Presented by Nalini Singh of ARROW Reclaiming & Redefining Rights ICPD+20: Status of Sexual and Reproductive Health and Rights in Asia Pacific (2013) htp://www.arrow.org.my/publicaNons/ICPD+20/ICPD +20_ARROW_AP.pdf

2. RECLAIMING
&
REDEFINING
RIGHTS
ICPD
+
20
Status
of
Sexual
and
Reproduc2ve
Health
and
Rights
in
Asia
Pacific
Nalini
Singh
Programme
Manager
–
Advocacy
&
Capacity
Building
Email:
nalini@arrow.org.my

3. Content
of
the
presentaNon
• IntroducNon
to
ARROW
• IntroducNon
to
the
Global
South
monitoring
iniNaNve
• Overall
context
of
the
region
• Key
findings
pertaining
to
ReproducNve
Health
and
Rights
• Key
conclusions-­‐
ReproducNve
Health
and
Rights
• Key
Findings
pertaining
to
Sexual
Health
and
Rights
• Key
conclusions
–Sexual
Health
and
Rights
• RecommendaNons

4. 1.
About
ARROW:
• ARROW
is
a
regional
non-­‐profit
women’s
NGO
based
in
Kuala
Lumpur,
Malaysia.
We
work
to
advance
women’s
health,
affirmaNve
sexuality
and
rights,
and
empower
women
through
informaNon
and
knowledge,
engagement,
advocacy
and
mobilisaNon.
• Established in 1993, ARROW works with NGO partners in 15
Asia-Pacific countries (and expanding) and across the five
regions in the Global South.
• Areas of work:
ü Evidence generation through research and monitoring for
advocacy.
ü Advocacy, capacity building and movement building through
partnerships.
ü Strategic information sharing and communication.

5. Monitoring
the
InternaNonal
Conference
on
PopulaNon
and
Development
• Monitoring
government
commitments
to
women’s
health
especially
their
sexual
and
reproducNve
health
and
rights
using
the
framework
of
the
ICPD
Programme
of
AcNon
(PoA),
which
Nll
today
remains
the
most
comprehensive
outline
and
approach
to
women’s
health
and
equality,
has
been
an
important
strategy
at
ARROW.
• ARROW
along
with
our
partners
have
been
consistently
monitoring
the
ICPD
PoA.
(+5,
+10,
+15
and
+20
now-­‐
in
the
Global
South).

6. 2.
The
Global
South
ICPD+20
Monitoring
IniNaNve
• In
2014
and
2015
as
the
target
dates
for
the
ICPD
PoA
as
well
as
the
MDGs
reach
their
respecNve
Nme
bound
goals,
ARROW
realised
the
importance
of
bringing
together
not
only
the
voices
and
realiNes
of
Asia-­‐Pacific
,
but
also
the
other
regions
from
the
Global
South
to
arNculate
southern
voices
and
southern
agenda
in
the
lead
up
to
2014-­‐2015
development
agenda.
• Thus
the
Global
South
ICPD+20
monitoring
iniNaNve
was
conceptualised
and
brings
together
five
regions
(49
countries)
-­‐
– Asia
Pacific
– Africa
– Eastern
Europe
– LaNn
America
and
the
Caribbean
– Middle
East
and
Northern
Africa
regions

7. The
Global
South
ICPD+20
Monitoring
IniNaNve
• “RECLAIMING
&
REDEFINING
RIGHTS
ICPD
+
20:
Status
of
Sexual
and
ReproducNve
Health
and
Rights
in
Asia
Pacific”
is
one
of
the
five
Global
South
reports.
• The
scope
of
monitoring
includes
issues
of:
– reproducNve
health
– reproducNve
rights
– sexual
health
–
sexual
rights
– women’s
empowerment
– health
financing

8. The
Global
South
ICPD+20
Monitoring
IniNaNve
• Asia
Pacific
monitoring
in
21
countries
:
–
East
Asia-­‐
China
–
South
Asia-­‐
Afghanistan,
Bangladesh,
Bhutan,
Sri
Lanka,
Maldives,
Nepal,
Pakistan,
India
– Southeast
Asia-­‐Cambodia,
Myanmar,
Lao
PDR,
Malaysia,
Philippines,
Indonesia,
Thailand,
Vietnam
– Pacific
countries
of
Fiji,
KiribaN,
Papua
New
Guinea,
and
Samoa.
• In
the
next
slides
we
present
to
you
key
findings
pertaining
to
Afghanistan,
Bhutan,
Bangladesh,
India,
Nepal,
Maldives,
Pakistan
and
Sri
Lanka.

