Women have the right to the enjoyment of the highest attainable standard of physical and mental health. . . . Good health is essential to leading a productive and fulfilling life, and the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment....However, health and well-being elude the majority of women.

The Beijing Platform for Action endorses women's right to enjoy the highest attainable standard of physical and mental health, but notes that most women do not do so. Accordingly, the platform urges that governments and private organizations work at:

• Making appropriate and affordable health care and information available to women of all ages;
• Bolstering preventive programmes that promote women's health;
• Beginning to address the problems of sexually transmitted diseases, HIV/AIDS, and sexual and reproductive health in gender-sensitive programmes;
• Promoting research and disseminating information on women's health;
• Increasing funding and monitoring results for women's health.

The reproductive and sexual health and rights of women are at the core of UNFPA's work. Key to this work is improving access to and availability of quality services, and 60 per cent of UNFPA's funding is devoted to this cause. Women bear the burden of ill-health from reproductive causes much more than men, and maternal mortality rates are still unacceptably high in many regions of the world: 1,200 per 100,000 live births in some sub-Saharan countries, for example. Yet most of these tragedies can be avoided if women and men have access to good-quality, affordable reproductive health services.

Since the high levels of maternal morbidity and mortality are to a great extent due to existing inequalities between men and women, the empowerment of women is a necessary key to addressing this problem.

Increasing Access to
Reproductive and Sexual Health Services and Information

UNFPA works to improve each nation’s ability to deliver and manage good-quality reproductive health information and services. The Fund takes a many-pronged approach: increasing adults’ and youth’s access to these services, training service providers, standardizing guidelines, providing contraceptives and basic medical equipment, and upgrading existing facilities.

In Egypt, UNFPA has helped improve and expand the training of nurses in counselling skills in reproductive health, family planning and sexual health. Manuals, brochures, overheads and video clips in English and Arabic were produced to help the nurses act as community counsellors for the rural community. As a result of their work, women and men are now coming forward with questions about reproductive and sexual health, and are demanding contraceptive services and pre- and post-natal care.

Sexual and reproductive health services are offered to women of all ages, as well as to men and adolescents, in separate channels if culturally appropriate. The promotion of women's reproductive rights is often a component of the service.

In the occupied Palestinian territories, UNFPA helped establish a women's centre in the Al Burey refugee camp in Gaza. The centre offers comprehensive reproductive health services and social assistance and counselling on women's rights, including reproductive rights. The centre is run by the Culture and Free Thought Association, with technical assistance from the Italian Association for Women in Development.

Preventing Sexually Transmitted Diseases,
Including HIV/AIDS

Women are rapidly reaching and surpassing the numbers of men infected with HIV. Of the 32.4 million adults infected as of 1999, 14.8 million were women. In Africa, HIV-positive women now outnumber infected men by 2 million. Women are unfortunately more at risk of HIV/AIDS infection than men, due to both biological and cultural factors.

Many UNFPA programmes combat this risk to women and girls, through education and contraceptive methods that can protect them against infection. In 1998, UNFPA supported AIDS-prevention activities in 131 countries. In 128 countries, UNFPA supports HIV/AIDS-prevention activities that specifically target youth; in 22 countries the focus is on men as the disease is most easily spread by their activities.

In the Philippines, UNFPA and the Women's Health Care Foundation are working together to improve access to reproductive health services with trained community health workers, street youth and street vendors. WHCF provides STD/HIV/AIDS clinical services, including referrals for testing, and they conduct education and counselling sessions for urban poor women and female sex workers. The foundation also provides outreach services to men and youth. UNFPA supports training service providers and volunteer health workers in counselling and community education, and funded a telephone service that answers callers’ questions on STDs and sexuality.

A UNFPA project in the Dominican Republic focuses on information, education and communication efforts, training health care providers, and condom provision. Women are screened for STDs, STDs are treated when diagnosed, and blood for a blood bank is screened for disease. Some 360 peer educators work with the primary health care system to raise awareness of HIV/AIDS. The population's condom use has increased and women are more able to negotiate matters of sex and condom use.

Reducing Maternal Mortality and
Morbidity--Safe Motherhood

UNFPA believes that pregnancy must be seen in the context of a woman's entire existence, and that reducing maternal mortality demands an integrated approach--including increasing society's commitment to safe motherhood; improving health care and women's access to it; and committing to meeting the special needs of girls and women throughout their lives. UNFPA holds that death from pregnancy or childbirth is a violation of reproductive rights and a social injustice that should be addressed through legal, political and health systems in all countries.

In most of its country programmes, therefore, UNFPA supports: • Family planning services;

• Training traditional birth attendants and midwives;
• Providing equipment and supplies for essential obstetric care;
• Strengthening of referral systems;
• Operations research;
• Community education and advocacy programmes.

In Uganda, a rural emergency relief programme helped reduce maternal deaths and increase the number of supervised deliveries via a referral system for emergency obstetric cases, linking traditional birth attendants, health clinics and hospitals. Also, life-saving supplies and equipment were provided and staff trained in their use. Transportation to health clinics and hospitals was also provided.

Addressing Adolescent Reproductive Health

The international community is recognizing more and more that young people, especially girls, are vulnerable and at risk for reproductive and sexual health problems. Ignorance, lack of power in gender relations, the scarcity of reproductive health services due to societal disapproval and lack of financing, negative provider attitudes and vulnerability to sexual abuse and violence are common dangers. Teenage mothers and their babies are likelier to get sick or die than mature women and their children. And adolescent pregnancies, childbearing and unsafe abortions can short-circuit young women's economic and educational opportunities.

UNFPA has worked to develop innovative measures to reach this population with reproductive health services and information. The Fund supports training health service providers to be sensitive to the needs of adolescent girls, advocates policy and legal reforms, and supports youth centres and youth groups as peer educators. In many countries, UNFPA supports "population and family life education" programmes for boys and girls.

In 128 countries, UNFPA is involved in HIV/AIDS-prevention activities aimed at young people, using youth centres, peer educators and even television series.

In Uganda, the Peer-Enhanced Adolescent Reproductive Life project supports multi-purpose youth centres to give young people information and services and a chance to socialize. District and community leaders, parents and religious leaders participate as well.

Increasing Male Involvement

Men play an important role in safeguarding the sexual and reproductive health of the women in their lives. They also have reproductive health needs of their own that should be met. UNFPA therefore promotes the partnership of women and men in all areas of family responsibility, especially men's shared responsibility for, and active involvement in: responsible parenthood; sexual and reproductive health; the prevention of STDs; shared control of and contribution to family income; children's education and health; and valuing children of both sexes equally.

In Namibia, men in the north-west region expressed a desire to learn more about reproduc tive health issues, and a number of discussion groups were set up for men only. The groups focused on reproductive health and family planning, as well as gender issues and personal decision-making. This UNFPA-led project resulted in an increase in men’s participation in reproductive health education.

Even in culturally conservative areas, community education targeting men can succeed in promoting greater contraceptive use by both sexes. In Pakistan, teams of community educators promoted family planning through home visits, distribution of condoms and other contraceptives and referrals to clinics. Despite concerns about a possible conservative backlash, the men were not only receptive to family planning, but they also wanted women educators to speak with their wives.

Integrating Health and Rights

UNFPA supports the empowerment of women with knowledge and skills to protect their health and successfully claim their reproductive and sexual rights.

In Morocco, the UNFPA reproductive health programme helps Morocco's Ministry of Health reach the least-served provinces with quality reproductive health services and information. It promotes male responsibility in reproductive health and conducts literacy programmes for women. In addition, the programme sponsors population education in schools and youth organizations.