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The SRHR situation in South Asia

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Need for Integrating
Sexual and
Reproductive Health
and Rights in the MDGs
A plea from South Asia
Ms. Indu Capoor, Founder-Director
Centre for Health Education, Training and Nutrition Awareness , Ahmedabad,
India
6th June 2007
Making MDGs a Reality
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The eight MDGs are an unprecedented
promise by all world leaders to accelerate
global efforts to meet the needs of the
worlds’ poorest by 2015. However, universal
access to reproductive health services and
focus on sexual and reproductive health and
rights was missing until recently.
None of the MDGs can be attained without
addressing SRHR. Due to absence of SRHR in
MDGs, SRHR has received less visibility, less
attention, lower priority and less funding.
Links between SRHR, poverty and
gender disempowerment
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Sexual and reproductive health among young
people is a poverty issue and forced early
marriage and early pregnancy is an outcome.
Pregnant girls drop out of schools. Without
education and employment unmarried pregnant
girls are poorly prepared to take responsibility of
childcare and face diminishing prospects for
income generation.
Addressing early pregnancy and empower-ment
women for safe motherhood are necessary
components for reducing maternal mortality and
improving child health.
While MDGs are a goal for the Global Commitment
Regional Disparities Exist
Reni
Born in South Asia
Often goes hungry
Works 10-12 hours
Is married at 10
Conceives at 13
Looses 3 children
Gives birth to 4
children
Receives no care
Is often abused
Dies at 21 years of age!
Rachel
Born in Europe
Eats nutritious food
Graduates from a good
institution
Is active in the job
market
Chooses her life partner
Mother of two healthy
children
Lives a healthy life!
The scenario in South Asia
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South Asia is the worlds most populous region. A
significant percentage of the population is denied
basic human needs-food, shelter, clothing and
education. (Per Capita Income ranges from USD
250 to 840)
A region of Class, caste, gender and race
inequalities, political crisis, terrorism and turmoil.
One fifth of the population in South Asia is between
the ages of 15 and 24. This is the largest number of
young people ever to transit into adulthood, both in
South Asia and in the world.
The SRHR situation in South Asia
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About 74 million women are missing in South
Asia. They are the victims of social and
economic neglect from the cradle to the grave.
The sex ratio is 94/100 as compared to 106/100
at the global level.
South Asia significantly contributes to the global
burden of maternal deaths (MMR ranges from
340-800).
More than 80% of adolescent girls and 85% of
pregnant women in South Asia suffer from
anemia.
In 2004 36% of the total deliveries in South Asia
were attended by a skilled health personnel.
The gap between policy and practice
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At policy level there has been some progress –
SRHR related issues are reflected in the youth,
health, education policies. However, the reality at
the ground is different! The implementation of
the policies is the real challenge among other
things because the public health systems are
weak.
While funding for reproductive health and
education has increased, its access by field-based
civil society organizations has become extremely
difficult, due to the focus on public-privatepartnerships.
Obstacles
The increasing global opposition against
sexual and reproductive rights through
budget restrictions – partlicularly the US
government (PEPFAR, GAG Rule)
пЃµ Religious opposition to sexuality education,
access to contraceptives, abortion etc.
пЃµ The culture of silence among women and
girls in South Asia
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What needs to be done?
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Build a strong and strategic advocacy
partnership.
Create new opportunities for people centered
advocacy at the local, national and regional
level.
Strengthen civil society and marginalized
women’s capacity to effectively advocate for
SRHR through field based evidence.
Hold decision makers and service providers
accountable.
Conduct simultaneous advocacy and create
linkages at state, national, regional and
international level.
Building Evidence and Ground for
Advocacy
Capacity
enhancemen
t of CBOs
and
community
to articulate
the denial of
their rights
Listening to
women narrate
experiences of
accessing care
from the public
health System
Lack of
infrastructure,
supplies,
absenteeism,
corruption
Documentation
of denial to
services in local
and national
languages
Developing
policy briefs
Scanning the environment for advocacy
interventions and opportunities - community,
state policies and programme and the political
agenda and power from local to national level
Advocacy efforts at various levels
Dialogue with
the community
and elected
representatives
for consensus
building and
affirmative
action
Dialogue with
the block and
district public
health
administrators
and media
Advocacy for
Women`s
Access to
Maternal
Health Services
from the Public
Health System
Voices of denial
at the state level
for state policy
action
National dialogue
with policy
makers, media,
donor agencies
to showcase the
evidence of
denial and
demand for
improved health
services
Opportunities, when ever available are seized at all levels,
to take community voices to the policy makers
Strong and tactful leadership
required
Global funding for the MDGs is not at the
promised level and you can lobby with your
government to put pressure on other donor
countries especially in the EU to contribute to
programmes that focus on a comprehensive
approach: Infant Mortality, young People’s
issues and maternal Health.
пЃµ Maintain focus on controversial issues to
support the global fight for a gender and
rights-based approach and help secure sexual
and reproductive rights.
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Strong and tactful leadership
required
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Pressurize your government to influence
negotiations during PRSPs so that the voice of
women’s organizations, especially organizations
working on advocacy for SRHR are heard and
that women’s rights-based programmes are
funded.
Review budgets for gaps and increase aid
allocation to fund civil society organizations for:
 Demand creation of health entitlements
 Ensuring accountability mechanisms
 Fund for enabling community feedback
mechanisms.
Strong and tactful leadership required
Hold dialogues with civil society organizations to
understand the political and social realities of
countries being funded.
пЃµ Local realities are complex, dynamic and
unpredictable, you can advocate for funding
sustainable civil society organizations that could
deepen the field understanding and link it to
practice where health service outreach is poor.
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Let us join hands for a Healthy South
Asia!
“Women’s health is a personal
and social state of balance
and well being
in which a woman feels strong,
active, creative,
wise and worthwhile;
where her body's vital power of
functioning
and healing is intact;
where her diverse capacities
and rhythms
are valued;
where she may decide and
choose, express herself and
move about freely.”
- from the 'Women and Health (WAH!)
Programme
Approach Document, 1993
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