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The views expressed in this presentation are the views of the author and do not necessarily reflect the

views or policies of the


Asian Development Bank Institute (ADBI), the Asian Development Bank (ADB), its Board of Directors, or the governments
they represent. ADBI does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any
consequences of their use. Terminology used may not necessarily be consistent with ADB official terms.

Sexual and Reproductive Health & Rights


UNFPA Asia Pacific Regional Priorities
Sae-Ryo Kim, Regional Partnerships Advisor, United
Nations Population Fund (UNFPA)’s Seoul Office
Catherine Breen Kamkong, Sexual and Reproductive
Health Adviser, UNFPA’s Asia Pacific Regional Office
SRH as a fundamental Human Right
Promoting a rights-based approach to health

Access to equitable, affordable and good quality sexual and reproductive


health (SRH) services is a fundamental human right, which must be upheld
and promoted universally.

UNFPA works with national authorities, policy makers and civil society to
devise, implement and promote policies which address sexual and
reproductive health and rights (SRHR) – including family planning and
contraceptive choices - in an inclusive and equitable manner.

Only in this way we can ensure that no one is left behind in accessing and
benefiting from comprehensive SRHR.
Addressing multiple inequalities
Inequalities for adolescents and youth Inequalities in access to services
Adolescents and unmarried youth, particularly young women, often face Typically, the poorest, more marginalized groups in a population
barriers in accessing SRH services in spite of wealth status or place of have the least access to SRH services. These groups include
residence. These barriers can be legal, cultural or brought about by negative rural communities, ethnic minorities, urban poor,
societal perceptions towards SRHR. migrant workers and refugees.

Financial inequalities Inequalities in availability and quality of services


Out-of-pocket (OOP) expenditures for health still account for a Even when services are nominally available, reality might be different.
considerable part of Total Health Expenditures in many countries Stock outs of essential commodities such as contraceptives, lack of
of the Asia Pacific region, with catastrophic consequences for trained health professionals, legal bottlenecks can
poorer and vulnerable groups. greatly limit the availability of SRH services.
UNFPA Regional Priorities for Asia Pacific
Focus on high MMR countries Family Planning for All: promote unrestricted access
Focus on Inequalities: Access to Focus on women’s agency: informed
services and demand-side barriers and voluntary uptake of contraceptive choices
Increase domestic financing for SRH services Improve method mix & increase quality
Improve availability of data Zero Zero unmet Less unintended pregnancies & unsafe abortions
Focus on women-centered preventable need for Improve quality of care & counselling
quality services – Midwifery maternal family Increase domestic financing – address
Preventing unsafe abortion deaths planning inequalities, strengthen supply chain

Full integration of GBV prevention Zero GBV Reduced Positive approach to Adolescent Sexuality
and response and SRH services and harmful adolescent Promotion of positive and respectful
Health sector response to GBV included practices pregnancies relations (with a focus on consensual sex)
in pre- and in-service training of providers Address country-specific issues: high adolescent
CSE as prevention of GBV & harmful practices fertility in context of early unions; rise of teenage
Reduce Gender-biased Sex Selection pregnancies (or high abortions) outside marriage
without compromising access to legal, safe abortion Focus on removing legal barriers to FP for adolescents
Address GBV, including sexual violence, in Access to age-appropriate CSE from age 5 and
humanitarian settings promotion of youth friendly services
Prevent IPV in pregnancy – health sector response Focus on reducing Child Marriage
Zero
preventable The context of maternal health in Asia Pacific
maternal deaths Higher prevalence of modern contraceptives is associated to lower
Around 85,000 maternal deaths out of 301,000
occurred in Asia Pacific in 2015 incidence of maternal mortality around the world

7 Countries
in Asia
Pacific
account for
almost 90%
of maternal
deaths
(high MMR
priority
countries)

Source: UNFPA APRO Analysis of World Development Indicators data (WDI)


Zero
preventable
maternal deaths
UNFPA Priorities and interventions
Out of the 12 high-MMR priority countries in Asia
Pacific, only 4 of them are set to meet the Global SDG • Need to improve availability, quantity and
Target of 70 deaths per 100,000 live births if current quality of data to build evidence on
trends of reduction continue at the same pace. maternal health and promote better
tailored policies (e.g. MDSR Analysis);

• Focus on improving the quality and


coverage of comprehensive maternal
health services, in particular:
strengthening Midwifery, access to quality
Emergency Obstetric and newborn care to
address leading causes of death,
addressing inequalities in access to
services, advocating for access to safe
abortion services where legal and post
abortion care universally;

• Focus on increasing the domestic


allocation of financial resources for SRHR,
leveraging the increasing investments in
Projected number of years (from 2016) required to reach MMR Target of 70/100,000 universal health coverage in countries
around the region.
Source: UNFPA APRO Analysis of WDI data
Zero unmet The context of Family Planning in Asia Pacific
need for Family
Planning The S-Curve pattern of modern contraceptive
prevalence growth rates
Family Planning
services and
contraceptive
choices are still
restricted by law in
many countries of
the region. In some
countries they
might be nominally
available but
cultural and
societal perceptions
limit their actual
use and
accessibility -
particularly for
adolescents and
unmarried young
women.

