The Women and Media Collective (WMC) recently launched the Country Profiles on Universal Access to Sexual and Reproductive Rights and Health Services during a national policy dialogue. The event was held at the Lakshman Kadirgamar Institute for International Relations and Strategic Studies on Friday, 4 December 2015. The event drew together about 70 participants from the government, civil society, UN agencies, media, medical and health sector personnel as well as female workers from the Katunayake Free Trade Zone.
A brief presentation on the development of the country profile on Sexual and Reproductive Rights (SRR), key findings and recommendations were given to the participants. This was followed by the launching of the profile which was handed over to the panel of speakers, Ms. Vijayakala Maheswaran (Deputy Minister of Women’s Affairs) as well as Azra Abdul-Cader of our partner organization ARROW.
The panel discussion on SRR that followed was moderated by Ms. Kumudini Samuel of WMC. The following panelist made brief presentations and the floor was then open for a lively question and answer session.
1. Dr. Nethanjali Mapitigama, Head of the Women’s Division, Family Health Bureau
The Government’s Perspective on Policy, Programmes and Grievance redress mechanisms for Sexual and Reproductive Rights
2. Dr. Thiloma Munasunghe, Consultant Community Physician
Relating Policy and Law to Sexual and Reproductive Health and HIV/STIs in Sri Lanka
3. Dr. Sepali Kottegoda, Executive Director, Women and Media Collective
Policies and Programmes to Prevent Gender based Violence
The Country Profile on Sexual and Reproductive Health (SRH) Services was launched after a brief presentation on some of the common myths related to SRH services in Sri Lanka that the country profile sheds light on. The panel discussion that followed was moderated by Dr. Sepali Kottegoda of WMC and was broadly on the gaps and challenges in access and availability of services. The following panelists gave brief presentations.
1. Ms. Madusha Dissanayake, Director HIV/AIDS & Advocacy, Family Planning Association
Services for Persons Living with HIV/AIDS and Sexually Transmitted Infections
2. Mr. Hans Bilimoria, Director, Grassrooted Trust
Sexuality Education and Adolescent sexual and Reproductive Health Services
3. Mrs. Sumika Perera, Coordinator, Women’s Resource
Practical Challenges in Accessing Sexual and Reproductive Health Services
The participants sound the discussion and panel session very useful and many were able to clarify their concerns and express their frustrations related to the SRR and SRH context in Sri Lanka. They also found the Country Profile to be a useful contextual guide and expressed that they will be using the profiles in their work (for example, Human Development Organisation requested 40 copies of the Tamil SRH profile to guide a SRH training they will be conducting). The translations to Sinhala and Tamil were useful as most of the organisations/individuals present work in local languages (sometimes in addition to English).September 20, 2015
Following a capacity building workshop in August 2015 in Bali, Indonesia, some partners of the #SRHR4ALL campaign collaborated on a short video highlighting the key SRHR issues in their respective countries.August 26, 2015
The Policy Dialogue on Universal Access to Sexual and Reproductive Health Post-2015 Development Agenda was organized by the Federation of Reproductive Health Associations, Malaysia (FRHAM) on 6 June 2015, at Empire Hotel Subang, Selangor. The project was supported by the Asian-Pacific Resource & Research Center for Women (ARROW) and the European Union (EU). A total of 41 representatives from international and regional organisations, government agencies, universities and non-governmental organizations participated in the policy dialogue.
The Policy Dialogue was officially opened by Yang Berbahagia Dato’ Hajah Mariam Mas bt Yacob, the Chairperson of the National Population and Family Development Board (NPFDB), who reviewed some of the global and country achievements of the Millennium Development Goals (MDGs). Despite Malaysia having done well at the national level in achieving the MDG 2015, Yang Berbahagia Dato’ emphasised that there was a need for specific interventions to address and eliminate the inequalities among the most-at-risk populations (MARPs). In order to address these gaps in the Post-2015 Development Agenda, a number of practical next steps would be needed and these include: “ensuring universal health-care coverage, access and affordability”; “ending preventable maternal, new-born and child deaths as well as malnutrition”; “ensuring the availability of essential medicines”; “realizing women’s reproductive health and rights”; and “realizing the vision of a future free of AIDS and tuberculosis”. In view of that, Yang Berbahagia Dato’ urged all the sexual and reproductive health experts, policy-makers, government agencies, civil society organizations, advocates, and other key stakeholders to use the policy dialogue as a platform to discuss and formulate recommendations towards the Post-2015 development agenda. The opening remarks was followed by a launch of the “Malaysian Profile on Universal Access to Sexual and Reproductive Health” by the Chairperson of the NPFDB.