9. 3.
Overall
context
of
the
region

10.
i.
Signatories
to
major
human
rights
instruments
Name
of
the
Country
Interna2onal
Covenant
on
Civil
and
Poli2cal
Rights
(1966)
Interna2onal
Covenant
on
Economic,
Social
and
Cultural
Rights(1966)
Conven2on
on
Elimina2on
of
All
Forms
of
Discrimina2on
Against
Women
(1979)
Conven2on
on
the
Rights
of
the
Child
(1989)
Afghanistan
1983
1983
2003
1994
Bhutan
1981
1990
Bangladesh
2000
1998
1984
1990
India
1979
1979
1993
1992
Nepal
1991
1991
1991
1990
Maldives
2006
2006
1993
1991
Pakistan
2010
2008
1996
1990
Sri
Lanka
1980
1980
1981
1991

11.
ii.
Gender
Inequality
Index
Name
of
the
Country
Gender
Inequality
Index
(Rank
and
Value)
MMR
Adolescent
Fer2lity
Rate
%
of
women
in
na2onal
parliament
Afghanistan
147
(0.712)
460
99.6
27.6
Bhutan
92
(0.464)
180
44.9
13.9
Bangladesh
111(0.518)
240
68.2
19.7
India
132
(0.610)
200
74.7
10.9
Nepal
102
(0.485)
170
86.2
33.2
Maldives
64
(0.357)
60
10.2
6.5
Pakistan
123
(0.567)
260
28.1
21.1
Sri
Lanka
75
(0.402)
35
22.1
5.8
Source:
Human
Development
Report
2013-­‐
The
rise
of
the
South:
Human
Progress
in
a
Diverse
World

12. iii.
Health
Financing
Name
of
the
Country
Total
expenditure
on
health
as
percentage
of
GDP
General
Government
Expenditure
on
Health
as
Percentage
of
GDP
Out
of
Pocket
Expenditure
on
Health
as
percentage
of
Total
Health
Expenditure
Afghanistan
10.4
22.5
83.0
Bhutan
4.3
84.6
11.9
Bangladesh
3.7
36.5
63.4
India
3.7
28.2
61.1
Nepal
5.1
37.4
54.4
Maldives
6.2
60.8
28.2
Pakistan
2.8
28.2
50.4
Srilanka
3.5
45.6
44.9

13. 4.
Key
Findings
on
Reproduc2ve
Health
and
Rights
Indicators

14.
i.
Total
and
Wanted
FerNlity
Rates
Name
of
the
Country
Total
Fer2lity
Rate
Wanted
Fer2lity
Rate
Afghanistan
-­‐
-­‐
Bhutan
-­‐
-­‐
Bangladesh
2.3
1.6
India
2.7
1.9
Nepal
2.6
1.8
Maldives
2.5
2.2
Pakistan
4.1
3.1
Sri
Lanka
-­‐
-­‐
Source:
RespecNve
Country
latest
Demographic
and
Health
Surveys

15. ii.
ContracepNve
Prevalence
Rates
(CPR)
• CPR
for
the
countries
under
review
takes
only
married
women
into
account.
• Women’s
access
to
range
of
contracepNves
is
sNpulated
in
the
ICPD
PoA,
however
an
examinaNon
of
CPR
in
the
countries
under
review
shows
CPR
is
considerably
high
in
Sri
Lanka
(68%)
and
Bhutan
(65.6%),
while
it
is
very
low
in
Pakistan
(29.6%)
and
Afghanistan
(21.8%).
• Access
to
range
of
services
is
limited
to
few
opNons
eg:
– oral
contracepNve
pills
being
the
predominant
method
in
Bangladesh
– injectables
in
Afghanistan
– female
steralisaNon
in
India
leaving
fewer
contracepNve
opNons
for
women
to
choose
from

