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Realizing the Potentialannual report

2013


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About this report

UNFPA, the United Nations Population

Fund, worked with 159 countries,territories and other areas in 2013 to

deliver a world where every pregnancy is

wanted, every childbirth is safe and every

young person’s potential is fulfilled.

Backed by $976.8 million in support from donor governments, partner

organizations, foundations and individuals in 2013, UNFPA delivered

results in the seven main programming areas of the organization’sStrategic Plan for 2008–2013:

• Expanding and improving maternal and newborn health;

• Increasing access to voluntary family planning;

• Making HIV and STI services more accessible to pregnant women

people living with HIV, young people and key populations;

• Advocating for gender equality and reproductive rights;

• Increasing young people’s access to sexual and reproductive health

services and information;

• Linking population dynamics, policymaking and development plans;

• Harnessing the power of data. T h i s p a g e : © U N F P A U g a n d a ; C o v e r i m a g e : © © G

M B A k a s h / P a n o s P i c t u r e s


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Contents

2 FOREWORD

3 FROM THE EXECUTIVE DIRECTOR

5 GLOBAL INITIATIVES

14 ARAB STATES

20 ASIA AND THE PACIFIC

26 EAST AND SOUTHERN AFRICA

32 EASTERN EUROPE AND CENTRAL ASIA

38 LATIN AMERICA AND THE CARIBBEAN

44 WEST AND CENTRAL AFRICA

50 RESOURCES AND MANAGEMENT


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ForewordThanks to the work of UNFPA, the United NationsPopulation Fund, there have been considerable advancesin the two decades since the International Conferenceon Population and Development.

The ICPD Programme of Action, or Cairo Consensus as

it came to be known, broke new ground in recognizingthat reproductive health and rights, as well as women’sempowerment and gender equality, are cornerstones ofpopulation and development efforts. UNFPA has playeda dynamic role in advancing these causes and pursuingsustainable development.

Working with governments, other United Nationsagencies and partners around the world, UNFPA has

helped reduce maternal deaths by nearly half and thedeaths of children by more than 40 per cent. This has

not only spared families the trauma of losing a lovedone, but also given hope and opportunity to millionsof women and children.

While much has been accomplished through the frame-work of the Millennium Development Goals, moreremains to be done. We have two key priorities: tointensify efforts to achieve these life-saving goals, and

to defne an ambitious post-2015 development agenda inwhich the needs and rights of women, young people andchildren are at the forefront.

As this work unfolds, we must also address new chal-lenges related to population demographics, such aschanging age and household structures, rapid urbaniza-tion, migration and the provision of services in contextso conict and disaster. New environmental realities,

including the urgent threat of climate change, are alsopart of the picture. These factors were less understoodand appreciated two decades ago. As Member States con-sider the way forward, I encourage them to draw on thewealth of information and analysis that has emergedrom the 2013 ICPD review led by UNFPA.

A sustainable uture, where everyone can ulfl theirpotential, requires that we promote health, cultivate

human capacities, and commit to individual dignityand human rights for every person, everywhere. UNFPAmakes important contributions to that effort, and I com-mend this report to policy-makers and others worldwideinvolved in that vital work.

—United Nations Secretary-General Ban Ki-moon

Secretary-General Ban Ki-moon speaks to a

young mother at Cama Hospital in Mumbai, India.


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From theExecutive DirectorTwenty years ago at the International Conference onPopulation and Development, 179 governments orged a groundbreaking consensus that changed the very defni-tion of development. Delegates from all regions and cul-tures put individuals, their human rights and dignity, atthe very heart of development, emphasizing that sexualand reproductive health is a fundamental human right.

They recognized that empowering women and girls is both the “right” thing to do and one of the most reliablepathways to improved well-being for all.

The conference delegates’ Programme of Action, whichcontinues to guide UNFPA’s work today, shifted popula-tion policy and programmes from a focus on numbers toa focus on individual human lives and rights. It markeda turning point on the path towards inclusive, equitable,

sustainable development.

To mark the past 20 years o implementation o theProgramme of Action, the General Assembly called onUNFPA to lead a global review of countries’ progress.The review, carried out in 2013, included a survey o176 countries and seven territories, regional and thematicconferences, and extensive stakeholder consultations.

The review found that since the International Conferenceon Population and Development, the world has madeimpressive gains: fewer women are dying in pregnancyand childbirth; more women have access to education,work and political participation; more children, girlsin particular, are going to school; and there are morelaws protecting and upholding reproductive and otherhuman rights.

But not all have benefted equally. Unacceptably large gaps

persist in access to services, opportunities and wealth. The

review ound that 53 per cent o the world’s income gainsover the past 20 years have gone to the top 1 per cent o thepopulation—and none to the bottom 10 per cent.

The gains we have made cannot be sustained unless wefully respect the rights of people, particularly youngpeople and adolescents, to education, including com-prehensive sexuality education, and help meet youngpeople’s needs for skills development, entrepreneurshiptraining, access to jobs and credit. There is also the needto have universal access to health services, includingaccess to information and family planning services.

Another fnding o the review is that rights are stillfar from universal. While most States are progressingtowards gender equality, in a number of countries therights and autonomy of women are deliberately cur-tailed. And in no country are women fully equal to menin political, social or economic power. Gender-baseddiscrimination and violence continue to plague mostsocieties. People living with disabilities, indigenouspeoples, racial and ethnic minorities, and other margin-alized and vulnerable people continue to face discrimi-nation—this despite the fact that a core message of the

International Conference on Population and Developmentwas the right of all persons to development.

Dr. Babatunde Osotimehin at youth centre in Eastern Samar, the Philippines.


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In the poorest communities, even in wealthier coun-tries, maternal death, child marriage, adolescentpregnancy and women’s overall status have seen little

positive change since 1994.

Poverty occurs in all countries, but women bear adisproportionate burden of its consequences, as do thechildren they care for.

Harmful practices such as early, child and forced mar-riage, and female genital mutilation/cutting, remainprevalent despite advances in legislation. Too often

laws, where they do exist, are not enforced and thus failto protect women and girls.

We do not possess a quick fx or panacea that canaddress all of these issues without paying attention tothe root cause, which is inequality. While human rightsmust be upheld universally, concrete approaches must be country-specifc. In addition, we cannot expect tomake any signifcant gains unless we pay greater atten-

tion to and make great improvements in health systems.Improvements must include the provision of appropri-ate human resources, building a robust supply-chainmanagement system and providing a social protectionoor that will enable all, without exception, to accessservices. This approach can reinforce the principles ofequity and respect for the rights of all.

The fndings o the review make it clear that the objectives

and principles of the Programme of Action are as relevanttoday as they were in 1994, and have the power not only topropel development in the next 20 years but also to helprectify many of the inequalities that are impeding progress. The fndings will also inorm the post-2015 Sustain-able Development Agenda—the United Nations successorcommitment to the Millennium Development Goals.

What the world looks like in the future will depend

heavily on how well we meet the needs and support theaspirations of young people, particularly adolescent

girls, today. There are now more young people thanever in the world. The new generation’s aspirations arealso greater than ever. With access to cell phones and

the internet, many are better informed of their rightsand the inequalities they experience. Capitalizing ontheir aspirations will require deep investments in theireducation, skills development, health and politicalparticipation. Much more attention should be placed ontheir ability to access comprehensive sexuality educa-tion, information and services, to enable them to makechoices that will promote healthy lifestyles and buildtheir agency to decide whether or when to have chil-dren. In 2013, UNFPA has steadastly supported coun-tries’ efforts to realize the full potential of every youngperson, and we will continue to support young peoplefor years to come, with particular focus on the mostmarginalized and excluded adolescent girls.

On 31 December 2013, the UNFPA Strategic Plan or2008–2013 came to a close. The new strategic plan, or2014–2017, equips UNFPA to respond more eectivelyand efciently to emerging opportunities and challengesand to shiting needs starting in 2014—a critical year orpopulation and development, for human rights and forreecting these priorities in the new global SustainableDevelopment Agenda.

Now is the ideal time to reafrm the core message o theInternational Conference on Population and Develop-ment: that individual dignity and human rights are the bedrock of a resilient, sustainable future. The path tosustainability is paved with equity and non-discrimina-tion; with investments in health and education, particu-larly for women and young people; with universal accessto sexual and reproductive health and secure reproduc-tive rights; with choices and opportunities for all.

