Unveiling Realities of the South Unveiling Realities of the South Asian region to achieve Asian region to achieve

Millennium Development GoalsMillennium Development Goals

  Indu Capoor* and CHETNA** team

Paper presented in 7th European Health Forum Gastein 2004at Salzburg, Austria, on October 6th, 2004

_________________________________________________________* Ms. Indu Capoor is a Nutritionist and Founder Director of CHETNA, whose activities started in 1980** Centre for Health Education, Training, and Nutrition Awareness (CHETNA) is a non- government support organization based in Ahmedabad in Gujarat State, India.

Realities and DisparitiesRealities and Disparities

Rachel is a 35-year- old graduate from a premier university in Western Europe.

Equipped with knowledge on sex and sexuality. She has chosen to remain single, to pursue an active career in politics:  

She has access to health facilities and an enabling environment that guarantees her all human rights and comforts for health and well being.

 Rachel has a lump in her breast and is being treated by experts for which she has insurance.

Realities and DisparitiesRealities and Disparities

Rami is a 35-year-old primary school dropout in a South Asian community.

Married off in her teens she works tirelessly in the fields, at home and the community level. Compelled to survive on meagre leftovers, she often goes hungry.

She has five children and has had three miscarriages. She has a lump in her breast, but no one knows about it except her due to the widely prevalent culture of silence in her society.

She wishes that her husband would stop drinking and beating her up daily.

CChallengehallenge

Bridge social, economical and cultural gaps between two regions to achieve the ambitious Goals of Millennium Development.

Millennium Development Goals aim to transform the lives of the people world wide and essentially includes,

reducing by half the number of people living in extreme poverty.

We believe…..We believe…..

Practical efforts to eradicate poverty rest directly upon the enforcement of basic human rights, which were emphasised during the ICPD programme of Action.

Meeting the ICPD goals will pave a smooth path directly towards reaching the MDGs.

Promoting gender equality and Promoting gender equality and empowering womenempowering women

Targets at eliminating gender disparities in primary and secondary education, preferably by 2005 and in all levels of education no later than 2015.

Socio-cultural realities hinders women’s access to education

South Asian South Asian RRealitealitiesies

• Early marriages, early and repeated pregnancies and solely responsible for household activities.

• High prevalence of violence against women

• Poor access to reproductive health services inhibits women in taking control over their own fertility

“I do not want to send my daughter for higher secondary school because she has to travel 2 km from our village to reach the school. I will remain in fear of her sexual harassment while commuting. I prefer to get her married.” Mother of a 12 year old girl from one of the villages of Gujarat state India

Improve Improve MMaternal Health aternal Health Target: Reduce Maternal Mortality Ratio by three quarters

South Asian Realities

• Maternal Mortality in many countries of South Asia has not declined since the last decade.

• Average woman in South Asia is 28 times more likely to die from maternal causes than an average woman in Europe.

• Poor access to contraceptives especially to young people

• Poor access to maternal health care services

• Poor access to abortion services

Combat HIV/AIDS, tuberculosis, Combat HIV/AIDS, tuberculosis, malaria and other diseases malaria and other diseases

Target: To halt spread of HIV/AIDS and begun to reverse the spread of HIV/AIDS by 2015. To halt and begin the reversal process of the incidence of malaria and other major diseases by 2015.

Universal access to reproductive health care is critically important in the fight against HIV/AIDS.

South Asian RealitiesSouth Asian Realities• Sex education is not encouraged and taking freely

about sex and sexuality is taboo

• Poor access to scientific information on reproductive and sexual health in local languages particularly for young unmarried girls and boys.

• Early sexual activities within and outside marriage

• Unavailability of youth friendly health services.

• Young women are forced towards sex work due to poor economic condition and migration

• High prevalence of TB. With a trend of increase in prevalence of HIV/AIDS South Asian countries face a major challenge of halting the spread of both HIV/AIDS and TB.

• Efforts are required to prevent communicable diseases , while on other hand the non-communicable disease are increasing in trend especially reproductive cancers and diseases related to heart.

• South Asian countries are going through a South Asian countries are going through a transitional phase. transitional phase.

South Asian Realities

UUniversal niversal PPrimary rimary EEducationducation

Target: to ensure that by, 2015, children all over the world, boys and girls alike, will be able to complete a full course of primary schooling.

This target can only be achieved if the gender gap among girls and boys is reduced/closed.

South Asian RealitiesSouth Asian Realities

• Discrimination towards girls child

• Poor access to primary and secondary education

• Lack of mobility among girls

• Household and child care responsibilities inhibit girl child’s access to education

Eradicate Eradicate EExtreme xtreme PPoverty and overty and HHungerunger

Target: Between 1990 to 2015 both, the proportion of people whose income is less than one dollar a day and the proportion of people who suffer from hunger will be halved  

To achieve this universal access to reproductive health care for men and women is imperative. The ICPD Programme of Action and ICPD+5 benchmarks aim for universal access to voluntary reproductive health services which will change the repetitive cycle of poverty.

Develop a Global Partnership for Develop a Global Partnership for DevelopmentDevelopment

The ICPD called on international donors to provide one third of the support needed for reproductive health programmes in developing countries worldwide: $5.7 billion (of the $17 billion total requirement) in 2000, rising to $7.2 billion by 2015.  

This indicates an urgency to call upon the governments of the region, international agencies and non-governmental organisations to pay serious attention to these challenges to build on the positive experience and lessons, and to work in close co-operation to make this possible.