Graph adapted from FP2020.org


Zero unmet
need for Family UNFPA Priorities and interventions
Average contraceptives prevalence rates in Asia Pacific
Planning among women (15-49) who are married or in union • Particularly in some countries, a wider
by wealth quintile and by place of residence. method mix and improved quality of
commodities need to be promoted; this will
reinforce women’s agency and reduce
unintended pregnancies. Counselling
services must also be promoted and their
quality improved;

• Focus on improving domestic financing of FP


for commodities (UNFPA Sustainability
Strategies and phasing out of UNFPA
Supplies support); inequalities need to be
addressed (e.g. reducing OOP for FP for
lower wealth quintiles; including FP into
health insurance policies and UHC);

• In 12 priority countries, Supply Chain


Management of FP commodities needs to be
strengthened, with a focus on reaching the
last mile and ensuring proper coverage and
availability of commodities.

Graphs adapted from UNFPA SWOP 2017.


Reduce adolescent
pregnancies The context of Adolescent sexuality and fertility in Asia Pacific
Adolescent Fertility rates 1995-2015 in selected countries of Asia Pacific • Promotion of respectful
relations amongst adolescents
In many 70
Philippines
and a positive approach to
countries of the adolescent sexuality must be
region
60 Thailand at the center of policy
adolescents
development in all countries
cannot access
Adolescent birth rate per 1000 women 15-19

Family Planning 50
of the Asia Pacific region.
Indonesia
services and
contraceptives • In some countries of the
40
due to Cambodia
region, the issues of
restrictions by adolescent fertility and
law (requiring 30
sexuality are interlinked with
consent of Viet Nam a high prevalence of child
parents or 20 marriages or early unions. In
guardians) or other countries an increase in
due to negative 10
Mongolia teenage pregnancies (or
attitudes and unsafe abortions) outside or
perceptions by prior to marriage can be
health workers 0
1995 - 2000 2000 - 2005 2005 - 2010 2010 - 2015
Malaysia
observed – which can
and broader subsequently lead to an
society.
United Nations, Department of Economic and Social Affairs, Population Division (2017)
increase in early marriages.
Reduce adolescent
pregnancies UNFPA Priorities and interventions
Adolescent birth rates in Asia Pacific (births per 1,000
women aged 15-19) by wealth quintile and by
• Focus must be on removing legal and other
place of residence.
barriers to accessing FP for adolescents
(married or unmarried).

• Youth-friendly services must be promoted and


counselling strengthened;

• Access to age-appropriate CSE is central to


ensure increased knowledge and information
on sexuality, reproductive health and FP;

• More research and data are needed to


understand patterns, drivers as well as impact
(both social and economic) of adolescent
pregnancies in high priority countries of the
region;

• The prevalence of child and forced marriages


in some countries of the AP region must be
addressed through continued advocacy and
engagement of communities.
Graphs adapted from UNFPA SWOP 2017.
Zero GBV
and harmful The context of GBV and harmful practices in Asia Pacific
practices

GBV and harmful practices


remain prevalent across
the region, with different
patterns identified in
particular groups of
countries (e.g. high
prevalence of GBV in the
Pacific sub-region, high
prevalence of child
marriages in South Asia,
gender-biased sex
selection).

As the AP region is
particularly prone to
natural disasters, the risk
of GBV during emergencies
and humanitarian crisis is
high and must be
addressed as a priority in
response activities.
Zero GBV
and harmful UNFPA Priorities and interventions
practices
• GBV prevention and response and SRHR interventions must
Gender-biased sex selection is still prevalent in countries be integrated. Health sector response to GBV, including
of the region, where the Sex Ratio at Birth (SBR) shows a through pre-service and in-service training of health
higher ration of male to female births. professionals needs to be strengthened; protocols and
guidelines for prevention and response to GBV need to be
116
Sex ratio at birth (SRB) in selected countries
developed in line with Essential Services Package for
women and girls subject to violence.
114
113.5 • Strengthen M&E of CSE in order to gather evidence on its
112
112.2 effect on prevention of GBV and harmful practices against
110 women and girls;
110
109.3
108
• In specific countries of the region, the focus must be on
106
107
107.4
reducing Gender-biased Sex Selection (GBSS) – while at the
105.3
same time ensuring that rights of women in terms of legal
104 access to safe abortion are not compromised;
102
• Strengthen multi-sectoral response to GBV, including
100 sexual violence, in humanitarian contexts through capacity
China South Korea Hong Kong India Singapore Taiwan Vietnam
strengthening of health professionals on clinical
management of rape, psychosocial first aid and referrals in
Source: UNFPA APRO Analysis
line with survivor-centred approach.