—Dr. Babatunde Osotimehin


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Global initiativesDOCUMENTING 20 YEARS OF PROGRESSAt the International Conference on Population andDevelopment (ICPD) in 1994, 179 governments adopted alandmark Programme of Action to deliver a more equal,sustainable world.

The Programme of Action, which continues to guidethe work of UNFPA, made a clear connection betweenhuman rights, sexual and reproductive health, popula-tion dynamics, poverty reduction and economic devel-opment. The Programme of Action was groundbreaking because it put people’s rights and dignity at the heart ofsustainable development. It emphasized that sexual and

reproductive health is fundamental to human rights,and that empowering women and girls is both the rightthing to do and one of the most reliable pathways forimproving well-being for all.

In the lead-up to the twentieth anniversary of the ICPD,the United Nations General Assembly called on UNFPAto lead a global review of progress in implementing theProgramme o Action. An ICPD Beyond 2014 Secretariatlocated in UNFPA coordinated and led the review inconsultation with Member States and in cooperationwith the United Nations system and other internationalorganizations. The review entailed a global survey

The Maternal Child Health Assistant School in Makeni, Bombali District, Sierra Leone.


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l o b a l i n i t i a t i v e s

of governments; consultations with civil society,United Nations partners and other stakeholders; andregional and global thematic conferences and meetings.

Regional population and development conferences wereheld in 2013 to assess the implementation o the Programmeof Action and propose actions for further implementa-tion beyond 2014. Global thematic conerences and meet-ings were also organized to consider specifc themes orissues: youth, human rights and women’s health.

Drawing on the fndings o the global survey, consulta-

tions with stakeholders and partners, and the outcomesof the regional and thematic conferences and meetings,the ICPD Beyond 2014 Secretariat set out to produce anunprecedented, authoritative report on the state ofpopulation and development and propose ways to seizeopportunities to speed up the implementation of theProgramme of Action in support of countries’ achieve-ment of development objectives.

The report, scheduled or publication in early 2014,reects the views o States and stakeholders and showsthat the Programme o Action has signifcantly contrib-uted to tangible progress: fewer women today are dyingin pregnancy and childbirth; skilled birth attendancehas increased by 15 per cent worldwide since 1990; morewomen have access to education, work and politi-cal participation; more children are going to school;and fewer adolescent girls are having babies. But the

report also warns that these successes have not reachedeveryone equally. In the poorest communities, verylittle progress has been reported in improving women’sstatus, reducing maternal death and preventing childmarriage in the past 20 years. In some instances, thesituation is worsening.

The report puts forward a framework for the futureof the Programme of Action, acknowledging that the

motivations for development are generated by humanaspirations for dignity and human rights, good health,

mobility and security of place. The framework alsocites the centrality of the well-being of the individualin sustainable development, the achievement of which

depends also on good governance and accountability.

The report will inform the discussions by Member Statesat the September 2014 United Nations General Assemblyspecial session on the follow-up to the ICPD.

NEW STRATEGIC PLAN ANDTHE UNFINISHED ICPD AGENDAAt the end o 2013, UNFPA closed the Strategic Plan that

had been guiding the organization since 2008. Earlierin the year, UNFPA developed a new Strategic Plan for2014 through 2017. The new plan is ocused squarely onaddressing the unfnished agenda o the InternationalConference on Population and Development, ICPD, witha particular concentration on sexual and reproductivehealth and reproductive rights.

The new Strategic Plan includes a strengthened results

framework, a new business model and improvementsto the funding arrangements and requirements. Thenew Plan will enable UNFPA to have a more signifcantimpact on the lives of women, adolescents and youtharound the world.

The new Plan reafrms UNFPA’s strategic direction,with the achievement of universal access to sexual andreproductive health, the realization of reproductive

rights and the reduction of maternal death at the centre,to accelerate achievement of the goals set forth in theICPD Programme of Action.

BUILDING PARTNERSHIPSCivil society plays a pivotal role in transforming theobjectives of the ICPD Programme of Action into realityand in helping UNFPA identify priorities and respondto the needs of women and young people in developingcountries. Civil society also has invaluable insights into


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local conditions that can facilitate or hamper progress.UNFPA formed a new Civil Society Advisory Panel in2013 to actively engage civil society organizations and

networks and other partners in programming and poli-cies. The Panel, which met three times in 2013, advisesUNFPA on civil society’s concerns and priorities andhelps build partnerships with stakeholders, govern-ments and communities.

Through the Panel, UNFPA keeps civil society abreastof developments and issues associated with the work ofUNFPA and the implementation of the ICPD Programme

of Action. UNFPA also engages the Panel in dialogueabout the organization’s strategic priorities, advocacyapproach and external engagement.

UNFPA also engaged parliamentarians in the review ofcountries’ progress in implementing the ICPD Programmeof Action at regional and thematic conferences, meetingsand consultations carried out as part o the ICPD 20-yearreview. Other outreach in 2013 engaged parliamentarians

rom G-8 and G-20 countries in discussions about sexualand reproductive health and reproductive rights.

In August, UNFPA and the Asian Forum of Parliamen-tarians on Population and Development and theInternational Planned Parenthood Federation organizedthe Pacifc Sub-Regional Conerence o Parliamentariansfor Population and Development, in Fiji, with the aimo engaging elected ofcials in discussions about the

post-2015 sustainable development agenda.

UNFPA, in collaboration with regional parliamentary groups on population and development, organized the Sec-ond Global Young Parliamentarians’ Consultation on ICPDand the Post-2015 UN Development Agenda in Negombo,Sri Lanka, in October. The meeting provided a platformfor younger members of national legislatures to positionissues related to women and young people in the ICPD

beyond 2014 and post-2015 processes to ensure they are atthe heart of the new sustainable development framework.

At the Women Deliver conference, in Kuala Lumpur in2013, UNFPA led a Parliamentarians’ Forum, as well as

a High-Level Panel on Family Planning. At the confer-ence, government ministers pledged to ensure thatsexual and reproductive health is central to the post-2015 development agenda.

RESPONDING IN DISASTERS AND CRISESThe devastation from Typhoon Haiyan in the Philippinesin November aected more than 14 million people, kill-ing more than 6,000, displacing more than 4 million and

leaving an estimated 250,000 pregnant women with noaccess to maternal health and delivery services.

Mothers at a presentation in the Philippines after Typhoon Yolanda.


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UNFPA organized 58 mobile clinics that provided emergency maternity and obstetric care to serve women infve storm-battered areas where services were in greatest

need. UNFPA also supplied more than 12,000 “dignitykits” containing soap and other hygiene items to preg-nant women, supported the establishment of psycho-social services for displaced people, and strengthenedservices aimed at preventing gender-based violence orassisting survivors of it.

All o Tacloban’s 15 radio stations were knocked o theair when the storm hit the city. Within 72 hours, volun-

teers set up First Response Radio, which helped UNFPAinform pregnant women and new mothers about howto access emergency services in their area.

UNFPA also continued responding in 2013 to the needso women in Syria and in reugee communities in Egypt,Iraq, Jordan, Lebanon and Turkey. In Syria, UNFPA andpartners provided medical services and psychosocialsupport to 38,000 survivors o gender-based violence,

including sexual violence. In Jordan, 20 reproductivehealth clinics were set up to serve nearly 70,000 people.

In 2013, UNFPA implemented liesaving programmesin a total o 31 countries, including the Central AricanRepublic and South Sudan, affected by disasters andhumanitarian emergencies.

Improving maternaland newborn healthEnsuring universal access to sexual and reproductivehealth services requires that comprehensive, quality services, underpinned by strong health systems, are avail-able. In 2013, UNFPA supported 34 countries’ eorts toplan, develop, strengthen or expand access to emergency

obstetric care so that more mothers survive and deliverhealthy babies. UNFPA also assisted countries to revise

or update national protocols for providing this life-savingcare, and developed or improved curricula to train doc-tors, midwives, nurses and other health-care providers

and mainstream emergency obstetric and neonatal careinto pre-service training programmes.

Some countries have made dramatic progress inimproving maternal health. Experience rom coun-tries such as Egypt, Guatemala and Sri Lanka showsthat maternal mortality in developing countries can bereduced rapidly i adequate political and fnancial sup-port is in place and effective approaches employed.

