€the€essential€obstetric€services€for€complications€ofÏpregnancy.€However,€Dr.€Rogo€also€pointed€out€a€lack€of€initiative€in€addressing€the€rootÏcauses€of€maternal€mortality.€For€instance,€consequences€of€unsafe€abortion€are€managedÏbut€the€underlying€reasons€for€unwanted€pregnancies€are€not.€Key€activities€in€reversingÏthis€trend€were€identified€as:€ÌÌòòParticipationóó:€Community€involvement€to€make€maternal€mortality€a€common€issue€shouldÐ ¬&t # Ðbe€achieved€through€advocacy,€service€and€information€provision€(including€access€toÏemergency€obstetric€care),€and€community„level€funding.€Private€and€NGO€sectorÏinvolvement€should€include€the€majority€of€nurses,€midwives€and€doctors€who€do€not€workÏin€the€public€system€and€to€enhance€competition.€Providers€should€be€geared€to€provideÏrelevant€services€through€networking€referral€systems.€Governments€should€formulateÏappropriate€policies€and€laws,€undertake€real€health€sector€reform,€provide€sufficientÏfunding,€and€encourage€intersectoral€collaboration.Ð  -è&* ЇòòProgrammingóó:€Process€indicators€should€be€reviewed.€Dr.€Rogo€recommended€the€UNICEFÐ 8 Ðindicators,€which€describe€the€minimum€acceptable€number€of€facilities€and€services€perÏpopulation,€and€emergency€obstetric€and€birth€facilities€available€to€women.€MarginalizedÏgroups€like€adolescents€should€be€urgently€addressed.€This€group€represents€30€per€centÏof€the€population€and€suffers€from€three€to€four€times€higher€than€average€maternalÏmortality.€In€many€cases€they€are€denied€services.€Dialogue€with€providers€is€also€anÏimportant€issue€and€it€should€be€improved.€Providers€are€well€trained€but€the€environmentÏis€not€conducive€for€providing€QOC.€Providers€have€to€be€involved€in€decisions€to€provideÏquality€services.ÌÌò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓBroadening€Constellation€of€Services€within€Existing€SystemsÔ#†XøX¼¼ÞY)#ÔÔ‡¼Þ¼XXøÔ:Ð p8  ÐThe€Case€of€BangladeshÔ#†XøX¼¼Þã)#ÔÔ L)Ôó óÐ „L  ÐòòMr.€Mohammad€Nizamuddin,€Director,€Technical€and€Policy€Division,€UNFPAÐ ˜`  Ðà @½ à€€€€€Ms.€Adrienne€Germain,€International€Womenððs€Health€Coalition,€USAóóÐ „L  ÐÓx)ÓÌImmediately€following€the€ICPD,€the€Government€of€Bangladesh,€together€with€a€donorÏconsortium€and€UN€agencies,€decided€to€develop€for€the€first€time€a€national€health€andÏpopulation€sector€strategy.€€It€was€agreed€that€the€ICPD€Programme€of€Action€would€beÏused€as€the€core€substantive€framework€and€that€the€design€process€would€include€theÏparticipation€of€representatives€of€all€stakeholders€at€every€stage.€A€great€deal€has€beenÏlearned€from€this€experience€on€such€matters€as€the€following:ÌÌ„€à ½ àHow€to€design€an€approach€to€RH€services€reflective€of€the€ICPD€commitment,€whileРИ Ðtaking€into€account€the€human€and€institutional€constraints€the€country€faces.€€In€the€caseÏof€Bangladesh,€the€national€(vertical)€family€planning€programme€has€a€25„year€history€ofÏinvestment€and€political€support,€and€the€Ministry€of€Health€and€Family€Welfare€is€itselfÏdivided€into€two€wings.€Thus,€developing€RH€policy€and€programmes€requires€not€simplyÏintegration€of€health€and€family€planning€services,€but€also€reorganization€of€bureaucraticÏstructures€at€all€levels.€What€is€the€best€process€for€achieving€this?ÌÌ„€à ½ àWhich€of€the€many€elements€of€sexual€and€RH€care€can€the€current€humanÐ 0"ø Ðresources€and€institutions€deliver?€€What€exact€steps€need€to€be€taken,€in€what€order,€toÏbuild€the€necessary€human€and€institutional€capacity€to€provide€sexual€and€RH€services,Ïmonitor€progress,€educate€the€public,€develop€partnership€with€NGOs€and€civil€society,€andÏensure€accountability?ÌÌ€„€à ½ àWhich€services€should€have€priority€in€the€allocation€of€scarce€resources?€€How€canÐ ¸'€!$ Ðall€stakeholders€participate€in€the€decision-making€process?€€What€are€appropriate€meansÏto€use€existing€resources€more€efficiently,€and€to€generate€increased€resources,€includingÏcollaboration€with€the€private€sector,€cost€recovery€through€fees€for€services,€andÏpartnerships€with€NGOs?€How€can€a€social€safety€net€be€maintained€to€ensure€access€toÏâ âservices€for€the€very€poor,€keeping€in€mind,€especially,€the€fact€that€women€have€lessÐ T,&) Ðaccess€to€cash€than€men€and€their€health€care€is€often€less€valued€than€menððs€inÏBangladesh€and€other€countries.Ìâ âÌ€„€à ½ àWhat€are€feasible€and€effective€means€to€improve€both€access€to€services€and€theÐ üÄ Ðquality€of€services,€especially€technical€quality€and€client-provider€interaction?ÌÌ€„€€à ½ àOnce€those€sorts€of€questions€have€been€addressed,€what€are€feasible€means,Ð À ˆ Ðthrough€a€participatory€process€to€design,€implement€and€monitor€detailed€implementationÏplans?ÌÌThe€Bangladesh€experience€makes€clear€that€"stakeholder€participation"€requiresÏinvestment€of€both€time€and€money€by€all€actors.€€This€investment€pays€off€in€a€strategyÏfirmly€rooted€in€reality€and€"owned"€by€all€those€who€participate.ÌÌò òÔ& ¤ ÔDiscussionÐ  è  Ðó óÌòòClient€perspective€and€empowermentóóÐ È ÐThe€Round€Table€pointed€out€that€the€QOC€provided€often€depends€on€the€socioeconomicÏstatus€and€literacy€of€clients.€€Groups€such€as€commercial€sex€workersÔ'¤ §6Ô,€unmarried€women,Ïyouth,€and€women€seeking€abortion€(where€it€is€not€against€the€law)€are€vulnerable€toÏhostile€treatment€from€prejudiced€health€care€providers.ÌÌThe€importance€of€empowering€clients€to€demand€QOC€by€raising€awareness€of€their€rightsÏand€on€QOC€was€stressed.€Information€to€create€such€awareness€and€demand€should€beÏprovided€outside€the€service€delivery€system,€for€instance,€through€the€media.€It€was€notedÏthat€clients€are€willing€to€pay€for€services€they€have€demanded.