The first session entitled “Current Situation of Sexual and Reproductive Health in Malaysia” chaired by YBhg Dato’ Dr. Kamruzaman Ali, President of FRHAM was designed to review the current success and challenges and formulate recommendations. The session started with Ms Lim Hwei Mian, Head, Programme Services, FRHAM presenting an overview and summary on the “Malaysian Profile on Universal Access to Sexual and Reproductive Health”. Her presentation focused on the current situation of contraceptive usage, maternal health, adolescent and young people’s sexual and reproductive health as well as HIV and AIDS in Malaysia.
With regard to contraception, the decline of total fertility rate, stagnated contraceptive prevalence rate in Malaysia and unmet needs of family planning were highlighted and it was suggested that the stalling of contraceptive usage may be attributed to the following factors:
1) The shift in national programme thrust from family planning to family development
2) Structural barriers such as non-functioning of State Reproductive Health Committees as well as lack of “coordinated planning and evaluation of implementing agencies at the State level to address barriers and improve performance”
3) Social cultural and personal barriers that hinder individuals from using contraception, and
4) Induce abortion
On the other hand, despite Maternal Mortality Ratio’s significant decline since 1991, Malaysia has yet to achieve the MDG 5a target, which is 11 per 100,000 live births. It was pointed out that Malaysian women made up 75% of maternal deaths and the three main direct causes of maternal deaths were haemorrhage, hypertension and obstetric embolism. In Malaysia, while the adolescent birth rates had declined from 28 to 13 per 1,000 women aged 15-19 years old, however, the maternal mortality ratio (MMR), teenage pregnancies and live births among adolescent girls aged 15 – 19 years old had increased significantly and is now a major concern. In recent years, there has been an increased number of girls below 18 years old getting married to adult or older men. This is a worrying trend and may result in increasing teenage pregnancies (wanted or unwanted) and MMR among young girls. Although the sexual and reproductive health information and services for adolescents and young people are available at the healthcare facilities of Ministry of Health (MOH) Malaysia, and MOH also has been taking initiatives in advocating and making the services more accessible, awareness among adolescents of the services and the quality of the services are still lacking. With regards to the HIV and AIDS situation in Malaysia, it was highlighted that the HIV epidemic is a concentrated epidemic, particularly among most at risk populations (MARPs) but the number HIV cases among women are increasing.
In order to strengthen the SRH services in Malaysia, it was proposed for Malaysia to:
1. Strengthen provision of comprehensive SRH information (e.g., promote usage of modern contraceptives, promote broad range of method-mix contraceptives, addressing the side-effects and discontinued usage of contraceptives, and availability of termination of pregnancy services) and services (e.g, counseling for contraception, and HIV and AIDS prevention, treatment, care and support) at the government, non-government and private health facilities to all, especially the marginalised, the poor, the migrant workers and the refugees.
2. Strengthen capacity and skills of health care service providers in terms of their awareness on the laws and policies pertaining to SRH, especially on delivering quality service to all without discrimination and stigma regardless of age, marital status, citizenship, sexual orientation and gender identities.
3. Promote the available SRH services for young people, including contraceptives and termination of pregnancy, at all levels of government health facilities in the urban and rural areas.
4. Ensure confidentiality of all young people who seek sexual and reproductive health services, especially at government health facilities
5. Mainstreaming sexual and reproductive health services, including HIV and AIDS as part of outpatient care.
6. Strengthen management and follow-up of sexually transmitted infections (STIs) to reduce transmission of HIV.
7. Strengthen initiatives on universal access to voluntary HIV counseling and testing, especially for individuals involved in high risk behaviours.
