Reproductive Health Issues in Asia and the Pacific: Old Challenges, New Strategies

REPRODUCTIVE HEALTH ISSUES IN ASIA REPRODUCTIVE HEALTH ISSUES IN ASIA AND THE PACIFIC: AND THE PACIFIC: OLD CHALLENGES, OLD CHALLENGES, NEW STRATEGIESNEW STRATEGIES

Dr. Sona SethiRegional Director, Asia

Overview of Asia and the PacificOverview of Asia and the Pacific Home to 60 per cent of the world's peopleHome to 60 per cent of the world's people Two out of every three people living in extreme Two out of every three people living in extreme

poverty live in the region and struggle to survive on poverty live in the region and struggle to survive on less than $1 a dayless than $1 a day

Includes more than half of the world's young people - Includes more than half of the world's young people - some 850 million. Some parts of South/South-east some 850 million. Some parts of South/South-east Asia, young people make up between ⅓ to ½ of the Asia, young people make up between ⅓ to ½ of the population population

Adolescents comprise more than 20 % of total Asian Adolescents comprise more than 20 % of total Asian population and are the most at risk of unwanted population and are the most at risk of unwanted pregnancies, sexually transmitted infections and AIDSpregnancies, sexually transmitted infections and AIDS

Overview of Asia and the PacificOverview of Asia and the Pacific

Nearly 40 million people in the region migrate Nearly 40 million people in the region migrate each year to urban areas in search of economic each year to urban areas in search of economic opportunity and end up living in slum-like opportunity and end up living in slum-like conditions - insecure tenure, inadequate housing, conditions - insecure tenure, inadequate housing, lack of access to water or sanitationlack of access to water or sanitation

Within the next 15 years, 18 of the projected 27 Within the next 15 years, 18 of the projected 27 megacities (urban areas with more than 10 million megacities (urban areas with more than 10 million people) will be in Asia, and over half of the people people) will be in Asia, and over half of the people will live in slums and informal settlements will live in slums and informal settlements

RH Issues – Old challengesRH Issues – Old challenges Gender-based violence remains widespread and has Gender-based violence remains widespread and has

only recently been recognized as a significant public only recently been recognized as a significant public health and development concernhealth and development concern

Low status of women and early marriage lead to high- risk adolescent pregnancies, Poverty and illiteracy are common

Strong son preference and Strong son preference and discrimination against the girl-child, has led to pre-natal sex selection or neglect of has led to pre-natal sex selection or neglect of infant girls; at least 60 million girls are 'missing' in Asia, infant girls; at least 60 million girls are 'missing' in Asia, with potentially serious social consequenceswith potentially serious social consequences

Poor access to reproductive health services, especially Poor access to reproductive health services, especially for the poor and those living in remote areasfor the poor and those living in remote areas

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PPFA-International in AsiaPPFA-International in Asia 16 projects in five countries: India, Myanmar, 16 projects in five countries: India, Myanmar,

Nepal, Thailand, PhilippinesNepal, Thailand, Philippines Country program focusCountry program focus Focus on youth, street kids, law enforcers, private Focus on youth, street kids, law enforcers, private

paramedics and chemists, clinic and community paramedics and chemists, clinic and community service providers, parliamentarians service providers, parliamentarians

Safe abortion, postabortion care, SRH information Safe abortion, postabortion care, SRH information and services, advocacy, STI/HIV/FP and gender and services, advocacy, STI/HIV/FP and gender mainstreaming mainstreaming

RH Issues – Old challengesRH Issues – Old challenges Maternal mortality ratios exceed 400 per 100,000 live Maternal mortality ratios exceed 400 per 100,000 live

births in some countries (Afghanistan, Bhutan, births in some countries (Afghanistan, Bhutan, Cambodia, India, Lao PDR, Nepal); others (Myanmar, Cambodia, India, Lao PDR, Nepal); others (Myanmar, Pakistan, Philippines) have large unmet RH needs Pakistan, Philippines) have large unmet RH needs

Although HIV/AIDS came later to Asia, HIV is quickly Although HIV/AIDS came later to Asia, HIV is quickly spreading to the general population. More than 6.5 spreading to the general population. More than 6.5 million people living with HIV/AIDS, some 5 million in million people living with HIV/AIDS, some 5 million in China and India alone (second highest number of HIV-China and India alone (second highest number of HIV-infected adults in the world)infected adults in the world)