16. CPR-­‐
Male
ContracepNon
• Male
contracepNon
as
percentage
of
total
contracepNon
is
very
low
in
all
the
countries
under
review
indicaNng
the
extent
of
(UNEQUAL)
shared
reproducNve
burden.
• Condom
usage
and
male
steralisaNon
are
key
male
contracepNon
methods.
• Condom
usage
is
highest
in
Maldives
(26.8%)
and
Pakistan
(23%).
It
needs
to
be
noted
the
overall
CPR
in
these
countries
is
quite
low.
• Among
the
countries,
male
steralisaNon
is
highest
in
Bhutan
and
Nepal.
• Male
involvement,
as
equal
partners,
in
decision-­‐making
on
reproducNon
as
sNpulated
in
the
ICPD
PoA
seems
to
have
had
limited
headway

17.
iii.
Unmet
Need
for
ContracepNon
Name
of
the
Country
Spacing
Limi2ng
Unmet
need
Afghanistan
-­‐
-­‐
-­‐
Bhutan
-­‐
-­‐
-­‐
Bangladesh
(2011)
4.4
7.3
11.7
India(2005-­‐06)
6.1
7.8
13.9
Nepal
(2011)
9.6
17.4
27
Maldives(2009)
15.0
13.6
28.6
Pakistan
(2007)
10.8
14.1
25.2
Sri
Lanka
(2007)
3.5
3.8
7.3
Source:
RespecNve
Country
latest
Demographic
and
Health
Surveys

18. iv.
Pregnancy
&
Childbirth
Related
Mortality
&
Morbidity
Name
of
the
Country
MMR
in
2010
Life2me
risk
of
maternal
death:
1
in
ICPD
Target
met?
Afghanistan
460
32
No
Bhutan
180
210
No
Bangladesh
240
170
No
India
200
170
No
Nepal
170
190
No
Maldives
60
870
Yes
Pakistan
260
110
No
Sri
Lanka
35
1200
Yes
World
Health
OrganizaNon.
(2012).
Trends
in
Maternal
Mortality:
1990
to
2010.
WHO,
UNICEF,
UNFPA
and
the
World
Bank
esNmates

19. Pregnancy
&
Childbirth
Related
Mortality
&
Morbidity
• Despite
progress
in
the
reducNon
in
maternal
deaths,
many
countries
such
as
India,
Pakistan,
Bangladesh,
Afghanistan
conNnue
have
high
maternal
deaths.
• The
causes
of
maternal
deaths
in
the
region
is
mostly:
–
Haemorrhage
(35%)
– Hypertension(17%)
– AborNon
(10%)

20.
IntervenNons
to
prevent
maternal
deaths-­‐
EmOC
and…
Name
of
the
Country
Skilled
a_endance
at
birth
ICPD
target
is
90%
by
end
of
2010
Post
partum
care
(post
natal
visit
within
2
days
of
childbirth)
Antenatal
Care
(4
visits)
Afghanistan
34%
23%
16%
Bhutan
64.5%
-­‐
77%
Bangladesh
26.5%
23%
23%
India
52.7%
(2007)
48%
50%
Nepal
36%
31%
29%
Maldives
94.8%
(2009)
67%
85%
Pakistan
38.8
(2006)
39%
28%
Srilanka
98.6%
(2006)
71%
93%

21. v.
Adolescent
Birth
Rates
Name
of
the
Country
Adolescent
Birth
Rates
Afghanistan
90.0
Bhutan
59.0
Bangladesh
133.4
India
38.5
Nepal
81.0
Maldives
15
Pakistan
16.1
Sri
Lanka
24.3
Source:
Latest
UN
staNsNcs,
Millenium
Development
Goals
Indicators
,
the
official
UN
site
for
MDG
indicators
Adolescent
Birth
Rate

22. vi.
Status
of
AborNon
Laws
in
the
countries
under
review
Name
of
the
Country
To
save
woman’s
life
Preserve
physical
health
Preserve
mental
health
Rape
or
incest
Foetal
Impairment
Economic
and
social
reasons
On
request
Afghanistan
x
-­‐
-­‐
-­‐
-­‐
-­‐
-­‐
Bhutan
x
x
x
x
-­‐
-­‐
-­‐
Bangladesh
x
-­‐
-­‐
-­‐
-­‐
-­‐
-­‐
India
x
x
x
x
x
x
-­‐
Nepal
x
x
x
x
x
x
x
Maldives
x
x
-­‐
-­‐
-­‐
-­‐
-­‐
Pakistan
x
x
x
-­‐
-­‐
-­‐
-­‐
Srilanka
x
-­‐
-­‐
-­‐
-­‐
-­‐
-­‐
Source:
World
AborNon
Policies
2012