8. Upscale antiretroviral treatment to more PLHIV, especially for the most-at-risk-populations.
The second presenter for the first session, Assoc. Prof. Dr. Mary Huang Soo Lee, Vice President of FRHAM provided an overview on several gaps on SRH in Malaysia, which included the following:
1. Growing number of child marriages and teenage pregnancies and their consequences on adolescent health, education, poverty and domestic violence
2. The lack of attention given to men’s SRH as well as their involvement in SRH
3. Limited HIV and SRH linkages despite the fact that they share the same root causes (such as unsafe sex, gender inequality, poverty, stigma, and sensitivity associated with sexuality), target groups, behaviours, messages and delivery of the services
4. SRH of the ageing population
5. Linking SRH with non-communicable diseases (NCDs)
6. Research gaps such as
b. the need for contraception and contraceptive use among indigenous populations, young people, refugees, migrant workers, sex workers and PLHIV
A number of perspectives emerged in the general discussion:
1. Linking SRH with human rights
SRH health framework needs to apply the principles of human rights in order for people to exercise their reproductive rights and access affordable, accessible and quality SRH services.
2. Multi-sectoral approach in addressing the gaps of SRH
The ministries and government agencies (other than MOH, NPFDB and Ministry of Women, Family and Community Development) such as Ministry of Finance, Ministry of Education, Ministry of Information, Communication and Culture, and Ministry of Youth and Sports need to be engaged and involved in the discussion of SRH issues and work together to address the gaps in SRH.
3. Proactive approach in delivering SRH information and services
Stakeholders and relevant agencies need to take a proactive approach to provide SRH information and services to all at every opportunity. It was also suggested that we engage the Ministry of Information, Communication and Culture in giving out information on SRH, especially to the communities in the rural area.
4. Strengthening SRH programmes and services through budget advocacy and allocation
Civil society organizations need to play a more active role in strengthening the effectiveness of resource use through advocacy, participation in national budget allocation process and enabling greater accountability of national programmes to the needs of communities, including universal coverage and equitable access to SRH.
5. Advocate and connect the country actions to international development agendas for SRH
It is important to advocate the SRH needs and issues by using the latest international documents, for example, CEDAW and Beyond 2014 ICPD review.
6. Educational workshop on preventing violence against women for children as an entry point for SRH
It was suggested to use the educational workshops on preventing violence against women for children (initiated by Ministry of Women, Family and Community Development) as entry points to convey messages on gender equity and equality, respect, sexuality and SRH to them.
7. Strengthening SRHR and HIV linkages
The needs of SRHR of most at risk populations such as contraceptive usage and safe abortion services for drug users and sex workers, and hormone usage by the transgender and the risk of breast cancer from excessive usage. HIV prevention programmes should be linked with SRH, especially for most at risk populations. In order to strengthen the linkages between HIV and SRHR, it is important to reduce stigma and discrimination towards people living with HIV and the most at risk populations. In addition, it is also important for the relevant agencies to have clear policy and guidelines on SRH and HIV linkages including guidelines on HIV counselling and testing as a reference for the service providers.
The second session was chaired by YBhg Datuk Dr.Raj Karim, Vice-President of FRHAM. YBhg To’ Puan Dr. Safurah binti Jaafar, Director of Family Health Development Division, MOH, presented the MOH’s perspective on the topic. She started with the definition and working framework of SRHR. The following SRH issues were highlighted as the priority areas for MOH:
• Sex disaggregated data
• Equity and access to healthcare services
• MMR and family planning
• Abortion and access to SRH services
• Violence against women
• HIV/AIDS- discrimination
• Mandatory testing for HIV
• Female circumcision
• Differing levels of access to healthcare for vulnerable women
• Non-citizens spouse
• Refugee women
• Indigenous women
• Privatization of healthcare services and health insurance
• Health of the aged
YBhg To’ Puan Dr. Safurah concluded her session by presenting MOH’s commitments on Post-2015 development agenda, which included the following:
• To extend life expectancy for all by achieving universal health coverage.
