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HOME: STATE OF WORLD POPULATION 2004: Reproductive Health and Family Planning
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Reproductive Health and Family Planning

Family Planning and Sexual Health
Contraceptive Access and Use
Unmet Need
Choice of Methods
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Quality of Care
Stronger Voices for Reproductive Health
Securing the Supplies
Men and Reproductive Health

Stronger Voices for Reproductive Health

Since the ICPD, UNFPA has worked to improve the quality of care, increase access to services, ensure adequate supplies and equipment, and upgrade the technical, managerial and interpersonal skills of health staff by providing technical support, equipment and training.

More recently, attention has also focused on mobilizing communities to push for higher quality health services and more participation of women in their management. UNFPA is supporting “Stronger Voices for Reproductive Health”, an innovative initiative that aims to empower users with knowledge about their reproductive health and rights and supporting community mechanisms so they will have a “stronger voice” to ensure steps are taken to improve reproductive health care. UNFPA partners with the International Labour Organization, UNICEF and WHO in this initiative.

COMMUNITIES OF EDUCATED CLIENTS. The premise is that better-informed users will have improved interactions with providers and will also be more likely to mobilize for change at the community level. Promoting the collective action of communities to demand quality care can also help ensure that the decentralization of health services under way in many countries does not result in a reduction of resources for reproductive health care.

The Stronger Voices project has built bridges between organizations that have previously not worked together—reproductive rights advocates, organized women’s groups, health care providers and organizations focusing on community financing or health reform.

Stronger Voices started in India, Kyrgyzstan, Mauritania, Nepal, Peru and the United Republic of Tanzania. Activities included participatory approaches to increase women’s access to reproductive health services, linking women’s groups with providers to promote better care and mobilizing young people to work with providers on youth-friendly services.

In Kyrgyzstan, community groups raised funds and renovated field obstetric stations; community women are speaking out against the old tradition of “bride-napping” as a violation of reproductive rights. In Mauritania, two community-based micro health insurance schemes were created to ensure poor women have access to maternity services. Project partners in Nepal developed a groundbreaking National Strategy for Quality of Care for Reproductive Health Services, which incorporates “demand” and reproductive rights as essential to delivering good quality services.

In the United Republic of Tanzania, project partners have established the country’s first rights-based approach to quality of care, with an emphasis on local capacity building and community monitoring of services that dovetails with decentralization efforts.

PAYING FOR SERVICES. Many countries are assessing means of charging for services, given shortfalls in government and donor funding for reproductive health. Cost-recovery efforts have had mixed results. In Bangladesh, for example, the 1997 Health and Population Sector Strategy prompted NGOs to move away from home-based provision of family planning and to charge modest fees for services that were previously free. At the same time, the NGOs worked to upgrade their services.

An assessment of the changes found that clients appreciated the services provided and felt they were treated with kindness and respect in the NGO clinics. It also found, however, that the changes resulted in “a widespread feeling that poor people face discrimination in health facilities and quality services are out of their reach because they cannot pay for them”. (50)

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