Reclaiming & Redefining Rights ICPD+20: Status of Sexual and Reproductive Health and Rights in Asia Pacific.
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The document presents an in-depth assessment of sexual and reproductive health and rights in the Asia-Pacific region as part of the ICPD+20 initiative. It highlights the disparities in access, legal frameworks, and health outcomes among various countries, emphasizing the need for improved policies and services to support women's health and rights. Key findings reveal ongoing challenges such as high maternal mortality rates, limited contraceptive access, and barriers in sexual health education for adolescents.
Reclaiming & Redefining Rights ICPD+20: Status of Sexual and Reproductive Health and Rights in Asia Pacific.
- 2. RECLAIMING & REDEFINING RIGHTS ICPD + 20 Status of Sexual and Reproduc2ve Health and Rights in Asia Pacific Nalini Singh Programme Manager – Advocacy & Capacity Building Email: nalini@arrow.org.my
- 3. Content of the presentaNon • IntroducNon to ARROW • IntroducNon to the Global South monitoring iniNaNve • Overall context of the region • Key findings pertaining to ReproducNve Health and Rights • Key conclusions-‐ ReproducNve Health and Rights • Key Findings pertaining to Sexual Health and Rights • Key conclusions –Sexual Health and Rights • RecommendaNons
- 4. 1. About ARROW: • ARROW is a regional non-‐profit women’s NGO based in Kuala Lumpur, Malaysia. We work to advance women’s health, affirmaNve sexuality and rights, and empower women through informaNon and knowledge, engagement, advocacy and mobilisaNon. • Established in 1993, ARROW works with NGO partners in 15 Asia-Pacific countries (and expanding) and across the five regions in the Global South. • Areas of work: ü Evidence generation through research and monitoring for advocacy. ü Advocacy, capacity building and movement building through partnerships. ü Strategic information sharing and communication.
- 5. Monitoring the InternaNonal Conference on PopulaNon and Development • Monitoring government commitments to women’s health especially their sexual and reproducNve health and rights using the framework of the ICPD Programme of AcNon (PoA), which Nll today remains the most comprehensive outline and approach to women’s health and equality, has been an important strategy at ARROW. • ARROW along with our partners have been consistently monitoring the ICPD PoA. (+5, +10, +15 and +20 now-‐ in the Global South).
- 6. 2. The Global South ICPD+20 Monitoring IniNaNve • In 2014 and 2015 as the target dates for the ICPD PoA as well as the MDGs reach their respecNve Nme bound goals, ARROW realised the importance of bringing together not only the voices and realiNes of Asia-‐Pacific , but also the other regions from the Global South to arNculate southern voices and southern agenda in the lead up to 2014-‐2015 development agenda. • Thus the Global South ICPD+20 monitoring iniNaNve was conceptualised and brings together five regions (49 countries) -‐ – Asia Pacific – Africa – Eastern Europe – LaNn America and the Caribbean – Middle East and Northern Africa regions
- 7. The Global South ICPD+20 Monitoring IniNaNve • “RECLAIMING & REDEFINING RIGHTS ICPD + 20: Status of Sexual and ReproducNve Health and Rights in Asia Pacific” is one of the five Global South reports. • The scope of monitoring includes issues of: – reproducNve health – reproducNve rights – sexual health – sexual rights – women’s empowerment – health financing
- 8. The Global South ICPD+20 Monitoring IniNaNve • Asia Pacific monitoring in 21 countries : – East Asia-‐ China – South Asia-‐ Afghanistan, Bangladesh, Bhutan, Sri Lanka, Maldives, Nepal, Pakistan, India – Southeast Asia-‐Cambodia, Myanmar, Lao PDR, Malaysia, Philippines, Indonesia, Thailand, Vietnam – Pacific countries of Fiji, KiribaN, Papua New Guinea, and Samoa. • In the next slides we present to you key findings pertaining to Afghanistan, Bhutan, Bangladesh, India, Nepal, Maldives, Pakistan and Sri Lanka.