€In€fact,€the€first€stop€forÏmany€clients€is€the€traditional€healer,€€whom€they€willingly€pay.€ÌÌCompetition€should€be€considered€as€a€means€to€improve€QOC.€If€there€is€a€choice€ofÏservice€delivery€points,€clients€can€use€the€services€that€best€live€up€to€the€clientsðð€demandÏfor€QOC.òòÐ è!° ÐÌProvider€perspectiveÌóóThe€need€to€assess€the€reasons€for€service€providersðð€under€use€of€resources€illustratedÐ ¬$t! Ðin€Dr.€RamaRaoððs€presentation€was€stressed.€Providers€are€often€demoralized€by€theirÏworking€environment€and€by€structurally€flawed€public€health€systems.€In€fact,€the€sameÏperson€in€the€private€sector€performs€much€better.€Providers€should€therefore€not€beÏconsidered€the€enemy€but€essential€to€improving€QOC.òòÐ \($"% ÐÌÔ& ° ÔTrainingóóÐ 4*ü#' ÐThe€Population€Council€is€implementing€a€programme€in€which€family€planning€providersÏand€supervisors€are€being€trained€to€improve€QOC.€€Such€training€creates€the€commitmentÏto€solve€problems€as€they€arise.€In€South€Africa,€a€pilot€scheme€isÔ'°4*½<Ô€underway€in€whichÐ ø,À&* Ðtraining€health€workers€in€hospitals€are€instructed€to€provide€greater€understanding€in€post„¼abortion€care.€The€curriculum€was€drawn€up€by€an€NGO.ÌÌSouth€Africa€has€also€effectively€used€the€training€methodology€of€€Health€Workers€forÏChange,€a€programme€that€enables€health€workers€to€self„identify€problems€in€the€care€theyÏprovide.€This€has€helped€to€build€morale€which€was€mentioned€several€times€as€being€atÏthe€core€of€improving€QOC.€ÌÌòòMinimum€standards€in€QOCóó€Ð ˜ ` ÐThe€Round€Table€participants€agreed€that€the€family€planning€QOC€framework€is€generallyÏapplicable€to€RH.€Many€techniques€and€skills€needed€are€the€same.€Issues€of€quality€suchÏas€confidentiality,€privacy,€counselling€and€interpersonal€relations,€remain.ÌÌThe€key€question€is,€how€to€define€minimum€standards€for€QOC,€and€how€to€improve€QOCÏcontinuously€as€more€resources€become€available.€The€debate€centered€on€the€need€toÏinterpret€international€QOC€standards€according€to€local€needs€and€perceptions.€It€wasÏunderlined€that€minimum€standards€should€also€apply€to€the€private€sector€just€as€specialÏattention€should€be€given€to€setting€minimum€standards€for€unfamiliar€or€new€services,€andÏfor€services€provided€in€emergency€situations.ÌÌThe€Round€Table€underscored€that€QOC€is€human€rights€in€action.€If€clients€are€notÏprovided€with€sufficient€information€to€make€fully€informed€choices€their€human€rights€areÏviolated.€This€is€the€case,€for€instance,€with€sterilization€clients€are€not€made€aware€of€theÏpermanence€of€the€procedure.ÌÌò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓFindings€of€the€Working€Group€on€Designing€Ð D  ÐHigh€Quality€Reproductive€Health€ProgrammesÔ DÔó óÐ X  ÐÔ#†XøX¼¼Þ#D#ÔÓBDÓÌò òòòÔ  ÔA.€à ½ àProgress€toward€implementation€of€the€ICPD€Programme€of€ActionÔ EÔóóó óÐ X  ÐÌSome€progress€since€ICPD€has€occurred€in€integration,€such€as€the€provision€of€moreÏservices€at€the€first€point€of€contact€and€in€the€establishment€of€referral€systems.€This€hasÏbeen€achieved€in€projects€conducted€by€NGOs.€€Countries€have€also€made€progress€withÏinitiatives,€often€begun€before€1994,€for€integrating€MCH€and€FP€services.€Since€ICPD,€€theÏfocus€has€been€to€further€integrate€these€services€with€STD/HIV/AIDS€prevention,€screeningÏand€treatment.€Integration€may,€however,€only€involve€that€services€are€offered€at€the€sameÏservice€delivery€place€while€different€providers€continue€to€address€individual€aspects€ofÏRH.€ÌÌMany€countries€have€adopted€the€quality€of€care€language€and€have€focused€on€providingÏthe€determing€factors€for€quality€of€care.€Some€progress€has€been€made€in€expandingÏcontraceptive€choice,€and€many€countries€(Bangladesh,€some€states€of€India€and€Mexico)Ïare€concerned€with€providing€information€and€counselling€and€ensuring€€informed€consentÐ @-'* Ðand€confidentiality.€NGOs€are€increasingly€involved€in€defining€and€implementing€QOC€andÏquality€assurance€systems€are€in€place€in€many€countries.ÌÌTaking€note€of€the€health€sector€reform€in€many€countries,€the€group€pointed€out€that€thisÏprocess€can€both€be€a€facilitator€and€an€impediment€to€comprehensive€and€integratedÏsexual€and€reproductive€health€QOC.€The€process€may€facilitate€integration,€collaborationÏbetween€sectors,€and€decentralization€but€there€are€the€risks€that€sexual€and€RH€does€notÏreceive€enough€priority€in€the€process€and€that€the€capacity€to€manage€the€new€system€isÏnot€present€at€the€decentralized€level.ÌÌIn€integrated€and€comprehensive€RH,€three€issues€have€emerged€as€global€concerns:Ïmeeting€the€need€for€family€planning,€ensuring€maternal€health€(including€reducing€unsafeÏabortion)€and€reducing€infant€mortality;€and€preventing€and€treating€STDs,€includingÏHIV/AIDS.ÌÌò òòòÔ  ÔB.€à ½ àConstraints€in€designing€quality€RH€programmesÔ MÔóóó óÐ  Ô  ÐÌThe€vertical€organization€structure€of€health€care€systems€constitutes€the€main€institutionalÏbarrier€€to€a€more€integrated€approach.€Separate€budget€allocations,€administrativeÏstructures€and€personnel€prevent€the€coordination€and€integration€services.ÌÌLack€of€political€commitment€€to€improve€QOC€endures€because€change€is€seen€as€tooÏcostly.€The€group€found€that€improving€the€quality€of€services€requires€not€only€expandedÏchoices€but€also€information€and€counselling€to€take€advantages€of€expanded€choices€andÏstrict€adherence€to€at€least€minimum€technical€standards€of€care.€Studies€reveal€thatÏimprovements€in€service€provision€can€be€made€at€reasonable€cost.ÌÌTechnologies€are€seriously€inadequate€in€STDs›,€including€HIV/AIDS.€The€female€condomÏis€expensive.