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Monthly update from UNFPA in Asia and the Pacifi c SEPTEMBER-OCTOBER 2011

Promoting Gender Equality and Womens Empowerment

is Key to Correcting Imbalanced Sex Ratios at Birth
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IN THIS ISSUE
Ending Gender Imbalances Remains a Priority page 3 Supporting Afghan Maternal, Newborn Health page 4 Midwives Are Key to Safe Deliveries in Afghanistan page 6 UNFPA Pledges Financial Support to Bangladesh page 8 More Bangladeshi Mothers Get Vital Childbirth Care page 10 Midwives in Bangladesh Are Going Back to School page 12 Urgent Need to Save Pregnant Women in Sindh page 13 APRO Rolls Out Humanitarian Guidelines page 14 Debate Highlights Youths Reproductive Health Needs page 15 Strengthening the Voice of Tomorrows Leaders page 16 European Parliamentarians Tour Indonesia page 17 Men Too Can Make a Difference page 18
Photo: UN Photo/Mark Garten

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Promoting Gender Equality and Womens Empowerment is Key to Correcting Imbalanced Sex Ratios at Birth
The biologically normal sex ratio at birth ranges from 104 to 106 boys per 100 girls. However, ratios as high as 115-120 boys per 100 girls have been observed in China (118.1 in 2009), India (110.6 in 2006-2008), Armenia (115.8 in 2008) and Azerbaijan (117.6 in 2009). In Viet Nam, the ratio was 111.2 boys per 100 girls in 2010.
Photo: William A. Ryan/UNFPA

According to international and national experts, the level of SRB increases in accordance with birth order. For example, in The biologically normal sex ratio at birth ranges from 104 to 106 boys per 100 girls. However, in Viet Nam, the ratio India in 2001, the SRB was 111.2 boys per 100 girls in 2010. was 111 for the first birth, 112 for the second, and up to 116 for the third birth. In HA NOI - The Imbalance of Sex Ratios at Birth China in 2005, the SRB was 108.4 for the first birth, (SRB) is an increasing concern in some South, East 143.2 for the second, and 156.4 for the third. In Viet and Central Asian countries, where about 117 million Nam in 2009 the SRB was 110.2 for the first birth and women and girls are reported as missing, mostly slightly lower, at 109, for the second birth. However, in India and China. According to the most optimistic for the third or later births the SRB was above 115. scenario, if the SRB levels were to come back to This observation suggests that prenatal sex selection normalcy within the next ten years, men in China could have been adopted by a number of couples and India will still face a serious marriage squeeze, even during their first pregnancies. as many of them would not be able to find a partner due to a shortage of women of marriageable age for One of the main factors behind this SRB rise relates several decades. These findings were presented in to son preference, which is deeply rooted in many Ha Noi at the international workshop on Skewed Asian countries for cultural, social and economic Sex Ratios at Birth: Addressing the Issue and the reasons. Daughters may be seen as a liability, Way Forward, organized on 5-6 October by the especially where dowries must be paid. Older parents Government of Viet Nam and the United Nations. largely rely on sons for support in terms of health care and living expenditures. And sons may be I highly appreciate the initiative of the Ministry needed to perform last rites or other rituals related of Health and the United Nations in Viet Nam in organizing this workshop. I hope that the experiences ancestor worship. and lessons learned from other countries will provide In addition, as many national policies support a good opportunity to help Viet Nam to reshape our policy in family development and to build an effective reductions in family size, many individuals have social and health care system to bring the sex ratio at begun to use ultrasound and other sex selection technology. Furthermore, there are many social birth back to normal, said Viet Nams Deputy Prime consequences for women who give birth to an Minister Nguyen Thien Nhan at the opening of the unwanted girl child. In some cases, this can include workshop. violence, abandonment, divorce or even death.

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Monthly update from UNFPA in Asia and the Pacifi c

SEPTEMBER-OCTOBER 2011

There is huge pressure on women to produce sons, which not only directly affects womens sexual and reproductive lives with implications for their health and survival, but also puts women in a position where they must perpetuate the lower status of girls through son preference, said Nobuko Horibe, Director for Asia-Pacific of UNFPA. A skewed SRB will affect the population sex ratio structure in future, which, in turn, will result in a situation where there is an excess of males in society. Scarcity of women could increase pressure on women to marry at a younger age, often sacrificing educational opportunities, there may be a rise in demand for sex work, and trafficking networks may also expand in response to this imbalance. Governments should give top priority to developing and promoting programmes and policies to support the girl child in areas such as inheritance laws, dowries and financial and other social protection in old age that reflect a commitment to human rights and gender equality, added Horibe. Governments in affected countries have undertaken a number of measures to halt increasing sex ratio imbalances. However, renewed and concerted efforts are now needed by governments and civil society, including efforts to address the deeply rooted gender discrimination against women and girls which lies at the heart of sex selection. To keep up the momentum toward achieving Millennium Development Goal 3 on gender equality in Viet Nam, efforts need to be dedicated to changing couples traditional preference for male children, as well as towards empowering womens position in the family and society as a whole. More qualitative research is also needed so we can better understand the underlying social and cultural factors behind the SRB imbalance. This will, in turn, provide a foundation for improving education activities and other interventions, said Eamonn Murphy, United Nations Resident Coordinator a.i in Viet Nam.