- 9. 3. Overall context of the region
- 10. i. Signatories to major human rights instruments Name of the Country Interna2onal Covenant on Civil and Poli2cal Rights (1966) Interna2onal Covenant on Economic, Social and Cultural Rights(1966) Conven2on on Elimina2on of All Forms of Discrimina2on Against Women (1979) Conven2on on the Rights of the Child (1989) Afghanistan 1983 1983 2003 1994 Bhutan 1981 1990 Bangladesh 2000 1998 1984 1990 India 1979 1979 1993 1992 Nepal 1991 1991 1991 1990 Maldives 2006 2006 1993 1991 Pakistan 2010 2008 1996 1990 Sri Lanka 1980 1980 1981 1991
- 11. ii. Gender Inequality Index Name of the Country Gender Inequality Index (Rank and Value) MMR Adolescent Fer2lity Rate % of women in na2onal parliament Afghanistan 147 (0.712) 460 99.6 27.6 Bhutan 92 (0.464) 180 44.9 13.9 Bangladesh 111(0.518) 240 68.2 19.7 India 132 (0.610) 200 74.7 10.9 Nepal 102 (0.485) 170 86.2 33.2 Maldives 64 (0.357) 60 10.2 6.5 Pakistan 123 (0.567) 260 28.1 21.1 Sri Lanka 75 (0.402) 35 22.1 5.8 Source: Human Development Report 2013-‐ The rise of the South: Human Progress in a Diverse World
- 12. iii. Health Financing Name of the Country Total expenditure on health as percentage of GDP General Government Expenditure on Health as Percentage of GDP Out of Pocket Expenditure on Health as percentage of Total Health Expenditure Afghanistan 10.4 22.5 83.0 Bhutan 4.3 84.6 11.9 Bangladesh 3.7 36.5 63.4 India 3.7 28.2 61.1 Nepal 5.1 37.4 54.4 Maldives 6.2 60.8 28.2 Pakistan 2.8 28.2 50.4 Srilanka 3.5 45.6 44.9
- 13. 4. Key Findings on Reproduc2ve Health and Rights Indicators
- 14. i. Total and Wanted FerNlity Rates Name of the Country Total Fer2lity Rate Wanted Fer2lity Rate Afghanistan -‐ -‐ Bhutan -‐ -‐ Bangladesh 2.3 1.6 India 2.7 1.9 Nepal 2.6 1.8 Maldives 2.5 2.2 Pakistan 4.1 3.1 Sri Lanka -‐ -‐ Source: RespecNve Country latest Demographic and Health Surveys
- 15. ii. ContracepNve Prevalence Rates (CPR) • CPR for the countries under review takes only married women into account. • Women’s access to range of contracepNves is sNpulated in the ICPD PoA, however an examinaNon of CPR in the countries under review shows CPR is considerably high in Sri Lanka (68%) and Bhutan (65.6%), while it is very low in Pakistan (29.6%) and Afghanistan (21.8%). • Access to range of services is limited to few opNons eg: – oral contracepNve pills being the predominant method in Bangladesh – injectables in Afghanistan – female steralisaNon in India leaving fewer contracepNve opNons for women to choose from
- 16. CPR-‐ Male ContracepNon • Male contracepNon as percentage of total contracepNon is very low in all the countries under review indicaNng the extent of (UNEQUAL) shared reproducNve burden. • Condom usage and male steralisaNon are key male contracepNon methods. • Condom usage is highest in Maldives (26.8%) and Pakistan (23%). It needs to be noted the overall CPR in these countries is quite low. • Among the countries, male steralisaNon is highest in Bhutan and Nepal. • Male involvement, as equal partners, in decision-‐making on reproducNon as sNpulated in the ICPD PoA seems to have had limited headway