€Few€women€have€a€method€that€they€can€use€to€protect€themselves€and€theirÏpartners;€simpler€diagnostic€tests€and€single€dose€treatments€are€not€available.ÌÌò òòòÔ  ÔC.€à ½ àActions€neededÔ 1QÔóóó óÐ Ì"” ÐòòÌMinistry€Levelóó€/òòService€DeliveryóóÐ ¤$l! Є€Increase€investment€in€the€òòmanagementóó€of€service€provision,€including:Ð %X" ÐÌÝ‚cÿÝÝ  ÝÝ‚c-RÝð"ðà0 ½ àÝ  ÝòòStructural€integration€of€œRH€servicesóó€or€at€least€functional€integration,€includingÐ h'0!$ Ðeffective€referral€systems€and€training€in€supervision€is€required€to€move€verticalÏservices€and€management€systems€to€integrated€comprehensive€care.݃c-RHR݌Р½(#½(# ÐŒÝ  ÝÌÝ‚cÿÝÝ  ÝÝ‚c¶SÝð"ðà0 ½ àÝ  ÝòòMake€the€most€of€existing€resourcesóó€to€provide€good€services,€improve€resourcesÐ +à$( Ðto€upgrade€standards€of€care€and€perform€continuing€evaluations.€GovernmentsÏshould€establish€regulations€that€ensure€standards€for€high€quality€health€services.݃c¶SÑSÝŒÐð,¸&*½(#½(# ÐŒÝ  ÝÌÝ‚cÿÝÝ  ÝÝ‚cNUÝð"ðà0 ½ àÝ  Ý€òòTrainingóó€service€providers€to€improve€their€technical€skills,€communications€andÐ $ì Ðsupervision.€Training€should€also€prepare€providers€to€communicate€clearly€withÏempathy€and€with€respect€for€human€rights,€gender€equality€(including€violenceÏagainst€women)€and€the€provision€of€dignified€care.݃cNUiU݌Р½(#½(# ÐŒÝ  ÝÌÝ‚cÿÝÝ  ÝÝ‚cWÝð"ðà0 ½ àÝ  ÝòòDevelop€indicators€to€monitor€QOC€provisionóó€and€train€managers€and€supervisorsÐ À ˆ Ðin€using€MIS›€for€QOC€improvement.òò݃cW,W݌Ь t½(#½(# ÐŒÝ  ÝÌóóÝ‚cÿÝÝ  Ýò òÝ‚c/XÝð"ðà0 ½ àÝ  Ýòòó óInstitutionalize€quality€assurance€measuresóó,€to€which€both€the€public€and€privateÐ „L  Ðsector€should€be€held€accountable.€There€is€also€a€need€to€develop€and€applyÏcommunity„driven€quality€assurance€by€applying€a€simple€QOC€framework.€òò݃c/XMXÝŒÐd, ½(#½(# ÐŒÝ  ÝÌDonors€and€international€agenciesóóÐ <  Є€In€STD€and€HIV/AIDS,€increased€subsidies€are€needed€to€broaden€access€to€femaleÏcondoms.€€òòInvestments€are€urgently€required€for€research€and€development€of€microbicides,Ð Ü  Ðsimple€diagnostic€tests€and€single€dose€treatmentsóó.Ð È ÐÌ„€Develop€a€system€for€monitoring€the€implementation€of€the€paragraph€8.25€of€the€ICPDÏProgramme€of€Action€regarding€òòsafe€abortionóó.Ð ÄŒ Ðò òÓ  ÓÔ‡¼Þ¼XXøÔÔ  ÔÌSession€3:€Access€to€RH/SH/FP€ServicesÔ Ù[ÔÔ#†XøX¼¼Þº[#ÔÐ ÄŒ ÐÌÓ®[ÓChair:à  àó óDr.€Mawaheb€El„MouehlyÐ Ì” Ðò òPresenter:ó óà  àMs.€Maria€Isabel€Plata,€Executive€Director,€PROFAMILIA,€ColombiaÐ Àˆ ÐÌò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓDiversifying€Service€Providers:€The€Participation€of€the€Private€SectorÐ  h ÐIncluding€NGOs€in€the€Provision€of€ServicesÔ#†XøX¼¼Þ)]#ÔÔ ]Ôó óÐ ´| ÐÓH]ÓòòÓ  ÓMs.€Maria€Isabel€Plata,€Executive€Director,€PROFAMILIA,€Colombiaóóò òÐ È  ÐÓ:^ÓÌó óPROFAMILIA,€a€financially€self„sufficient€NGO€in€Colombia,€provides€more€than€60€per€centÐ ¨"p Ðof€national€family€planning€and€legal€services€specializing€in€family€law.€Ms.€Plata€chartedÏthe€progress€of€PROFAMILIA,€which€started€distributing€condoms€30€years€ago,€to€theÏcurrent€organization,€which€has€a€$28€million€annual€budget€and€more€than€1,000€staffÏmembers.€Mindful€of€womenððs€autonomy,€PROFAMILIA€launched€a€legal€service€in€1986Ïwhich€expanded€into€an€office€for€Sexual€and€Reproductive€Rights€and€œGender›€in€1995.ÌÌWhen€PROFAMILIA€started€operations€it€met€opposition€from€the€medical€profession€andÏthe€Catholic€Church,€but€the€government€let€PROFAMILIA€conduct€its€work.€The€programmeÏgrew€by€meeting€public€demand€with€high€quality€services€and€a€growing€number€ofÏColombians€now€accept€family€planning.€Today,€family€planning€is€a€constitutional€right€andÏis€a€part€of€new€public€and€private€health€plans.€Ð Ì,”&) ЇInitially€donor€support€was€critical€for€increasing€outreach,€but€through€its€cost€recoveryÏprogramme,€PROFAMILIA€can€now€subsidize€services€in€poor€and€remote€communities€andÏfor€teenagers.€Cost€recovery€has€helped€ensure€voluntary€and€informed€choice€as€well€asÏmaintain€high€quality€of€care.€Reliance€on€cost€recovery€prevents€abuse:€ð ðWe€sleep€betterÏknowing€people€have€to€pay€for€a€tubal€ligation€or€vasectomy,ðð€Ms.€Plata€said.€ð ðNo€one€isÏgoing€to€pay€for€something€they€do€not€want.ðð€ÌÌMs.€Plata€underscored€the€importance€of€NGOs€being€politically€independent€andÏconstantly€correcting€mistakes.€€While€governments€never€supported€PROFAMILIA€theÏpolitical€independence€was€important€for€governments€nevertheless€to€allow€it€to€conductÏits€work.€€She€also€stressed€the€importance€of€œMIS€to€improve€QOC€to€meet€the€needs€ofÏthe€community€is€essential,€especially€in€a€program€that€depends€on€cost€recovery.€ÌÌò òDiscussionÐ 4ü  Ðó óÌThe€discussion€focused€on€the€relation€between€PROFAMILIA€and€the€government,€and€theÏsustainability€of€PROFAMILIA.ÌÌòòÔ& ° ÔNGOs€and€governmentóóÐ Ø  ÐThe€lesson€of€the€PROFAMILIA€shows€that€the€flexibility€of€NGOs€enables€them€to€promoteÏRH€through€their€own€services€without€absolving€governments€of€their€responsibility€toÏprovide€a€fullÔ'°ØµfÔ€package€of€services.€PROFAMILIA€showed€how€an€NGO€can€collaborateÏclosely€with€a€government.€€PROFAMILIA€provides€a€unique€example€of€how€public€fundsÏcan€be€used€for€paying€for€private€sector€services.€Its€applicability€in€all€poor€countries€isÏquestionable,€however,€because€of€the€absence€of€national€health€insurance.€ÌòòÌSustainabilityóóÐ 8 ÐMs.€Plata€notes€that€levels€of€self„sufficiency€can€be€duplicated€by€NGOs€that€have€supportÏof€the€international€community.€Self„sufficiency€requires€the€efficient€management€ofÏfinances€and€planning.€In€Colombia,€user€fees€are€found€to€empower€clients€to€demandÏbetter€services.€€This€effect€was€noted€by€conference€participants€with€experience€fromÏother€regions.