Transcript Document

The biggest demographic challenge and
opportunity of the region is its enormous
population of youth.
About 850 million people in Asia and the Pacific are
between the ages of 10 and 24 = More than half of
the world's young people
This demographic surge of people
entering their productive and
reproductive years is great potential
for development - if countries invest
wisely in the education, health,
skills and economic opportunities of
Asia is also home have a
very fast growing aged
population, most of whom will
be women.
People > 60 made up about
9.3% of the region's population
in 2005 and are projected to
account for almost 15% by
Major challenge will be the provision of old
age security and health insurance for the
The population growth rate for Asia and the Pacific is
now close to the world's average (1.21 per 1,000
population), with some countries having reached
fertility levels of 2.1 or below.
However, high fertility in
some countries, especially in
South and West Asia,
continues to outpace
economic and development
gains and stall poverty
reduction efforts.
The large percentage of young people means that the
region will continue to grow for years to come, although
some Pacific island countries are losing population and
capacity, due to migration
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. This urbanization poses
serious environmental threats, including high levels of
water and air pollution and attendant health risks.
Urbanization is occurring at an unprecedented pace,
bringing with it both problems and possibilities.
Nearly 40 million people in
the region, many of them
women and young people,
migrate each year to urban
areas in search of economic
The majority end up living in
slum-like conditions
characterized by insecure
tenure, inadequate housing
and a lack of access to
water or sanitation.
Global estimates for adults and children
end 2005
40.3 million [36.7 – 45.3 million]
People living with HIV
New HIV infections in 2005
4.9 million [4.3 – 6.6 million]
Deaths due to AIDS in 2005
3.1 million [2.8 – 3.6 million]
00003-E-3 – December 2005
Adults and children estimated to be living
with HIV as of end 2005
Western & Central
North America
1.2 million
[650 000 – 1.8 million]
300 000
[200 000 – 510 000]
Latin America
1.8 million
[1.4 – 2.4 million]
720 000
[570 000 – 890 000]
Eastern Europe
& Central Asia
1.6 million
[990 000 – 2.3 million] East Asia
North Africa & Middle East
510 000
[230 000 – 1.4 million]
Sub-Saharan Africa
25.8 million
[23.8 – 28.9 million]
870 000
[440 000 – 1.4 million]
South & South-East Asia
7.4 million
[4.5 – 11.0 million]
74 000
[45 000 – 120 000]
Total: 40.3 (36.7 – 45.3) million
00003-E-4 – December 2005
Estimated number of adults and children
newly infected with HIV during 2005
43 000
[15 000 – 39 000]
[140 000 – 610 000]
270 000
North Africa & Middle East
30 000
[17 000 – 71 000]
Latin America
200 000
Eastern Europe
& Central Asia
22 000
North America
[15 000 – 120 000]
Western & Central
[130 000 – 360 000]
67 000
[35 000 – 200 000]
Sub-Saharan Africa
3.2 million
[2.8 – 3.9 million]
East Asia
140 000
[42 000 – 390 000]
& South-East Asia
990 000
[480 000 – 2.4 million]
[2400 – 25 000]
Total: 4.9 (4.3 – 6.6) million
00003-E-5 – December 2005
Estimated adult and child deaths
from AIDS during 2005
North America
18 000
[9000 – 30 000]
24 000
[16 000 – 40 000]
Latin America
66 000
[52 000 – 86 000]
Western & Central
Eastern Europe
& Central Asia
[<15 000]
[39 000 – 91 000]
12 000
62 000
North Africa & Middle East
58 000
[25 000 – 145 000]
Sub-Saharan Africa
2.4 million
[2.1 – 2.7 million]
East Asia
41 000
[20 000 – 68 000]
& South-East Asia
480 000
[290 000 – 740 000]
[1700 – 8200]
Total: 3.1 (2.8 – 3.6) million
00003-E-6 – December 2005
People Living with
Generally poor and voiceless in
They as well as their families are
discriminated against.
Do not receive the care and support
they need
They need support not pity to live
…a powerful duo
 Stigma = attitude
 Discrimination= action
Attaches to pre-existing stigmas
 Cycle of shock, shame, secrecy, silence…
The lifetime risk of maternal death in Asia is 18 times
greater than in Europe. (UNFPA) but within Asia Pacific it
is also very different between countries.
Maternal Mortality Rates:
6 per 100,000 life-births
30 per 100,000 life-births
390 per 100,000 life-births
470 per 100,000 life-births
650 per 100,000 life-births
Every year 30 000-50 000 mothers die from the
complications of pregnancy or childbirth. More than
40% of all maternal deaths occur in five countries
(Cambodia, the Lao People's Democratic Republic,
Papua New Guinea, the Philippines and Viet Nam)
whose combined populations account for only 10% of
the Region' s population.
There are also huge variations in rates within countries.