- 17. iii. Unmet Need for ContracepNon Name of the Country Spacing Limi2ng Unmet need Afghanistan -‐ -‐ -‐ Bhutan -‐ -‐ -‐ Bangladesh (2011) 4.4 7.3 11.7 India(2005-‐06) 6.1 7.8 13.9 Nepal (2011) 9.6 17.4 27 Maldives(2009) 15.0 13.6 28.6 Pakistan (2007) 10.8 14.1 25.2 Sri Lanka (2007) 3.5 3.8 7.3 Source: RespecNve Country latest Demographic and Health Surveys
- 18. iv. Pregnancy & Childbirth Related Mortality & Morbidity Name of the Country MMR in 2010 Life2me risk of maternal death: 1 in ICPD Target met? Afghanistan 460 32 No Bhutan 180 210 No Bangladesh 240 170 No India 200 170 No Nepal 170 190 No Maldives 60 870 Yes Pakistan 260 110 No Sri Lanka 35 1200 Yes World Health OrganizaNon. (2012). Trends in Maternal Mortality: 1990 to 2010. WHO, UNICEF, UNFPA and the World Bank esNmates
- 19. Pregnancy & Childbirth Related Mortality & Morbidity • Despite progress in the reducNon in maternal deaths, many countries such as India, Pakistan, Bangladesh, Afghanistan conNnue have high maternal deaths. • The causes of maternal deaths in the region is mostly: – Haemorrhage (35%) – Hypertension(17%) – AborNon (10%)
- 20. IntervenNons to prevent maternal deaths-‐ EmOC and… Name of the Country Skilled a_endance at birth ICPD target is 90% by end of 2010 Post partum care (post natal visit within 2 days of childbirth) Antenatal Care (4 visits) Afghanistan 34% 23% 16% Bhutan 64.5% -‐ 77% Bangladesh 26.5% 23% 23% India 52.7% (2007) 48% 50% Nepal 36% 31% 29% Maldives 94.8% (2009) 67% 85% Pakistan 38.8 (2006) 39% 28% Srilanka 98.6% (2006) 71% 93%
- 21. v. Adolescent Birth Rates Name of the Country Adolescent Birth Rates Afghanistan 90.0 Bhutan 59.0 Bangladesh 133.4 India 38.5 Nepal 81.0 Maldives 15 Pakistan 16.1 Sri Lanka 24.3 Source: Latest UN staNsNcs, Millenium Development Goals Indicators , the official UN site for MDG indicators Adolescent Birth Rate
- 22. vi. Status of AborNon Laws in the countries under review Name of the Country To save woman’s life Preserve physical health Preserve mental health Rape or incest Foetal Impairment Economic and social reasons On request Afghanistan x -‐ -‐ -‐ -‐ -‐ -‐ Bhutan x x x x -‐ -‐ -‐ Bangladesh x -‐ -‐ -‐ -‐ -‐ -‐ India x x x x x x -‐ Nepal x x x x x x x Maldives x x -‐ -‐ -‐ -‐ -‐ Pakistan x x x -‐ -‐ -‐ -‐ Srilanka x -‐ -‐ -‐ -‐ -‐ -‐ Source: World AborNon Policies 2012
- 23. AborNon • Different extremes with regards to women’s access to safe aborNon services –Nepal has legalised aborNon while Afghanistan and Sri Lanka are most restricNve. • Unplanned and unwanted pregnancies lead to unsafe aborNons which are either self-‐ induced, or induced by untrained pracNNoners, leading to complicaNons that can lead to maternal deaths.
- 24. AborNon • In Bangladesh, although ‘aborNon’ is only available to save the life of the woman, in the mid-‐70s, the government slowly started introducing menstrual regulaNon (MR) services as an opNon for early terminaNon of pregnancy. During the last 20 years, menstrual regulaNon services have been extended throughout Bangladesh and the government has trained over 10,000 physicians and other health care providers, primarily family welfare visitors, to provide menstrual regulaNon services.
