Emerging Issues Related to Sexual and

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Emerging Issues Related to Sexual and
Reproductive Health and Rights
by
Assoc. Prof. Dr. Mary Huang Universiti Putra
Malaysia
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Demographic situation
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Population of youths
The biggest demographic challenge and opportunity
of the region is its enormous population of youth.
About 850 million people in Asia and the Pacific
are between the ages of 10 and 24 More than
half of the world's young people
This demographic surge of people entering their
productive and reproductive years is great
potential for development - if countries invest
wisely in the education, health, skills and
economic opportunities of youth.
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Asia is also home have a very fast growing aged
population, most of whom will be women.
People gt 60 made up about 9.3 of the region's
population in 2005 and are projected to account
for almost 15 by 2025
Major challenge will be the provision of old age
security and health insurance for the elderly.
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The population growth rate for Asia and the
Pacific is now close to the world's average (1.21
per 1,000 population), with some countries having
reached fertility levels of 2.1 or below.
However, high fertility in some countries,
especially in South and West Asia, continues to
outpace economic and development gains and stall
poverty reduction efforts.
The large percentage of young people means that
the region will continue to grow for years to
come, although some Pacific island countries are
losing population and capacity, due to migration
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Within the next 15 years, 18 of the projected 27
megacities (urban areas with more than 10 million
people) will be in Asia, and over half of the
people will live in slums and informal
settlements. This urbanization poses serious
environmental threats, including high levels of
water and air pollution and attendant health
risks.
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Urbanization is occurring at an unprecedented
pace, bringing with it both problems and
possibilities.
Nearly 40 million people in the region, many of
them women and young people, migrate each year to
urban areas in search of economic opportunity.
The majority end up living in slum-like
conditions characterized by insecure tenure,
inadequate housing and a lack of access to water
or sanitation.
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HIV/AIDS
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People Living with HIV/AIDS

• Generally poor and voiceless in society
• They as well as their families are discriminated
  against.
• Do not receive the care and support they need
• They need support not pity to live

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a powerful duo

• Stigma attitude
• Personal
• Discrimination action
• Attaches to pre-existing stigmas
• Cycle of shock, shame, secrecy, silence

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Maternal Mortality
The lifetime risk of maternal death in Asia is 18
times greater than in Europe. (UNFPA) but within
Asia Pacific it is also very different between
countries.
Maternal Mortality Rates Australia 6 per
100,000 life-births Malaysia 30 per 100,000
life-births PNG - 390 per 100,000
life-births Indonesia - 470 per 100,000
life-births Laos - 650 per 100,000 life-births
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EMERGING ISSUES RELATED TO SEXUAL AND
REPRODUCTIVE HEALTH
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Every year 30 000-50 000 mothers die from the
complications of pregnancy or childbirth. More
than 40 of all maternal deaths occur in five
countries (Cambodia, the Lao People's Democratic
Republic, Papua New Guinea, the Philippines and
Viet Nam) whose combined populations account for
only 10 of the Region' s population.(WHO)
There are also huge variations in rates within
countries. For example, national data in the Lao
People's Democratic Republic for 1995 reveal a
MMR of 150 in Vientiane and over 9000 in more
remote provinces.
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GENERAL FACTORS THAT CONTRIBUTE TO MATERNAL DEATH

• About 80 of maternal deaths are due to causes
  that are directly related to childbirth and
  pregnancy.
• The five major direct causes of maternal deaths
  are
• Hemorrhage
• Sepsis
• Hypertension disorders
• Prolonged or obstructed labor
• Unsafe abortion.

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• About 20 of maternal deaths arise from
  pre-existing conditions that are aggravated by
  pregnancy.
• The indirect causes of maternal deaths are
• Cardiovascular system
• Infections (excluding puerperal sepsis)
• Connective tissue disease
• Place of delivery
• substandard care

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• Approximately 20 of maternal deaths arise from
  pre-existing conditions that are aggravated by
  pregnancy such as
• Anemia
• Malaria
• Hepatitis
• Heart disease
• HIV/AIDS.

