Unfpa inputs in connection with the Human Rights Council Resolution 19/37, requesting a report from ohchr on the right of the child to the highest attainable standard of health unfpa framework for the Child’s Right to the Highest Attainable Standard of

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UNFPA inputs in connection with the Human Rights Council Resolution 19/37, requesting a
report from OHCHR on the right of the child to the highest attainable standard of health

UNFPA Framework for the Child’s Right to the Highest Attainable Standard of Health

Advancing child health to the highest attainable standard is featured on the agenda leading up to 2014 for the 20th anniversary of the International Conference on Population and Development (ICPD+20) and is consistent with the ICPD Programme of Action 1994 (ICPD-PoA) to “ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect” and which called on leaders to act forcefully against patterns of discrimination within the family and “to eliminate excess mortality of girls, where such a pattern existed.”1

Four overarching principles guide the UNFPA framework for action on adolescent and youth health:

- achieving social equity by paying special attention to vulnerable groups;

- protecting the rights of young people, particularly to health, education and civic participation;
- maintaining cultural sensitivity by advocating for sexual and reproductive health (SRH) insensitive and engaging ways; and
- affirming a gender perspective that, while recognizing boys’ needs, preserves spaces for girls, especially the poor and vulnerable. 2

UNFPA is committed to work with governments and civil society to focus on adolescents and youth, ensuring their inclusion in policies and programmes and avoiding their marginalization generally and in humanitarian emergencies caused by natural disasters or conflict. 3

This submission outlines UNFPA priority areas for advancing child and adolescent health, including: maternal health including early childbirth complications such as obstetric fistula, child marriage, female genital mutilation/cutting (FGM/C), HIV/ AIDS, gender based violence and comprehensive sexuality education - in reply to the Human Rights Council Resolution 19/37 question about the main health challenges/barriers related to children’s right to health, and asking for examples of good practices undertaken to protect and promote children's right to health, particularly in relation to children and adolescents in especially difficult circumstances.

  1. Main health challenges or barriers related to children’s right to health

Preventable maternal, infant and child morbidity and mortality
Pregnancy and childbearing at an early age are associated with higher risks of morbidity and mortality. Preventing early marriages and avoiding high-risk childbearing among children and adolescents are two key objectives of ICPD- PoA. In developing countries, 90 per cent of births to adolescents aged 15-19 are to married girls, and pregnancy-related complications are the leading cause of death for adolescent girls. The Secretary-General’s report to the 45th session of the Commission on Population and Development in April 2012 noted that the adolescent birth rate (the number of births per 1,000 women aged 15 to 19) dropped from 71 in 1990 to 56 in 2008, but progress has been uneven. In Africa, the adolescent birth rate was 101, almost double the global average. The African continent is not only recording the highest adolescent birth rate, it is also reporting the smallest gain in reducing adolescent pregnancies since 1990. 4
Child Marriage

Of girls married before age eighteen, one third were married by their fifteenth birthday. In the least developed countries, the rate of child marriage (CM) is around 47 percent. 5 The ICPD PoA recommended key actions to eradicate child marriage.6 When it comes to poverty as a predictor for child marriage, over half (51.3 percent) of the young women from the poorest 20 percent of the households in Africa married before age 18, compared to only one-fifth among the richest 20 percent. Lastly, the proportion of girls married by 18 is nearly twice as high in rural (44.2 percent) than in urban areas (22.5 percent).7