- 25. AborNon • Women also face policy barriers such as mandatory spousal authorisaNon for aborNon services in Maldives. • In Pakistan, although the law allows aborNon on a number of grounds, it is usually perceived as illegal. • In 2002, India adopted legislaNon aimed at improving access to safe aborNon faciliNes by moving authoriNes to approve faciliNes from the state level to the district level. The law, which is intended to simplify the approval process for new faciliNes, also increases criminal penalNes for providers and facility owners who operate without approval
- 26. vii. ReproducNve Cancers • Most of the countries under review in the ARROW ICPD+20 monitoring, are countries in low resource serngs. • Early screening for cancers can go a long way in reducing the incidence and mortality from cervical and breast cancers • Health systems in respecNve countries in the region have to be geared to put in place effecNve prevenNon strategies, early detecNon, which comprises of diagnosis, screening including cervical cancer screening, HPV tesNng, mammography screening, treatment and palliaNve care. • Therefore, populaNon-‐based data on cancer incidence and mortality become the starNng point for any intervenNon and countries need to start collecNng this informaNon.
- 27. 6. Key Conclusions -‐ReproducNve Health and Rights in the Region • Progress across the region is uneven and slow with regards to reproducNve health and reproducNve rights indicators with no one country having made progress in every single indicator of RH and RR. • PoliNcal will of governments is crucial in making laws, allocaNng resources, and deploying trained staff • Access for marginalised groups is a concern across all countries, with women who are poor, less educated, live in remote areas and/or rural areas and hard to reach areas facing greater difficulNes in accessing services and realising the autonomy of their bodies
- 28. 7. Key Findings on Sexual Health and Rights Indicators
- 29. i. Sexual rights of adolescents to highest atainable standard of health in relaNon to sexuality • Progress on imparNng sex educaNon and sexuality educaNon to adolescents is staggered and uneven. • In all countries, unmarried young people sNll face many barriers, some legal and some socially discriminatory, to accessing SRH services. • It is clear from the lack of provision of educaNon, informaNon, and services to young people who are in dire need of these, that governments in the region are hesitant to recognise the role of sexuality beyond its funcNon in reproducNon.
- 30. ii. Sexually Transmited InfecNons • The prevenNon and treatment of STI in the countries under review have largely been driven by the HIV intervenNon efforts. • HIV intervenNon focuses on high-‐risk behaviour groups. As a result, the larger populaNon, who are at risk of STI but do not fall under the high risk categories, are not prioriNsed for prevenNon and treatment programmes
- 31. iii. HIV AND AIDS • The epidemic in the region is largely concentrated among higher risk groups such as men who have sex with men, sex workers and injectable drug users. • Few governments in the region have addressed sNgma and discriminaNon through laws, policies and programme. SNgma, especially for the vulnerable populaNons, hinders access to HIV treatment and care.
- 32. HIV AND AIDS • Coverage of ART remains a challenge in many countries in the region. • In designing future programmes on HIV and AIDS it is imperaNve to note that not all sex is heterosexual and vaginal. • Gender analysis also needs to take into account the role of sexuality and diversity as well as meanings of and within sexual relaNons.
- 33. iv. Legal Age and Median Age at Marriage Name of the Country Women Men Median age at marriage for women Remarks Afghanistan 16 18 17.7 Bhutan 18 18 Bangladesh 18 21 15 India 18 21 17.4 Nepal 20 20 17 Maldives 18 18 19.0 Government policy strictly discourages marriages under 16 Pakistan 16 18 19.1 Sri Lanka 18 18 22.4 Does not apply to Muslim PopulaNon
- 34. v. Marriages: Arranged and Forced • In Bhutan,Maldives, Nepal and Sri Lanka – the legal age of marriage is the same for both men and women. In other countries, the legal age of marriage of women tends to be lower than that of men. • Afghanistan, and Pakistan in the region have a legal age of marriage under 18. • Arranged and forced marriages are both quite common and deeply embedded in the cultures and tradiNons of South Asia. • Afghanistan Independent Human Rights Commission esNmates that over 38% of women have been vicNms of forced marriage
- 35. vi. Sexual Violence Against Women • Rape: Out of the countries examined here, with the excepNon of Maldives, all countries have laws against rape and these usually exist within the penal code or the criminal code. However, any barriers remain prevenNng jusNce for vicNm-‐ survivors of rape. • Marital rape: Marital rape is a contested issue in almost all the countries in the region. In India marital rape legislaNon is part of the overall domesNc violence laws, however counteracNng laws exist that counter marital rape.