For example, national data in the Lao People's
Democratic Republic for 1995 reveal a MMR of 150 in
Vientiane and over 9000 in more remote provinces.
• About 80% of maternal deaths are due to
causes that are directly related to childbirth and
• The five major direct causes of maternal deaths
Hypertension disorders
Prolonged or obstructed labor
Unsafe abortion.
• About 20% of maternal deaths arise from
pre-existing conditions that are aggravated
by pregnancy.
• The indirect causes of maternal deaths are
– Cardiovascular system
– Infections (excluding puerperal sepsis)
– Connective tissue disease
– Place of delivery
– substandard care
Approximately 20% of maternal deaths
arise from pre-existing conditions that are
aggravated by pregnancy such as
–Heart disease
Contraceptive Prevalence Rates
Modern method
Any Method
Persistently low levels of contraceptive use are
found in some Countries
Emergency Contraceptive not easily available
Among the prominent cultural barriers preventing men,
women and the youth from accessing RH services are
those, which are gender-related.
Many of the barriers are rooted in gender inequalities
that restrict women’s access to income, mobility,
decision-making power, that together culminate in a
general lack of empowerment.
Worldwide, every minute, 100 women have
an abortion, 40 of which are unsafe
About 14 unsafe abortions occur for every 100
live births in Asia. Excluding East Asia, where
safe abortion is widely accessible, one unsafe
abortion occurs for every 5 live births.
Source: Ahman, Elisabeth and Iqbal Shah. 2002. Unsafe
abortion: Worldwide estimates for 2000. Reproductive Health
Matters 10(19): 13-17.
•Unsafe abortion is a major threat to women's
•About 1/3 of women who have unsafe
abortions experience complications that pose
major risks to their lives and health.
•The WHO estimates that unsafe abortion is
responsible for 13% of all maternal deaths
globally. About 70,000 women die each year
from complications of unsafe abortion.
•Millions more women suffer from debilitating
complications and illness, e.g incomplete
abortion, tears in the cervix, perforation of
the uterus, fever, infection, septic shock, and
severe hemorrhaging.
Maternal Mortality is
inversely proportionate
to the percentage of
deliveries by skilled
ARROW: Monitoring Ten Years of ICPD Implementation “The
Way Forward” pg. 30
Poverty increases the risk of maternal Mortality due
to lack of access to good quality health care
Challenges of growing numbers of young people in
the region
Programs designed by adults may not be suitable for
the young
Adults regard the young as a problem
while the young want adults to treat them
as a solution
Should/can sex education be provided
before they drop out of school
Right to contraception before
Gender inequality and cultural
vulnerability are two issues that constitute
particular challenges
Gender disparities persist in the areas of health,
literacy, education, political participation, income
and employment. As a result, many women,
especially those who are impoverished, are
prevented from exercising their human rights and
realizing their full potential. Their families,
communities and countries miss out as well.
A combination of cultural and institutional
barriers is implicated in the root causes of
poverty, reproductive ill-health and indicators
of the poor socio-economic status of women.
Sexual double standards are part of the masculinity norm,
resulting in negative reproductive health consequences
for women, which are manifested in many forms. For
example, in cultures where virginity is highly valued,
unmarried young women may be persuaded to engage in
anal sex or other practices that preserve their virginity,
but place them at higher risk of infection
.Virginity norms may also make young women reluctant or
ashamed to seek treatment for reproductive tract
infections (RTIs). On the other hand, masculinity norms as
expressed in macho complexes lead men to engage in
reckless behaviors such as having multiple sex partners,
patronizing sex workers and perpetrating violence.
In Thailand, it is reported that young men’s infidelity is
generally accepted such that if a young man does not
patronize prostitutes he would be thought to be homosexual
 Chauvinist cultural views on sexuality,
including the perception of female sexuality as
being passive, devoid of desire and
subordinate to male needs; prescription of
virginity and sexual monogamy for women
while condoning multiple sexual partners for
men before and during marriage; and to the
norm of conjugal sexuality as being mainly
oriented towards reproduction.
 The association between women’s empowerment
and improved reproductive health and child health
– through education, employment, decisionmaking, access to social services and credit
facilities, for example – is strong testimony to the
dividends that accrue from investing in gender
Cultural Expectations of roles within relationships
Belief in the inherent superiority of males
 Values that give men proprietary rights over women
and girls
Notion of the family as the private sphere under male
 Customs of marriage, (bride price/dowry)
 Acceptability of violence as a means to
resolve conflict
Although most countries in the region have signed or
ratified the UN Convention on the Elimination of All
Forms of Discrimination against Women, not all ensure
equal rights for women in their own constitutions.
Gender-based violence remains widespread and has
only recently been recognized as a significant public
health and development concern.