UNFPA launched the Maternal Health Thematic Fundin 2008 to accelerate progress towards MillenniumDevelopment Goal 5 (to improve maternal health) in43 poor countries with high maternal mortality ratios.Between 2008 and 2013, donors contributed some$134 million to the Fund, which aims to build politicaland social commitment to maternal health, and assistcountry health systems to scale up provision of a full

spectrum of maternity care in the context of sexualand reproductive health services (including increas-ing access to emergency obstetric care, investing inhuman resources for health with midwifery skillsand empowering women to exercise their rights tosexual and reproductive health care). Achievementsin the frst fve years o the Fund include training or10,000 midwives who assist 1.75 million births annuallyand, since 2003, the surgical repair o obstetric fstulaor 34,000 women through the UNFPA-coordinatedCampaign to End Fistula.

A regional initiative by the World Bank and UNFPA in2013 will improve maternal and reproductive healthand address issues related to adolescent girls in theSahel. The World Bank’s $200 million Sahel Women’sEmpowerment and Demographics Project will improvethe availability and affordability of reproductive healthcommodities, strengthen specialized training centres


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for rural-based midwifery and nursing services,and share knowledge on adolescent girls’ initiatives.

O the World Bank’s new unding, $100 million has been committed to UNFPA, which will help to create the

preconditions for a demographic dividend by addressingfertility levels, population growth, gender equality andaccess to reproductive health commodities and services.The goal is to accelerate the region’s economic and socialdevelopment and strengthen the resilience of its people,communities and countries.

UNFPA, the International Federation of Gynecologyand Obstetrics, the United Kingdom’s Department for

International Development, the United States Cen-ters for Disease Control and Prevention and the WorldHealth Organization in 2013 jointly produced technical guidance for maternal death surveillance and response,or MDSR. Through MDSR, governments track incidentsof maternal death (during pregnancy, delivery and thepost-partum period) in real time to identify the cause,highlight critical gaps in service provision, and respondwith improvements and other actions that can help

prevent future deaths.

In addition, UNFPA helped strengthen midwiferyeducation: 1,000 midwiery tutors received training;175 midwiery schools received textbooks, clinical train-

ing models, equipment and supplies; and eight e-learningprogrammes were developed through a partnership withIntel, Jhpeigo and the World Health Organization.

Also in 2013, preliminary data show that 10,700 womenreceived treatment or obstetric fstula with UNFPAsupport, nearly a 20 per cent increase over 2012.

Increasing access to familyplanning and reproductivehealth suppliesThrough a family planning strategy, Choices Not Chance,launched in 2013, UNFPA outlined the rameworkthe organization will adopt to help countries achieveuniversal access to rights-based voluntary family plan-

ning. The strategy will guide UNFPA through 2020 in itsefforts to increase access to voluntary family planninginformation, services and supplies, to allow individualsand couples to choose whether, when and how manychildren they have.

The strategy sets out a framework for measurable results:

• Enabled environments or human rights-based amily

planning as an integral part of sexual and reproduc-tive health and reproductive rights;• Increased demand or amily planning according

to clients’ reproductive health intentions;• Improved availability and reliable supply o quality

contraceptives;• Improved availability o good quality, human

rights-based, family planning services; and• Strengthened inormation systems pertaining to

family planning.

Intake forms at a reproductive health centre in Sierra Leone.


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The Global Programme to Enhance Reproductive HealthCommodity Security, the largest trust fund managed byUNFPA, promotes access to a reliable supply of contra-

ceptives, condoms, medicine and equipment for familyplanning, maternal health services and prevention ofHIV and other sexually transmitted infections. Since itsinception in 2007, the Programme has mobilized about$565 million. A Steering Committee chaired by UNFPA’sExecutive Director and comprising key donors and part-ners was set up in 2013 to ensure oversight and guidancefor the Programme.

UNFPA continued to build on existing partnerships andorged new ones in 2013. UNFPA has remained engaged

at all organizational levels with the FP2020 platorm,which encourages partners to align their agendas, pooltheir talents and use existing structures in new and

complementary ways. In 2013, UNFPA and the Interna-tional Planned Parenthood Federation also launched aneffort to increase access to family planning by youth,including vulnerable adolescents, in sub-Saharan Africa.Other signifcant partnerships in place in 2013 includedthose with the Bill & Melinda Gates Foundation, John Snow, Inc., and the United Nations Commissionon Life-Saving Commodities for Women and Children.

Making HIV and STIservices more accessibleUNFPA helped develop HIV and Adolescents: Guidance forHIV Testing and Counselling and Care for Adolescents Living

with HIV , released by the World Health Organization inNovember 2013. These guidelines address legal consent

for accessing testing and counselling, good practices incommunity-based testing and counselling approaches,and care for adolescents living with HIV. Adolescents(10–19 years) and young people (20–24 years) are sociallyand economically vulnerable to HIV infection. This isparticularly true for adolescents—especially girls—wholive in settings with a generalized HIV epidemic or whoare members of key populations at higher risk for HIVacquisition or transmission through sexual activity and

injection drug use. As o 2012, there were an estimated2.1 million adolescents living with HIV, and about onein seven new HIV infections occurs during adolescence.Between 2005 and 2012, HIV-related deaths amongadolescents increased by 50 per cent, while the globalnumber o HIV-related deaths ell by 30 per cent. Theincrease in adolescent HIV-related deaths, according tothis new guidance, is primarily the result o insufcient

priority given to adolescents in national HIV plans,inadequate provision of accessible and acceptable HIV

PROGRAMME EXPENSESBY COUNTRY GROUP FOR 2013*

IN MILLIONS OF US$ BY PERCENTAGE

Group A

Group B

Group C

Other countries/territories†

Global and regional activities

Provisional figures as of 31 March 2014.

*About the country groupings

Group A: Countries and territories in mostneed of assistance to realize goals of the

International Conference on Population and

Development

Group B: Countries that have made consider-

able progress towards achieving goals of the

International Conference on Population and

Development

Group C: Countries and territories that have

demonstrated significant progress in achieving

the goals of the International Conference on

Population and Development

Other countries/territories: Countries or

territories that received technical assistance

or project support from UNFPA but receivedno regular resources from UNFPA

† Includes Global and Regional Programmes

0.3%

29.0%

4.4%

13.5%

52.8%

Fromnon-coreresources

Fromcoreresources

Totalexpenses

402.3

221.5

33.7

102.9

2.5

201.7 200.6

40.4 62.5

12.7 21.0

1.0 1.5

142.1 79.4


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testing and counselling and treatment services, and lackof support for adolescents to remain in care and adhereto antiretroviral therapy.

UNFPA’s Condomize! campaign to promote condomuse reached 2,500 university students in Malawi in2013. In Zambia, UNFPA trained 45 community serviceproviders in condom education. The campaign calls on governments, donors and users to intensify access to,and demand for, quality condoms as a primary defenceagainst HIV.

Male and female condoms remain the most effec-tive tool to stop HIV transmission. In 2013, UNFPAremained the largest supplier of female condoms,providing 20 million, and supplied an unprecedented1 billion male condoms.

In 2013, UNFPA, UNAIDS, the World Bank, the WorldHealth Organization and the Global Network of SexWork Projects published Implementing Comprehensive HIV/

STI Programmes with Sex Workers: Practical Approaches from Col-laborative Interventions. The publication provides practical guidance for health-service providers and cites evidence-informed and human rights-based programming toprotect the health o this population. Also in 2013,UNFPA supported the development and disseminationof Operational Guidelines for Monitoring and Evaluationof HIV Programmes for Sex Workers, Men Who Have Sex

with Men and Transgender People.

UNFPA and the United Nations Development Programme jointly led an Urban Health and Justice Initiative forkey populations in 2013. The Initiative has resultedin the development o plans in 12 countries that placemigration, mobility, urbanization and related serviceaccess at the heart of the HIV response.

Advocating gender equalityand reproductive rightsUNFPA and UN Women joined orces in 2013 to launcha our-year Joint Global Programme on Essential Servicesfor Women and Girls Subject to Violence, which aims toreach global consensus on standards and guidelines fordelivering quality essential services, as well as providingtechnical advice to implement them and building thecapacity of service providers to deliver them.

The new Programme will fll the gap between interna-tional commitments and country-level activities forresponding to gender-based violence, and will assistcountries in ulflling international obligations to provide quality essential services that are widely acces-sible to women and girls. It will tackle the “continuumof violence” and the key entry points to address it:health, police and justice, social support services,and governance.