23. AborNon
• Different
extremes
with
regards
to
women’s
access
to
safe
aborNon
services
–Nepal
has
legalised
aborNon
while
Afghanistan
and
Sri
Lanka
are
most
restricNve.
• Unplanned
and
unwanted
pregnancies
lead
to
unsafe
aborNons
which
are
either
self-­‐
induced,
or
induced
by
untrained
pracNNoners,
leading
to
complicaNons
that
can
lead
to
maternal
deaths.

24. AborNon
• In
Bangladesh,
although
‘aborNon’
is
only
available
to
save
the
life
of
the
woman,
in
the
mid-­‐70s,
the
government
slowly
started
introducing
menstrual
regulaNon
(MR)
services
as
an
opNon
for
early
terminaNon
of
pregnancy.
During
the
last
20
years,
menstrual
regulaNon
services
have
been
extended
throughout
Bangladesh
and
the
government
has
trained
over
10,000
physicians
and
other
health
care
providers,
primarily
family
welfare
visitors,
to
provide
menstrual
regulaNon
services.

25. AborNon
• Women
also
face
policy
barriers
such
as
mandatory
spousal
authorisaNon
for
aborNon
services
in
Maldives.
• In
Pakistan,
although
the
law
allows
aborNon
on
a
number
of
grounds,
it
is
usually
perceived
as
illegal.
• In
2002,
India
adopted
legislaNon
aimed
at
improving
access
to
safe
aborNon
faciliNes
by
moving
authoriNes
to
approve
faciliNes
from
the
state
level
to
the
district
level.
The
law,
which
is
intended
to
simplify
the
approval
process
for
new
faciliNes,
also
increases
criminal
penalNes
for
providers
and
facility
owners
who
operate
without
approval

26. vii.
ReproducNve
Cancers
• Most
of
the
countries
under
review
in
the
ARROW
ICPD+20
monitoring,
are
countries
in
low
resource
serngs.
• Early
screening
for
cancers
can
go
a
long
way
in
reducing
the
incidence
and
mortality
from
cervical
and
breast
cancers
• Health
systems
in
respecNve
countries
in
the
region
have
to
be
geared
to
put
in
place
effecNve
prevenNon
strategies,
early
detecNon,
which
comprises
of
diagnosis,
screening
including
cervical
cancer
screening,
HPV
tesNng,
mammography
screening,
treatment
and
palliaNve
care.
• Therefore,
populaNon-­‐based
data
on
cancer
incidence
and
mortality
become
the
starNng
point
for
any
intervenNon
and
countries
need
to
start
collecNng
this
informaNon.

27. 6.
Key
Conclusions
-­‐ReproducNve
Health
and
Rights
in
the
Region
• Progress
across
the
region
is
uneven
and
slow
with
regards
to
reproducNve
health
and
reproducNve
rights
indicators
with
no
one
country
having
made
progress
in
every
single
indicator
of
RH
and
RR.
• PoliNcal
will
of
governments
is
crucial
in
making
laws,
allocaNng
resources,
and
deploying
trained
staff
• Access
for
marginalised
groups
is
a
concern
across
all
countries,
with
women
who
are
poor,
less
educated,
live
in
remote
areas
and/or
rural
areas
and
hard
to
reach
areas
facing
greater
difficulNes
in
accessing
services
and
realising
the
autonomy
of
their
bodies

28. 7.
Key
Findings
on
Sexual
Health
and
Rights
Indicators

29. i.
Sexual
rights
of
adolescents
to
highest
atainable
standard
of
health
in
relaNon
to
sexuality
•
Progress
on
imparNng
sex
educaNon
and
sexuality
educaNon
to
adolescents
is
staggered
and
uneven.
• In
all
countries,
unmarried
young
people
sNll
face
many
barriers,
some
legal
and
some
socially
discriminatory,
to
accessing
SRH
services.
• It
is
clear
from
the
lack
of
provision
of
educaNon,
informaNon,
and
services
to
young
people
who
are
in
dire
need
of
these,
that
governments
in
the
region
are
hesitant
to
recognise
the
role
of
sexuality
beyond
its
funcNon
in
reproducNon.

