Transcript Document

Linking Sexual and Reproductive
Health to HIV and Environment
Presenter: Benson Singa
CCR Seminar 19th Sept. 2012
Overview
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SRH & MDGs
Maternal Health
Demographic and Environmental interplay
Family Planning
Misses opportunities
Conclusion
SRH and MDGs
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
5. Improve maternal health
• Target 5a: Reduce by three-quarters the maternal
mortality ratio
Indicators:
– 5.1 Maternal mortality ratio
– 5.2 Proportion of births attended by skilled health
personnel
• Target 5b: Achieve universal access to reproductive health
Indicators:
– 5.3 Contraceptive prevalence rate
– 5.4 Adolescent birthrate
– 5.5 Antenatal care coverage
– 5.6 Unmet need for family planning
SRH & MDGs
• SRH underpins nearly all MDGs, either directly or indirectly.
Specifically,
• it supports Goal 1 because smaller families and wider birth intervals
allow families to invest more in each child’s nutrition and health,
and can reduce poverty and malnutrition for all members of a
household.
• It also contributes to improving educational prospects for children,
especially by closing the gender gap in education (Goal 2);
empowering women (Goal 3); reducing child mortality (Goal 4); and
curbing the AIDS pandemic (Goal 6).
• In developing countries, slower population growth can reduce
pressure on environmental resources (Goal 7).
• Achieving Goal 5 would require improved cooperation between
global, national and local actors (Goal 8).
National Adaptation Programs of
Action (NAPA)
• Analysis of the reports shows that:
– in addition to concerns regarding the impact of
changing weather conditions on factors such as
vulnerability to flood, drought and decreased crop
yield, 37 of the reports (93%) were found to cite
“rapid population growth” as a factor that
compounds these problems.
Demographic and climatic interplay
• Given the speed of demographic change in
many least-developed countries, population
growth is identified as problematic in
strategies concerned with natural resource
depletion. (NAPA reports)
Key themes in the NAPA reports
• (i) reducing supply – rapid population growth and climate
change act cumulatively to degrade the source of key
natural resources, for example through soil erosion and
deforestation;
• (ii) increasing demand – rapid population growth is
projected to escalate the demand for resources that are
diminished by climate change, including fresh water and
food; and
• (iii) vulnerability to natural disaster – rapid population
growth heightens human vulnerability to natural disasters
caused by climate change, such as by forcing more people
to migrate and settle in areas at risk of floods, storms,
drought and infectious disease.
Issues cited as linked to Population
growth by 37 of 40 NAPA reports
1. Soil degradation/erosion -21
2. Fresh water scarcity -18
3. Migration -18
4. Deforestation -17
5. Inadequate farm land per capita -14
6. Loss of biodiversity -11
7. Disease and health system constraints -8
8. Loss of natural habitat -8
9. Diminishing fish stocks -7
10. Desertification -5
Guttmacher Institute
Adding It Up: The Costs and Benefits of Investing
in Family Planning and Maternal and Newborn
Health (2008)
Benefits of investing in the health of
women and their newborns
• Fewer unintended pregnancies;
• fewer maternal and newborn deaths;
healthier mothers and children;
• greater family savings and productivity; and
• better prospects for educating children,
strengthening economies and reducing the
pressure on natural resources in developing
countries.
GI & IPPF; estimates for 2008
• 215 million women who want to avoid a pregnancy are
not using an effective method of contraception, despite
increases in use in recent years;
• only about one-half of the 123 million women who give
birth each year receive antenatal, delivery and newborn
care (including routine care and care for complications),
and many who get care do not receive all the
components of care they need; and
• about 20 million women have unsafe abortions each
year, and three million of the estimated 8.5 million who
need care for subsequent health complications do not
receive it.
meeting the need for family planning
and maternal and newborn health
• Unintended pregnancies would drop by more than two-thirds, from
75 million in 2008 to 22 million per year.
• 70% of maternal deaths would be averted—a decline from 550,000
to 160,000.
• Forty-four percent of newborn deaths would be averted—a decline
from 3.5 million to 1.9 million.
• Unsafe abortions would decline by 73%, from 20 million to 5.5
million (assuming no change in abortion laws),
• The number of women needing medical care for complications of
unsafe procedures would decline from 8.5 million to 2 million.
• The healthy years of life lost due to disability and premature death
among women and their newborns would be reduced by more than
60%.