UNFPA continued to raise global awareness on childmarriage through the Too Young to Wed photographyexhibit, which travelled to Canada, Denmark, Finland,Morocco, the Netherlands and Washington, D.C. in 2013.The exhibit drew attention to the needs and rights of girls subjected to child marriages, 39,000 o which occurevery day.

UNFPA and UNICEF continued in 2013 to support the Joint Programme for the Abandonment of FemaleGenital Mutilation/Cutting in 15 countries, where anestimated 12,357 communities have committed to aban-doning this practice.

UNFPA also developed technical guidance for its countryofces on issues o human rights and gender equality infamily planning and for applying human rights stan-

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Increasing young people’saccess to servicesUNFPA began rolling out its strategy on adolescents and youth in 2013. The strategy commits to working with young people to create a future in which adolescent girls and boys can enter adulthood educated, healthy,free from sexually transmitted infections, includingHIV, and are not exposed to violence, unintended preg-nancy or unsafe abortion.

In line with the strategy, UNFPA launched Action forAdolescent Girls, a fve-year partnership with govern-ments and civil society in 12 countries. The initiativewill support countries in Africa, Asia and Latin Americato jumpstart girl-centred programming and to protect girls’ human rights through targeted interventions thatdelay marriage, prevent unintended pregnancy, and buildup health, social and economic assets among the most vulnerable girls. More than 3,000 girls in Guatemala and

Niger enrolled in these programmes in 2013. In Guatemala,Mayan girls between the ages o 8 and 18 in 50 commu -nities are participating in Abriendo Oportunidades (OpeningOpportunities), a one-year programme that aims to help girls stay in school, prevent pregnancy and experience greater autonomy. In Niger, which has the highestrates of child marriage in the world, out-of-school girls between the ages o 10 and 19 are participating in an eight-month programme, Burkinatarey Bayrey/Ilimin Zaman Dunia.

The programme, operational in 40 communities acrossfour regions, provides girls with a health check-up (withan optional HPV vaccination for eligible girls), literacytraining, and a birth certifcate or national identity card.

UNFPA is intensifying efforts to increase young people’saccess to sexual and reproductive health. In Colombia,Myanmar and the Philippines, for example, UNFPAworks with governments to ensure health services meet

quality standards and that young people will feel

New perspectives onadolescent pregnancyMotherhood in childhood is a huge global problem,

especially in developing countries, where every year7.3 million girls under 18 give birth, according to UNFPA’s

The State of World Population 2013.

Of these 7.3 million births, 2 million are to girls 14 or

younger, who suffer the gravest long-term health and

social consequences from pregnancy, including high

rates of maternal death and obstetric fistula, according

to the report, entitled “Motherhood in Childhood: Facing

the challenge of adolescent pregnancy.”

The report placed particular emphasis on girls 14 andyounger who are at double the risk of maternal death

and obstetric fistula and offered a new perspective on

adolescent pregnancy, looking not only at the girls’

behaviour as a cause of early pregnancy, but also at the

actions of their families, communities and governments.

“Too often, society blames only the girl for getting

pregnant,” UNFPA Executive Director Dr. Babatunde

Osotimehin said at the launch of the report. “The reality

is that adolescent pregnancy is most often not the

result of a deliberate choice, but rather the absence

of choices, and of circumstances beyond a girl’s control.

It is a consequence of little or no access to school,

employment, quality information and health care.”

The report advocates a holistic approach to tackling

the challenge of adolescent pregnancy, which does

not dwell on changing the

behaviour of the girl, but rather

on changing the attitudes and

actions of the society she livesin. This includes keeping girls in

school, stopping child marriage,

changing attitudes about gender

roles and gender equality,

increasing adolescents’ access

to sexual and reproductive

health, including contraception,

and providing better support to

adolescent mothers.


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comfortable using them. UNFPA also developed opera-tional guidance on the design and implementation ofcomprehensive sexuality education programmes and is

working in 10 sub-Saharan Arican countries to improvecurricula for young people in and out of school.

UNFPA in 2013 produced Girlhood, Not Motherhood: Preventing Adolescent Pregnancy, a report by an expert advisory groupthat presents the best available evidence and latestthinking on strategies and interventions that empower girls and reduce their vulnerabilities.

UNFPA was involved in 2013 in the Global Education FirstInitiative. Led by the Secretary-General, the initiative brings together world leaders and advocates who aspire touse the transformative power of education to build a betteruture or all. UNFPA Executive Director Dr. BabatundeOsotimehin advocates the initiative’s three priorities: makeit possible for every child to be in school, improve the qual-ity of learning, and foster global citizenship. The initiativeaims to raise the political profle o education, strengthen

the global movement to achieve quality education, and gen-erate additional and sufcient unding through sustainedadvocacy efforts, all of which are essential for achievingprogress towards all the Millennium Development Goals.

Linking populationdynamics to policymakingUNFPA continued building countries’ capacities in 2013to incorporate population dynamics and sexual andreproductive health into development policies, plansand programmes. UNFPA equipped policymakers andplanners in an additional 10 countries with knowledgeand skills and supported their use of data and otherevidence in development programmes.

UNFPA published a global analysis of statistics onadolescents, young people and adolescent pregnancy.

The report, Adolescent Pregnancy: A Review of the Evidence,provided data cited in The State of World Population 2013.

UNFPA also ensured that population and developmentissues were taken into account in discussions and processesthat are leading to the development of sustainable develop-ment goals to succeed the Millennium Development Goalsater 2015. The Global Consultation on Population Dynamicsand the Post-2015 Development Agenda led by UNFPA inpartnership with United Nations Department on Economicand Social Affairs, UN Habitat, the International Organiza-tion for Migration and the Governments of Bangladesh and

Switzerland, resulted in an authoritative report, “Popu-lation Dynamics in the Post-2015 Development Agenda.”

In the lead-up to the October 2013 United NationsHigh-level Dialogue on International Migration andDevelopment, UNFPA, the International Organization forMigration and the Global Migration Group publishedInternational Migration and Development: Contributions and Recom-

mendations of the International System. The report illustrated

the work by contributors in support of migrants, theirfamilies and societies touched by migration, and drawspolicymakers’ attention to tools, guides and good practicesin the area of international migration and development.

Harnessing the power of dataIn 2013 with UNFPA support, 20 additional countries

completed their 2010 population and housing censuses,raising the total to 78.

UNFPA continued helping build capacities for produc-ing and disseminating data collected through censusesand other surveys. By 2013, UNFPA had supported71 countries in their production o in-depth analyses opopulation censuses and household surveys. In addition,UNFPA analyzed data on adolescents at risk of child

marriage and adolescent pregnancy in 2013.


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ArabStates

Deliveringsafely in unsafesurroundings

After a mortar killed her husband inthe Homs, Syria schoolyard where

he worked, Radia didn’t know

what to do. She was 22, pregnant

UNFPA SUPPORTED 13 ARAB STATES’efforts to engage young people in policy dialogu e

and programming in 2013.

© U N F P A / H . S

m e s e m


17/60

and had lost her only source of

support. Her dream of a happy

family had shattered.

She worried about how—or

where—she would deliver her baby.

Having lost her husband and now

displaced from her home, Radia had

no means to pay for a hospital

stay or even antenatal care.

Then one day, a mobile health

team supported by UNFPA

approached Radia and offered

her a reproductive health voucher,

which she could take to a local

clinic and receive free maternal

health and obstetric services.

“I was so worried about how I

would manage to give birth on my

own. Thanks to the voucher, I have

my beautiful baby girl to give me

new hope,” Radia says.

Through 23 mobile outreach teams

and a network of volunteers, UNFPA

has so far made reproductive health

vouchers available to about 110,000

women across Syria.

Health worker who assisted Radia’s delivery

holds Radia’s child at follow-up visit.


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16

CONTEXT AND CHALLENGESProtracted crises and fragile contextsadversely impacted development inmany parts of the Arab States regionin 2013. The security challenges acingsome countries and recent politicaland constitutional transitions havelimited the attention placed on arange of development issues, includingsexual and reproductive health andreproductive rights.

