Partnerships Can Provide Better Reproductive Health Care Round-table Speakers Report

United Nations Population Fund
Contact: in New York:
Hugh O'Haire
Alex Marshall
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Abubakar Dungus
William Ryan .

The ICPD+5 review process

DHAKA, Bangladesh, 30 July -- Collaboration between governments and non-governmental organizations (NGOs) is essential to quality reproductive health care the Round Table on Partnership with Civil Society in the Implementation of the ICPD Programme of Action heard today. The meeting began its final day with presentations on how partnerships in Peru, Egypt, Bangladesh, Nigeria and Eastern Europe have promoted access to reproductive health and family planning services.

Convened by the United Nations Population Fund (UNFPA) and hosted by the Government of Bangladesh, the four-day round-table meeting is part of "ICPD+5", a series of international activities reviewing progress since the the 1994 International Conference on Population and Development (ICPD) in Cairo. They will culminate in an international forum next February in The Hague, the Netherlands, and a special session of the United Nations General Assembly in June and July 1999.

About 70 participants from some 40 countries -- representatives from NGOs and other sectors of civil society as well as from governments -- are discussing civil society involvement in carrying out the ICPD action plan. The aim is to identify successes and constraints, and recommend actions to accelerate progress -- particularly policy changes that will facilitate partnerships involving a broad range of civil society actors, as called for in the Programme of Action.

The first speaker this morning, Susana Galdos Silva, from Peru, talked about the creation in July 1997 of a Tripartite Board, comprised of 24 government institutions, civil society groups and international agencies. It seeks to promote better conditions for women, equality between the sexes, the empowerment of women, men’s involvement and access to reproductive and sexual rights.

The process of working with grass-roots groups, she said, has educated health providers about women’s reproductive health concerns such as pain during delivery, vaginal infections and the bearing of too many children. The partnership supports the aims of the ICPD, by, for instance, campaigning against sexual violence against girls. In addition, she noted, a law punishing violence against women has been enacted and police officers are being trained to enforce it.

Women often mention domestic violence as a cause of reproductive health problems, Ms. Galdos Silva reported. While information on the laws against violence has been distributed, it has not reached the rural areas. Many rural women, she added, still accept the myth that violence is a sign of affection, believing the saying, "the more you love me, the more you hit me."

Reproductive health services should be extended to geographically and culturally isolated communities and laws against violence more widely distributed and enforced, she concluded. Civil society groups should work more closely with local authorities, and families should be more involved in reproductive health programmes. Most important, she stressed, programmes should place greater emphasis on reproductive health needs that clients identify as most important.

Moushira Al-Shafie, First Under-Secretary of Egypt’s Ministry of Health and Population, described how the Government, international agencies and civil society groups had increased their collaboration in advocating for reproductive health, including an expansion of family planning services. One result was their successful advocacy against female genital mutilation, which ultimately led to the practice’s prohibition in Egypt.

"Without the help of NGOs and other actors in civil society we would never have made this kind of progress, " she said.

Health services in Egypt are provided by partnerships of the public, private, and NGO sectors. The private sector provides about 50 per cent of modern contraceptives, while more than 12,000 pharmacists, assistants and doctors have been trained since the Cairo conference. Public sector provision of services has risen, however, from 35.7 per cent to 40.7 per cent since then.

Abu Yusuf Choudhury, Director of the Programme for the Introduction and Adaptation of Contraceptive Technology, Bangladesh, called for better coordination between the Government and NGOs. They should agree, for instance, on whether both sides will charge prices for their reproductive health and family planning services. Although Bangladesh is a poor country, he suggested, the Government could start charging moderate prices for its services just as the NGOs are doing. However, safety nets to protect the interests of the poor must be retained.

Boniface Oye-Adeniran of Nigeria, President of the Confederation of African Medical Associations, spoke extensively on his organization. He also talked about unsafe abortion in Nigeria, which accounts for a significant portion of the country’s high maternal mortality. By law, abortion is allowed only to save the life of a mother; it is nevertheless available to the rich, but not to the poor, he said. A group of doctors, nurses, lawyers, social scientists and democracy activists have formed an NGO to campaign against unwanted pregnancy and for a reform of the abortion law.

Janet Jackson of the London-based International Planned Parenthood Federation, spoke about her work with NGOs in Central and Eastern Europe. She said women in the region are becoming poorer, in part because they have to pay more for reproductive health services.

"Women are poor in health because the health system is breaking down due to cuts in the health budgets and the deterioration of the purchasing power of allocated amounts due to inflation," she said. "The quality of services is sliding, with less choice available to women." One consequence of the transition to market economies, she said, is that women’s voices are heard less than previously. "That is partly because women’s associations are seen as part of the old, socialist regimes. The challenge is to work with the associations to provide more services."

There is an urgent need in Eastern Europe, she continued, for better education on reproductive health services, to correct misinformation about the choices available. To meet this need, NGOs are working with the media to promote contraception and reproductive health, using television and radio messages from respected figures. Partnerships with youth groups have helped to break down taboos surrounding open discussion of sexuality, and to counter the influence of the pornography industry. Parents, she added, have been brought into partnerships to address youth concerns to and to help bridge the generation gap. Partnerships have also helped to reduce the price of contraceptives in some countries.

Participants then went into their respective working groups to complete their reports. Conclusions will be presented at the closing session on Thurdsay afternoon.

(For information purposes only. Not an official document.)

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