Perspectives in Family Planning
• Health perspective:
– reduces maternal mortality. (MM is estimated at
1.8 times higher without contraceptive use;
additional 272,000 deaths)
– It is estimated that contraceptive use has reduced
maternal deaths by 44 percent by reducing the
number of unintended pregnancies.
– If all women requiring FP had access to services
MM would be reduced by a further 30%
Perspectives in FP
• Environmental impact perspective:
– Reduced population growth rate could reduce
future CO2 emissions.
– Rapid urbanization could increase CO2 emissions.
– on balance, slowing population growth through
increased voluntary contraceptive use would have
profound climate-related benefits.
MDGs perspective
• Perspective on effects of family planning on poverty,
hunger, primary education, and promotion of gender
equality
• These issues relate to Millennium Development Goals
1, 2, and 3, and studies have shown the enormous
benefits of spacing births on a woman’s improved
income and nutrition, increased opportunities to work
in the formal labor force, as well as improved nutrition
and education of her children.
• The economic benefits can be seen at both the
household level and the country level.
Human rights perspective
• Human rights can shape policies and programs
to increase access to contraceptives.
• From this perspective, civil societies and other
stakeholders can hold governments and all
providers accountable for the quality of
services offered.
GARY DARMSTADT
• “Regardless of which perspective rings most
true for you, the evidence confirms that
providing a woman with the right to decide
when and how many children to have is
beneficial in many different ways for her, her
family, her nation and the world”.
Missed opportunities
• Aid for family planning as a proportion of total
health aid to developing countries fell from
8.2% in 2000 to 2.6% in 2009, whereas
• funding for HIV rose from 3% to 26%.
• In the massive scale-up of HIV services the
opportunity to deal with family planning at
the same time was missed.
Cost effectiveness of integration
• A 2009 systematic review of 58 studies found that
linking HIV and reproductive health services could
– enhance program efficiency and effectiveness and
– increase uptake of services, coverage of underserved
populations, and use of effective contraceptive
methods.
• However, important questions remain about
when, where, and how best to integrate, as well
as the cost effectiveness of integration.
FP and HIV services
• Have multiple overlapping objectives, which
may not be fully achieved through separate,
vertical programs.
• Linking these services makes intuitive sense,
as the same behaviors that result in pregnancy
also put people at risk for HIV
Evidence for Integrated services
• Evidence demonstrates that integrated services can:
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have a positive impact on client satisfaction,
improve access to component services, and
reduce clinic-based HIV-related stigma, and that
They are cost-effective.
• Evidence of FP services reaching men and adolescents
and of their impact on health outcomes is inconclusive.
• Several studies found that providers frequently miss
opportunities to integrate care and that the capacity to
maintain the quality of care is also influenced by many
programmatic challenges.
U.S. President’s Emergency Plan for
AIDS Relief (PEPFAR) in 2004
• Resulted in an exponential expansion in U.S. HIV
support to Kenya, which increased from $34
million in 2003 to $534 million in 2009.
• Dramatically shifted the focus of U.S. assistance,
with investments in HIV dwarfing other
programming.
• In 2008, $534 million was targeted to HIV, $3.4
million to material and child health (MCH), and
$13 million to family planning (which increased
to $17 million in 2009).
CSIS Commission on Smart Global
Health Policy – Aug 2009
• Governance issues pose among the most challenging obstacles to
mounting an effective national response.
• Health planning and expenditures, systems of procurement and oversight,
• political spillover into the health sector, and anemic country ownership of
health programs all underscore the uncertainty around sustainability of
current U.S. investments.
• Of particular concern in sustainability of investments is the growing “HIV
mortgage” that increasing demand, access, and cost of HIV first- and
second-line antiretroviral (ARV) therapy will entail.
• Currently the donor community shoulders 98 percent of this burden.
• The Kenyan government faces multiple human security challenges that
affect health outcomes, including severe food insecurity, chronic water
scarcity in parts of the country, spillover from regional conflicts, and a
growing humanitarian crisis among refugees.
The Case for AMPATH
• Provides an alternative model for integrating programs,
• provides clinical care, training, research, and capacity
building within neighboring communities.
• Originally established to prevent and treat HIV/AIDS,
the partnership, with significant external funding,
• now works to address associated challenges of disease,
hunger, and poverty through agriculture and rural
development projects, supplemental feeding, and
economic development training.
Conclusion
• Investments in the health sector will have
diminishing marginal returns if other critical
sectors are not adequately addressed
LEST WE FORGET
“I will not let my HIV status stand in the way."
(Decisions on motherhood among women on
ART in a slum in Kenya- a qualitative study)
COMMENTS
Thank You