Ending Gender Imbalances Must Remain International Priority, Says UNFPAs AsiaPacific Director
Warns that 117 million women now missing in Asia

Nobuko Horibe (left) addressing the workshop

HA NOI - Joint international and national actions to end prenatal sex selection and discrimination against women should remain a priority for all, Nobuko Horibe, the Director of UNFPAs Asia and Pacific Regional Office, said at the opening of the workshop on Skewed Sex Ratios at Birth: Addressing the Issue and the Way Forward. Held on 5-6 October, the international forum aims to find more ways to reduce sex ratio imbalances. We must join forces to ensure that sex selection is understood as discrimination against women and girls and should end, Horibe said in her speech to experts from 11 Asian, Eastern European and Caucasian nations. We must accelerate our efforts and give priority to developing programmes and policies that foster norms and an attitude of zero tolerance for discrimination, harmful attitudes and unethical practices, such as prenatal sex selection. Gender equality is at the very heart of each countrys successful development. Horibe told participants that some 117 million women were missing in Asia today and suggested ways forward. Improving gender equality and supporting national policies to address sex ratio imbalance require urgent, concerted efforts by all segments of the government and society, she stressed. It requires strong political commitment as well as downstream actions at the community level to promote behaviour change and to address complex socio-cultural realities. That is why we are all here today. By bringing together our experiences

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Photo: UNFPA Viet Nam

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and capacities, we can strengthen our efforts to tackle sex selection. She reaffirmed UNFPAs commitment to continue supporting efforts to end sex ratio imbalances at national, regional and global levels, based in its experience. Addressing this issue is central to the work of UNFPA, said Horibe. For more than 20 years, UNFPA has broken taboos to pioneer campaigns against the phenomenon. Throughout these years, UNFPA has sounded the alarm over son preference, worked with a broad spectrum of stakeholders and supported community networks to advocate against sex selection. It has also sensitized healthcare providers, young people as well as faith and community leaders to view sex selection as reinforcing discriminatory attitudes towards women and girls. The Director warned about the dire consequences of gender imbalances. Many men face the prospect of not finding brides, creating the risks of potential social unrest, increased sexual violence against women, and trafficking, said Horibe. Already, we are seeing an increase in cross-border brides, and there are signs of how the upcoming marriage squeeze could lead to social disturbances.

Chief of UNFPA Pledges to Strengthen Support for Afghan Maternal, Newborn Health
KABUL (UNAMA news release) - Without sufficient access to health services and education, Afghan women have too many children too frequently exposing them and their families to dangers, the head of UNFPA said on his first official visit to Asia. One in 16 women of reproductive health dies in child birth. For every one that dies, five or six have permanent damage. It is important that we put in place health services that prevent this from happening, and that we strengthen the ability of women to determine how many children they have, Dr. Babatunde Osotimehin, Executive Director of UNFPA, told reporters in Kabul. The average Afghan woman has 6.5 children, while data shows she wants only three or four, the Executive Director said, adding that Afghanistans population growth doubled in the last 30 years stressing economic development and making the country increasingly at risk for possible famines. As part of the solution, the Executive Director noted education in directly linked to women having greater opportunities to make decisions about their bodies, make them less likely to marry early and more secure from gender-based violence. During his visit on 16 August, Osotimehin said he wanted to see firsthand the progress Afghanistan was making on the UN Secretary-Generals Every Woman Every Child campaign. Launched before the UN General Assembly in 2010, the campaign challenges governments, businesses and civil society to commit to helping maternal and newborn health. Afghanistan was one of the first 16 countries to join. Afghanistan has an international commitment to deliver health services to every woman and child, with the purpose of creating better living conditions, said the acting Minister of Public

VIDEO

Bringing Family Planning to Remote Lao Villages

Nearly 30 per cent of Lao women who want to avoid pregnancy are not using a family planning method. To help close this gap, a new initiative uses villagers to distribute contraceptives in communities that are far from regular health services.
Link: http://www.youtube.com/unfpaasia#p/u/0/7-T9aEyUaew

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Monthly update from UNFPA in Asia and the Pacifi c

SEPTEMBER-OCTOBER 2011

From left to right: In Afghanistan, Executive Director Dr. Babatunde Osotimehin dons a bullet-proof jacket, meets acting Minister of Public Health Dr. Suraya Dalil, and visits the Central Statistical Offi ce

Health, Suraya Dalil, who also spoke at the press conference. The commitments include hiring and training additional health care workers, as well as supporting education for girls and women, creating greater economic opportunities and improving the countrys transportation. The Government is due to announce next month a project supported by UNFPA, WHO, UNICEF, UNAIDS, World Bank and other partners, to intensify work in these areas. About 60 per cent of the Afghan population mostly women and children - have access to health services, according to government figures, and only about 24 per cent of births are overseen by skilled birth attendants. The biggest challenge we face is a lack of medical staff and attendees to reach all the provinces, Minister Dalil said. As part of his visit, Osotimehin attended a midwifery training centre in Kabul where he spoke with 23 students from Bamyan and Dai Kundi. The girls, between 18 and 35 years old, will return to their villages after the two-year training period and provide medical care for pregnant women and infants through the Family Health Houses programme led by the Ministry of Public Health. Osotimehin called the midwifery school a major step forward and pledged continued UNFPA support for the students.

Maternal and newborn health is one of the five priority areas for the UN in Afghanistan, along with dialogue and peace, human rights protection, subnational governance and rule of law, and sustainable livelihoods. During every 100,000 live deliveries, 1,400 mothers die according to figures cited by Minister Dalil. The high-profile visit comes just weeks before the world population is expected to reach a record 7 billion on 31 October. With the International Year of Youth recently over, Osotimehin urged officials to engage with young people to make wise decisions. They will decide when we reach 8 or 9 billion. We must make young people feel included, he said. About 70 per cent of the Afghan population is 25 years old or younger. On 15 August, Osotimehin discussed the situation of womens health with second Vice President Mohammad Karim Khalili. Osotimehin praised the Government for its commitment to the issue and for the progress made, and reiterated UNs commitment to support new and continued efforts to combat maternal mortality.