30. ii.
Sexually
Transmited
InfecNons
• The
prevenNon
and
treatment
of
STI
in
the
countries
under
review
have
largely
been
driven
by
the
HIV
intervenNon
efforts.
• HIV
intervenNon
focuses
on
high-­‐risk
behaviour
groups.
As
a
result,
the
larger
populaNon,
who
are
at
risk
of
STI
but
do
not
fall
under
the
high
risk
categories,
are
not
prioriNsed
for
prevenNon
and
treatment
programmes

31. iii.
HIV
AND
AIDS
• The
epidemic
in
the
region
is
largely
concentrated
among
higher
risk
groups
such
as
men
who
have
sex
with
men,
sex
workers
and
injectable
drug
users.
• Few
governments
in
the
region
have
addressed
sNgma
and
discriminaNon
through
laws,
policies
and
programme.
SNgma,
especially
for
the
vulnerable
populaNons,
hinders
access
to
HIV
treatment
and
care.

32. HIV
AND
AIDS
• Coverage
of
ART
remains
a
challenge
in
many
countries
in
the
region.
• In
designing
future
programmes
on
HIV
and
AIDS
it
is
imperaNve
to
note
that
not
all
sex
is
heterosexual
and
vaginal.
•
Gender
analysis
also
needs
to
take
into
account
the
role
of
sexuality
and
diversity
as
well
as
meanings
of
and
within
sexual
relaNons.

33. iv.
Legal
Age
and
Median
Age
at
Marriage
Name
of
the
Country
Women
Men
Median
age
at
marriage
for
women
Remarks
Afghanistan
16
18
17.7
Bhutan
18
18
Bangladesh
18
21
15
India
18
21
17.4
Nepal
20
20
17
Maldives
18
18
19.0
Government
policy
strictly
discourages
marriages
under
16
Pakistan
16
18
19.1
Sri
Lanka
18
18
22.4
Does
not
apply
to
Muslim
PopulaNon

34. v.
Marriages:
Arranged
and
Forced
• In
Bhutan,Maldives,
Nepal
and
Sri
Lanka
–
the
legal
age
of
marriage
is
the
same
for
both
men
and
women.
In
other
countries,
the
legal
age
of
marriage
of
women
tends
to
be
lower
than
that
of
men.
• Afghanistan,
and
Pakistan
in
the
region
have
a
legal
age
of
marriage
under
18.
• Arranged
and
forced
marriages
are
both
quite
common
and
deeply
embedded
in
the
cultures
and
tradiNons
of
South
Asia.
•
Afghanistan
Independent
Human
Rights
Commission
esNmates
that
over
38%
of
women
have
been
vicNms
of
forced
marriage

35. vi.
Sexual
Violence
Against
Women
• Rape:
Out
of
the
countries
examined
here,
with
the
excepNon
of
Maldives,
all
countries
have
laws
against
rape
and
these
usually
exist
within
the
penal
code
or
the
criminal
code.
However,
any
barriers
remain
prevenNng
jusNce
for
vicNm-­‐
survivors
of
rape.
• Marital
rape:
Marital
rape
is
a
contested
issue
in
almost
all
the
countries
in
the
region.
In
India
marital
rape
legislaNon
is
part
of
the
overall
domesNc
violence
laws,
however
counteracNng
laws
exist
that
counter
marital
rape.