In most countries, the majority of adolescent girls’ sexual activity takes place within marriage. It is not a coincidence that the highest adolescent birth rates are found where child marriage rates are high, including much of West, Central and East Africa, as well as South Asia. 8 The number of married girls is also significant. Worldwide, more than 51 million adolescent girls are married and in the next decade 100 million more will be married by their eighteenth birthday, should present trends continue. 9 This is despite the fact that child marriage is a violation of the Convention on the Rights of the Child, and despite the fact that child marriage is against the law in many countries. Additionally, child marriage places adolescent girls at major health risks. Child brides typically have higher levels of unprotected sexual relations (often forced or coerced) and intense pressure to become pregnant. They are typically married to older, more sexually-experienced spouses, putting them at risk of HIV infection and other STIs as well. With little access to quality, health care services, information and support, they become mothers, often giving birth without a skilled attendant.
About one-half of girls worldwide who are affected by child marriage live in South Asia. Though there has been an increase in the average age of marriage in the region, several countries still have high levels of marriage of girls aged under 18 (with Bangladesh, Nepal, India, and Afghanistan at levels of 43-66%). Many such marriages are unregistered and unofficial, and are hence not a part of national data systems. Despite the existence of generally favorable laws regarding legal age at marriage10, these are poorly enforced in the identified countries. Adolescent fertility is relatively high and every year, approximately 6 million adolescent girls in Asia Pacific become mothers, the majority of these (4.5 million) in South Asia, with maternal mortality being the leading cause of death in girls 15-19 in South Asia. Married adolescent girls age 15-19 have the highest levels of unmet need for contraception amongst married women, yet this is not being addressed in family planning programmes in the region due to prevailing socio- cultural norms and gender inequality amongst other factors. 11

Female Genital Mutilation and Cutting
Female Genital Mutilation and Cutting (FGM/C) affects over 100 million women and girls worldwide and about three million girls are at risk of being cut annually. This deeply entrenched harmful practice is predicated on long-held perceptions of how the practice is needed to fulfill religious and cultural obligations, family honour and the preservation of virginity as a prerequisite for marriage.12

Obstetric Fistula

Failure to address preventable maternal morbidity results in a high number of girls and young women who survive childbirth but suffer chronic disabilities, the most devastating of which is obstetric fistula.

Each year, nearly 70,000 adolescents die as a result of pregnancy complications. At least 2 million more are left with chronic illness or disabilities that may bring them life-long suffering, shame, and abandonment.
Violence against Children and Gender Based Violence

Violence against children is often masked by a culture of silence. It knows no social, economic or national borders. All countries are affected by it. Gender Based Violence (GBV) against women and girls is one of the most pervasive, yet least reported human rights abuse in the world. It undermines development, generates instability and makes peace harder to achieve. GBV against adolescent women and girls takes many forms: rape, domestic violence, sex trafficking, crimes in the name of honour, sexual assault and abuse and traditional practices like female genital mutilation/cutting and dowry. Even when these harmful practices are not directed to boys, their mental and behavioural health can be profoundly affected and they can be drawn into perpetuation of the cycle of violence in their families and communities. Violence against girls is justified by societal norms that perpetuate their subordinate status and are inextricably reinforced by systemic gender-based inequalities. Violence has profound effects on the reproductive health of children and adolescents. It can result in unwanted pregnancies, fistula, unsafe abortion, and sexually transmitted infections, including HIV. It leaves deep psychological scars. Worldwide, health systems often fail to meet survivors’ needs. Health services are ill-equipped to handle the specific physical and emotional traumas faced by young survivors of violence. GBV intensifies in natural disasters, as well as post-crisis and security-compromised situations.

Sexual and Reproductive Health and HIV/AIDS
Young people between 15 and 24 years of age account for more than 40 per cent of all new HIV infections among those aged 15 years or over because of the social and economic factors and other inequities that increase their vulnerability, including stigma and discrimination, gender-based and sexual violence, gender inequality and violations and lack of accurate information on HIV and other sexually transmitted infections and ready access to sexual and reproductive health, including HIV services.13

Unmet Needs in Sexual and Reproductive Health Services
A recent report found that among 29 Sub-Saharan African countries, 24 per cent of married women had an unmet need for contraception. Unmet need was lower on average in South and Southeast Asia (11 per cent), North Africa and West Asia (10 per cent) and the Latin America region (12 per cent). Lack of access to contraceptive information and services is often greatest for adolescents. Health impacts of these unmet needs include preventable maternal mortality and morbidity among adolescent women and girls, as well as prevalence of HIV and STI cases in adolescents and children. Recognizing the impact of unsafe abortion as “a major public health concern”, the ICPD PoA urges governments to spare no effort in preventing unwanted pregnancies and reducing “the recourse to abortion through expanded and improved family planning services.”

The UNFPA Asia-Pacific Regional Office reports that persons under 18 years of age face particular barriers in accessing sexual and reproductive health services, care, and information in Asia, because in the majority of countries young people require parental consent. The legal age of consent is set higher than the average age at which adolescents become sexually active. As a result young people do not have access to services including contraceptives, harm reduction programmes and HIV testing.