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Midwives Are Key to Safe Deliveries for Afghani Women

Photo: Zubaida Akbar/UNFPA

While access to reproductive and maternal health care is expanding, local custom kept Fereshta, like many women in Afghanistan, from seeking timely emergency obstetric care.

KABUL - Fereshta, 28, repositions herself slowly in her bed at Malalai Hospital, on the western outskirts of Kabul. It is just a day after she has received surgery to repair an obstetric fistula, a childbirth injury that left her incontinent after her first delivery ten years ago, when still just a teenager herself. During the decade she lived with obstetric fistula, Fereshta gave birth to another six children. Only one survived - her daughter, now six years old. Though crying moments earlier, as she recounted the years of isolation her injury caused, Fereshta stops instantly when a doctor returns to check on her. But her reaction is one neither of relief nor celebration. Instead, Fereshta stiffens, and with urgency in her voice asks when she will be able to go back home to Jalalabad. I dont want to lose my daughter, I need to see her. Today, Fereshta has only one immediate concern. Her husband wishes to take another wife and have more children - and he plans to exchange Fereshtas daughter to pay for his new bride. Fereshta had not sought medical treatment for her fistula until now, though she knew the treatment existed. Her husband desired children, and a common misconception among many in this region is that the surgery causes infertility. Giving birth too young, too often and with too little time between pregnancies Womens subordinate status in the household remains as much of an obstacle to reducing maternal

death and injury in Afghanistan as geographic and conflict-related factors. Under pressure from the patriarchal society, and without access to education and health care, women and girls like Fereshta and her daughter continue to give birth too young, too often or with too little time between pregnancies. And when complications in pregnancy do arise, cultural factors are among the reason they delay or are unable to seek care. Afghan culture does not allow women to be treated by male doctors. During her first pregnancy, Fereshta went to her mothers house to deliver. Traditionally, Afghan women are also expected to conceal labour pain to their families. When the pain became unbearable for Fereshta, and it was clear that she was not facing a normal delivery, her family finally decided to bring her to the hospital. But by that time, it was too late - Fereshta delivered in the car. The child, which was in the difficult breech position, died before they reached hospital. Fereshta developed a vesico vaginal fistula, a hole between the uterine wall and the bladder. The challenges facing the Afghan health system are many - decades of conflict, cultural restrictions, poverty, poor health education, gender inequity and a shortage of women health workers trained in midwifery all prevent women from accessing health care. Just 14 to 24 per cent of all births are attended by skilled health personnel (the different figures are from UN and government assessments, respectively). It is no surprise, then, that women in Afghanistan face shocking rates of maternal death and injury. The next page

Monthly update from UNFPA in Asia and the Pacifi c

SEPTEMBER-OCTOBER 2011

maternal mortality ratio is 1,400 deaths per 100,000 live births - more than four times the threshold of 300 per 100,000 live births that is generally considered high. The survival of newborns is equally tenuous: 5 out of every 100 babies die during the first 28 days after birth. Women, communities and policymakers forge consensus on the need to save more lives Recently, however, there has been growing consensus in Afghanistan about the need to reduce maternal and neonatal deaths. President Karzai included maternal, newborn and child health in his July 2010 address to the Kabul Conference, which brought regional, international and national stakeholders in Afghanistans development together to outline a roadmap forward. In September 2010, the Government of Afghanistan made strong commitments to the Global Strategy for Womens and Childrens Health including to: Increase per capita health spending from $10.92 to $15 by 2020 Nearly double the midwifery workforce to increase skilled birth attendance to 75 per cent Expand the proportion of women with access to emergency obstetric care, to 80 per cent Strengthen health service outreach to communities Increase the contraceptive prevalence rate from 15 per cent to 60 per cent Expand immunization programs to cover 95 per cent of children Mainstream international protocols for integrated management of childhood illness Since 2010, UNFPA and the International Confederation of Midwives have supported a midwifery training programme in Afghanistan. In a society dominated by men and by a male doctor health system, the role of these midwives is crucial for patient and care provider alike. The State of the Worlds Midwifery 2011 , report released by UNFPA and partners in June 2011, found that Afghanistan needs almost 4,000 additional midwives to attain 95 per cent skilled birth attendance by 2015. Since January 2011, the Nursing and Midwifery Department of Ministry of Public Health has received technical and financial support from UNFPA to
Photo: William A. Ryan/UNFPA

Midwifery trainees practising their skills

develop the first National Policy and Strategy for Nursing and Midwifery Services. The plan, approved in August, gives nurses and midwives a clear roadmap to achieve a healthier Afghanistan for women and newborns. That same month, UNFPAs Executive Director, Dr. Babatunde Osotimehin, visited Afghanistan and announced additional support to raise funds for the development Afghanistans health system. Female midwives can enter doors that are closed to male doctors Saleha Hamnawzada, 35, graduated from the Balkh Institute of Health Sciences in Afghanistan and is now the Executive Director of the Afghanistan Midwifery Association (AMA). In a country like Afghanistan where women, especially in remote areas, cant really access medical facilities because [they lack] women heath workers, a midwife can save a womans life, Saleha explains. The midwife is the only one who can really enter the family. She can talk with the husband and she can influence the familys decisions. A mother of four children, Saleha faced her own uphill struggle to reach her current position. She practiced midwifery for ten years in mobile health clinics in remote areas of Afghanistan, and later managed a programme to train community midwives in Bamyan Province. Working in these areas, it became clear to Saleha that cultural and gender norms are among