€ÌÌHealth€reform€can€create€healthy€competition€between€the€public,€private€and€NGO€sectors.ÏOnce€fees€are€standardized€clients€will€be€attracted€to€the€clinic€which€offers€the€best€QOC.€Ìâ âÐ „&L # Ðò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓÔ& ` Ôâ âFindings€of€the€Working€Group€on€Access€to€RH/SH/FP€ServicesÔ#†XøX¼¼Þ‚k#ÔÔ ukÔó óÐ 8 ÐÓ¡kÓò òòòÌÔ  ÔA.€à ½ àProgress€toward€implementation€of€the€ICPD€Programme€of€ActionÔ blÔÐ 8 Ðó óÌEducationóóÐ  Ø ÐInformation€and€the€confidence€to€take€action€in€personal€and€institutional€relationships€areÏa€precondition€for€sexual€and€RH.€NGOs€have€been€successful€in€building€the€knowledgeÏbase€and€confidence€of€women,€men€and€adolescents€to€claim€their€sexual€andÏreproductive€rights€and€promote€their€sexual€and€RH€including€the€effective€use€of€healthÏservices.€Ô'` 8­kÔÌÌInnovative€methodologies€and€materials€have€been€developed€to€help€people€realize€theirÏsexual€and€RH€and€rights.€These€include€drama,€mass€media€and€peer€education.ÌÌòòService€Deliveryóó€Ð H  ÐThe€diversification€of€service€provision€for€selected€RH€services€such€as€family€planningÏhas€improved€access€in€some€countries.€Community„based€distribution€programmes€andÏsocial€marketing€are€proven€to€be€effective€and€cost„effective.Ìò òòòÌÔ  ÔB.€à ½ àConstraints€in€improving€access€to€RH/SH/FP€ServicesÔ GpÔÐ ä¬ Ðó óóóÌPrevailing€economic€conditions€and€the€resulting€poor€health€care€infrastructure€continueÏto€obstruct€access€to€services.€€Barriers€to€service€include€distance,€cost,€ignorance€and€theÏpoor€attitude€of€€providers.ÌÌThe€separation€of€basic€primary€health€care€services€places€an€exceptional€burden€onÏwomen€to€meet€their€diverse€needs€and€those€of€their€children.€It€also€leads€to€duplicationÏof€infrastructural,€management,€information€and€other€systems.€Men€often€can€preventÏwomenððs€access€to€sexual€and€RH€care€and€endanger€their€health€and€lives.€ÌÌñd ñÐ  "Ð Ðñd ñòòò òÔ  ÔC.€à ½ àActions€neededÔ sÔ€óóó óÐ "Ð ÐÌòòGovernment/Legislative€óóÐ à#¨  Є€òòEquityóó€is€a€precondition€to€achieving€the€right€to€health.€òòHealth€sector€reforms€must€beÐ Ì$”! Ðdesigned€to€ease€peopleððs€access€to€servicesóó.€Investments€must€be€made€to€healthÐ ¸%€" Ðfinancing€systems€to€safeguard€equity€of€access,€while€facilitating€the€use€of€diverseÏproviders€including€NGOs,€the€private€and€the€public€sectors.Ìâ âòòÐ |(D"% ÐÔ& ˆ Ôâ âMinistry/Executive€óóÐ 8 Є€Because€health€services€cannot€function€without€infrastructure,€òògovernments€must€makeÐ $ì Ða€priority€of€developing€and€maintaining€servicesóó€such€as€water€supply,€power,€sanitation,Ð Ø Ðroads,€transport,€and€communications.€Health€services€should€give€priority€to€womenððsÏhealth€needs.ÌÔ'ˆ89uÔÌòòService€providersÐ À ˆ Ðóó„€òòEmpowering€peopleóó€to€uphold€their€sexual€and€reproductive€rights€and€health€requires€thatÐ ¬ t Ðinformation€be€available€and€that€it€be€relevant€and€easily€understandable.€GovernmentsÏand€NGOs€should€increase€efforts€to€evaluate€the€effectiveness€of€communicationsÏtechniques€and€materials€and€share€them€widely.€Content€must€include€common€humanÏexperience€such€as€sexuality€and€power€relations€between€men€and€women,€includingÏviolence.€ÌÌò òÓ  ÓÔ‡¼Þ¼XXøÔÔ  ÔÔ& x ÔSession€4:€€Creating€Necessary€Conditions€for€Implementing€SexualÐ  è  Ѐand€Reproductive€Health€and€Rightsó ó€ò ò(Part€I)Ô ÿxÔÔ#†XøX¼¼Þàx#ÔÔ‡¼Þ¼XXøÔó óÐ 4ü  ÐÔ#†XøX¼¼ÞÔy#ÔÓÔxÓà ½ àà  àà m àà Å àà  àÌò òChair:à  àó óà m àDr.€Mawaheb€El„MouehlyÐ 4ü Ðò òPresenters:à  àó óà m àMr.€Jackson€Chekweko,€Reproductive,€Education€and€CommunityÐ (ð Ðà ½ àà  àà m àà Å àHealth€Programme€(REACH),€UgandaÌà ½ àà  àà0 m àMs.€Wanda€Nowicka,€Federation€for€Women€and€Family€Planning,ÏPolandÐ m (#m (# Ðò òDiscussants:ó óà m àMs.€Ylva€Sorman€Nath,€Womenððs€Forum,€SwedenРਠЀ€€€€€€€€€€€€€€€€€€€€€€€à0 m àMs.€Anika€Rahman,€Center€for€Reproductive€Law€and€Policy,€USAÐÔœm (#m (# ÐÌÔ'x   yÔò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓFemale€Genital€Mutilation€in€UgandaÔ#†XøX¼¼Þ}#ÔÔ  }Ôó óÐ ¬t ÐÓ6}ÓòòÓ  ÓMr.€Jackson€Chekweko,€Reproductive,€Education€and€Community€HealthÐ Àˆ ÐProgramme€(REACH),€UgandaóóÐ ¬t ÐÓÄ}ÓÌMr.€Chekweko€set€the€scene€for€the€discussion€on€violence€by€describing€the€REACHÏprogramme,€a€unique€UNFPA„funded€project€which€has€greatly€reduced€FGM€in€theÏKapchorwa€area€of€Uganda,€one€of€30€African€countries€where€the€practice€takes€place.ÌÌFGM€poses€severe€physical€and€psychological€risks.€€Nonetheless,€the€district€resistedÏefforts€by€government€and€NGOs€to€eradicate€the€practice€because€resented€what€it€sawÏas€outside€interference.€€At€one€point,€Kapchorwa€District€had€passed€a€law€requiring€theÏcircumcision€of€all€women.ÌÌThe€REACH€project€began€in€1995.€€It€involved€allowing€people€to€determine€and€bringÏabout€change€on€their€own.€€REACH€succeeded€by€separating€FGM€from€the€cultural€valuesÏit€was€supposed€to€save,€proposing€alternative€activities€to€sustain€those€ideals,€and€byÏconsulting€the€custodians€of€community€ethics.€€The€process€of€acceptance€involvedÐ ”,\&) Ðawareness€workshops€and€seminars€held€at€all€levels€in€the€district€for€all€sectors€of€theÏcommunity;€peer€education€both€at€school€and€rural€areas;€extension€of€RH€servicesÏintegrated€with€FGM;€sensitization€through€the€training€of€health€workers;€participation€inÏall€events€and€functions;€training€of€circumcisers€to€be€TBAs;€and€undertaking€operationalÏresearch.€€The€project€found€opportunities€to€enable€free€discussion€of€FGM€especiallyÏamong€young€males,€empowering€women€through€education,€and€establishing€a€NGO€link.ÏIn€1996€FGM€dropped€by€36€per€cent.ÌÌAccording€to€Mr.