REPRODUCTIVE HEALTH ISSUES IN ASIA AND THE PACIFIC: OLD CHALLENGES, NEW STRATEGIES Dr. Sona Sethi Regional Director, A

1. REPRODUCTIVE HEALTH ISSUES IN ASIA AND THE PACIFIC: OLD CHALLENGES, NEW STRATEGIES Dr. Sona Sethi Regional Director, Asia

2. 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

3. 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

4. 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 high- risk 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 ,

5. 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

6. 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 HIV-infected 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

7. 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 near-universal use of skilled attendants at birth.

8. “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

9. 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

10. 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.

11. New Strategies …. • 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.

12. 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

13. New Strategies …. • 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)

14. Unsafe Abortion Youth Friendly Reproductive Health Services D e c r e a s e d I n c i d e n c e o f U n w a n t e d P r e g n a n c y S a f e r S e x u a l B e h a v i o u r & D e c r e a s e d S T I I n c i d e n c e E f f e c t i v e & D y n a m i c y o u t h o r g a n i z a t i o n s U n s a f e S e x u a l B e h a v i o u r & S T I s U n w a n t e d P r e g n a n c y H e a l t h P r o g r a m P r o b l e m - b a s e d & R e s u l t - o r i e n t e d Y o u t h - I n i t i a t e d P r o g r a m s I n n o v a t i v e A p p r o a c h e s t o A d v o c a c y S m a l l G r a n t s P r o g r a m Productive Diversional Activities A r t s & C u l t u r e L i t e r a t u r e L o c a l Y o u t h D e v e l o p m e n t C e n t e r P e r f o r m i n g A r t s V i s u a l A r t s RH Knowledge P r e v e n t i o n o f U n s a f e A b o r t i o n Leadership P u b l i c S p e a k i n g Organizational Management Youth & Youth Orgs S p o r t s

15. Replicable Best Practices

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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