The region has also faced high unem-ployment rates among young people, theerosion of already-weak health systemsand contention in some countries overissues such as human rights, genderequality and women’s empowerment.Violence against women and girls hasescalated in countries facing humani-tarian crises; harmful practices suchas female genital mutilation/cuttingpersist in some areas. Together, thesechallenges have created an unfavorableenvironment for sexual and reproduc-

tive health and reproductive rightsin a number of countries.

a r a b s t a t e s


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17

O p p o s

i t e p a g e : © U N F P A / A r a l K a l k ; T h i s p a g e , t o

p : © U N F P A / A r a l K a l k ; B o t t o m : © U N F P A / F i t s u m T . H a b t e r m a r i a m

The conict in Syria and its eects on neighbouring

countries have led UNFPA to concentrate its interventions in the region on addressing humanitarianemergencies and their impact on reproductive andmaternal health, and on protecting women and girls from sexual violence, especially among refugees and displaced persons.

The region has not yet fully tapped the potential ofits large youth populations to respond to the crisesor to shape future development.

PROGRESSUNFPA, UNICEF and the World Health Organiza-tion jointly launched an eort in 2013 to supportpriority countries in accelerating progress towardsachieving Millennium Development Goal 4, toreduce child death rates, and Millennium Develop-ment Goal 5, to improve maternal health. UNFPA

also supported countries’ efforts to promote inclu-sion of maternal health in the Sustainable Devel-opment Goals that will succeed the MillenniumDevelopment Goals in 2015.

Expanding access to maternal and newborn healthis at the core of the UNFPA response to the con-ict in Syria and aected neighbouring countries.UNFPA has supported 80 health acilities, 32 mobile

teams and 28 static clinics inside Syria; established27 reproductive health clinics in Jordan and Iraq;and supported 72 health acilities in Lebanon, Iraqand Egypt. These initiatives together have resultedin provision of lifesaving maternal and reproduc-tive health services to about 2.6 million women and girls of reproductive age in Syria and neighbour-ing countries. The UNFPA Humanitarian Hub inAmman, Jordan, has been instrumental in coordi-

nating the organization’s work in the area.

Arab States > REGIONAL INDICATORS

48of every 1,000 females

between the ages

of 15 and 19 give birth

44%

of married women between the

ages of 15 and 49 use a modern

method of contraception

21%

of the population is between

the ages of 10 and 19

Average number of

children per woman

3.3

Gender parity index (1=parity)

The gender parity index, GPI, shows

inequalities in access to primary education. A

GPI of 1 indicates parity between girls and boys.

A GPI lower than 1 indicates girls have less

access than boys.

Primary

education

0.94

Secondary

education

0.91


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18

© U N F P A / I d r i s s Q a r q o u r i

UNFPA also supported improvements to systems for man-aging inventories and distribution of reproductive healthsupplies and equipment in Egypt, Morocco and Yemen.

In partnership with the League o Arab States, UNICEFand Dubai, UNFPA facilitated discussions involving young people that led to an agreement on their role inresponding to HIV/AIDS in the region. The discussionswere part of a larger regional effort to develop and rollout the Arab HIV/AIDS Strategy. The UNFPA-supportedY-PEER youth network reached more than 1.5 million young people in the Arab States in 2013 with theatre-

based programmes that provide information aboutsexual and reproductive health. Y-PEER also helpedraise awareness among refugees or displaced persons

in Iraq, Jordan, Lebanon,Sudan and Syria.

UNFPA in 2013 developed aregional strategy on gender- based violence prevention

and response or 2014–2017.UNFPA also supported theproduction of a documentaryabout boys’ and men’s rolesin stopping gender-based violence in Iraq, Jordan,Lebanon and Palestine.

UNFPA support for a

conerence in June 2013 toreview progress in imple-menting the Programme ofAction of the InternationalConference on Popula-tion and Development inthe Arab States includeda gathering of the ArabYouth Coalition, which

issued a Call for Action

to meet, respect and protect young people’s rights.The Call to Action covered issues of migration, par-ticipation, sexual and reproductive health, changingfamily formation, population, the environment andclimate change, and gender-based violence.

Also in 2013, UNFPA supported eorts to build capaci-

ties for generating population data and using the

IN 12 ARABSTATES IN2013, UNFPAsupported youth-led

organizations thatpromoted young

people’s participation

in policy dialogue and

programming.

WITH THESUPPORT FROMUNFPA, 7 ARABSTATES providedtraining to staff of

partner organizations

in prevention of

gender-based

violence in

humanitarian

settings.

a r a b s t a t e s


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19

7.3%

13.6%

6.2%

5.3%

16.3%

0.5% 3.3%

47.0%

0.5%

Arab States RegionAlgeria 505Djibouti 1,157

Egypt 2,343

Iraq 5,890

Jordan 4,204

Lebanon 2,881

Libya 699

Morocco 1,535

Oman 786

Palestine 3,545

Somalia 14,873

Sudan (the) 14,654

Syrian Arab Republic 8,167Tunisia 636

Yemen 9,425

Total country programmes 71,300

Regional projects in Arab States 5,789

Total programme expensesin Arab States Region 77,089


2013 PROGRAMME EXPENSES

IN THOUSANDS OF US$

(Includes core and non-core resources)

Population dynamics Maternal and newborn health

Family planning

HIV and STI preventionservices

Gender equality andreproductive rights

Young people’s SRH andsexuality education

Data availability and analysis

Programme coordination

and assistance

Other

FOCUS AREA AS A PERCENTAGE OF TOTAL

inormation to guide policymaking in Egypt, Jordan, Libya, Palestine,Qatar, Saudi Arabia, Somalia, Sudan and Yemen. UNFPA also supportedmigration surveys in the region, in collaboration with the League ofArab States, the United Nations Economic and Social Commission orWestern Asia, the European Union, the International Labour Organization,the International Organization for Migration, the United NationsHigh Commissioner for Refugees and the World Bank.

PROGRAMME EXPENSES

BY FOCUS AREA

IN MILLIONS OF US$


Fromcoreresources

Totalexpenses

1.0 4.6

26.2 10.0

0.9 1.6

0.2 0.2

7.8 4.8

1.6 2.5

7.9 2.6

- 4.8

0.4 -

5.6

12.6

2.5

10.5

36.2

4.1

0.4

4.8

0.4


22/60

Reproductive healthcare for the vulnerableEvelyn Capones, 18, was six months

pregnant with her second child

when Typhoon Haiyan blew through

Tacloban, the Philippines, with

destructive winds and a merciless tidal

surge that took her house. Three weeks

later, her family occupied a corner of a

dark school classroom shared with five

other storm-refugee families who had

nowhere else to go.

Asia andthe Pacific

UNFPA OFFICES IN 22 COUNTRIESof Asia and the Pacific had emergency-preparedness

and humanitarian response capacities.

© U N F P A / W i l l i a m A . R y a n


23/60

Her traumatic experience during thetyphoon, the loss of her home and

all her possessions, and the hardship

of displacement while caring for a

young daughter left Evelyn weak and

worried about her pregnancy.

Recognizing that displaced women

and girls have urgent reproductive

health needs, UNFPA sent teams of

doctors and midwives to care for

pregnant and lactating women across

Haiyan’s path of destruction. A

team came to Evelyn’s displacement

centre on 28 November.

After receiving a prenatal exam and

information on staying healthy, Evelyn

was relieved but still a bit anxious.

“I am happy the medical mission

came, because I learned that my

baby is fine,” she said. “I will take the

vitamins they gave me. But the doctor

advised me to eat fresh vegetables

and I can’t afford to buy them.”

Evelyn did not know where she

would go to give birth when the

time came. But she will have goodoptions, since UNFPA and partners

have provided equipment and other

support to re-establish safe delivery

services at dozens of facilities

damaged by Haiyan.

After two pregnancies in quick

succession, Evelyn was grateful to

learn for the first time about choices

for family planning, and said she

would start using a contraceptive

method after she has her baby.

Dr. Donna Monterd, a localpaediatrician on the UNFPA team,

was proud to be part of the first

post-Haiyan mission to specifically

target pregnant women and those

who recently gave birth. “This is

the most vulnerable population that

should be given utmost attention,”

she explained.

“These women are still fighting for

the lives of their families and children,”

the doctor added. “Despite what has

happened, they are resilient.”