Cambodia, Myanmar and Thailand are dealing with Cambodia, Myanmar and Thailand are dealing with serious epidemics, but Thailand has shown that it is serious epidemics, but Thailand has shown that it is possible to reverse the spread of the infection with possible to reverse the spread of the infection with large-scale, sustained and concerted programminglarge-scale, sustained and concerted programming

RH Issues – Old challengesRH Issues – Old challenges Several factors have muted an effective response: Several factors have muted an effective response:

denial of the problem, stigma and discrimination denial of the problem, stigma and discrimination against those living with infection, lack of resources & against those living with infection, lack of resources & political commitment, increasing volume of migration, political commitment, increasing volume of migration, trafficking of women and youth. trafficking of women and youth.

Some 220,000 women in Asia die each year from Some 220,000 women in Asia die each year from complications of pregnancy and childbirth, complications of pregnancy and childbirth,

The lifetime risk of maternal death in Asia is 18 times The lifetime risk of maternal death in Asia is 18 times greater than in Europe. greater than in Europe.

Sri Lanka reduced its maternal mortality rate from Sri Lanka reduced its maternal mortality rate from more than 1,500 per 100,000 live births to 60 by more than 1,500 per 100,000 live births to 60 by making safe motherhood a priority and achieving near-making safe motherhood a priority and achieving near-universal use of skilled attendants at birth.universal use of skilled attendants at birth.

“ “To confront the challenges of the twenty-first To confront the challenges of the twenty-first century successfully, we must strive to promote, century successfully, we must strive to promote, respect and protect all human rights: economic, respect and protect all human rights: economic,

social, civil and political. Asia has made excellent social, civil and political. Asia has made excellent progress over the past 30 years and we must progress over the past 30 years and we must

maintain the momentum”.maintain the momentum”.

- Thoraya Ahmed Obaid, Thoraya Ahmed Obaid, Executive Director, UNFPA Executive Director, UNFPA

New Strategies ….New Strategies ….

Poor people must be empowered to take steps to Poor people must be empowered to take steps to improve their lives, governments must assist them by improve their lives, governments must assist them by ensuring that they can obtain the services they need: ensuring that they can obtain the services they need: universal access to reproductive health and primary universal access to reproductive health and primary education (ICPD, 1994). education (ICPD, 1994).

Need to have community-based programs to combat Need to have community-based programs to combat widespread poverty and illiteracy, gender widespread poverty and illiteracy, gender discrimination, growing demands in urban areas, discrimination, growing demands in urban areas, environmental degradation and spread of HIV/AIDS environmental degradation and spread of HIV/AIDS through greater political commitment and financial through greater political commitment and financial supportsupport


HIV/AIDS programming requires a multisectoral response HIV/AIDS programming requires a multisectoral response that reaches beyond the health system to the community. that reaches beyond the health system to the community. Effective strategies include: behavior change, condom Effective strategies include: behavior change, condom programming, targeting and involving specific sectors of programming, targeting and involving specific sectors of society, including those living with HIV/AIDS.society, including those living with HIV/AIDS.

HIV/ AIDS programs include three strategic interventions: HIV/ AIDS programs include three strategic interventions: – ensuring that information and services reach and ensuring that information and services reach and

involve young people, especially adolescent girls;involve young people, especially adolescent girls;– ensuring that pregnant women and their children can ensuring that pregnant women and their children can

remain HIV-free, and remain HIV-free, and – ensuring that condoms are accessible, and used ensuring that condoms are accessible, and used

correctly and consistently. correctly and consistently.


Priority RH interventions: – safe motherhood, including care of the new-

born;– family planning and menstrual regulation; – prevention and management of complications of

abortion;– Management of RTI/STI/HIV/infertility; – adolescent reproductive health.