Comprehensive Sexuality Education
Barriers constructed by laws, regulations and social norms and customs that block access by adolescents to reproductive health information, education and services were noted in the 1994 ICPD PoA and are still on the agenda for ICPD +20 in 2014.

  1. Examples of good practices undertaken to protect and promote the child's right to health, particularly in relation to children and adolescents in especially difficult circumstances

Five global strategic priorities developed by UN agencies through the United Nations Adolescent Girls Task Force, all contribute to adolescent girls attaining their right to health:

  1. Educate girls , especially ensure successful transitions from primary to secondary school

  2. Improve girls health, including sexual and reproductive health;

  3. Protect girls from violence;

  4. Building leadership skills; and

  5. Count adolescent girls. 14

Countering GBV in Humanitarian Emergencies and Conflict

The UNFPA ‘Second Generation’ Humanitarian Strategy contributes to the UNFPA overarching goal of achieving universal access to Sexual and Reproductive Health including advancement of gender equality and reproductive rights, particularly through evidence-based advocacy and implementation of law and policy reform.15 Key to its new Second Generation Humanitarian Strategy, UNFPA recognizes the potential of young people to reverse cycles of violence and instability, to become responsible decision-makers and to rebuild devastated communities, offering their nations new prospects for the future. 16

Multi-sectoral Coordination in South Asia – Child Marriage and Child Abuse

UNFPA is an active member of SACG - The South Asia Coordinating Group on Action against Violence against Women and Children - the regional interagency body composed of UN agencies, (UNFPA, UNICEF, ILO) donors and international NGOs (Plan, SCF, ECPAT) working to end violence against children, which was instrumental in supporting the establishment of The South Asian Initiative to End Violence against Children (SAIEVAC) by the South Asia Association for Regional Cooperation (SAARC) to mainstream regional and state accountability in addressing all forms of violence against children. 17

Youth Leadership for Sexual and Reproductive Health
For SRH information and awareness, The UNFPA Asia-Pacific Regional Office works with YouthLEAD - a regional network of young people from key affected populations actively advocating to governments on the need for services for minors. 18 For SRH data collection for policy making and monitoring, the Interagency Task Team on HIV in the Asia Pacific Region, in cooperation with young key affected populations, has been advocating for increased availability of data on young people 15-19, and inclusion of young people under 18 in behavioural surveys. Philippines and Indonesia now have age-disaggregated behavioural surveys on young people injecting drugs and young people involved in paid sex. In Turkmenistan, UNFPA with the Ministry of Education in 2011 gathered gender and sex disaggregated data on health behaviour among 15-year old adolescents in three velayats and the capital, to be used by the Ministry in developing evidence-based health policies for adolescents on issues such as HIV/STI and early pregnancy. For increased access to SRH education and services, UNFPA promotes access to essential packages of SRH services without discrimination. The Community-Based Rehabilitation programme in the Solomon Islands is a Ministry of Health and Medical Services programme, spread throughout the country with assistance from UNFPA and UNICEF, to train staff in the area of SRH, so that they can respond to child and adolescent health needs, provide basic advice and make referrals where necessary. In Moldova, groups of young people with disabilities are integrated in the public health and education systems to inform their peers and communities, including the Roma, on SRH, sexually transmitted infections (STI) and domestic violence. In Bulgaria, UNFPA co-partnered with the Bulgarian Association of Persons with Intellectual Disabilities on developing a guide for parents on how to address SRH needs of their children. With UNFPA support, partners in various countries including Egypt, Mongolia, Brazil, Nicaragua, Vietnam and Colombia, are contributing to the implementation of new comprehensive sexuality education programs. In South Africa, a WHO case study of the National Adolescent Friendly Clinic Initiative, started in 2000 as an ongoing drive to establish adolescent-friendly services in South Africa’s 5000 public clinics to increase the use of essential health services by adolescents found considerable success in this approach.19 The UNFPA Adolescent and Youth Cluster gives priority response to the SRH needs of marginalized adolescents and youth in humanitarian settings, in line with new Fund-wide direction on expanding and improving access to SRH. 20
Countering Violence