22


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22

© U N

F P A V i e t N a m / D o a n B a o C h a u

a s i a a n d t h e p a c i fi c

CONTEXT AND CHALLENGESMuch o Asia and the Pacifc has seenremarkable economic growth, but ben-efts have not been distributed equitably;the world’s most populous and diverseregion has 900 million poor people and12 o the least developed countries.Severe inequality persists within the

majority of countries that have attainedmiddle-income status. Social and eco-nomic gains in a number of countriesare threatened by political instability.Declining development assistance posesadditional challenges.

Most countries have made good progresstowards universal access to sexual and

reproductive health, but have pro-nounced disparities. Poor women aremuch less likely than those better off

to receive antenatal care, skilled deliveryassistance or family planning services.

Women’s deaths during pregnancy andchildbirth have been reduced in mostcountries, but too slowly to achieve mater-nal mortality reduction targets by 2015.In South Asia, only half of all deliveries

are with a skilled birth attendant, con-tributing to high rates of maternal death,obstetric fstula and uterine prolapse.

An estimated 140 million women have anunmet need for family planning in Asia.Adolescents aged 15–19 have the high-est levels of unmet need among marriedwomen. Some 38 per cent o pregnancies

are unintended and 21 per cent end inabortion. Unsafe abortion accounts for8 per cent o all maternal deaths, and

UNFPASUPPORTED THEDEVELOPMENT of national plans

and policies to

end gender-based

violence in 17 Asian

and Pacific countriesin 2013.

14 COUNTRIES INASIA AND THEPACIFIC designed,implemented

or evaluated

comprehensive

sexuality educationprogrammes with

unfpa support in 2013.

23


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23

T o p : ©

C h i e n - C h i C h a n g / M a g n u m P h o t o s , L a o s ;

B o t t o m : © U N F P A / W i l l i a m A . R y a n

annually over 2 million women are hospitalizeddue to abortion-related complications.

There are almost two new HIV infections for everyperson receiving treatment. Infections are decliningin many countries, but increasing in Bangladesh,Indonesia, the Philippines and Sri Lanka. Newinections, 95 per cent o them among young people,are concentrated among sex workers, men havingsex with men, transgender people and people whoinject drugs. Yet HIV programmes for these popula-tions continue to be inadequate.

Most countries have youth policies, but imple-mentation has been low and youth participationlimited. Relatively few adolescents receive com-prehensive sexuality education. Child marriageand early childbearing are prevalent in fve SouthAsian countries.

Gender inequality and discriminatory norms con-tribute to high levels of violence against womenand girls. Son preference and prenatal sex selectionresult in skewed sex ratios at birth in China, Indiaand Viet Nam.

International migration and the population of olderpersons are growing at a pace and scale unmatchedin any other region.

Asia and the Pacifc is the world’s most disaster-proneregion, and pregnancy-related deaths and gender- based violence soar during humanitarian crises.

PROGRESSActions to improve maternal health in Asia and thePacifc in 2013 included support or urther devel-opment of midwifery policies, standards or curri-

cula in Afghanistan, China, Iran, Myanmar and

Asia and the Pacific > REGIONAL INDICATORS


between the ages


63%




18%



Average number of

children per woman

2.2



inequalities in access to primary education.

A GPI of 1 indicates parity between girls and

boys. A GPI lower than 1 indicates girls have

less access than boys.

Primary

education

0.99

Secondary

education

0.95

24


26/60

24

Sri Lanka, and supported midwifery training in Ban- gladesh, the Lao People’s Democratic Republic and Myan-mar. Support to the Association o South-East Asian Nations

contributed to the development of subregional guidelines forskilled birth attendance.

UNFPA supported efforts by Afghanistan, Bangladesh,Bhutan, Indonesia, the Democratic People’s Republic ofKorea, the Maldives, Myanmar, Nepal, Papua New Guineaand the Indian State of Orissa to strengthen managementof contraceptive supplies, and helped Nepal to provide

long-acting methods at 45

remote clinics. Several coun-tries also received UNFPAsupport to improve the qual-ity of family planning care.Myanmar was encouraged toincrease spending on contra-ceptives one hundred fold;and the Philippines becamesel-sufcient, procuring

enough modern contracep-

tives to ensure a constant supply. The Lao People’s Demo-cratic Republic, Mongolia and Timor-Leste also increasedfamily planning budgets.

UNFPA helped in integrating HIV and sexual and repro-ductive health for key affected populations in Cambodia,China, Myanmar and Mongolia in 2013, applying lessonsdocumented in The HIV and Sex Work Collection: InnovativeResponses in Asia and the Pacific, published jointly the previ-ous year by UNFPA, UNAIDS and the Asia-Pacifc Net-work of Sex Workers. To understand violence against sexworkers and how to prevent it, a multi-country study

was undertaken with partners in Indonesia, Myanmar,Nepal and Sri Lanka.

UNFPA with other agencies helped China draft anational anti-violence family law. It helped Indonesiadevelop a web-based mechanism for reporting violenceagainst women and national guidelines on prevent-ing gender-based violence. Partners for Prevention,a United Nations joint programme including UNFPA,

published the frst multi-country study on masculinity

Mothers and their babies receiving free reproductive health services in Tondo, Manila.

22 COUNTRIESOF ASIA ANDTHE PACIFIChad institutional

mechanisms in place

in 2013 to partner

with young people

in policy dialogue

and programming.

UNFPASUPPORTEDYOUNG PEOPLE’Sparticipation in

policy dialogue and

programming in

22 Asian and Pacific

countries in 2013.

UNFPASUPPORTED THECERTIFICATION of 544 reproductive

health personnel in

providing a minimum

initial service package

in Asia and the Pacificin 2013.

25


27/60

© U N

F P A P h i l i p p i n e s

and violence. Training sessionsallowed countries to share experi-ences in addressing gender-based

sex selection and gender-based violence in humanitarian settings.

UNFPA helped Mongolia to intro-duce comprehensive sexualityeducation in secondary schools,and Timor-Leste to pilot a sexualand reproductive health curricu-lum. In Indonesia it set up a model

social-franchising programme toprovide sexual and reproductivehealth services for unmarried young people. Bangladesh andIndia received support for develop-ing adolescent health strategies.

Also in 2013, UNFPA supporteda population survey in Cambodia

and contributed to a regional ini-tiative to strengthen civil registra-tion and vital statistics systems.

In Mongolia, UNFPA and two government ministries jointlypublished the frst comprehen-sive analysis of linkages betweenpopulation dynamics and the

country’s economic and socialdevelopment, including implica-tions of population trends on thelabour force, economic growth,poverty, social services and urban-ization. It indicates future trendsand includes clear policy recom-mendations.

Asia and the PacificAfghanistan 14,609

Bangladesh 11,030

Bhutan 1,285

Cambodia 5,002

China 4,194

Democratic People’s Republicof Korea (the) 610

India 9,241

Indonesia 5,887

Iran (Islamic Republic of) 1,527

Lao People’s Democratic Republic (the) 3,608

Malaysia 424

Maldives 598

Mongolia 4,784

Myanmar 16,854

Nepal 3,653

Pacific Island Countries1 6,833

Pakistan 7,506

Papua New Guinea 3,046

Philippines (the) 14,433

Sri Lanka 1,791

Thailand 1,905

Timor-Leste 2,088

Viet Nam 5,445


Regional projects in Asiaand the Pacific 7,390

Total programme expensesin Asia and the Pacific 133,743


1 Figures for Pacific Island Countries comprise several

islands which, for reporting purposes, are classified

under one heading, including the Cook Islands, Fiji,

Kiribati, the Marshall Islands, the Federated States of

Micronesia, Nauru, Niue, Palau, Samoa, the Solomon

Islands, Tokelau, Tonga, Tuvalu and Vanuatu.


IN THOUSANDS OF US$


PROGRAMME EXPENSES

BY FOCUS AREA

IN MILLIONS OF US$

9.6%

16.1%

8.7%

7.6%

11.2%

3.0% 10.0%

33.3%

0.5%

Population dynamics Maternal and newborn health

Family planning






and assistance

Other



Fromcoreresources

Totalexpenses

0.7 12.2

18.4 26.1

2.7 10.7

1.2 2.8

3.7 11.3

1.2 8.9

8.8 12.7- 11.6

0.5 0.2

12.9

15.0

13.4

21.5

44.5

10.1

4.0

11.6

0.7


28/60

A young mother in

Madagascar regainsher healthIn Madagascar, too many women

still die from complications related to

pregnancy and childbirth, or end up

severely disabled. The country has

reduced maternal mortality since 1990;

however, the ratio remains high at 440

per 100,000 live births. Every day, 10

women die from complications related

to pregnancy and childbirth.

