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KAMPALA, Uganda, 23 June--The design of quality sexual and reproductive health services was the focus on day two of the expert meeting here on reproductive rights and the implementation of reproductive health programmes. Presentations addressed the implementation of feasible standards of care; the broadening of services within existing health systems; reducing maternal mortality; and programme reform efforts in Bangladesh and India.
Fifty experts from around the world are attending the Expert Round-table Meeting on Ensuring Reproductive Rights and Implementing Sexual and Reproductive Health Programmes, Including Women's Empowerment, Male Involvement and Human Rights. The UNFPA-organized meeting at the International Conference Centre here is part of ICPD+5, a year-long evaluation of progress in the five years since the 1994 International Conference on Population and Development in Cairo.
For the implementation of feasible standards of care in India, the Philippines and Zambia, Saumya Rama Rao, an expert from the Population Council, recommended the development of clear protocols, the training of health care workers, the provision of supportive supervision and appropriate evaluation.
Aspects of broadening of services were addressed by Mohammed Nizamuddin, Director of UNFPA's Technical and Policy Division.
Adrienne Germain, president of the New York-based International Women's Health Coalition, outlined the process that has been under way for two years to develop a new national health and population policy for Bangladesh. The effort, backed by international donors, aims to integrate the now-separate family planning and health sectors and to adopt a participatory approach. This will require better coordination and training, and changes in job descriptions and performance measures. "Governments, donors and NGOs are convinced this is the only way forward," she said.
Sharad Iyengar, Executive Director of Action Research and Training for Health (ARTH), reported on recent policy and programme changes in India since the ICPD. India's reproductive health and rights situation mirrors its wide demographic diversity, sociocultural influences and the various capacities of civil institutions, he said. But one common thread is the need to translate policy changes into concrete, sustainable actions. He cited decentralization measures and the abolition in 1995 of family planning targets and quotas. This was done without creating a demand-based alternative to the top-down approach, and contraceptive acceptance declined. In response, there was pressure to return to past methods. As a result, well-intentioned attempts to assess unmet need for contraception turned into something that "looked, felt and smelled like targets," he said.
The presentations of technical papers were followed by discussions.
Participants later broke into four working groups for more detailed deliberations that will lead to recommendations on key future actions.
Their themes are: policies for sexual and reproductive health; designing quality sexual and reproductive health services; access to services; and creating the conditions for implementing sexual and reproductive health and rights.
Wednesday, the round table's third day, will witness the presentation of papers on gender-based violence, particularly on female genital mutilation (FGM) in Uganda and the role of the health and education sectors in combating violence in Poland. A theme for that day will be access to reproductive and sexual heath and family planning services.
According to Sunetra Puri, the meeting's rapporteur, the experts are making progress in identifying successful strategies that have emerged since the ICPD, constraints and further action needed.
"This is one of the most important of the round tables because it deals with the essence of the whole Cairo agenda: sexual and reproductive health and rights. The quality of the people who are here, and their commitment to see the Cairo agenda go forward, make me believe that the recommendations which come out of the round table will form some of the priorities in the [United Nations] Secretary-General's paper to the General Assembly," she said, referring to the report that will be presented to a special session of the assembly on ICPD+5, in June-July 1999.