€Chekweko,€local€communities€should€occupy€a€central€position€in€theÏimplementation€of€the€programme,€and€governments€in€consultation€with€communitiesÏshould€design€laws€to€protect€women€from€all€forms€of€violence.€€Discussions€of€€FGMÏshould€be€included€in€school€curricula,€girl€child€education€should€be€encouraged€andÏresearch€that€is€sensitive€to€culture€be€undertaken.€€Those€who€earn€their€income€byÏperforming€the€practice€must€be€shown€alternative€ways€to€support€themselves.€InteragencyÏcollaboration€is€needed€at€all€levels€to€deliver€the€same€message€to€the€community.ÌÌò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓViolence€Against€Women:€the€Role€of€the€Health€and€Education€SectorsÔ#†XøX¼¼Þ‹†#ÔÔ ~†Ôó óÐ øÀ ÐÓª†ÓòòÓ  ÓWanda€Nowicka,€Federation€for€Women€and€Family€Planning,€PolandÐ  Ô ÐóóÓY‡ÓÌMs.€Nowicka€described€acts€of€gender„based€violence€during€the€womanððs€life.€€BeforeÏgiving€birth,€women€suffer€gender„based€violence,€including€sex„selective€abortion,Ïbattering€during€pregnancy€and€coerced€pregnancy.€€During€infancy,€violence€includesÏfemale€infanticide,€emotional€and€physical€abuse,€and€the€relegation€of€inferior€food€andÏmedicine€to€females.€Gender„based€violence€among€children€includes€child€marriage,€FGM,Ïsexual€abuse€and€child€prostitution.€€In€adolescence,€girls€face€sexual€abuse€andÏharassment,€forced€prostitution€and€trafficking.€During€womenððs€reproductive€span,€theyÏface€marital€rape,€dowry€deaths,€psychological€and€sexual€abuse.€In€addition,€the€abuse€ofÏelderly€widows€is€increasing.ÌÌTo€prevent€violence€towards€women,€Ms.€Nowicka€recommended€sex€education€thatÏpromotes€gender€equality,€human€rights€and€training€for€the€police€and€other€lawÏenforcement€institutions€such€as€the€judiciary.€€Health€care€systems€should€recognize€theÏconsequences€of€violence€and€address€both€the€prevention€and€the€consequences€ofÏviolence.€€Most€of€all,€provide€full€information€to€women€and€facilitate€their€access€toÏreproductive€health€services€including€abortion€(where€it€is€not€against€the€law)€and€familyÏplanning.€It€is€important€to€include€communication€skills€and€education€on€violence€in€theÏcurricula€of€medical€and€nursing€schools.€Counseling€and€referral€systems€should€beÏdeveloped€in€the€health€care€system€and€health€care€services€should€be€improved€toÏidentify€and€treat€casualties€of€violence.€The€issue€of€violence,€including€the€identificationÏof€child€abuse,€should€also€be€included€in€teachersðð€training.€€All€this€should€beÏsupplemented€by€the€provision€of€shelters€for€victims€of€gender€based€violence.€Finally,€MsÏNowicka€urged€energetic€efforts€to€persuade€the€media€to€end€their€indifference€to€gender„¼based€violence.Ð -à&* Ðò òÌDiscussionÌó óÌMs.€€Ylva€Sorman€Nath€discussed€her€work€in€trying€to€eliminate€FGM€in€Sweden,€whereÏit€is€practiced€among€some€Somali€migrants.€€Sweden€developed€guidelines€about€FGM€forÏhealth€workers€and€incorporated€these€into€womenððs€rights€work€and€into€education€andÏmaternal€and€child€health€programs.€€The€media€was€educated€on€FGM€and€carriedÏresponsible€stories€that€raised€awareness€among€Swedes€and€Somalis.ÌÌThe€FGM€project€in€Gothenburg€involves€Somali€doctors,€men€and€religious€leaders,€nursesÏand€schools€in€discouraging€FGM.€€These€efforts€have€succeeded€in€curbing€€the€practice,Ïalthough€some€Somali€women€still€feel€it€is€necessary€to€keep€their€daughters€eligible€forÏmarriage€by€making€them€undergo€FGM.€€Ms.€Nath€recommends€using€SomaliÏprofessionals,€encouraging€religious€leaders€to€emphasize€that€the€practice€is€not€requiredÏby€any€faith,€involving€Somali€men€to€see€the€disadvantages€of€FGM€and€educating€theÏmedia€on€the€issue.ÌÌòòHuman€rightsóóÐ ô¼ ÐGender€based€violence€should€be€seen€as€a€human€rights€issue.€€Education€and€trainingÏof€the€health,€education€and€law€enforcement€sectors€is€essential.€€Strategies€to€preventÏgender„based€violence€should€encourage€male€participation.€€ÌÌòòCommunity€approachóóÐ X ÐIt€was€suggested€that€any€project€initially€reflect€gender„based€violence€as€a€global€problemÏand€then€focus€on€the€problems€in€the€community.€ÌÌòòInteragency€collaborationóóÐ @ ÐIt€was€recommended€that€the€success€of€the€WHO/UNICEF/UNFPA€effort€in€FGM€shouldÏbe€broadened€to€gender„based€violence.€€Successful€programmes€need€to€be€analyzed€andÏbest€practice€results€disseminated€widely.€€ÌÌâ â€Ð Ü"¤ ÐÔ&   Ôâ âò òÔ‡¼Þ¼XXøÔÓ  ÓÔ  ÔSession€5:€€Creating€Necessary€Conditions€for€Implementing€SexualÐ 8 Ðand€Reproductive€Health€and€Rights€(Part€II)Ô ?–ÔÔ#†XøX¼¼Þ–#ÔÐ L ÐÌÓ3–ÓChair:à  àó óDr.€Isaiah€NdongÐ T  Ðò òPresenters:ó óà  àMs.€Anika€Rahman,€Center€for€Reproductive€Law€and€Policy,€USAÐ H  Ðà ½ àà  àMs.€Barbara€Klugman,€Womenððs€Health€Project,€South€AfricaÌÌò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓReproductive€Health€as€a€Human€Right:€Gender€Equality€and€WomenððsÐ  Ü ÐEmpowermentÔ#†XøX¼¼Þ7˜#ÔÔ *˜Ôó óÐ (ð ÐòòMs.€Anika€Rahman,€Center€for€Reproductive€Law€and€Policy,€USAóóÐ <  ÐÓV˜ÓÌMs.€Rahman€reviewed€the€legal€foundation€for€reproductive€rights€in€the€UniversalÏDeclaration€on€Human€Rights€and€other€human€rights€instruments€adopted€by€theÏinternational€community€sinceÔ'  8û•Ô€1945.€The€right€to€the€highest€attainable€standard€of€health,Ïand€sexual€and€reproductive€rightsò ò€ó óare€based€on€UN€conventions,€signed€by€governments,Ð Ø   Ðwhich€include€the€International€Covenant€on€Economic,€Social€and€Civil€Rights,€TheÏConvention€on€Elimination€of€All€Forms€of€Discrimination€Against€Women€(CEDAW),€andÏthe€Convention€on€the€Rights€of€the€Child€and€the€International€Convention€against€RacialÏDiscrimination.€They€can€be€used€as€instruments€of€advocacy€and€as€frameworks€forÏactivism.