• No one must be left behind.
• Commit to accelerating the progress made to date in reducing infant, child and maternal mortality by ending all preventable deaths of infants, children and expectant mothers by 2030.
• Ensure universal access to SRH care services, including for FP, information and education.
• Accelerate equally the pace of progress made in fighting malaria, HIV/AIDS, tuberculosis and other communicable diseases and epidemics.
• Devote greater effort to tackling non-communicable diseases.
• To end preventable deaths of newborns and children under 5 years of age, in line with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births by 2030.
The second presentation was presented by Dr. Hamizah Mohd Hassan on the NPFDB’s perspectives. Dr. Hamizah gave an overview on NPFDB’s policies, programmes, research studies and services on SRH including adolescents SRH such as PEKERTI programmes. She also shared the preliminary findings of the 2014 Malaysian Population and Family Survey (MPFS):
• The CPR for any method and modern method in Peninsular Malaysia has increased slightly, from 51.9 in 2004 to 55.4 in 2014 and 34.4 to 35.7, respectively.
• The CPR for Sabah and Sarawak for any method has also increased from 53 in 2004 to 61.4 in 2014, while the CPR for modern method has increased from 42.3 to 45.4.
• The unmet need for contraception has declined slightly, from 24.5% in 2004 to 22.7% in 2014. Factors influencing unmet needs in Malaysia included socio-economic factors, education level (primary education or no education) and age (40 years and above).
• The reasons for not using contraceptive include wanting more children (21.9%), fear of side effects (22.7%), medical and health reasons (4.2%), husband’s objection (2.5%) and others (44.3%).
• Oral contraceptive pills (15.8%) remained as the most popular modern method, followed by female sterilization (7.5%), injection (5.9%), condom (5.4%) and IUD (2.5%).
• Withdrawal (10.3%) was found as the most common traditional method, followed by rhythm (4.8%) and abstinence (1.0%).
• In regards with adolescents SRH awareness, it was found that:
o 44% were aware of family planning methods available
o 3.1% admitted to ever having premarital sex
o 47.5% admitted to masturbating
o 35.8% were exposed to pornography
As for the Post 2015 Development Agenda, NPFDB would focus on the following:
• Increase accessibility of SRH services to the community, especially to the high risk groups.
• Increase collaboration between government sectors, private sectors and NGO in expansion of adolescent psychosexual programs.
• Provision of SRH services for the ageing population.
• Continue to monitor and evaluate the research studies
Dr. John Teo was the last speaker. He shared on “Tales from the Field” from the NGO’s perspectives. He started his presentation by sharing some global and country statistics and cases studies relating to unintended pregnancies. In order to address the issue of unintended pregnancies, he recommended the following:
1. Implement age-appropriate comprehensive SRH education (which includes facts about pregnancy risks, contraceptive knowledge and access) in schools and universities nationwide.
2. Intensify efforts to dispel myths and misinformation about contraception and highlighting the benefits of contraceptive usage with regard to women’s health through media, internet, public health campaigns and forums at schools, universities and workplaces.
3. Inclusion of contraceptive skills and knowledge in existing medical curriculum and continuing professional development (CPD) Programmes for all healthcare professionals, especially those who work in primary healthcare.
4. Strengthen stakeholders’ (MOH, NPFDB and FRHAM) commitment and effort in increasing contraceptive uptake and prevalence as well as reducing the unmet need of contraceptive.
5. Ensure that contraceptives are easily available and accessible (as accessible as the fast food outlets).
6. Expanding the range of contraceptive choices, in particular promoting long acting reversible contraceptives such as Implant and IUCD.
At the end of the session, Dr. Teo urged the audience to rethink the issue of unintended pregnancies in its broader perspective, as an outcome of poverty, gender inequality, discrimination, lack of access to services rather than an individual girl or woman’s problem due to her own behaviour or fault. He concluded his presentation by saying that “We Need to Deliver a Malaysia Where Every Pregnancy is Wanted, Every Childbirth is Safe and Every Malaysian Young Person`s and Woman`s Potential Fulfilled”.