UNFPA’s extensive experience in many countries has demonstrated that, while culture never can be allowed to excuse violence, culturally sensitive solutions are essential to effective violence reduction programming. In Morocco, UNFPA pushed for widespread public acceptance of the Government-led strategy to combat violence against women and girls. In Turkey, UNFPA contributed to a protocol in which imams will work with state ministries to combat violence against women and girls, providing technical assistance in training police, judges and health workers. In Venezuela, the National Assembly, supported by UNFPA, passed a law on violence against women that recognizes "obstetric violence" and "gynaecological violence" as form of GBV. In Mauritania, UNFPA supported midwives in working with imams to mobilize against rape. This led to developing the first batch of national statistics on the issue and the establishment of the first centre for survivors in that country. In Rwanda, UNFPA is working with other UN agencies to set up “one-stop centres” to address diverse needs of victims and survivors of violence. In Haiti, Uganda, Sierra Leone and Nepal, UNFPA works with multi-stakeholders to address the unique needs of women and girls subjected to GBV in the aftermath of a conflict and/or disaster.


Gender-based violence and vulnerability to HIV are intertwined. Good practices require integrated actions to prevent and respond to violence against women and girls as an essential part of the HIV response. This includes prevention, screening and access to health, social and legal services, which include post-exposure prophylaxis (PrEP); diagnosis and treatment of STIs.


The UNFPA-UNICEF Joint Programme on Female Genital Mutilation/Cutting was established in 2008 as the main UN instrument to promote acceleration in the abandonment of FGM/C and is currently being implemented jointly in 15 countries in West, East and North Africa. 21 UNFPA supports evidence-based and constructive dialogue with religious and community leaders, combined with legal and policy measures. This dialogue has relied on the provision of factual information on the negative impacts of harmful practices on the health and rights of women and girls; on children’s education and health; and the ripple effect of declining economic development of households and communities. However, this experience has also demonstrated that it is insufficient to focus on changing people’s individual knowledge, attitudes and practices. The nature of these issues had to be addressed through collective strategies that result in public and group-level manifestations of commitment. In Senegal, within the UNFPA-UNICEF Joint Programme, sustained education and dialogue on human rights in partnership with the NGO Tostan, has changed social norms. As of 2012, more than 5300 communities have participated in public declarations that emphasize not only abandonment of FGM/C, but also respect for the rights of girls and women more broadly and an end to all harmful practices, including child marriage. 22

Maternal Mortality
Nepal has seen a fifty per cent reduction in maternal mortality over the past decade and a significant rise in the proportion of births delivered by a skilled birth attendant - from 17 per cent in 2006 to 29 per cent in 2009. Government provision of free maternity services targeting women living in poverty and marginalized women has contributed to this improvement.

In Burundi nearly 40 per cent of health services are provided by faith-based organizations. UNFPA has developed a series of advocacy and sensitization activities with political and religious leaders to address sexual and reproductive health needs. This advocacy led to the inclusion of family planning in the country’s second poverty reduction strategy and the national health development plan. In Senegal, to increase demand for family planning UNFPA identified mother-in-laws as agents of social change and gatekeepers for sexual and reproductive health. This has helped to ensure that young women receive adequate information and advice on issues such as family planning, sexuality education and maternal health.

Obstetric Fistula
UNFPA launched a global campaign to end fistula in 2003, with significant growth and success since. 23 In Pakistan, with approximately 5,000 new cases of obstetric fistula every year, young girls are disproportionately affected as a result of child marriage and early pregnancy. UNFPA supports interventions to prevent fistula from occurring, to treat girls and women who are affected, and to help those who underwent treatment to return to full and productive lives. 24