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


RH strategies now include integrated services for women’s health that are client-centered

Massive re-orientation of the existing vertical program structure

More prominent role for NGOs, the private sector, physicians and operations, and operations research organization (evidence-based data)

Replicable Best PracticesReplicable Best Practices

Replicable Best Practices for RH Replicable Best Practices for RH programming programming

Develop alliances with key players – INGOS, local Develop alliances with key players – INGOS, local NGOs, govts., for better impact in the country NGOs, govts., for better impact in the country

Partner with local NGOs with diverse expertise: Partner with local NGOs with diverse expertise: legal, research, community-based, service delivery legal, research, community-based, service delivery

Organize joint meetings with all partners to obtain Organize joint meetings with all partners to obtain feedback on the SRH need in the country for feedback on the SRH need in the country for advocacy, training, services, etc., advocacy, training, services, etc.,

Develop a country-wide joint program with all Develop a country-wide joint program with all partners (key results and strategies) with clear partners (key results and strategies) with clear roles and responsibilities roles and responsibilities


Facilitate periodic “Partners’ Meet” to share Facilitate periodic “Partners’ Meet” to share achievements, lessons learned, IEC materials, build achievements, lessons learned, IEC materials, build relationship among partners, provide TA and share relationship among partners, provide TA and share resourcesresources

Establish public-private partnerships (Establish public-private partnerships (an innovative approach for the public and private sectors to work together to achieve intended results) to obtain to obtain feedback on policy reform, service delivery guidelines, feedback on policy reform, service delivery guidelines, etc. etc.

Conduct annual dissemination meetings and invite key and invite key GO/ INGO/ NGOsGO/ INGO/ NGOs


Document cases of violation of RRs and Document cases of violation of RRs and develop litigation strategies with legal develop litigation strategies with legal organizationsorganizations

Sensitize media and highlight violations of Sensitize media and highlight violations of RRsRRs

Obtain inputs from key stakeholders and the Obtain inputs from key stakeholders and the community regarding the existing RH law for community regarding the existing RH law for policy reform policy reform


Increase awareness on SRH issues among law Increase awareness on SRH issues among law enforcers, judges, police, pharmacists and enforcers, judges, police, pharmacists and community-based service providerscommunity-based service providers

Identify GO/NGO facilities that provide SRH Identify GO/NGO facilities that provide SRH services and establish referral linkages services and establish referral linkages

Conduct IEC sessions to change the attitudes of Conduct IEC sessions to change the attitudes of service providersservice providers

Conduct client satisfaction surveys and provide Conduct client satisfaction surveys and provide feedback to service providers and clinic stafffeedback to service providers and clinic staff

Replicable Best Practices for YRH Replicable Best Practices for YRH

Involve youth in developing strategies, key messages Involve youth in developing strategies, key messages and IEC materialsand IEC materials

Include youth in the Project Steering Committee Include youth in the Project Steering Committee Conduct SRH sessions for in- & out-of-school youth Conduct SRH sessions for in- & out-of-school youth

and include gender issuesand include gender issues Conduct life skills training; link to vocational trainingConduct life skills training; link to vocational training Sensitize community stakeholders – religious Sensitize community stakeholders – religious

leaders, teachers, parents, mothers-in-laws and leaders, teachers, parents, mothers-in-laws and involve them in project interventions involve them in project interventions

Conduct SRH sessions for the to-be-married and Conduct SRH sessions for the to-be-married and newly married youth newly married youth

Replicable Best Practices for YRH Replicable Best Practices for YRH

Train young couples to provide information and Train young couples to provide information and services to other young couplesservices to other young couples

Develop youth leaders and give them recognition Develop youth leaders and give them recognition Train youth to be Peer Educators Train youth to be Peer Educators Encourage youth to organize dramas, quiz Encourage youth to organize dramas, quiz

competitions, develop folk songs, games on SRH competitions, develop folk songs, games on SRH issuesissues

Conduct inter-community and inter-school drama Conduct inter-community and inter-school drama competitions on SRH issuescompetitions on SRH issues

Establish social marketing, community-based Establish social marketing, community-based distribution of contraceptives distribution of contraceptives

Replicable Best Practices for YRH Replicable Best Practices for YRH Encourage youth to develop newsletter ‘By the Encourage youth to develop newsletter ‘By the

Youth for the Youth’Youth for the Youth’ Organize sports events to convey SRH messages Organize sports events to convey SRH messages Organize residential RH camps to bring youth Organize residential RH camps to bring youth

togethertogether Conduct workshops for the media to sensitize Conduct workshops for the media to sensitize

them on YRH issuesthem on YRH issues Train teachers on SRH issues so that they could Train teachers on SRH issues so that they could

conduct sessions for the youthconduct sessions for the youth

Reproductive Health Issues in Asia and the Pacific: Old Challenges, New Strategies

Health & Medicine

Transcript of Reproductive Health Issues in Asia and the Pacific: Old Challenges, New Strategies