1. Reframing sexuality education
There is no specific subject called “sex education” in the school curriculum because of the sensitivity attached to the word “sex”. However, sex education has been introduced by the Ministry of Education as Pendidikan Kesihatan, Reproduktif dan Sosial (PKRS or Reproductive, Social and Health Education) since 2011.
It was suggested that sex education should go beyond abstinence and be more comprehensive. It should include life skills to enable adolescents and young people to make informed decisions about their sexuality and health and increase responsible behaviours.
On the other hand, some issues faced by teachers in teaching sexuality education are such as the lack of capacity and skills, feeling uncomfortable and embarrass. Objection from parents should also be addressed. Nonetheless, parents need to be taught that sex education is not about the sex act itself.
2. Working with adolescents to address their SRH needs
It is important for the service providers to work with the adolescents and young people to understand their healthcare and SRH needs through the young people’s perspective.
3. Socio-cultural approach in addressing SRH
The issues on SRH need to be understood from broader perspective such as human rights, poverty, socio-cultural practices and gender relations. It is important to address the SRH issues from the socio-cultural approach and not just the biomedical approach.
4. Health budget for Malaysians
It was noted that the health budget allocation for Malaysians remained at 3-4% of GDP, which was slightly lower than WHO’s recommendation (5% of GDP). As such there is a need to advocate for a higher budget allocation for the health sector.
5. SRH programmes and research studies of NPFDB
The SRH programmes and services of NPFDB for adolescent such Kafe@Teen are publicised through social media such as Kafe@Teen’s Facebook and outreach programmes lead by teen educators. In addition, NPFDB provides SRH information and training for students in the boarding schools, high risk youth, and lecturers from Teachers Training College, teachers, wardens and parents through the PEKERTI programme. Issues such as gender equality, HIV, LGBT have been addressed in the module CAKNA Diri for PEKERTI programme.
NPFDB also explained that their data on premarital sex was collected from their survey which is cross-sectional data collected through qualitative and quantitative methods. The respondents for quantitative study included adolescents or young people who are school drop-outs.
6. Increasing trend of sexual violence and abuse among domestic workers
According to Tenaganita, the increasing incidence of sexual violence and abuse of domestic workers is of concern. There is a need to address their SRHR needs as most of them may not be able to access to SRH information and the public healthcare services.
7. Training on contraceptive skills and knowledge for all healthcare professionals
Currently, Sabah Family Planning Association is collaborating with MOH and Obstetrical and Gynaecological Society of Malaysia (OGSM) to organise one-day basic FP course for healthcare providers. In addition, NPFDB also organised basic FP courses three times a year. However, more publicity is needed as most healthcare providers, especially those from private hospitals may not be aware of the courses.
It was suggested that the training programmes or courses on contraception for medical personnel be accredited for the benefit of participants. Alternatively, medical schools must make sure that contraception and FP be incorporated into existing medical curriculum and continuing professional development (CPD) Programmes for all healthcare professionals in Malaysia be conducted.
In addition, greater emphasis should be given to long-acting reversible contraception methods such as implants and IUCDs to increase the uptake of these methods as it is more effective in preventing unintended pregnancies.
8. Provision of SRH services for vulnerable groups or most at risk populations such as people in the prisons and rehabilitation centres
Ministry of Health would be extending healthcare services for the prisoners by assigning a doctor to be based in each prison.
At the end of the session, YBhg Datuk Dr.Raj Karim summarised the presentations and concluded the discussion by making the following points:
1. From time to time all the stakeholders should gather to discuss and share information, experiences, issues and programmes related to SRH. It was suggested the FRHAM organises a post-dialogue amongst a smaller group as a follow-up to the forum and Post-2015 Development Agenda.
2. More effort is needed to achieve some of the Post-2015 development goals, such as maternal health and MMR. It was proposed that review on the indirect causes of maternal death be carried out in order to have a more targeted approach to reduce MMR.