Ending Child Marriage

At the country level, UNFPA has conducted advocacy with partners and supported multi-faceted strategies at the national and community levels to address child marriage as a harmful practice. In Ethiopia “Berhane Hewan” is a programme in the Amhara Region that promotes girls’ education, functional literacy, life skills, and reproductive health education for adolescent girls to avoid child marriage and increase girls’ life options. Evaluation results from the pilot phase show that younger girls in this programme were 90 percent less likely to be married compared to peers in other villages. The “Biruh Tesfa” programme provides a combination of health, literacy, civic education, and mentorship opportunities for girls who live in the urban slum of Addis Ababa and have run away from their rural villages to escape child marriage. In Malawi, nearly 50 percent of young women ages 20-24 marry by age 18. UNFPA worked with Malawi’s National Youth Council to conduct an advocacy campaign aimed at parliamentarians in order to end child marriage. These efforts resulted in successfully repealing a law that allowed 16 as the legal age of marriage. These efforts also led to a UN Joint Programme on Adolescent Girls led by UNFPA that supports governments and partners to target girls at risk of child marriage and early pregnancy by providing non-formal education, protection from violence, mentors for vulnerable girls, and access to sexual and reproductive health services. 25In Niger, three out of four young women ages 20-24 years old in Niger were married by age 18 - the highest proportion in the world. 26 Moreover, women give birth to an average of 7 children. 27 Recognizing the socio-cultural factors that increase girls’ vulnerability to child marriage, UNFPA has worked at the community level with the Association of Traditional Chiefs (leaders from the country’s eight regions) to raise awareness of the dangers of this practice, including risk of maternal death. As part of an interagency effort UNFPA is leading in Niger the development of a multi-sectorial girl centered programme designed to significantly reduce child marriage and ensure safe, healthy and productive transitions into adulthood for marginalized adolescent girls. In Pakistan, in Punjab province, UNFPA recently supported a youth policy formulation process that addresses child marriage and early pregnancy. Youth networks have also raised awareness in their communities about the dangers of this practice. Building on this work, UNFPA’s next country programme will have a strong focus on ending child marriage.

  1. UNFPA views on the most important elements to be included in ongoing work to ensure the child’s right to the highest attainable standard of health

  • Implementation of the Global Strategy for Women’s and Children’s Health
    UNFPA – as a founding member of the “H4+” group of UN agencies – places a priority on increasing coordinated and harmonized support to accelerate progress towards achieving Millennium Development Goals 4 and 5 by 2015. 28 OHCHR Technical Guidance on a human rights-based approach to maternal mortality and morbidity will be a useful tool to mainstream human rights in the work of the H4 + operational agencies.

  • A founding member of the UN Adolescent Girls Task force , UNFPA is leading and coordinating the work of the UN system to collectively advance the rights of adolescent girls in line with the UN joint Statement on Adolescent Girls.

  • Global Action Plan from the UN Commission on Information and Accountability for Women’s and Children’s Health for increasing availability, affordability, accessibility and rational use of essential commodities for women’s and children’s health. 29

  • Inclusion of groups of youth with special needs in action plans, national poverty reduction strategies, reform of laws, policies and programs that promote the right of the child to the highest attainable standard of health, including groups of youth described as: child brides, adolescent mothers, indigenous, very young adolescents, migrant, internally displaced/ refugee, disabled, unemployed/out-of-school, sex workers, LBGTI, living with HIV/AIDS. 30

  • More National Action Plans to end FGM/C that incorporate long-term human rights-based, community empowerment programs supported by UN agencies, as seen in Senegal.31

  • Global Advocacy to end Child Marriage - including the MDG post-2015 development agenda for urgent investments in multi-sectoral programmes that target girls at risk and viable socio-economic alternatives for impoverished families to avoid marrying off their young daughters - as part of national strategies for poverty reduction and law reform to eradicate child marriage. 32

  • Implementation of comprehensive sexuality education and access to sexual and reproductive health services consistent with the Commission on Population and Development Resolution 2012/1 on Adolescents and Youth and the 2010 Bogota Principles for Comprehensive Sexuality Education, grounded in fundamental human rights as a means to empower young people to protect their health, well-being, privacy and dignity.

1 For ICPD documentation, see http://www.un.org/popin/icpd2.htm In its report, Sex Differentials in Childhood Mortality (2011), the UN Department of Economic and Social Affairs Population Division noted that China and India were the only two countries in the world where female infant mortality was higher than male infant mortality in the 2000s. In China, female disadvantage is particularly concentrated among young infants and in India, female infant mortality was slightly higher than male infant mortality, but girls’ survival disadvantage was particularly acute in the 1-4 age group. In the 2000s, the ratio of male to female child mortality was estimated to have fallen to 56. Expressed in terms of excess female mortality, this means the risk of dying between ages 1 and 5 is more than 75 per cent higher for girls. ST/ESA/SER.A/314

2 UNFPA Framework for Action on Adolescents and Youth (2007) p.6 http://www.unfpa.org/webdav/site/global/shared/documents/publications/2007/framework_youth.pdf

3 Decisions of the Executive Board NP2012/2; also in 2012, the UNFPA Executive Committee approved the Second Generation Humanitarian Strategy, which focuses on the mandated areas of health, population dynamics, gender equality, gender-based violence and young people in crisis situations.