- 36. Sexual Violence Against Women • Sexual Harassment: Provisions for anN-‐sexual harassment in the workplace exist in Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, and Sri Lanka, and these provisions are part of the labour law in Bangladesh, and Pakistan. • Trafficking: Trafficking laws seem to be in place in most countries seem to be in place, the implementaNon and enforcement of such laws is quesNonable in the region
- 37. vii. Trafficking • Afghanistan is a source, transit, and desNnaNon country for men, women, and children subjected to forced labour and sex trafficking. According to the Ministry of the Interior, trafficking within Afghanistan is more prevalent than transnaNonal trafficking. • In India, evidence shows that trafficking of girls and young women for sexual exploitaNon and other abusive purposes is rampant. According to the 2006 CEDAW Shadow Report, intra-‐country trafficking is very high, and it was also noted that 94% of trafficked women are from rural India and from the lower socioeconomic levels.
- 38. viii. Sex work • All 21 countries in Asia Pacific under review criminalise sex work or certain acNviNes related to sex work. • All forms of sex work including sex work in private, soliciNng sex and brothel keeping are illegal in Afghanistan, Bhutan, Maldives, and Pakistan in South Asia. • CriminalisaNon of sex work or of some forms of sex work legiNmises violence and discriminaNon. Incidents of sexual assaults by police and military personnel against sex workers has been reported in Bangladesh, India,Nepal, and Sri Lanka.
- 39. ix. Status of diverse sexual and gender idenNNes • In most of the countries in the region, the laws are silent on same-‐sex sexual preference, and hence, it is not criminalised. • Among the countries monitored, same-‐sex sexual relaNons (both male to male and female to female) is illegal in Afghanistan, Bhutan, Maldives and Sri Lanka. Female to female relaNons are not illegal in Bangladesh, India, Pakistan. Same-‐sex sexual relaNons are not illegal in Nepal.
- 40. x. Transgenderism • Nepal seems to be the most progressive country in the region, having decriminalised laws which control sexuality and having recognised sexual minoriNes as ciNzens with equal rights regardless of sexual orientaNon and gender idenNty. • Transgendered people are now able, through a Supreme Court ruling to amend the ConsNtuNon, to obtain ciNzenship with the idenNty of the third gender. A government commitee had also been set up to review the marriage system to amend it accordingly with this new ruling.
- 41. 9. Key Conclusions-‐ Sexual Health & Rights • Sexual health is sNll being framed in limited paradigms across the region. • PoliNcal will of governments is crucial in recognising the sexual health and sexual rights of ciNzens • Sexual rights are not as contenNous as perceived with many aspects of sexual rights have been accepted and legislated by the governments.
- 42. 10. Key recommendaNons • There is need for policy change underpinned by commitment to the ICPD POA, with respect to reproducNve rights and sexual rights. • Ensure universal access to comprehensive, affordable, quality, gender-‐sensiNve services to enable the realisaNon of the highest standard of sexual and reproducNve health. • Ensure conNnued, commited and sustained investments in women’s SRHR by governments and donors. • Ensure SRHR of all are fully realised and exercised, especially those of young people and adolescents , those with diverse sexual orientaNon and marginalised groups
- 43. Reference: RECLAIMING & REDEFINING RIGHTS ICPD + 20: Status of Sexual and ReproducNve Health and Rights in Asia Pacific (2013) htp://www.arrow.org.my/publicaNons/ICPD+20/ICPD +20_ARROW_AP.pdf
- 44. Thank You