3. Greater focus, non-bias and non-judgemental approach is needed when providing SRH services to young people who currently make up about 30% of the total population.
4. Linkages between SRH and HIV need to be intensified. SRH needs to be incorporated into the new National Strategic Plan on HIV. Malaysian AIDS Council (MAC) would also introduce SRH programme and services for drug users, sex workers and young people through the needle exchange and sex worker programmes in order to address the rising trend of sexual transmission of HIV.
5. It was also reminded that SRH should be assessed or analysed not only from a biomedical standpoint but also from a broader perspective which include socio-cultural factor, rights and gender. It is important to ensure universal access to SRH care services for all, where quality services must be available, accessible, acceptable, affordable, gender sensitive and free from stigma and discrimination as well as address the needs of the marginalized populations.
#May28 is the International Day of Action for Women’s Health. Today women’s rights activists from around the world advocate and mobilize in various ways to remind governments that #WomensHealthMatters, particularly with regard to the negotiations around the post-2015 development agenda.
Despite Sri Lanka’s impressive national health indicators, there are disparities that exist especially in the conflict-affected areas of the North and East, districts that are economically under-performing and the estate sector. This year we highlight forms of institutional violence that violate women’s SRHR including denial of access to sexual and reproductive health services.
Pakistan launched its family planning programme in mid-1950’s and despite various other national programmes and policies that have been launched since then, achieving the MDGs and ICPD Programme of Action (PoA) commitments still look like a distant dream for Pakistan. According to Pakistan’s Millennium Development Goals Report in 2013, the country still has a very high maternal mortality ratio (276). The report also reveals that progress on indicators such as proportion of births attended by skilled birth attendants, contraceptive prevalence rate, and total fertility rate has been dismal.
Challenges such as lack of a solid financial infrastructure to ensure universal provision of health services, a poor monitoring and evaluation mechanism of existing systems, political changes and fading commitments by the state plague Pakistan’s progress in the area of sexual and reproductive health services.
The findings of a national study, Post-Abortion Care in Pakistan, issued by Population Council in 2013, show that Pakistan has made strides of progress in the area of sexual and reproductive health (SRH). However, there is still a long way to go as a large proportion of women still have unmet need for contraception (as high as 20%, according to the latest PDHS) and safe abortion needs. A huge percentage of women are still experiencing post- abortion complications (estimated 15 per 1,000 women of reproductive age) and the contraception prevalence rate is still very low (approximate level of contraceptive use among married women aged 15-49 is as low as 30 percent).
On May 28 International Day of Action for Women’s Health, we emphasize that #WomensHealthMatters in Pakistan as well as in the rest of the region and the world.
We call on our government, international organizations, UN agencies, civil society partners and relevant duty bearers to take the following actions:
February 28, 2015
A policy dialogue towards achieving universal access to sexual and reproductive health was held in Kathmandu on 23 November, 2014 joining hands with People’s prior to the in Kathmandu, Nepal.
The dialogue intended to make aware stakeholders about the ground-reality situation of Sexual and Reproductive Health and Rights (SRHR) in the country; ensure commitment from different stakeholders towards pro-action; ensure that universal access to SRHR services in the South Asia region remain high on the development agenda including post 2015; and that national and international policy and decision-makers are improving SRHR policies.
The turnout was the maximum. A hundred and twenty five present to share and discuss the SRHR policy.
Key invitees were, Dr. Shilu Aryal of Family Health Division (FHD), Dr. Khem Karki from Nepal Health Research Council (NHRC), Ms. Ishwori Shrestha, Chief Health Administrator Ministry of Health and Population (MOHP), Dr. Jageshwor Gautam from Maternity Hospital, Ms. Chandrakala Sharma from Tribhuwn University Institute of Management (TU IOM) Nursing Campus, Ms. Ambika Pandey DPHO, Lalitpur, Yashoda Rajbhandari – District Public Health Office (DPHO) Makwanpur and Ms. Bindra Hada and Dr. Badri Pokharel – Ex Sec. Nepal Government etc.