4 Report of the Secretary-General on Adolescents and Youth, E/CN.9/2012/4 http://www.un.org/esa/population/cpd/cpd2012/Agenda%20item%203/Introductory%20statements/CPD45_Hovy-Intro-SG-Report-Adolescents-Youth.pdf

5 UNICEF. Progress for Children: A Report Card on Adolescents. New York, NY: UNICEF, 2012

6 ICPD para 4.21 and para 5.5 recommends “strictly enforce laws to ensure that marriage is entered into only with the free and full consent of the intending spouses.”

7 UNFPA Global Database 2012. Calculations based on 42 countries in Africa using DHS and MICs national surveys for the period 2000-2010

8 UNFPA, Giving Girls Today and Tomorrow: Breaking the Cycle of Adolescent Pregnancy, 2007.

9 UNFPA, State of the World Population. The Promise of Equality: Gender Equity, Reproductive Health and the Millennium Development Goals, 2005.

10 Legal age for marriage for males and females respectively: Afghanistan 18 (M) 16 (F), Bangladesh 21 (M) 18 (F), India 21 (M) 18 (F), Maldives 18 (M), 18 (F), Nepal 21 (M) 18 (F) (without parental permission), 18 (M) 16 (F) with parental permission, Pakistan 18 (M) 16 (F), Sri Lanka 18 (M) 18 (F)

11 Report from the UNFPA Asia Pacific Regional Office 2012


13 Commission on Population and Development Resolution 2012/1 on Adolescents and Youth

14 UNFPA and UNICEF co-chaired the task force, with ILO, UNESCO, UN Women (as UNIFEM) and WHO. http://www.unfpa.org/public/cache/offonce/news/pid/4969

15 UNFPA emergency preparedness and response includes the engagement of men and boys in gender equality efforts “in ways that respect existing cultural values + beliefs.” To accomplish this and other related outcomes, UNFPA is working to strengthen strategic and operational links with UN Women at the global level. UNFPA Second Generation Humanitarian Response Strategy (2012), p.18 http://www.unfpa.org/public/cache/offonce/home/publications/pid/11572;jsessionid=572828774EC52763FE49956261512E69.jahia01

16 Spotlight on Humanitarian Action: UNFPA responding to the unique needs of women and girls in emergencies, Evidence and Action, Issue 5, May 2012

17 As a multi-sectoral model, the SAIEVAC Board of Governors consists of government representatives from the eight member countries, the SACG chair, two young person representatives, and two civil society organization representatives. The SAARC Development Fund provided a grant for $ 2.6 million to SAIEVAC, and the UNFPA Asia-Pacific Regional Office (APRO) supports implementation of joint action plans by providing technical assistance. SAEIVAC made child marriage a priority concern as a harmful practice, in addition to corporal punishment and child sexual abuse. SAARC country members have committed to implement the work plan on child marriage and abuse and report back to SAIEVAC on agreed indicators, in line with the SAARC Convention on Regional Arrangements for the Promotion of Child Welfare in South Asia and the UN Convention on the Rights of the Child.

18 YouthLEAD accomplishments include: a survey of barriers to access amongst young key affected populations; advocacy and inclusion of the issue in the outcome statements of the intergovernmental Asia-Pacific Regional Consultation on Universal Access in Bangkok as well as of the ESCAP Asia-Pacific High-level Intergovernmental Meeting on the Assessment of Progress against Commitments in the Political Declaration on HIV/AIDS and the MDGs. UNFPA Asia-Pacific Regional Office Report 2012.