East andSouthern Africa

IN 2013, WITH UNFPA SUPPORT, 5,891 women in East a nd Southern Africa underwent

surgery to repair obstetric fistula.

©

F r a n c i s R a h a m a n t s o a


29/60

Thousands of women and girls also

suffer from obstetric fistula, with an

estimated 2,000 women developing

a fistula each year in the country.

Sophia, 20, was forced by her

parents when she was 14 to marry

a boy who was 15, even though child

marriages are against the law in

Madagascar.

Two years into her marriage, Sophia

became pregnant, and during labourshe endured complications. “I had

to be evacuated by car to a city

five hours away from my village.

My delivery lasted for a week,” she

says. As a result of the obstructed

labour, Sophia’s baby was stillborn,

and to save her life, the surgeon had

to remove her uterus. Shortly after

the delivery, she discovered that she

was also suffering from an obstetric

fistula. When her husband learned

of the fistula, he abandoned her. She

returned to live with her parents.

Obstetric fistulas can result from

prolonged, obstructed deliveries inthe absence of skilled health care

providers and are more common

among very young mothers. Only

44 per cent of Malagasy women

receive assistance from a health

professional during childbirth, and

only 35 per cent of deliveries take

place in health facilities.

Weak infrastructure, referral systems

and equipment, and lack of qualified

staff, make access to health care

especially difficult in rural areas.

Sophia learned of a hospital inTuléar, a city in south-western

Madagascar, where she underwent

reconstructive surgery as part of

the Campaign to End Fistula, a joint

initiative between the Ministry of

Public Health and UNFPA.

“After the surgery, I was so happy.

My friends have come back to me,”

she says.

Since 2011, 247 women suffering

from obstetric fistula in Madagascar

received free reconstructive surgery

with support from UNFPA. The

surgeon who treated Sophia was oneof 14 who were trained to perform

the procedure through a programme

supported by UNFPA.

28


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© R o

b i n H a m m o n d / P a n o s P i c t u r e s

e a s t a n d s o u t h e r n a f r i c a

CONTEXT AND CHALLENGESThe population o East and Southern Arica is growing2.58 per cent a year, with the average woman having4.7 children.

As a result, the region’s population is increasingly young, with an estimated 160 million people betweenthe ages o 10 and 24, accounting or about one third othe region’s total population. If current trends continue,the youth population could reach 282 million by 2050.These young people will need access to education, healthcare, skills development and job opportunities.

The region continues to experience high rates of mater-nal death and illness. HIV/AIDS remains a major

contributor to maternal death and is the single larg-est source of life-years lost in the region, particularlyamong young people and people of reproductive age.

Violence against women and girls is widespread, par-ticularly in countries experiencing crises or conictsand where security is limited. At least 20 per cent oemales between the ages o 15 and 24 in seven countriesreported they had experienced sexual violence from anintimate partner. The rate of sexual violence increaseswith age as they enter into long-term relationships.

In the region, UNFPA is supporting human rights-basedsexual and reproductive health, including voluntaryfamily planning; empowerment of women and girls;

St. Joseph

Hospital’s

fistula clinic

in Kinshasa,

supportedby UNFPA.

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© U N F P A U g a n d a ; B o t t o m : © G a b r i e l B l a n c

o

the elimination of gender-based violence; andcapacity-building to respond to the sexual andreproductive health needs of vulnerable groupsin humanitarian situations. Through innovativeapproaches, UNFPA is also contributing to the adop-tion of healthy lifestyles by young people to betterenable them to realize their full potential.

PROGRESS

In support of the African Union’s efforts to con-tinue to advance the Campaign on AcceleratedReduction of Maternal Mortality in Africa, orCARMMA, UNFPA collaborated with partners,intensifed policy dialogue and advocacy or thecampaign at the global, regional, subregional andnational levels in 2013, and supported implementa-tion by countries in the region. As o 2013, 20 coun-tries in East and Southern Arica have launchednational campaigns.

In January 2013 in Addis Ababa, Ethiopia, UNFPAsupported the African Union’s CARMMA High-LevelEvent, which brought together 32 Heads o Stateand government, who called for expanded effortsto reduce maternal mortality in the region.

UNFPA partnered with the Pan-African Parliament

to tackle violence against women and girls through joint support or the 2013 Women ParliamentariansConference of the Pan-African Parliament. Theevent resulted in recommendations by womenparliamentarians about how the region coulddevelop and enforce legislation aimed at protect-ing women and girls.

UNFPA, UNESCO, UNAIDS and other United Nations

bilateral and civil society partners supported

East andSouthern Africa > REGIONAL INDICATORS


between the ages


31%

of married women between theages of 15 and 49 use a modern


23%



Average number of

children per woman

4.7







Primaryeducation

0.97

Secondaryeducation

0.88

30

a


32/60

e a s t a n d s o u t h e r n a f r i c a

governments’ efforts to expand access to comprehensivesexuality education in 2013. Also in 2013, UNFPA andUNESCO partnered with Advocates or Youth to increase

the capacity o 36 developers o comprehensive sexualityeducation curricula.

Eight countries in the region developed plans in 2013to integrate sexual and reproductive health services,including family planning, and HIV/AIDS services,including HIV testing and counselling. With fundingfrom the United Kingdom, UNFPA supported the scale-up of comprehensive condom programming in Lesotho,

Malawi, Uganda and Zambia in 2013.In December 2013, UNFPA provided reproductive healthsupplies to affected populations in the South Sudancrisis to reduce pregnancy-related complications anddeaths and gender-based violence. Supplies includedoxytocin, intravenous uids, antibiotics, clean deliverykits and rape treatment kits.

About 150,000 people were aected in 2013 by oods

in Gaza, Mozambique. UNFPA joined the government,other United Nations agencies and non-governmentalorganizations to reduce the impact, especially amongthe most vulnerable. The efforts focused on prevent-ing maternal death and illness by ensuring women inthe ood-aected areas had access to obstetric care and

skilled birth attendants.UNFPA also supported the government’s efforts toprotect women and girlsfrom violence.

© U N

F P A U g a n d a

UNFPASUPPORTED THECERTIFICATION of 579 reproductive

health personnel in

providing a minimum

initial service package

in East and Southern

Africa in 2013.

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East and Southern AfricaAngola 3,674Botswana 2,085

Burundi 4,074

Comoros (the) 1,131

Democratic Republic ofthe Congo (the) 12,864

Eritrea 2,374

Ethiopia 12,270

Kenya 5,417

Lesotho 2,734

Madagascar 6,297

Malawi 10,967

Mauritius 76

Mozambique 8,176Namibia 2,061

Rwanda 5,471

Seychelles 58

South Africa 2,841

South Sudan 14,635

Swaziland 2,748

Uganda 17,452

United Republic of Tanzania (the) 6,936

Zambia 4,849

Zimbabwe 19,579


Regional projects in Eastand Southern Africa 16,262

Total programme expensesin East and Southern Africa 165,031



IN THOUSANDS OF US$


PROGRAMME EXPENSES

BY FOCUS AREA

IN MILLIONS OF US$

7.1%

10.8%

7.8%

5.1%

11.8%

9.9%19.7%

29.3%

Population dynamics

Maternal and newborn health Family planning





Programme coordinationand assistance



Fromcoreresources

Totalexpenses

3.0 8.7

30.5 17.8

25.3 7.2

10.6 5.8

12.0 7.5

4.0 4.5

8.1 9.7

0.7 12.1

11.7

19.5

32.5

17.8

48.3

8.5

16.4

12.8


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Breaking the silence

on domestic violenceIa’s vibrant personality shines whenever

she smiles. She hasn’t, however, always

seemed as poised and self-confident

as she does now. When she entered a

Tbilisi-based shelter for the survivors of

domestic violence a few years ago, her

life was a shambles, and she seemed

“pale, frightened and disoriented,” one

of the shelter’s staff recalls.

Ia, 45, had spent 15 years in a marriage

with an abusive husband. She lived in

constant fear as her husband controlled,

EasternEurope and

Central Asia

14 COUNTRIES IN EASTERN EUROPE AND CENTRAL ASIAreceived unfpa support in 2013 to promote gender equality, advocate

women’s empowerment and uphold reproductive rights.