36. Sexual
Violence
Against
Women
• Sexual
Harassment:
Provisions
for
anN-­‐sexual
harassment
in
the
workplace
exist
in
Afghanistan,
Bangladesh,
Bhutan,
Maldives,
Nepal,
and
Sri
Lanka,
and
these
provisions
are
part
of
the
labour
law
in
Bangladesh,
and
Pakistan.
• Trafficking:
Trafficking
laws
seem
to
be
in
place
in
most
countries
seem
to
be
in
place,
the
implementaNon
and
enforcement
of
such
laws
is
quesNonable
in
the
region

37. vii.
Trafficking
• Afghanistan
is
a
source,
transit,
and
desNnaNon
country
for
men,
women,
and
children
subjected
to
forced
labour
and
sex
trafficking.
According
to
the
Ministry
of
the
Interior,
trafficking
within
Afghanistan
is
more
prevalent
than
transnaNonal
trafficking.
• In
India,
evidence
shows
that
trafficking
of
girls
and
young
women
for
sexual
exploitaNon
and
other
abusive
purposes
is
rampant.
According
to
the
2006
CEDAW
Shadow
Report,
intra-­‐country
trafficking
is
very
high,
and
it
was
also
noted
that
94%
of
trafficked
women
are
from
rural
India
and
from
the
lower
socioeconomic
levels.

38. viii.
Sex
work
• All
21
countries
in
Asia
Pacific
under
review
criminalise
sex
work
or
certain
acNviNes
related
to
sex
work.
• All
forms
of
sex
work
including
sex
work
in
private,
soliciNng
sex
and
brothel
keeping
are
illegal
in
Afghanistan,
Bhutan,
Maldives,
and
Pakistan
in
South
Asia.
• CriminalisaNon
of
sex
work
or
of
some
forms
of
sex
work
legiNmises
violence
and
discriminaNon.
Incidents
of
sexual
assaults
by
police
and
military
personnel
against
sex
workers
has
been
reported
in
Bangladesh,
India,Nepal,
and
Sri
Lanka.

39. ix.
Status
of
diverse
sexual
and
gender
idenNNes
• In
most
of
the
countries
in
the
region,
the
laws
are
silent
on
same-­‐sex
sexual
preference,
and
hence,
it
is
not
criminalised.
• Among
the
countries
monitored,
same-­‐sex
sexual
relaNons
(both
male
to
male
and
female
to
female)
is
illegal
in
Afghanistan,
Bhutan,
Maldives
and
Sri
Lanka.
Female
to
female
relaNons
are
not
illegal
in
Bangladesh,
India,
Pakistan.
Same-­‐sex
sexual
relaNons
are
not
illegal
in
Nepal.

40. x.
Transgenderism
• Nepal
seems
to
be
the
most
progressive
country
in
the
region,
having
decriminalised
laws
which
control
sexuality
and
having
recognised
sexual
minoriNes
as
ciNzens
with
equal
rights
regardless
of
sexual
orientaNon
and
gender
idenNty.
• Transgendered
people
are
now
able,
through
a
Supreme
Court
ruling
to
amend
the
ConsNtuNon,
to
obtain
ciNzenship
with
the
idenNty
of
the
third
gender.
A
government
commitee
had
also
been
set
up
to
review
the
marriage
system
to
amend
it
accordingly
with
this
new
ruling.

41. 9.
Key
Conclusions-­‐
Sexual
Health
&
Rights
• Sexual
health
is
sNll
being
framed
in
limited
paradigms
across
the
region.
• PoliNcal
will
of
governments
is
crucial
in
recognising
the
sexual
health
and
sexual
rights
of
ciNzens
• Sexual
rights
are
not
as
contenNous
as
perceived
with
many
aspects
of
sexual
rights
have
been
accepted
and
legislated
by
the
governments.

42. 10.
Key
recommendaNons
• There
is
need
for
policy
change
underpinned
by
commitment
to
the
ICPD
POA,
with
respect
to
reproducNve
rights
and
sexual
rights.
• Ensure
universal
access
to
comprehensive,
affordable,
quality,
gender-­‐sensiNve
services
to
enable
the
realisaNon
of
the
highest
standard
of
sexual
and
reproducNve
health.
• Ensure
conNnued,
commited
and
sustained
investments
in
women’s
SRHR
by
governments
and
donors.
• Ensure
SRHR
of
all
are
fully
realised
and
exercised,
especially
those
of
young
people
and
adolescents
,
those
with
diverse
sexual
orientaNon
and
marginalised
groups

43. Reference:
RECLAIMING
&
REDEFINING
RIGHTS
ICPD
+
20:
Status
of
Sexual
and
ReproducNve
Health
and
Rights
in
Asia
Pacific
(2013)
htp://www.arrow.org.my/publicaNons/ICPD+20/ICPD
+20_ARROW_AP.pdf

44. Thank You