19 Case Study, WHO (2009) http://whqlibdoc.who.int/publications/2009/9789241598361_eng.pdf

The essential services provided at each clinic are: 1. Information and education on sexual and reproductive health, 2. Information, counselling and referral for violence/abuse and mental health problems, 3. Contraceptive information and counselling, and provision of methods including oral conceptive pills, emergency contraception, injectables and condoms, 4. Pregnancy testing and counselling, antenatal and postnatal care

5. Pre- and post-termination of pregnancy counselling and referral, 6. Sexually transmitted infections information, including information on the effective prevention of STIs and HIV, diagnosis and syndromic management of STIs

20 UNFPA Second Generation Humanitarian Strategy (2012) 19-20.

21 Progress towards abandonment of this harmful practice will contribute to the empowerment of women and girls (MDG 3); improvement of maternal health (MDG 5) and reduction in child mortality (MDG 4).

22 Programmatically, the public declarations organized by communities in Senegal represented a significant moment in the decision-making process for the abandonment, with qualitative data indicating that actual abandonment took place following this demonstration of collective commitment. UNFPA Country Office Report 2012.

23 The growth and success of the global campaign to end fistula is documented at: www.unfpa.org/webdav/site/global/shared/documents/publications/2009/fistula_annual_report_2008.pdf

24 The UNFPA project includes seminars for community members and health care professionals that explain the direct linkages between child marriage, early pregnancy and fistula in a culturally sensitive manner. To create awareness, the project relies on sensitization workshops for media personnel on women’s rights, child marriages, and fistula prevention and treatment.

25 The Malawi Growth and Development Strategy II (MGDS II), which represents the government’s national blueprint for poverty reduction, also highlights the role of girls’ education and delayed marriage as an essential strategy for social development. The MGDS II will support advocacy for delayed marriage, girls’ retention in schools at all levels, and scholarships for needy girls.

26 Population Council and UNFPA. 2009. The Adolescent Experience In-depth: Using Data to Identify and Reach the Most Vulnerable Young People. DHS Country Reports from Niger(DHS 2006). New York: Population Council. http://www.unfpa.org/youth/dhs_adolescent_guides.html

27 Niger 2006 DHS. Accessed at http://measuredhs.com/Where-We-Work/Country-Main.cfm?ctry_id=29&c=Niger&Country=Niger&cn=

28 H4+ aims to provide joint support to countries with the highest rates of maternal, newborn and child mortality, in order to accelerate progress in saving the lives and improving the health of women and newborns. The H4+ comprises the UN Population Fund (UNFPA), the UN Children’s Fund (UNICEF), the World Health Organization (WHO), and the World Bank, members since 2008, and the Joint United Nations Programme on HIV/AIDS (UNAIDS), and UN Women, more recent members. http://www.everywomaneverychild.org/resources/h4

29 Set up in March 2012 the Commission’s initial scope is to focus on 13 essential, overlooked commodities in 4 categories (reproductive health, maternal health, newborn health, and child health) will be considered by the Commission in order to understand the main barriers that prevent access to many medicines and health products: 3 reproductive health (female condoms, implants, and emergency contraception); 3 maternal health (magnesium sulfate, oxytocin and misoprostol); 4 newborn health (chlorhexidine, injectable antibiotics, resuscitation equipment for asphyxia, and antenatal corticosteroid); 3 child health (oral rehydration solution, zinc, amoxicillin),


30 UNFPA Framework for Action on Adolescents and Youth

31 In building on the demonstrated Senegalese success of public declarations and national government commitments in law, policies and programmes, stronger connections need to be made and sustained between community-based efforts and government services, such as access to health, education and livelihood. Strengthened awareness of human rights at the community level connects to abandonment of harmful practices, which in turn leads to greater demand for health services, education and livelihood opportunities for girls. Lack of such services provided by the State or other NGOs hinders community-based efforts for longer-term changes. http://www.unfpa.org/public/home/about/Evaluation/EBIER/TE/pid/10103

32 Enactment and enforcement of laws to ensure that marriage is entered into only with the free and full consent of the intending spouses, as well as laws concerning the minimum legal age of consent and the minimum age for marriage, including raising the minimum age for marriage where necessary and establishing birth and marriage registration, are all needed for full implementation. IPPF, Young Positive, and UNFPA, Ending Child Marriage: A Guide for Global Policy Action. 2006

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