Transcript PPFA-International (PPFA

REPRODUCTIVE HEALTH ISSUES IN
ASIA AND THE PACIFIC:
OLD CHALLENGES,
NEW STRATEGIES
Dr. Sona Sethi
Regional Director, Asia
Overview of Asia and the Pacific
 Home to 60 per cent of the world's people
 Two out of every three people living in extreme
poverty live in the region and struggle to survive on
less than $1 a day
 Includes more than half of the world's young people some 850 million. Some parts of South/South-east
Asia, young people make up between ⅓ to ½ of the
population
 Adolescents comprise more than 20 % of total Asian
population and are the most at risk of unwanted
pregnancies, sexually transmitted infections and AIDS
Overview of Asia and the Pacific
 Nearly 40 million people in the region migrate
each year to urban areas in search of economic
opportunity and end up living in slum-like
conditions - insecure tenure, inadequate housing,
lack of access to water or sanitation
 Within the next 15 years, 18 of the projected 27
megacities (urban areas with more than 10 million
people) will be in Asia, and over half of the people
will live in slums and informal settlements
RH Issues – Old challenges
 Gender-based violence remains widespread and has
only recently been recognized as a significant public
health and development concern
 Low status of women and early marriage lead to highrisk adolescent pregnancies, Poverty and illiteracy are
common
 Strong son preference and discrimination against the
girl-child, has led to pre-natal sex selection or neglect
of infant girls; at least 60 million girls are 'missing' in
Asia, with potentially serious social consequences
 Poor access to reproductive health services,
especially for the poor and those living in remote
areas
,
PPFA-International in Asia
 16 projects in five countries: India, Myanmar,
Nepal, Thailand, Philippines
 Country program focus
 Focus on youth, street kids, law enforcers, private
paramedics and chemists, clinic and community
service providers, parliamentarians
 Safe abortion, postabortion care, SRH information
and services, advocacy, STI/HIV/FP and gender
mainstreaming
RH Issues – Old challenges
 Maternal mortality ratios exceed 400 per 100,000 live
births in some countries (Afghanistan, Bhutan,
Cambodia, India, Lao PDR, Nepal); others (Myanmar,
Pakistan, Philippines) have large unmet RH needs
 Although HIV/AIDS came later to Asia, HIV is quickly
spreading to the general population. More than 6.5
million people living with HIV/AIDS, some 5 million in
China and India alone (second highest number of HIVinfected adults in the world)
 Cambodia, Myanmar and Thailand are dealing with
serious epidemics, but Thailand has shown that it is
possible to reverse the spread of the infection with
large-scale, sustained and concerted programming
RH Issues – Old challenges
 Several factors have muted an effective response:
denial of the problem, stigma and discrimination
against those living with infection, lack of resources &
political commitment, increasing volume of migration,
trafficking of women and youth.
 Some 220,000 women in Asia die each year from
complications of pregnancy and childbirth,
 The lifetime risk of maternal death in Asia is 18 times
greater than in Europe.
 Sri Lanka reduced its maternal mortality rate from
more than 1,500 per 100,000 live births to 60 by
making safe motherhood a priority and achieving nearuniversal use of skilled attendants at birth.
“To confront the challenges of the twenty-first
century successfully, we must strive to promote,
respect and protect all human rights: economic,
social, civil and political. Asia has made excellent
progress over the past 30 years and we must
maintain the momentum”.
- Thoraya Ahmed Obaid,
Executive Director, UNFPA
New Strategies ….
 Poor people must be empowered to take steps to
improve their lives, governments must assist them by
ensuring that they can obtain the services they need:
universal access to reproductive health and primary
education (ICPD, 1994).
 Need to have community-based programs to combat
widespread poverty and illiteracy, gender
discrimination, growing demands in urban areas,
environmental degradation and spread of HIV/AIDS
through greater political commitment and financial
support
New Strategies ….
 HIV/AIDS programming requires a multisectoral response
that reaches beyond the health system to the community.
Effective strategies include: behavior change, condom
programming, targeting and involving specific sectors of
society, including those living with HIV/AIDS.
 HIV/ AIDS programs include three strategic interventions:
– ensuring that information and services reach and
involve young people, especially adolescent girls;
– ensuring that pregnant women and their children can
remain HIV-free, and
– ensuring that condoms are accessible, and used
correctly and consistently.
New Strategies ….
 Priority RH interventions:
– safe motherhood, including care of the newborn;
– family planning and menstrual regulation;
– prevention and management of complications of
abortion;
– Management of RTI/STI/HIV/infertility;
– adolescent reproductive health.
New Strategies ….
 A life-cycle approach whereby specific RH
services would be designed according to the
following stages:
– Before sexual maturity
– Sexually mature and unmarried
– Sexually mature and married
– After the fertile period
New Strategies ….
 RH strategies now include integrated
services for women’s health that are clientcentered
 Massive re-orientation of the existing vertical
program structure
 More prominent role for NGOs, the private
sector, physicians and operations, and
operations research organization (evidencebased data)
Replicable Best Practices
Replicable Best Practices for RH
programming
 Develop alliances with key players – INGOS, local
NGOs, govts., for better impact in the country
 Partner with local NGOs with diverse expertise:
legal, research, community-based, service delivery
 Organize joint meetings with all partners to obtain
feedback on the SRH need in the country for
advocacy, training, services, etc.,
 Develop a country-wide joint program with all
partners (key results and strategies) with clear
roles and responsibilities
Replicable Best Practices for RH
programming
 Facilitate periodic “Partners’ Meet” to share
achievements, lessons learned, IEC materials, build
relationship among partners, provide TA and share
resources
 Establish public-private partnerships (an innovative
approach for the public and private sectors to work
together to achieve intended results) to obtain
feedback on policy reform, service delivery guidelines,
etc.
 Conduct annual dissemination meetings and invite key
GO/ INGO/ NGOs
Replicable Best Practices for RH
programming
 Document cases of violation of RRs and
develop litigation strategies with legal
organizations
 Sensitize media and highlight violations of
RRs
 Obtain inputs from key stakeholders and the
community regarding the existing RH law for
policy reform
Replicable Best Practices for RH
programming
 Increase awareness on SRH issues among law
enforcers, judges, police, pharmacists and
community-based service providers
 Identify GO/NGO facilities that provide SRH
services and establish referral linkages
 Conduct IEC sessions to change the attitudes of
service providers
 Conduct client satisfaction surveys and provide
feedback to service providers and clinic staff
Replicable Best Practices for YRH
 Involve youth in developing strategies, key messages
and IEC materials
 Include youth in the Project Steering Committee
 Conduct SRH sessions for in- & out-of-school youth
and include gender issues
 Conduct life skills training; link to vocational training
 Sensitize community stakeholders – religious
leaders, teachers, parents, mothers-in-laws and
involve them in project interventions
 Conduct SRH sessions for the to-be-married and
newly married youth
Replicable Best Practices for YRH
 Train young couples to provide information and
services to other young couples
 Develop youth leaders and give them recognition
 Train youth to be Peer Educators
 Encourage youth to organize dramas, quiz
competitions, develop folk songs, games on SRH
issues
 Conduct inter-community and inter-school drama
competitions on SRH issues
 Establish social marketing, community-based
distribution of contraceptives
Replicable Best Practices for YRH
 Encourage youth to develop newsletter ‘By the
Youth for the Youth’
 Organize sports events to convey SRH messages
 Organize residential RH camps to bring youth
together
 Conduct workshops for the media to sensitize
them on YRH issues
 Train teachers on SRH issues so that they could
conduct sessions for the youth