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Contraceptive Use
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Persistently low levels of contraceptive use are
found in some Countries
Emergency Contraceptive not easily available
Among the prominent cultural barriers preventing
men, women and the youth from accessing RH
services are those, which are gender-related.
Many of the barriers are rooted in gender
inequalities that restrict womens access to
income, mobility, decision-making power, that
together culminate in a general lack of
empowerment.
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Unsafe Abortions
Worldwide, every minute, 100 women have an
abortion, 40 of which are unsafe
About 14 unsafe abortions occur for every 100
live births in Asia. Excluding East Asia, where
safe abortion is widely accessible, one unsafe
abortion occurs for every 5 live births.
Source Ahman, Elisabeth and Iqbal Shah. 2002.
Unsafe abortion Worldwide estimates for 2000.
Reproductive Health Matters 10(19) 13-17.
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• Unsafe abortion is a major threat to women's
  health
• About 1/3 of women who have unsafe abortions
  experience complications that pose major risks to
  their lives and health.
• The WHO estimates that unsafe abortion is
  responsible for 13 of all maternal deaths
  globally. About 70,000 women die each year from
  complications of unsafe abortion.
• Millions more women suffer from debilitating
  complications and illness, e.g incomplete
  abortion, tears in the cervix, perforation of the
  uterus, fever, infection, septic shock, and
  severe hemorrhaging.

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Ensuring skilled attendants at birth
Maternal Mortality is inversely proportionate to
the percentage of deliveries by skilled
attendants.
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ARROW Monitoring Ten Years of ICPD
Implementation The Way Forward pg. 30
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Poverty
Poverty increases the risk of maternal Mortality
due to lack of access to good quality health care
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SRH AND RIGHTS OF YOUNG PEOPLE
Challenges of growing numbers of young people in
the region
Programs designed by adults may not be suitable
for the young
Adults regard the young as a problem while the
young want adults to treat them as a solution
Should/can sex education be provided before they
drop out of school
Right to contraception before Marriage????
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Gender inequality

• Gender inequality and cultural vulnerability are
  two issues that constitute particular challenges

• Gender disparities persist in the areas of
  health, literacy, education, political
  participation, income and employment. As a
  result, many women, especially those who are
  impoverished, are prevented from exercising their
  human rights and realizing their full potential.
  Their families, communities and countries miss
  out as well.

• A combination of cultural and institutional
  barriers is implicated in the root causes of
  poverty, reproductive ill-health and indicators
  of the poor socio-economic status of women.

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• Sexual double standards are part of the
  masculinity norm, resulting in negative
  reproductive health consequences for women, which
  are manifested in many forms. For example, in
  cultures where virginity is highly valued,
  unmarried young women may be persuaded to engage
  in anal sex or other practices that preserve
  their virginity, but place them at higher risk of
  infection

• .Virginity norms may also make young women
  reluctant or ashamed to seek treatment for
  reproductive tract infections (RTIs). On the
  other hand, masculinity norms as expressed in
  macho complexes lead men to engage in reckless
  behaviors such as having multiple sex partners,
  patronizing sex workers and perpetrating
  violence.

• In Thailand, it is reported that young mens
  infidelity is generally accepted such that if a
  young man does not patronize prostitutes he would
  be thought to be homosexual

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• Chauvinist cultural views on sexuality, including
  the perception of female sexuality as being
  passive, devoid of desire and subordinate to male
  needs prescription of virginity and sexual
  monogamy for women while condoning multiple
  sexual partners for men before and during
  marriage and to the norm of conjugal sexuality
  as being mainly oriented towards reproduction.

• The association between womens empowerment and
  improved reproductive health and child health
  through education, employment, decision-making,
  access to social services and credit facilities,
  for example is strong testimony to the
  dividends that accrue from investing in gender
  equality.

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• Cultural Expectations of roles within
  relationships

• Belief in the inherent superiority of males

• Values that give men proprietary rights over
  women and girls

• Notion of the family as the private sphere under
  male control

• Customs of marriage, (bride price/dowry)

• Acceptability of violence as a means to resolve
  conflict

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Gender Based Violence

• Although most countries in the region have signed
  or ratified the UN Convention on the Elimination
  of All Forms of Discrimination against Women, not
  all ensure equal rights for women in their own
  constitutions. Gender-based violence remains
  widespread and has only recently been recognized
  as a significant public health and development
  concern.

• A strong preference for sons in some countries
  has led to pre-natal sex selection or neglect of
  infant girls, with the result that least 60
  million girls are 'missing' in Asia, with
  potentially serious social consequences.

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Sex Work in the Region

• The ESEA region has become a target for sex
  tourism and trafficking of women, men, and
  children for many reasons, but chiefly for sexual
  purposes.

• Due to unequal gender relations, sex work tends
  to be a highly stigmatized profession, with
  female sex workers at risk of prosecution, whilst
  male clients are free to buy sexual services with
  impunity, and are often regarded as being quite
  normal for doing so.

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Trafficked women

• Trafficked women are likely to be amongst those
  with least access to reproductive health
  information and services.
• Many of them are highly vulnerable to sexual
  abuse and physical violence, unwanted pregnancy,
  STDs and HIV/AIDS due to the nature of the work
  they end up doing at their destination points.
• Due to their social and legal invisibility they
  often have no way of accessing health care.