€The€realizations€of€reproductive€rights€calls€for€the€dissemination€of€informationÏabout€those€rights,€establishing€a€culture€of€rights€in€each€country,€and€developingÏindicators€for€monitoring€their€implementation.ÌÌReproductive€rights€include€reproductive€self„determination,€which€in€turn€include€rightsÏexplicitly€guaranteed€in€international€conventions:€the€right€to€decide€the€number€andÏspacing€of€children,€the€right€to€marry€and€to€have€a€family,€the€right€to€freedom€from€tortureÏor€other€cruel€or€degrading€forms€of€treatment€or€punishment;€the€right€to€modify€customsÏthat€discriminate€against€women,€and€the€right€to€freedom€from€sexual€assault€andÏexploitation.€€Advocacy€methods€useful€in€advancing€reproductive€rights€include€lobbyingÏfor€legal€and€or€policy€reforms,€instituting€legal€proceedings;€educating€policy€makers€andÏthe€public,€building€coalitions€and€global€networks;€and€negotiating€with€public€institutions,Ïincluding€donors.ÌÌAdvocates,€before€embarking€on€lobbying€or€court€actions,€must€first€examine€existing€laws,Ïespecially€those€dealing€with€sterilization€and€abortion,€and€how€they€are€interpreted€orÏenforced,€and€consider€whether€the€public€is€aware€of€them.€€When€further€action€isÏrequired,€it€is€often€easier€to€push€for€changes€in€policy€rather€than€laws,€because€effortsÏâ âto€alter€laws€involve€more€time.Ð )Ü"% ÐÔ& ˆ Ôâ âò òÔ  ÔÔ‡¼Þ¼XXøÔÓ  ÓLegislating€and€Implementing€Reproductive€Rights€in€South€AfricaÔ#†XøX¼¼Þá¡#ÔÔ Ô¡ÔòòÐ 8 Ðó óMs.€Barbara€Klugman,€Womenððs€Health€Project,€South€AfricaóóÐ L ÐÓ¢ÓÌMs.€Klugman€reported€on€the€gains€made€in€legislating€and€implementing€reproductiveÏrights€in€South€Africa€since€the€end€of€apartheid.€The€new€constitution€provides€for€healthÏcare€and€sexual€and€reproductive€rights.€South€Africa€recently€adopted€a€population€policyÏand€its€parliament€passed€the€Termination€of€Pregnancy€Act€in€1997.ÌÔ'ˆ8»¡ÔÌSouth€Africa€is€unique€among€countries€dealing€with€reproductive€rights€issues€because€theÏAfrican€National€Congress€won€the€national€election€on€a€human€rights€platform.€There€isÏalso€a€powerful€moral€imperative€to€end€discrimination,€including€that€against€women,€andÏto€end€family€planning€for€population€control€reasons.€The€minister€and€governmentÏleadership€are€committed€to€sexual€and€reproductive€health.€€They€favor€the€involvementÏof€civil€society€in€policy,€through€the€use€of€green€papers€and€draft€white€papers€for€publicÏscrutiny€and€public€hearings.€There€also€exist€soft€boundaries€between€politicians,Ïgovernment€and€policy€activity,€which€can€create€opportunities€for€discussion.ÌÌThe€Womenððs€Health€Project€identified€abortion€as€a€public€health€issue€during€theÏnumerous€seminars€and€meetings€at€all€levels.€It€developed€a€strategic€advocacy€planÏwhich€included€alliances,€influencing€politicians€and€educating€the€media.€The€ProjectÏformed€an€€alliance€with€all€groups€interested€in€RH.€It€then€promoted€a€public€discussionÏon€the€population€policy,€encouraged€NGOs›€and€members€of€the€civil€society€to€respondÏto€the€governmentððs€draft€White€Paper€on€the€population€policy,€thus€strengthening€theÏdemocratic€process.ÌÌTo€bring€politicians€to€support€the€Termination€of€Pregnancy€Act,€the€Project€collaboratedÏwith€the€renowned€Medical€Research€Council€to€conduct€research€and€disseminate€itsÏfindings€on€numbers€and€cost€of€unsafe€abortions.€Two€public€hearings€were€organized€onÏabortion:€on€the€issue€itself€and€on€legislation.€The€Project€invited€a€male€black€doctor€whoÏworked€in€the€rural€area€and€knew€first„hand€the€results€of€botched€illegal€abortions.€YoungÏgirls€who€had€undergone€illegal€abortions€also€testified.€The€news€media,€uncommitted€atÏfirst,€was€galvanized€into€supporting€legal€abortion€when€a€€girl€who€was€made€pregnant€byÏa€Catholic€priest€testified€that€the€priest€had€encouraged€her€to€have€an€abortion.ÌÌThe€example€of€South€Africa€offers€valuable€lessons.€It€is€important€to€understandÏpoliticiansðð€€concerns€and€to€convince€them€that€their€support€for€the€desired€change€willÏhelp€their€careers€and€constituents.€For€this€purpose€research€and€data€underscore€theÏvalidity€of€the€problem€and€the€potential€solution.€The€strategic€use€of€the€news€media€toÏcreate€public€awareness€and€political€support€is€also€recommended.€In€addition,€it€is€usefulÏto€find€research€to€answer€the€perspectives€put€by€opponents,€whether€civil€societyÏlobbyists€or€politicians.Ìâ âÐ ,,ô%) ÐThe€mobilization€of€mass€organizations€and€the€inclusion€of€important€members€of€theÏâ âpublic€who€speak€on€the€issue€strengthen€advocatesðð€campaigns.€€It€is€also€useful€toÏprepare€potential€legislation,€and€to€publicize€individual€testimonies,€reminding€politiciansÏthat€the€questions€at€hand€affect€their€constituents.€€Because€the€civil€service€is€influencedÏby€concerns€about€the€costs€of€new€legislation,€and€advocates€can€win€their€support€byÏshowing€the€cost€effectiveness€of€intervention,€including€social€costs.€It€is€also€importantÏto€assess€the€capacity€and€willingness€of€bureaucracy€to€implement€a€consultative€process.Ìò òÌÔ& ¤ ÔDiscussionÌó óÌòòOppositionóóÐ €H  ÐIn€dealing€with€religious€opposition€without€confrontation,€it€was€noted€that€an€alliance€wasÏformed€of€pro„choice€religious€leaders€who€were€used€as€spokes„people€with€the€media.Ô'¤  ß°ÔÌÌòòAlliancesóóÐ 0ø  ÐThe€South€African€example€showed€that€while€the€consultative€process€was€democratic,€aÏdivision€of€labour€was€established:€urban€NGOs€undertook€practical€campaigning€andÏlobbying€while€rural€NGOs€offered€first„hand€testimony€to€public€opinion.