35/60

harassed and battered her daily.

“I had to ask for permission every

time I left the house,” she recalls.

“He beat me in front of my children,

he beat me in front of his parents.

I was suffering, but even worse, my

children were suffering too.”

Then came the day when she decided

she couldn’t take it anymore. That

was the day she saw a public service

announcement on television that

called domestic violence a crimeand provided a hotline number for

women seeking help. She dialed the

number as soon as it appeared on

her television. The next day she told

her story to a case worker and was

offered accommodation. She and her

children fled her home that same day.

The public service announcement

was part of a UNFPA-led awareness-

raising campaign. UNFPA and local

partner organizations also used

social media and put up billboards

in Georgia’s capital, Tbilisi, to tell

women about the services availableto them. In addition to the campaign,

UNFPA organized awareness-raising

sessions for more than 2,000

community leaders, teachers,

students and journalists.

Ia’s story is not unique, but her

determination and courage to speak

up and seek help are uncommon in a

country where 75 per cent of women

say they believe domestic violence is

a “private affair.” Only 2 per cent of

survivors reach out to police, lawyers

or other service providers when they

face violence at home.

Ia says picking up the phone and

calling the hotline was the best

decision she has made in her life.

At the government-run shelter, she

received physiological, medical and

legal assistance. Through services

provided by the shelter, her two

children were able to go to school,

do their homework and play without

fear. Her hope is that other women

who are suffering in silence will find

the strength, courage and support

to find their own way to speak out,

escape the violence and start over.

Detail from UNFPA’s domestic

violence awareness campaign poster.

34

s i a


36/60

© U N F P A / B e s f o r t K r y e z i u

e a s t e r n e u r o p e a n d c e n t r a l a s

CONTEXT AND CHALLENGESAs the countries o Eastern Europe and Central Asiaemerge from more than two decades of often painfulpolitical, social and economic transitions and upheaval,much remains to be done in the region to ensure universal access to sexual and reproductive health, makeprogress towards gender equality and respondto pressing population dynamics.

Facing the challenge of low fertility rates, ageing popu-lations, large-scale emigration and high male mortal-

ity rates, many countries in the region have yet todevelop effective policies focusing on investments inhuman capital, particular in the health and educationof young people.

Women in the region are having fewer children thanin the past, except for Turkey and Central Asian coun-tries, where fertility levels are higher and population growth continues. Throughout the region, access to or

use of sexual and reproductive health services, includ-ing family planning, is limited. About half of women

Roma in Albania

face difficulties

accessing

education,

jobs, health

services, andhousing with

unemployment

and illiteracy

rates four times

higher than

average.

35


37/60

T o p :

© U N F P A / B e s f o r t K r y e z i u ; B o t t o m : © U N F

P A U z b e k i s t a n / U l u g b e k H a k i m o v

in Eastern Europe and Central Asia use moderncontraceptive methods. In some countries of theregion, the rate of modern contraceptive use islower than 20 per cent. As a result, the numberof unintended pregnancies remains high amongwomen and adolescents. The region still has someof the highest abortion rates in the world, withan estimated 360,000 unsae abortions annuallyin Eastern Europe alone.

At the same time, HIV infection rates are still onthe rise in the region. Some 1.4 million people areliving with HIV, an increase o over 50 per centsince 2001. Young injecting drug users and sexworkers, as well as their clients and partners,are particularly vulnerable. High levels of cervicalcancer increase the burden of disease and result inthousands of preventable deaths among women.

The region has made signifcant progress in reduc-ing maternal death, although in some countries,mainly in Central Asia, and among marginalizedpopulation groups, such as the Roma, maternaldeath rates are still high.

Although governments have strengthened legalframeworks regarding gender equality, millionsof women still do not fully and equally participatein society, and gender-based violence and otherharmful practices persist. Prenatal sex selection, based on son preference and discrimination against girls, continues in some countries in the southernCaucasus and parts o southeastern Europe. Andthe persistence or revival of practices such as childmarriage and bride kidnappings still constitutesa grave threat to the lives and future prospects of

adolescent girls in parts of the region.

Eastern Europeand Central Asia > REGIONAL INDICATORS


between the ages


53%




13%



Average number of

children per woman

1.8







Primaryeducation

1.00

Secondaryeducation

0.99

36


38/60

© C r e d i t h e r e

PROGRESSUNFPA support contributed to a sharp reductionin maternal death in one of Kyrgyzstan’s regions bytraining health-care providers on effective perinatalservices with a focus on emergency obstetric and ante-natal interventions. Only one woman died giving birthin 2013 in this region.

After two workshops hosted by UNFPA in 2013, mostcountries in the regiondeveloped action plans tointroduce a “total marketapproach” to expand accessto modern contraceptivesand other reproductivehealth medicines and sup-plies. The approach relieson a partnership betweenthe public and private sec-tors to ensure these goods

are developed, procured anddistributed to individualsand clinics.

A resolution was adopted by Kazakhstan’s Women’sAairs Commission in 2013to ensure sex workers haveaccess to health and HIV

services. The resolutioncalled for better monitor-ing of, and action against, violence against sex work-ers, a marginalized groupseverely affected by HIVin the region.

In Belarus, UNFPA sup-

ported government efforts

to introduce specifc penalties or domestic violence andestablish better protection and services for survivors.UNFPA also supported the establishment of crisis roomsand shelters, trained health workers, police ofcers andteachers, and supported a toll-free hotline that receivedover 3,600 calls in 2013. In Albania, UNFPA trained3,200 primary health care providers in identiying andaddressing gender-based violence.

In Kyrgyzstan, UNFPA developed manuals for schoolteachers and peer educators on how to promote healthylifestyles among young people. In Uzbekistan, the UNFPA-supported peer education network, Y-PEER, reached30,000 young people with sessions on healthy liestyles.Drawing on fndings o a UNFPA-survey, Kazakhstan’sNational Youth Forum called for the age of consent forreceiving reproductive health services without parentalconsent to be lowered rom 18 to 16. In Turkmenistan, anew youth law was adopted, opening opportunities for youth-friendly sexual and reproductive health services.

UNFPA played a leading role in developing Georgia’sNational Youth Policy and Action Plan. The documents

GOVERNMENTOFFICIALS ANDrepresentatives

of civil societyin 10 countries

received unfpa

support in increasing

the capacities of

judic iaries, national

human rights

institutions, lawyers

and watchdog

organizations to

protect reproductive

rights in 2013.

IN 2013, UNFPABUILT THECAPACITY OFcommunity-led

organizations in

13 Eastern European

and Central Asian

countries to

reduce the risk of

both violence and

sexual transmitted

infections, including

hiv , among sex

workers.

Midwifery traning, Tajikistan.

37


39/60

© C

r e d i t h e r e

are examples of evidence-basedpolicy formulation, as they incor-porate results from a national youth survey and studies on earlymarriage and gender attitudes.

In Tajikistan, UNFPA supportedthe publication of census resultsand the development of a newdatabase for use by provincialstatistical ofces to inormpolicy formulation. In Bosniaand Herzegovina, UNFPA helpeddevelop and tap into new infor-mation technology to collectand analyze data on migration.In Moldova in 2013, UNFPA provided technical assistance foran upcoming census. 6.7%

9.8%

22.4%

11.0%

14.1%

6.3%

7.8%

19.5%

2.4%


IN THOUSANDS OF US$


PROGRAMME EXPENSES

BY FOCUS AREA

IN MILLIONS OF US$

Population dynamics

Maternal and newborn health

Family planning






and assistance Other


Eastern Europe

and Central AsiaAlbania 714

Armenia 598

Azerbaijan 743

Belarus 787

Bosnia and Herzegovina 663

Georgia 1,767

Kazakhstan 701

Kyrgyzstan 1,105

Republic of Moldova (the) 478

Russian Federation (the) 821

Serbia 899*

Tajikistan 1,417

The former Yugoslav Republicof Macedonia 259

Turkey 3,508

Turkmenistan 712

Ukraine 947

Uzbekistan 1,763


Regional projects in Eastern Europeand Central Asia 7,590

Total programmeexpenses in Eastern Europeand Central Asia 25,472


*Includes Kosovo.

T h i s

p a g e :

unfpa ar 2013 lr final

Documents