 A strong preference for sons in some countries has led
to pre-natal sex selection or neglect of infant girls, with
the result that least 60 million girls are 'missing' in Asia,
with potentially serious social consequences.
The ESEA region has become a
target for sex tourism and
trafficking of women, men, and
children for many reasons, but
chiefly for sexual purposes.
 Due to unequal gender relations, sex
work tends to be a highly
stigmatized profession, with female
sex workers at risk of prosecution,
whilst male clients are free to buy
sexual services with impunity, and
are often regarded as being quite
‘normal’ for doing so.
Trafficked women are likely to be amongst
those with least access to reproductive
health information and services.
Many of them are highly vulnerable to sexual
abuse and physical violence, unwanted
pregnancy, STDs and HIV/AIDS due to the
nature of the work they end up doing at their
destination points.
Due to their social and legal ‘invisibility’ they
often have no way of accessing health care.
 Because of cultural definition of men’s perceived
physical needs, in most of the ESEA countries it is
quite acceptable for men to visit prostitutes, or even to
have second, ‘minor’ wives
 Whilst virginity is highly rated in a bride
and monogamy within marital
relationships, men are nevertheless
perceived as needing an outlet for their
sexual urges. Hence there is tacit approval
for prostitution in most countries in the
Sex workers themselves however are generally looked
down on and are regarded as a necessary social evil,
whilst the legal status of commercial sex work varies
between countries.
Main Trafficking Routes
Countries of
Viet Nam
Transit Countries
Countries of
Hong Kong
Source: UNIFEM. East and South-East Asia Regional Office and UNIAP.
Trafficking in Persons: A Gender and Rights Perspective. Briefing Kit.
Under cultural vulnerability, reference is made to:
i) ethnic and religious minorities, two of the key groups
that are often outside of the mainstream socio-cultural
setting in a country and
ii)groups who practice or are exposed to risky
reproductive and sexual beliefs and practices.
These two sets of groups are often subject to
discrimination of some form or another
Drug Users
Sex Workers
Migrant workers
Single mothers
The Indigenous
Service providers sometimes reflect
their own cultural or religious values,
particularly when dealing with
sensitive issues such as unwanted
pregnancies and contraceptives. In
Indonesia service providers seemed
to be more tolerant towards clients
wishing to terminate unwanted
pregnancies due to contraceptive
failure, rather than for other reasons.
In all cases, however, continuation of
the pregnancy was usually
In Myanmar many health providers felt they should
scold the clients who came in for post-abortion
complications, and that this scolding was in the
interest of the clients in order to keep them from
seeking abortions in the future. Many village women
delayed seeking help for even severe complications
due to fear of being reprimanded, as well as fear of
neighbors finding out about the abortion
In a survey carried out among formal and informal
sector health providers in Lao PDR,18 percent of the
providers considered it their duty to inform the parents
of their children’s sexual activity. They hoped that the
parents could exert influence on their children to
refrain from sexual relationships.
oThe religious and/or spiritual frameworks within
which most communities operate can be an
important entry point for reproductive health
oIssues relating to sexual and
reproductive health are often highly
sensitive or even taboo to discuss
openly, but when positively
engaged and provided with
evidence-based information,
religious and spiritual leaders are
often willing to collaborate and to
interpret their teachings
•In the area of RH it is
acknowledged that men as
spouses or partners are normally
the ones who take decisions in the
home and who therefore need to
be more involved in RH
•In this regard, it is imperative for
boys and men to be socialized or
re-socialized to take responsibility
for the effects of their own sexual
Behaviour on their partners’ and
children’s health and well-being.
1. Health and social services have to become
stigma sensitive
2. Sexual and reproductive health services need
to become both truly youth-friendly and girlfriendly – and stigma free.
3. Unpacking the entry points for mainstreaming
4. Protection from discrimination must become a
true multisectoral issue
5. Responses to the AIDS epidemic have to
ensure that they do not inadvertently promote
Source: IPPF
…seven recommendations
1. New international fora to bring together SRHR
2. Microbicides Advocacy, Research and Action
needs to become a stronger part of the global
3. Explicit mention should be made of the
continuum of care ( prevention, treatment, care
and support) in the Principles
…seven recommendations
4. Addressing – in action- the sexual health
needs of men is key
5. GIPA ( Greater Involvement of People
Living with HIV/AIDS)
6. Pooling of common messages especially those aimed at young people
7. Joint donor and government advocacy
by the two communities
Since ICPD we have made great strides in addressing
SRHR in the Region
However vast variations in gains exist between
countries and also within countries
We know that all of us have to work within the country
context and will be subject to socioeconomic situations.
However as SRHR providers we know our business is
saving lives and as such there is no time to waste. We
cannot wallow in self pity and admit defeat.
We must work like the brave and angry women who in
the fifties went to jail just because they advocated for
women’s right to Family Planning. The battle is not won.