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the biggest challenges for Afghanistan today. But she has seen examples of where this has been transformed to benefit pregnant women, mothers and babies. She credits not only to the establishment of fully-equipped delivery rooms in remote areas, but also a change in the general perception of a midwife in society. Dreaming of, and working toward, a better future Today a midwife [who] graduates from a [community midwifery education] programme is a woman well respected by the community, Saleha says. She can earn her own salary, and she represents a role model for the future generation. A midwife is not only saving women and childrens lives, she is also bringing a huge contribute to a more equal Afghanistan. Saleha Hamnawzadas hope for the future of Afghanistan is to see a midwife leading the Ministry of Public Health. As for Fereshta, she hopes to have a healthy family and to keep her six-year-old daughter at home. It was her husbands decision to take another wife that finally pushed her to seek treatment for her fistula at the Malalai Hospital Fistula Centre, supported by UNFPA. Being able to have more children is my dream for the future. After years of loneliness, I hope that this operation will help me to be part of the family again. - Gaia Chiti Strigelli

UNFPA Executive Director Pledges Financial Support to Bangladesh

DHAKA - UNFPA Executive Director Dr. Babatunde Osotimehin pledged that the Fund will work to raise $70 million to support the countrys next five-year (2012-16) plan to improve maternal and reproductive health and tackle violence against women. He made the announcement at a press conference Dr. Babatunde Osotimehin (right) with mother and newborn on 21 August, the last day of his mission to Bangladesh. For its last five-year programme, the UNFPA funding was around $40 million. At the press conference, he commended Bangladeshs commitment to health and poverty reduction. Healthy and educated people are human capital that helps nations fight poverty and promote development, he told reporters. Leaders should help them invest their energies in their nations progress. Osotimehin also called violence against women a major concern. I appeal to all men to Man Up and help end violence against our sisters and daughters. He said that UNFPA will continue working with the Ministry of Women and Childrens Affairs to curb violence and build model support centres to protect and rehabilitate survivors of violence. Accelerating progress in maternal, child and newborn health Earlier in the week, Osotimehin met with and complimented Bangladesh Prime Minister Sheikh Hasina and her government for their staunch commitment to maternal and child health in meetings here last week. Bangladesh has made remarkable progress in realizing the healthrelated MDGs, he noted. Bangladesh is one of eight UNFPA priority countries that is intensifying its efforts to improve maternal, newborn and child health as part of the broader Every Woman, Every Child effort. In the last 35 next page

Photo: William A. Ryan/UNFPA

Monthly update from UNFPA in Asia and the Pacifi c

SEPTEMBER-OCTOBER 2011

years, fertility rates have dropped from 6.3 children per woman to about 2.5. The country has reduced its maternal mortality rate by 61 per cent since 1990, putting it on track to meet the MDG target. Still, there is considerable room for improvement, the Executive Director said, while commending the countrys commitment. Following through on commitments At last years launch of Every Woman, Every Child, which grew out of the UN Secretary-Generals Global Strategy on Maternal and Child Health, Prime Minister Hasina made strong and specific commitments including: Doubling the percentage of births attended by a skilled health worker by training an additional 3000 midwives (until recently, there was no cadre of trained midwives in the country) Staffing all 427 sub-district health centres to provide round-the-clock midwifery services Upgrading all 59 district hospitals and 70 Mother and Child Welfare Centres as centres of excellence for emergency obstetric care services Reducing the rate of adolescent pregnancies through social mobilization Enacting legislation to end child marriage Providing adolescent friendly sexual and reproductive health services

Halving the unmet need for family planning (from the current level of 18 per cent) by 2015 UNFPA is helping the government to achieve these goals and improve maternal health by identifying gaps in service and prioritizing interventions and supporting a three-year midwifery degree programme (with a focus on students who will work in underserved rural areas) and a six-month specialized training for nurses. It is also working with national institutions to strengthen monitoring and evaluation of its programmes. Visits to health programmes in Manikanj On 18 August the Executive Director travelled to Manikanj District, 70 kilometres west of Dhaka, accompanied by the Minister of Health and Family Welfare, Dr. A. F. M. Ruhal Haque. Osotimehin spoke with health workers and patients at several facilities that provide safe deliveries, family planning and other reproductive health services. Child marriage and early pregnancy are significant contributors to maternal mortality and urgent human rights concerns, he said, noting the urgency of implementing the legal age of marriage and providing adolescent-friendly reproductive health services. Outside a rural community clinic in Pukuria village, he observed a courtyard meeting, where local women were instructed about staying healthy during pregnancy. At the Shivaloy sub-district hospital, newly trained community skilled birth attendants demonstrated a training exercise simulating a prenatal home visit. The next day, Osotimehin visited the Dhaka Medical Collage Hospital Obstetric Fistula Centre and met patients awaiting surgery to repair internal injuries sustained during childbirth. UNFPA supports programmes that range from surgery and rehabilitation to economic and social reintegration after survivors are cured.