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• Because of cultural definition of mens perceived
  physical needs, in most of the ESEA countries it
  is quite acceptable for men to visit prostitutes,
  or even to have second, minor wives

• Whilst virginity is highly rated in a bride and
  monogamy within marital relationships, men are
  nevertheless perceived as needing an outlet for
  their sexual urges. Hence there is tacit approval
  for prostitution in most countries in the region

• Sex workers themselves however are generally
  looked down on and are regarded as a necessary
  social evil, whilst the legal status of
  commercial sex work varies between countries.

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Main Trafficking Routes Countries of Transit
Countries Countries of Origin Destinati
on Cambodia Cambodia Cambodia
China Myanmar China Lao PDR
Thailand Thailand Myanmar
Singapore Thailand Taiwan Viet
Nam Malaysia Hong Kong
Japan Source UNIFEM. East and South-East
Asia Regional Office and UNIAP. Trafficking in
Persons A Gender and Rights Perspective.
Briefing Kit.
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Cultural Vulnerability

• Under cultural vulnerability, reference is made
  to
• ethnic and religious minorities, two of the key
  groups that are often outside of the mainstream
  socio-cultural setting in a country and
• groups who practice or are exposed to risky
  reproductive and sexual beliefs and practices.
• These two sets of groups are often subject to
  discrimination of some form or another

MSM
Drug Users
PLWHAs
Sex Workers
Migrant workers
Single mothers
The Indigenous
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Health Providers as Moral Police

• Service providers sometimes reflect their own
  cultural or religious values, particularly when
  dealing with sensitive issues such as unwanted
  pregnancies and contraceptives. In Indonesia
  service providers seemed to be more tolerant
  towards clients wishing to terminate unwanted
  pregnancies due to contraceptive failure, rather
  than for other reasons. In all cases, however,
  continuation of the pregnancy was usually
  recommended

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• In Myanmar many health providers felt they should
  scold the clients who came in for post-abortion
  complications, and that this scolding was in the
  interest of the clients in order to keep them
  from seeking abortions in the future. Many
  village women delayed seeking help for even
  severe complications due to fear of being
  reprimanded, as well as fear of neighbors finding
  out about the abortion

• In a survey carried out among formal and informal
  sector health providers in Lao PDR,18 percent of
  the providers considered it their duty to inform
  the parents of their childrens sexual activity.
  They hoped that the parents could exert influence
  on their children to refrain from sexual
  relationships.

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Forging Partnerships

• The religious and/or spiritual frameworks within
  which most communities operate can be an
  important entry point for reproductive health
  programming.

• Issues relating to sexual and reproductive health
  are often highly sensitive or even taboo to
  discuss openly, but when positively engaged and
  provided with evidence-based information,
  religious and spiritual leaders are often willing
  to collaborate and to interpret their teachings
  progressively.

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Promoting male participation

• In the area of RH it is acknowledged that men as
  spouses or partners are normally the ones who
  take decisions in the home and who therefore need
  to be more involved in RH interventions.
• In this regard, it is imperative for boys and men
  to be socialized or re-socialized to take
  responsibility for the effects of their own
  sexual Behaviour on their partners and
  childrens health and well-being.

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Marrying HIV/AIDS and SRHR

• Health and social services have to become stigma
  sensitive
• Sexual and reproductive health services need to
  become both truly youth-friendly and
  girl-friendly and stigma free.
• Unpacking the entry points for mainstreaming
• Protection from discrimination must become a true
  multisectoral issue
• Responses to the AIDS epidemic have to ensure
  that they do not inadvertently promote stigma.

Source IPPF
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seven recommendations

• 1. New international fora to bring together SRHR
  and HIV/AIDS
• 2. Microbicides Advocacy, Research and Action
  needs to become a stronger part of the global
  agenda
• 3. Explicit mention should be made of the
  continuum of care ( prevention, treatment, care
  and support) in the Principles

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seven recommendations

• 4. Addressing in action- the sexual health
  needs of men is key
• 5. GIPA ( Greater Involvement of People Living
  with HIV/AIDS)
• 6. Pooling of common messages - especially those
  aimed at young people
• 7. Joint donor and government advocacy by the
  two communities

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In conclusion
Since ICPD we have made great strides in
addressing SRHR in the Region
However vast variations in gains exist between
countries and also within countries
We know that all of us have to work within the
country context and will be subject to
socioeconomic situations. However as SRHR
providers we know our business is saving lives
and as such there is no time to waste. We cannot
wallow in self pity and admit defeat.
We must work like the brave and angry women who
in the fifties went to jail just because they
advocated for womens right to Family Planning.
The battle is not won.
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Thank you and all the best