€The€Alliance€ofÏNGOs€for€RH€and€RR€now€runs€a€sexual€rights€campaign€at€all€levels€to€ensure€that€theÏpolicy€is€implemented.ÌÌòòMale€involvementóóÐ ¤l ÐThe€need€for€male€involvement€in€empowering€women€is€crucial€in€South€Africa.€DuringÏpeer€education€programmes,€couples€are€not€only€given€contraceptives€but€are€drawn€intoÏdiscussions€on€power€relationships.€€To€involve€men,€the€leadership€must€be€committed.ÏNo€minister€in€South€Africa€can€make€a€speech€without€mentioning€HIV/AIDS,€and€mostÏMinisters€are€men.€€Human€rights€and€sex€education€in€schools€should€address€both€menÏand€women.€ÌÌThe€issue€of€male€reproductive€rights€provoked€a€great€deal€of€œdiscussion€during€thisÏsession,›€with€some€participants€arguing€that€men€and€women€should€have€equal€rights.€ItÏwas€pointed€out€by€others,€however,€that€one€of€the€points€is€that€women€must€obtain€andÏbe€able€to€exercise€the€reproductive€rights€due€to€them€which€have€traditionally€been€deniedÏthem.€Only€when€women€can€freely€exercise€these€rights€can€both€sexes€say€that€they€areÏenjoying€equal€rights.€Gender€equity€and€not€only€gender€equality€should€be€achieved.Ì€Ô& œ ÔÌœò òÔ  ÔÔ‡¼Þ¼XXøÔà@²² ÆàFindings›€of€the€Working€Group€on€Creating€Necessary€ConditionsÔ#†XøX¼¼Þ–·#ÔÔ ‰·Ôó óˆÐ x'@!$ ÐÌò òòòÔ  ÔA.€à ½ àProgress€œtoward›€implementing€the€ICPD€Programme€of€ActionÔ Z¸Ôóóó óÐ x)@#& ÐÌSeveral€countries€have€developed€policies€banning€FGM,€œhave›€followed€up€withÏâ âprogrammes€and€have€developed€laws€or€policies€on€sexual€and€gender€violence,€whichÔ'œŒ&x·ÔÐ <,&) Ðhave€received€far€more€attention€since€the€ICPD.€Some€countries€have€abolished€spousalÏconsent€for€the€provision€of€contraceptive€services.Ìâ âÌPioneering€projects€are€being€developed€by€NGOs€working€with€young€people,€with€theÏpolice€and€health€care€providers€in€training€the€judiciary€to€deal€with€violence€againstÏwomen.Ìò òòòÌÔ  ÔB.€à ½ àConstraints€in€creating€necessary€conditionsÔ »Ôóóó óÐ ¬ t ÐÌDue€to€lack€of€political€will€at€the€national€level,€gender€concerns€in€the€formulation€andÏimplementation€of€policies€and€programmes€are€not€articulated.€This€is€further€complicatedÏby€poor€funding€for€national€womenððs€organizations.€Also,€there€is€relatively€little€operationalÏand€qualitative€research€on€these€issues.€€This€fact€contributes€to€inconsistencies€betweenÏpolicy€frameworks€and€implementation€strategies.€Appropriate€indicators€for€monitoring€areÏlargely€absent.ÌÌMany€social,€cultural€and€religious€attitudes€and€beliefs€still€put€womenððs€childbearingÏfunctions€before€other€roles,€restrict€womenððs€decision€making€in€the€private€and€the€publicÏdomain.€€Restrictive€attitudes€also€limit€womenððs€economic,€political€and€educational,€restrictÏtheir€access€to€and€control€of€€land€and€credit€as€well€as€information€and€knowledge,€andÏexclude€their€views€as€important€stakeholders€in€policy€formulation,€planning€andÏimplementation.€The€restrictions€perpetuate€gender€gaps,€hinder€efforts€to€empowerÏwomen,€thwart€strategies€to€integrate€a€human€rights€perspective€and€nullify€legal€andÏrelated€interventions€to€promote€gender€equality.ÌÌOne€of€the€most€pernicious€obstacles€to€gender€equality€and€equity€is€gender€based„¼violence.€€Little€headway€has€been€made€in€addressing€violence€against€girls€and€womenÏas€a€human€rights€and€public€health€issue.€Sexual€coercion,€abuse€and€violence€remainsÏpervasive€in€the€lives€of€many€girls€and€women.€ÌÌò òòòÔ  ÔÔ& œ ÔC.€à ½ àActions€neededÔ >ÁÔóóó óÐ à!¨ ÐÌòòPolitical/Legislative/Ministry€levelóóÐ ¸#€  Є€òòCreate€an€enabling€environment€through€participatory€processesóó€at€all€levels€of€societyÐ ¤$l! Ðfor€womenððs€empowerment,€male€involvement€in€promoting€sexual€and€reproductiveÔ'œà!KÁÔ€rightsÏin€a€human€rights€framework.€This€requires€the€adoption€of€a€gender€perspective€thatÏaccounts€for€the€different€realities€and€constraints€that€confront€men€and€women.€ÏProgrammes€specifically€for€women€are€essential€means€for€addressing€gender€inequalitiesÏand€inequities.ÌÌ„€òòRevise€and€ensure€the€repeal€of€restrictive€and€punitive€laws€and€policiesóó€to€advance€theÐ +à$( Ðsexual€and€reproductive€health€and€rights€of€girls€and€women.ÌÐ ð,¸&* Є€òòIntroduce€mechanisms€to€provide€human€rights„based€implementation€of€the€ICPDÐ 8 ÐProgramme€of€Actionóó€by€all€actors€(UNFPA€and€other€UN€agencies,€Governments,€NGOs,Ð $ì Ðcivil€society€partners€and€human€rights€treaty€bodies)€which€are€accountable,€transparent,Ïand€evaluated€on€regular€basis,€by:€(a)€increasing€NGO€involvement€in€state€partiesÏimplementation€to€human€rights€treaty€bodies;€(b)€establishing€human€rights€commissionsÏin€countries€which€address€sexual€and€reproductive€rights;€and€œ(c)promoting›€involvementÏof€civil€society€in€preparation€of€shadow€reports€to€human€right€treaty€bodies.ÌÌ„€òòInvestments€are€needed€to€support€menððs€contribution€to€the€sexual€and€reproductiveÐ ˜ ` Ðhealth€of€their€partnersóó,€such€as€partnersðð€access€to€reproductive€health€care€and€menððsÐ „L  Ðinvolvement€in€child€care.€Information€and€services€for€boys€and€men€themselves€need€toÏbe€increased€to€enable€them€to€take€responsibility€for€their€own€reproductive€and€sexualÏbehaviour€(such€as€information€on€and€access€to€contraceptive€methods€that€provideÏprotection€against€œSTDs›/HIV),€taking€responsibility€for€avoiding€unwanted€pregnancy.ÏThese€investments,€however,€must€not€detract€programmes€and€services€for€women.Ì̜Р øÀ ÐÑ  e Ñòò›Ó  ÓÔ‡¼Þ¼XXøÔò òConcluding€Remarks€by€Mr.€œMohammad›€Nizamuddinó óÔ#†XøX¼¼ÞäÉ#ÔóóÐ ° ÐÌÓØÉÓMr.€Nizamuddin,€after€thanking€the€Government€of€Uganda€for€hosting€the€meeting€and€theÏparticipants€for€their€varied€contributions,€noted€several€issues€that€were€debated€duringÏthe€Round€Table.