Photo: UNFPA

A fi stula patient sitting in her bed, waiting for surgery

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More Bangladeshi Mothers Get Vital Care During Childbirth
He said, It is the man who brings home money, so I will decide what to do, the health worker recalls. Subsequently, he would claim no one told him his daughter-in-law was in danger. When Kanchan and a medical officer showed up later at the familys home (a dark, crowded shack made of corrugated iron and thatch), the young mother-to-be was lying unattended and in agony. After some discussion the father-in-law relented, and once a heavy downpour subsided Taslima was put in a tricycle taxi.
Thanks to the support from the government and UNFPA, Kanchan (left) is now able to manage normal deliveries better at the health centre

Photo: William A. Ryan/UNFPA

MAULVIBAZAR, Bangladesh - When a woman in labour seeks her help, Kanchan Bala Roy is confident she can ensure a safe delivery. The rural health centre where she works was recently equipped for deliveries, as part of a broad initiative to make childbirth in Bangladesh safer. Kanchan, a family welfare visitor, got new training; she now is better able to manage normal deliveries at the centre or in clients homes. And she can tell when a mother needs to be rushed to the district hospital. But what if the woman is powerless to heed her potentially lifesaving guidance? Kanchan was alarmed by the case of Taslima, 18, who came to her centre one August morning after a night of severe labour pain. Hours later, Taslimas cervix had not dilated. The clinic has no electricity and evening was approaching. The patient was suffering for a long time and there was no progress, Kanchan says. I told her relatives this could seriously harm mother and baby. She has to deliver in the hospital, not at home or in the clinic.

Fortunately, it was not too late and the hospital emergency team was ready for her. She had a successful Caesarean section that night. Hospital deliveries are increasing Surgical deliveries have doubled at the district hospital here since a UN project last year trained additional doctors and nurses, and built a new operation theatre that can accommodate two procedures at a time. The upgrade is part of a joint effort by UNFPA, UNICEF and the World Health Organization to help the Government improve maternal and newborn health care. In four of the countrys 64 districts, community clinics, family welfare centres, subdistrict health complexes and hospitals have gotten new equipment and stocks of basic drugs and supplies. Health workers at various levels have received training. Communities are being mobilized to use the improved services.

Despite Taslimas condition, her father-in-law took her back home rather than pay for a longer trip to the district hospital. The fare, equivalent to two dollars, was a substantial sum for a family living hand to mouth.

Taslima (middle) was taken to the hospital for an emergency Caesarean section

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Photo: William A. Ryan/UNFPA

Who makes life-and-death decisions?

Monthly update from UNFPA in Asia and the Pacifi c

SEPTEMBER-OCTOBER 2011

Three out of four women still deliver at home Childbirth in Bangladesh has become safer in the past 20 years, but there is a long way to go. The United Nations estimates that every year some 12,000 die from avoidable causes related to pregnancy and delivery. Three out of four women still deliver at home without a skilled birth attendant. To help address this gap, free prenatal and delivery services are being offered closer to where women live. In Maulvibazar district, 28 previously abandoned community clinics have been renovated with support from the joint project. The number of clients has risen steadily since the clinic in Mobarakpur village reopened last year. Roshana Begum, a paramedic, has been trained to conduct prenatal check-ups and normal deliveries. Malnutrition and early pregnancies increase risks Eight out of 10 pregnant women she examines are malnourished, Roshana says. Many are at additional risk because of their young age. Two thirds of Bangladeshi girls are married before age 18 and many marry much earlier. Beauty, four months pregnant at 16, came to the clinic weakened by anaemia, jaundice and a reproductive tract infection. Roshana was very concerned. She told Beauty to go see a doctor at the subdistrict health complex right away. Sadly, Beauty had no say in the matter. Two days later, her family had still not taken her to the doctor. Instead, they were treating her with herbal remedies. Then a visitor from a local NGO persuaded them that there

Two C-Sections are performed simultaneously at the refurbished district hospital.

could be serious problems if they ignored Roshanas instructions. Beauty was taken to the doctor the next morning. He judged her problems serious enough to refer her to the district hospital. There she had to wait for a bed briefly, but soon started treatment and went home six days later in much better condition. Community health workers serve a vital role Beautys case, like Taslimas, shows why authorities are employing more grassroots-level health motivators, to educate poor communities about maternal and child care and the importance of using the services now available. They provide a vital link between health providers and clients. Community health volunteer Momtaz Begum keeps track of pregnant women in 600 families in villages near Mobarakpur (currently there are 40). She visits their homes to counsel them on giving birth safely. Momtaz also leads outdoor group discussions with women and adolescent girls on family planning and staying healthy during pregnancy. In a shantytown teeming with small children, Sriti Rani Malakar advises her pregnant neighbours to use the nearby family welfare centre, where Kanchan provides basic services. Sriti, 20 and single, became a health volunteer after finishing high school, a rarity in her community. Dipali, expecting her fourth child, is having a prenatal exam for the first time. Sriti had to make four visits before the family agreed to send her to the centre. After thrice giving birth, painfully, at home on her own, Dipali says she plans to have this baby at the clinic with Kanchan attending. - William A. Ryan

Photo: William A. Ryan/UNFPA

Beauty, four months pregnant at 16, came to the clinic in a weakened condition.

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Photo: William A. Ryan/UNFPA

The United Kingdom, the European Union and Canada are funding the interagency project, which will soon be scaled up to cover 16 more districts.

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Midwives Go Back to School
Our motto is, Practise independently, says midwifery trainer Sufia Khatun. At the same time, the students learn to recognize when a case is too risky and must be referred for surgical delivery. This summer the first graduates of the programme returned to their hospitals to start using their new skills. At the health complex in Tongi Bari, midwife Hasne Ara Begum is providing follow-up care to Midwives in Bangladesh are now upgrading their knowledge, spending several months in the Liza, 20, after the birth of her classroom followed by practical training second son, Jihad. Liza has used oral contraceptives, but sometimes forgot to take NARAYANGANJ, Bangladesh - To make further the pills; she wants to use a longer-lasting family progress in reducing maternal deaths and disability, planning method. Hasne tells her about other Bangladesh is creating a cadre of full-time midwives options. trained according to international midwifery standards. A direct-entry midwifery programme will start soon. Prime Minister Sheikh Hasina has pledged to deploy - William A. Ryan 3,000 midwives by 2015. UNFPA is supporting the effort. Hundreds of nurses are now upgrading their knowledge, spending several months in the classroom followed by practical training. In the district hospital maternity ward one recent morning, trainees were showing new mothers how to breastfeed their babies. Earlier in the day, several helped to stabilize an emergency patient brought in with post-partum bleeding. Fatima has been a nurse midwife for 12 years, but says shes learned a lot. I used to conduct prenatal exams without even asking the patients history, she admits. Now she is trained to provide sensitive, holistic care, interacting with patients in a motherly manner and monitoring their progress throughout their pregnancies. She has also learned to keep hands off during delivery rather than trying to pull the baby out. She can now manage difficult deliveries on her own, knowing when to administer drugs to induce labour or prevent haemorrhaging.