Hon’ble. Ms. Ranju Thakur, member of Constituent Assembly (C.A.) graced the occasion as Chief Guest and launched country profiles developed by Beyond Beijing Committee (BBC) in collaboration with Swedish International Development Cooperation Agency (SIDA), European Union (EU) and Asian Resource and Research Centre for Women (ARROW), as part of the initiative of Strengthening Networking, Knowledge Management and Advocacy capacities of an Asia – Pacific Network for SRHR.
As such, the dialogue proved very successful with the presence of key stakeholders and full participation and relevant recommendations being drawn up in the end.October 30, 2014
The country profiles on universal access to sexual and reproductive health services and on the achievement of sexual and reproductive rights were launched through a dissemination forum entitled, “SRHR in the Philippines: 20 years after Cairo” last August 29.
The forum was attended by over 120 participants from multi-sectoral groups — government officials and staff, legislators’ staff from Senate and Congress, RH leaders and personalities, grassroots women and youth organizations, NGOs, RH organizations, women’s organizations, LGBTs, HIV and AIDS organizations, women with disabilities, health professionals, legal practitioners, media practitioners, academics, labor organizations, business, interfaith and secular groups development partners and International NGOs. The policy forum served as a venue where current gaps, issues and steps forward were identified.
Dr. Junice Melgar, Executive Director of Likhaan, presented the background, topic outline, key findings and recommendations of the country reports. Panel of speakers were invited to give their reactions to the reports.
On access to RH, Dr. Paje of DOH shared the DOH Programs to Increase Access to RH Services which includes upgrading of health facilities, trainings for service providers on family planning, safe motherhood, women and child protection, and adolescent health. The DOH also conducts the DOH Health road shows that provide mobile health advocacy and RH services in different areas. Media campaign on RH has already started with a video on family planning that was showed on TV as commercial breaks. Dr. Remonte of PhilHealth shared PhilHealth’s policies on Reproductive Health. There was an increase in the number of indigents enrolled and accredited health care institutions. While there was an increase in the coverage of maternal deliveries, vasectomy, ligation, IUD insertion, cervical cancer screening and Antiretroviral drugs, the utilization of covered family planning services was still low. Efforts are being made to improve its messages to encourage members to access its services. Dr. Remonte also recognized the recommendations in the reports.
On the achievement of Sexual and Reproductive Rights, Atty. Sta. Maria of the Ateneo Law School pointed out the gaps and challenges on the laws on women and its implementation – anti-rape law, anti-violence against women and children, RH Law, anti-sexual harassment. As well as on the discriminatory provision of the revised penal code on abortion and the Constitutional provision on equal protection clause. Atty. Parajas of the Commission on Human Rights shared CHR’s work on SRHR. As Gender Ombud in the Magna Carta for Women, CHR was tasked to investigate complaints under the law. The operational guidelines on violations of sexual and reproductive rights including discrimination based on sexual orientation and gender identity has already been undertaken. CHR was actively involved in the campaign to revoke the Executive Order on contraception ban in Manila and support for the passage of the RH Bill. Atty. Parajas reiterated CHR’s support in the promotion of SRR.
Dr. Perez of POPCOM walked us through the ICPD UNGASS processes and shared what took place in the ICPD UNGASS meeting last April as well as the Philippine delegation plans for the September UNGASS meeting.
The open forum provided a venue for the participants to clarify the DOH and PhilHealth policies and programs on RH especially for the poor and marginalized groups. The participant from the Filipino Deaf Women’s Health and Crisis Center shared the experiences and discrimination of deaf women on SRHR. Dr. Melgar apologized for not including the SRHR of women with disabilities in the report.