€€Some€attention€needed€to€be€given€to€menððs€roles€and€responsibility€inÏreproductive€health€including€support€for€partnerððs€access€to€reproductive€health€care€asÏwell€as€information€on€and€access€to€services.€€Concerning€resources,€Mr.€NizamuddinÏadded€that€more€attention€needed€to€be€addressed€to€resource€shortages,€and€thatÏconcrete€suggestions€for€both€developing€and€developed€countries€were€needed.€€HeÏhoped€that€the€resource€situation€would€become€clearer,€as€would€data€about€resources,Ïby€next€year,€enabling€UNFPA€to€establish€to€where€it€stood€five€years€after€Cairo.ÌÔ‡¼Þ¼XXøÔò òòòÌà@’ ’ ÆàClosing€Remarks€by€Mr.€œJotham›€Musinguzióóó óÔ#†XøX¼¼Þ“Í#ԈРX  ÐÌMr.€œJotham›€Musinguzi,€Director€of€the€Population€Secretariat€of€the€Government€of€Uganda,Ïstated€that€since€ICPD€in€1994,€the€Ugandan€Government€had€attempted€innovative€waysÏof€implementing€the€Programme€of€Action€by€identifying€areas€of€priority,€which€previouslyÏhad€not€been€adequately€addressed:€adolescent€needs;€womenððs€empowerment,Ïreproductive€health€and€rights.€€ÌÌMr.€Musinguzi€concluded€that€the€Government€could€point€to€some€success€in€its€efforts,Ïand€could€point€to€achievements€in€the€empowerment€of€women,€the€involvement€of€men,Ïand€respect€for€human€rights.€€Although€the€Government€had€taken€action,€Mr.€MusinguziÏadded€that€ð ðour€best€is€not€enoughðð,€and€he€assured€the€chairman€of€the€final€session€thatÏUganda€would€take€the€Report€on€the€Round€Table€with€great€seriousness.ÌÐ  (x  МòòÔ  ÔÑ  € ÑAnnex›€1óóò òÔ zÑÔÐ ° ÐÌÔ‡¼Þ¼XXøÔÓ  ÓRegional€Perspectives€on€Progress€Achieved€in€Ensuring€ReproductiveÐ à ÐRights€and€in€Implementing€Reproductive€Health€Since€ICPDÔ#†XøX¼¼ÞÉÑ#Ôó óÐ ¤ô ÐÓèÑÓÌÌAmong€òòAsian€countriesóó,€the€Bangladeshi€national€family€planning€programme€had€forÐ  à Ðdecades€made€great€progress€in€the€promotion€of€contraception.€€But€by€the€midœ„1990s›,€theÏstatus€of€womenððs€health€remained€low.€€Half€the€population€was€younger€than€15,€whichÏunderscored€the€need€to€ensure€opportunities€for€adolescents€to€delay€marriage€andÏreproduction.€Furthermore,€the€risk€of€HIV/AIDS€and€œSTD›€epidemics€loomed.€The€broaderÏRH€framework€therefore€had€immediate€relevance€and€the€ICPD€recommendations€wereÏwidely€discussed€among€the€government,€NGOs€and€donors.€The€post„ICPD€consultationsÏresulted€from€government€interest,€vibrant€NGOs€and€an€unusually€positive€atmosphere€ofÏdonor€cooperation.€€ÌÌBangladesh€also€offers€a€unique€example€of€NGOs€engaged€in€consortium€and€of€donorsÏworking€together€towards€a€common€goal.€The€intention€of€moving€toward€RH€in€the€healthÏsector€is€reflected€in€the€1997€ð ðHealth€and€Population€Sector€Strategyðð,€which€affirms€theÏprinciples€of€ICPD€and€recognizes€the€need€for€a€client„centered€approach€and€for€goodÏservice€delivery.€In€1997,€a€National€Reproductive€Health€Strategy€was€formulated€with€theÏinvolvement€of€NGOs,€professional€groups€and€consultants.€Four€service€areas€haveÏpriority:€safe€motherhood,€family€planning,€menstrual€regulation€and€care€of€post€abortionÏcomplications€and€the€management€of€œRTIs›/œSTDs›.€It€is€based€on€a€life€cycle€approach,€inÏwhich€women€are€the€objects€of€specific€services€and€people€are€treated€holistically.ÌÌòòIn€Africaóó€since€the€adoption€of€the€ICPD€Programme€of€Action,€heads€of€states€in€Ghana,Ð P ÐKenya,€Uganda€and€Senegal€have€made€public€statements€of€support€especially€forÏreproductive€health€in€general€or€for€specific€aspects€such€as€birth€spacing,€AIDS,€or€FGMÏand€other€harmful€traditional€practices,€such€as€expected€early€childbearing€and€femaleÏreligious€bondage.€Although€these€statements€have€not€been€followed€by€further€legislativeÏprovisions€or€other€means€of€enforcement,€they€have€provided€a€òòde€factoóó€visa€for€actionÐ œ!ì Ðespecially€for€sexual€and€reproductive€health€and€reproductive€rights.€€In€some€countries,Ïpopulation€policies€adopted€before€1994€have€been€or€are€in€the€process€of€being€revisedÏin€accordance€with€the€Programme€of€Action.€€ÌÌPost„ICPD€population€policies€have€been€developed€in€line€with€the€Programme€of€ActionÏin€Ghana,€Mauritania,€Uganda,€Chad€and€the€Central€African€Republic.€Other€countries€areÏin€the€process€of€moving€towards€a€reproductive€health€approach.ÌÌòòLatin€American€and€the€Caribbeanóó€is€noteworthy€for€the€relationship€established€in€manyÐ è)8%( Ðpolicies€between€reproductive€health€and€primary€health€care€and€the€broader€context€ofÏsustainable€development.€The€Government€of€Peru,€for€example,€approved€in€1996€the€newÏRH€and€Family€Planning€Programme,€which€recognizes€abortion€as€a€public€health€problem,Ð ¬,ü'+  Ðproposes€an€emergency€plan€to€reduce€maternal€mortality€and€considers€FP€as€a€strategyÏto€reduce€poverty.€€In€Brazil,€a€Commission€on€Population€and€Development€was€createdÏafter€ICPD€with€a€broad€participation€of€the€civil€society.€Reproductive€health€is€central€toÏits€agenda€among€other€development€issues€and€in€1997,€the€Congress€approved€aÏNational€Family€Planning€Law.€All€temporary€contraceptive€methods€are€covered€by€the€law,Ïthat€also€recognizes€sterilization€as€an€acceptable€procedure€for€reimbursement€by€theÏUnified€Health€System.€ÌÌAmong€òòArab€Statesóó,€a€Ministry€of€Population€has€been€established€in€Morocco.€In€the€œMOH,›Ð ˜ ` Ðthe€MCH€division€has€been€changed€to€the€Division€on€Reproductive€Health,€whereÏreproductive€health€is€defined€as€taking€an€integrated€approach€to€œwomenððs€health.›ÏConsequently,€MCH€and€FP€are€now€under€the€same€roof,€while€linkages€are€beingÏstrengthened€to€the€division€responsible€for€STD/AIDS.€Population€commissions€have€beenÏreactivated€at€