Photo: William A. Ryan/UNFPA

VIDEO

More Bangladeshi Mothers Get Vital Care

Efforts are under way to make childbirth safer in Bangladesh, by training midwives, upgrading facilities and providing lifesaving care closer to where women live. Empowering women to use the services is another challenge.
Link: http://www.youtube.com/unfpaasia#p/u/1/oP5eGJd0yTQ

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Monthly update from UNFPA in Asia and the Pacifi c

SEPTEMBER-OCTOBER 2011

Urgent Need to Fill the Funding Gap to Save Thousands of Pregnant Women in Sindhs Severely Affected Districts
flood affected districts while working with Government and NGO partners. These districts are Badin, Tando Mohammad Khan, Tando Allahyar, Nawabshah, Mirpurkhas, Khairpur, Sanghar and Omar Kot. These fully equipped mobile vehicles are offering basic emergency obstetric In this August 2010 photo, midwife Farzana Sarki delivered Noor Banos baby in a camp for fl ood victims in Sindh care services ISLAMABAD - In response to the Governments including basic primary health care to women and call for assistance, UNFPA has activated lifesaving adolescent girls. UNFPA is also providing psychohumanitarian activities for the flood victims in social and protection services to gender based Pakistan. UNFPA estimates 1.4 million women and violence survivors. However, we anticipate as girls of childbearing age in the 8 most severely conditions change, these services will be delivered affected districts in Sindh require immediate access through static or fixed health facilities, said Shahnaz to reproductive health services. Of them, over Shallwani, UNFPA Provincial Coordinator in Karachi. 160,000 pregnant women require lifesaving services in the next 6 months. After the onset of floods, UNFPA distributed hygiene kits, newborn and safe delivery kits for an estimated As part of the consolidated appeal, UNFPA requested 0.6 million population in the floods affected districts. for US$3.8 million to address the most urgent Additional supplies of hygiene and reproductive reproductive health needs, including emergency health kits are being procured to cater to the needs obstetric services. Estimates show that 440 women of a population of one million for the next one month. go into labour every day, 60 of whom may have potentially life threatening pregnancy-related UNFPA, on governments request, has initiated a complications. According to UNFPA Representative comprehensive reproductive health and gender Rabbi Royan, the funding gap will have to be filled based violence assessment in the above affected in order to ensure the safe delivery of thousands districts in Sindh. The assessment, when completed, of these pregnant women and girls in the next six will help address all aspects of reproductive months. health, protection needs and ensure sustainable comprehensive emergency obstetric services for the Access to the mobile health facilities has been one women in the flood affected areas for the coming of the major challenges. UNFPA, in its initial phase, months. has mobilized 50 mobile service units in the 8 worst

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Photo: William A. Ryan/UNFPA

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UNFPA APRO Rolls Out Humanitarian Guidelines, Holds Disaster Preparedness Meeting
The Guidelines address key data issues related to preparedness and to acute, chronic and postcrisis phases of humanitarian emergencies. Each chapter focuses on data issues relating to each phase of a humanitarian crisis, and is accompanied by key indicators that would be useful for that phase and the specific role expected of the Country Office. Data issues cut across all of these humanitarian phases, said Christophe Lefranc, Technical Adviser in APRO. Timely and accurate information is very important, he added, so this workshop would provide directives on what to do before, during and after a crisis strikes. Following the rollout workshop, APRO organized another meeting on 15-16 September aimed at sharing Country Office experiences on disaster preparedness. As the frequency and magnitude of disasters increases in the region, UNFPA is gearing towards becoming a stronger humanitarian actor, said Ali Shirazi, Programme Specialist of APRO. This meeting can help us to better understand the current challenges in the region and develop approaches to disaster preparedness. The two-day meeting included presentations, interactive discussions and sharing of Country Offices experiences staff in responding to disasters. In Pakistan, we are documenting and evaluating lessons learned during previous humanitarian emergencies, like that of last year, said Mobashar Malik. In 2010, several provinces in Pakistan, particularly Sindh, were ravaged by floods, affecting over 20 million people. Deemed as one of the greatest crises in recent history, the disaster had seen the launch of UNs largest humanitarian appeal, the Pakistan Floods Emergency Response Plan. This year, Sindh is flooded

Photo: Samson Lamlenn/UNFPA

Forty staff members from across the Asia-Pacifi c region, as well as UNFPA Headquarters, participated in back-to-back regional meetings on new guidelines for humanitarian situations and on disaster preparedness. BANGKOK - In partnership with the Humanitarian Response Branch (HRB), UNFPAs Asia and the Pacific Regional Office (APRO) organized a workshop from 12-14 September to enhance staff utilization of the recently issued UNFPA Guidelines on Data Issues in Humanitarian Crisis Situations, and to strengthen UNFPAs data collection capacity in humanitarian situations. The Guidelines on Data Issues in Humanitarian Crisis Situations will support UNFPA staff to better collect, analyse and disseminate data in both natural disasters and complex emergencies. Samson Lamlenn, Technical Adviser of HRB, told participants: UNFPA, in its capacity as lead agency on data for development, should play a major role in the assembly of relevant demographic and social data from the most reliable sources. During the preparedness phase, we need to contribute to the creation of a common database for use by all stakeholders, and to actively participate in all assessments during the response and post-crisis periods.