Current international support is less than half of this required level.

Recommendations for Recommendations for South Asian CountriesSouth Asian Countries

Gender sensitivity, access, equity, quality of Gender sensitivity, access, equity, quality of services, accountability and responsiveness services, accountability and responsiveness through strengthened public health systemsthrough strengthened public health systems

•Strengthen public primary health care and referral systems to ensure universal, comprehensive, effective, efficient, and gender sensitive health services.

•Increase allocations and expenditures in real terms for strengthening public health services including sexual and reproductive health services including through innovative measures such as a cess for health improving cuts in military

•Ensure that, where health insurance is introduced, it should be on a universal basis and include priority sexual and reproductive health services such as those for pregnancy and delivery, abortion and in-patient gynaecological care.     

•More effective monitoring and regulation of the private and public sector.

•Strengthen accountability of health providers through institutional mechanisms involving local bodies, and informing communities about relevant laws and rights to services so as to enable people to make informed choices:

•Ensure gender sensitivity and responsiveness at all levels from policy makers, managers, programme implementers to field health workers through regular capacity enhancement.

Gender equality, women’s Gender equality, women’s empowerment and male responsibilityempowerment and male responsibility

•Insuring systematic efforts to learn from successful programmes and interventions in different sectors and to scale them up.

•Integration of gender programmes through a bottom-up approach across relevant sectors.

•Institutionalising gender training at all levels to replace adhoc training programmes.

•Expanding government, and NGO programmes and effective use of the media in order to sensitise households and communities, including both women and men, girls and boys on the harmful effect of gender bias, and to respect women’s human rights.

•Recognising that the scope of male responsibility according to the ICPD POA goes beyond male contraception to include gender sensitisation of men and behavioural change towards responsibility for women’s health well-being and human rights including sexual and reproductive health and rights.

•Enacting and implementing legislation to bring gender-based violence under the purview of law such as domestic violence, honour killing, dowry-related violence and workplace harassment:

•Ensuring fair judicial recourse for victims of gender based violence

•Instituting special measures to protect victims of violence through ensuring the right to abortion for rape and incest victims: setting up safe shelters and half-way houses. And removing discriminatory laws, rules and regulations that reinforce the low status

Maternal mortality, unsafe abortion, and family planning in Rights’ framework approach

•Recognise the close links between growing impoverishment, continued gender bias and poor nutrition for women as a major long-term cause of maternal and neo-natal mortality, and ensuring food security for poor women and girls on a priority basis

•Go beyond the debate over the relative merits of TBAs (Traditional Birth Attendants) versus institutionalised delivery to identify the circumstances under which each may be able to contribute to safe maternal and child outcomes

•Ensure adequate funding, staffing, and facilities for safe, affordable and accessible delivery and emergency obstetric and neo-natal care

•Ensure accountability for safe maternal outcomes through focused training of health personnel for zero tolerance of maternal deaths and illness including such measures as identifying the medical officer to be made responsible.

•Provide information about the prevention of unwanted pregnancy including all safe and appropriate legal methods. And the pros and cons of different methods including side-effects

•Expand the availability of quality and low-cost family planning services and ensuring access and follow-up services.

•Make abortion legal, safe, accessible and affordable by reviewing restrictive abortion laws and amending them, introducing new legislation as appropriate and ensuring implementation

•Provide clear and full information about the legality of abortion, and rights to confidential services

HHIV/AIDS and sexual and IV/AIDS and sexual and reproductive healthreproductive health

•To recognise that a right-based approach is the basis of HIV/AIDS prevention, treatment and care policies and programmes:

•To ensure strategic integration of HIV with sexual and reproductive health and right policies and programmes for women. Men and young people as a critical vehicle for stemming HIV transmission.

•To pay particular attention to increasing women’s ability to exercise their sexual and reproductive rights through sensitisation, training information and services:

•To focus on improved surveillance, treatment and care of STIs/RTIs as a key entry point for reducing HIV transmission and initiating early treatment.

• To create mechanisms for the meaningful involvement of people living with HIV/AIDS in the design, implementation and evaluation of policies and programmes.

• To reorient family planning approaches to emphasize dual protection contraceptive methods that are the best proven methods for reducing HIV/AIDS transmission

• To emphasize comprehensive, quality and accessible sexual and reproductive health information and services as critical to addressing the distinct needs of people living with HIV/AIDS especially HIV positive women.

Access to EducationAccess to Education

•Ensure primary and secondary education accessible to both girls and boys.

•Review school education curriculum, curriculum of medical education, nursing and other health trainings from a gender perspective.

•Create gender sensitive health literacy by developing health education and training material for different levels of government and non government functionaries.

In order to achieve the above In order to achieve the above the Developing Countries Need the Developing Countries Need

Your Support Your Support …..…..

Financial and Technical support Financial and Technical support

required required in following areain following areas…s… •Design and implementing innovative programmes in line to achieve ICPD and MDG with a vision to upscale innovation.

•Improve public health infrastructure and access to maternal health care services including Emergency Obstetric Health Care

•Create networks and partnerships both within and across countries in the region to enable the sharing of promising practices and experience.

•Enhancing Health literacy especially for behavioural change communication programmes especially for young people.

•Facilitate policy dialogue within and across countries in the region in context to reproductive health including maternal health and young people’s reproductive and sexual health.

WWe can collectively achieve the e can collectively achieve the Millennium Development GoalsMillennium Development Goals

Let’s begin now!Let’s begin now!