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Monthly update from UNFPA in Asia and the Pacifi c

SEPTEMBER-OCTOBER 2011

again and UNFPA is once again providing humanitarian support. Addressing womens vulnerability in conflict situations, Rizvina de Alwis, Programme Specialist of APRO, said: In times of crisis brought on by war, incidents of gender-based violence also tend to increase due to social upheaval and mobility. Aside from disaster preparedness, we are also focusing our attention on cases of violence against women, said Raza Abdulkadir of Afghanistan. This topic is sensitive and often justified by cultural norms. Currently, we are partnering with religious leaders and the police to address this issue. At the last day of the meeting, participants were grouped to develop a checklist on what needs to be done to strengthen disaster preparedness strategies. They were also asked to put together a template for their Country Offices contingency plan. This meeting on disaster preparedness provides an opportunity to gain knowledge about other colleagues experiences. The best practices shared here are very applicable and useful, particularly for countries that are extremely prone to natural disasters, commented Rosilawati Anggraini of Indonesia.

Debate Competition Highlights Sexual and Reproductive Health Needs of Sri Lankan Youth
COLOMBO - The first nationwide youth led debate competition on adolescent sexual and reproductive health (ASRH) was recently held in the Sri Lankan capital in celebration of the International Year of Youth. With the support of UNFPA, Participants reviewing their notes before the actual debate The event came at an important time as the population of young people is currently at 5.6 million - the highest in Sri Lankas demographic history. Sri Lankan youth have limited knowledge and access to information on sexual and reproductive health, pre-marital and unprotected sex, sexually transmitted infections, and HIV/AIDS. With sexuality being culturally a taboo subject to talk about with elders and teachers, there is little guidance for young people on how to approach sex and the issues related to it. It was therefore seen as essential to create a dialogue among young people on the importance of ASRH and allow them to raise their voice about the problems they face in day-to-day life. The debate competition brought up some of the most pressing yet controversial issues affecting Sri Lankan youth and saw young people from across the country becoming passionate about their points of view on certain topics. The increase of the world population to 7 billion, the role of new social media in ASRH, young peoples right to contraception, and the inclusion of sexual and reproductive health education in schools were among the issues heatedly argued by the young debaters. Twentyfive district teams were sent to Colombo to compete in more rounds of gruelling debates, and were judged by prominent activists, lawyers, politicians and university professors. The debates were in Sinhala or Tamil, depending on the language used by the teams. At the conclusion, the Kurunegala and Mannar teams were declared as winners, with the most convincing arguments and the best delivery skills. During the awarding ceremony, inspirational speeches were given by the Deputy Speaker of Parliament, the UNFPA Representative in Sri Lanka, and a famous young actress and provincial council member. They all highlighted the importance of ASRH and its role in shaping the lives of young people in Sri Lanka.

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Photo: UNFPA Sri Lanka

news@apro
NewGen Asia: Strengthening the Voice of Tomorrows Leaders
members of key groups committed to advancing HIV prevention, with support from members of the Asia-Pacific Interagency Task Team on Young Key Affected Populations. The course uses a participatory approach to build skills in advocacy and leadership so that young key affected populations can have a stronger voice in the AIDS response. The event also launched the NewGen mentorship programme which pairs 30 young leaders representing or working with young key affected populations and 30 experienced leaders from civil society, the United Nations and other development partners, and governments in the region. Milinda Rajapaksha, a young mentee from Sri Lanka and a member of Youth LEAD, shared his enthusiasm for the initiative. The NewGen programme will give me an opportunity not just to share my experiences and skills but to learn from people I look up to. It is creating an avenue to make leadership transformation systematic and sustainable. During the launch, mentors and mentees discussed their backgrounds and expectations and planned various activities they will engage in over the coming year. All agreed that the transferring of skills and knowledge from one generation of leaders to the next would be a two-way learning and sharing exercise. The multi-pronged NewGen Asia initiative is the result of cooperation and collaboration from a number of UN and civil society partners. Anupama Rao Singh, UNICEFs Director of East Asia and the Pacific Region, commented on the importance of the initiative: The NewGen Asia initiative, with support from the regional interagency task team, will build young peoples leadership to advocate policies and programmes that concern them and prepare a new generation of change agents for the regions AIDS response. next page

Photo: UNAIDS

Participants at the launch of NewGen Asia

BUSAN, Republic of Korea (Joint news release) - The Asia-Pacific Interagency Task Team on Young Key Affected Populations launched the New Generation (NewGen) Asia initiative on 27 August at the International Congress on AIDS in Asia-Pacific (ICAAP). NewGen Asia engages young people from or working with young key affected populations as leaders and active participants and empowers them through a multi-faceted capacity-development programme. Across the Asia-Pacific region an estimated half a million young people aged 15-24 are living with HIV. A significant number all new infections are among young key populations at higher risk of HIV infection, such as sex workers, men who have sex with men, transgender people and those who inject drugs. Young people from key affected populations often face challenges accessing existing HIV prevention, treatment and care services and may face greater vulnerability due to legal barriers including age of consent. A hundred guests enjoyed a lively long-table lunch, which launched a five day leadership course for young people from key affected populations and those working with them. The course, piloted this week in Busan in advance of ICAAP, has been developed and delivered by a team of technical experts from YouthLEAD, a regional network of

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Monthly update from UNFPA in Asia and the Pacifi c

SEPTEMBER-OCTOBER 2011

European Parliamentarians Tour Indonesia

Gwang-Jo Kim, Director of the UNESCO Regional Bureau for Education, concurred and added that the initiative is an important contribution to ensuring a new generation of leaders and a regional response which is dynamic, sustainable and effective. Too often, agencies pay only lipservice to youth participation or leadership. The NewGen initiative makes the term youth-led truly meaningful and moreover an enduring reality, said Margaret Schuler, Director of Save the Childrens Global Initiative on HIV&AIDS. According to George Tembo, UNFPAs Chief of HIV, The many young leaders here today have shown commitment to HIV prevention for their peers. Most have faced and overcome many challenges including stigma and discrimination in their own lives. Adultyouth partnerships to support their on-going work are critical. Speaking on behalf of the UNAIDS Executive Director, Michel Sidibe, UNAIDS Director of Programme Effectiveness and Country Support, Tim Martineau, underlined the importance of ensuring young people from key populations are systematically involved in planning and implementation of programmes. More than anyone, these young leaders know their environments and are the most powerful engine we have for transformation and progress. These are not just our leaders of tomorrow: these are our leaders of today, he said. It is hoped that the multi-pronged NewGen Asia initiative will reap clear benefits in increasing the effective engagement of key affected populations in the Asia-Pacific region who are bearing the brunt of the AIDS epidemic.

Parliamentarians listening to a short lecture on the health services offered by health centres in Yogyakarta

JAKARTA - Six parliamentarians from Europe went on a study tour in Indonesia from 21 to 27 August to examine the countrys family planning and reproductive health policies. Jointly organized by the European Parliamentary Forum on Population and Development (EPF), the Indonesian Forum of Parliamentarians on Population and Development, Countdown 2015 Europe, and the UNFPA Offices in Geneva and Indonesia, the tour emphasized field project visits. In Yogyakarta, participants visited health centres providing free reproductive health services and supplies. They also went to temporary shelters for people affected by Mount Merapis volcanic eruption last year, and met with NGOs that provide counselling services to young people and women who experienced domestic violence. Participants learned that while Indonesias family planning policy has a successful track record, including effective state leadership and cooperation with the religious leaders, most services in the country are geared towards married couples and are not accessible to unmarried young people. They observed that due to decentralization in the country, much of the population expertise that the central government used to possess has been lost at provincial and district levels. This could lead to faster population growth, threatening Indonesias poverty reduction strategies. They also found that Indonesias maternal mortality rates are persistently high and that the country still has not adopted coherent guidelines on midwifery. The parliamentarians called for continued advocacy efforts and international support to ensure the success of reproductive health and family planning policies. Parliamentarians from Austria, Belgium, Cyprus, Ireland, Portugal and the United Kingdom took part in the study tour. The delegation also stopped in Jakarta to meet with their counterparts and representatives of donor agencies.

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Photo: EPF

Men Too Can Make a Difference

Transport Minister Kumara Welgama stressed the importance of encouraging women to take action against gender-based violence that occurs frequently in public transports. He pointed out that women refrain from doing corrective actions due to shyness, ignorance and fear. M.L.A.M. Hizbullah, Deputy Minister of Child Development and Women Affairs, further supported the statement, saying that prevention of gender-based violence begins at home; all women should be treated the same way as you would treat your own mother or sister. Tissa Karaliyadda, Minister of Child Development and Women Affairs, meanwhile emphasized that women have the right and freedom to dress as they like. Indrani Sugathadasa, Chairperson of the Security and Exchange Commission, followed with a powerful statement underlining the importance of treating women as human beings, and that violence at homes will influence childrens behaviour later in life. She also advocated for more involvement by women in politics and for change in mens attitudes towards women.

Photo: UNFPA Sri Lanka

Participants at the workshop

COLOMBO - in collaboration with the Ministry of Child Development and Women Affairs, recently conducted a workshop to engage men in addressing gender-based violence in Sri Lanka. This was both a bold and a pioneering step with the engagement of male ministers, policymakers and military officials - to inform on the role men can play in addressing gender-based violence. It was reported that around 30-40 per cent of women in Sri Lanka suffer from some form of violence, including gender-based violence. In most cases, men are reported as the main perpetrators. The workshop saw 140 men participants from diverse fields, including politicians, police officers, bankers, lawyers, military officials, trade union leaders, administrators, and representatives from the health, justice, transport and education sectors. A range of panel discussions, speeches, campaign advertisements and musical performances were featured at the workshop, aimed at changing mens attitudes and encouraging them to join women in taking a stand against gender-based violence at home and in their community. Several male government officials shared their insights about gender-based violence, and what they believe can be done to prevent it in the future.

PUBLICATION

Engaging Men and Boys in Gender Equality

Vignettes from Asia and Africa
This report generates specific, detailed lessons for successful implementation of initiatives that engage men and boys in advancing gender equality and reproductive health. Four case studies from Bangladesh, Philippines, Cambodia and Uganda are presented, followed by lessons learned and recommendations for supporting work related to engaging men.
Link: http://asiapacific.unfpa.org/public/pid/8535

UNFPA Asia-Pacific Regional Office, 4th Floor UN Service Building, Rajdamnern Nok Avenue, Bangkok 10200, Thailand Facebook: http://www.facebook.com/UNFPAasia, Twitter: http://www.twitter.com/UNFPAasia Flickr: http://www.flickr.com/UNFPAasia, Youtube: http://www.youtube.com/UNFPAasia Website: http://asiapacific.unfpa.org

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