The Policy Dialogue on Universal Access to Sexual and Reproductive Health and Rights towards the ICPD Review and Post-2015 Development Agenda was organized by the Federation of Reproductive Health Associations, Malaysia (FRHAM) as part of the Asian-Pacific Resource & Research Center for Women (ARROW)’s initiative with the support of Swedish International Development Cooperation Agency (SIDA) on 3 September 2014, at Holiday Villa, Subang Jaya, Selangor. A total of 51 representatives from government agencies [Ministry of Health (MOH), Ministry of Education (MOE) and National Population and Family Development Board (NPFDB or LPPKN)], Suruhanjaya Hak Asasi Manusia (SUHAKAM), universities and non-governmental organizations (All Women’s Action Society (AWAM), Malaysian AIDS Council (MAC), Pengasih, Pertubuhan Advokasi Masyarakat Terpinggir, PT Foundation, Women’s Aid Organization (WAO) and Women’s Centre for Change (WCC)) participated in the policy dialogue. Representatives were also present from the international and regional agencies such as United Nation Population Fund (UNFPA) Malaysia, UNICEF, the International Planned Parenthood Federation (IPPF) East, South East Asia and Oceania Regional Office and ARROW.
The policy dialogue started with the opening remarks by YBhg Tan Sri Dato’ Napsiah Omar, Chairperson of LPPKN. In her opening remarks, YBhg Tan Sri Dato’ provided an overview of Malaysia’s achievements during the 20-year ICPD PoA. Despite some impressive achievements in the area of sexual and reproductive health (SRH), there were gaps identified, especially in terms of funding allocated in SRH, programme implementation and interventions for the vulnerable population groups, including the young people. In order to increase the political commitment, resources and implementation efforts to create a more equal and more sustainable world and to ensure SRHR for all, she urged all the key agencies and relevant stakeholders to use this policy dialogue as a platform to discuss and formulate recommendations towards the ICPD review and Post-2015 development agenda.
After the opening remarks, the “Malaysian Profile on Universal Access to Sexual and Reproductive Rights” prepared by FRHAM was launched by YBhg Tan Sri Dato’ Napsiah Omar.June 26, 2014
Migrant Assistance Programme (MAP Foundation) was hard at work during the month of May, advocating for universal access to SRHR, particularly on behalf of Burmese migrant women in Thailand. MAP completed its country profile “On Universal Access to Sexual and Reproductive Rights (SRR),” as part of ARROW’s initiative “Strengthening the Networking, Knowledge Management and Advocacy Capacities of an Asia-Pacific Network for SRHR,” with the assistance of the European Union.
While the report primarily assesses Thai law and policy vis-à-vis SRHR and how migrants are or are not incorporated into these, the report also acknowledges the importance of taking into account the trans-national nature of migrants’ lives. As MAP primarily works with Burmese migrant workers, who comprise over 80 percent of the migrant population in Thailand, Myanmar’s SRHR-related laws and policies are also noted in some sections.
On 23 May 2014, MAP launched its country profile on SRR at a policy dialogue in Bangkok. Despite the formal proclamation of a coup d’etat the night before, the policy dialogue saw a strong turnout from both Thai and Myanmar NGOs, Thai Government representatives and a representative from the International Labour Organization (ILO).
Malyn Ando of ARROW gave the keynote address, providing an overview of SRHR across the Asia-Pacific, along with the strides that have been made and the gaps that remain. Malyn eloquently noted that when migrants go from one country to another, they still retain their desire for companionship and their desire for love. Therefore, SRHR truly has no borders.
MAP then provided an overview of its Women Exchange program, which are monthly/bi-monthly meetings held in approximately 20 different locations throughout Thailand and increasingly in Myanmar as well. These Women Exchange meetings are held by local migrant women leaders, and topics pertaining to SRHR have become particularly popular. MAP showed a short video it had produced, elucidating the issues migrant women commonly face in Thailand. One woman in the video had been involuntarily sterilized after giving birth, entirely unaware of what was happening to her, due to language barriers, until the procedure was over. Another woman was the sole breadwinner in her family due to her husband’s alcoholism and constant absence from the home. Nevertheless, she always made it a point to attend the Women Exchange meetings when she can. Lastly, the film showed one of the Women Exchange leaders who revealed her aspirations to educate thousands of migrant women each year on such issues as domestic violence and women’s rights.
Later in the day, another Women Exchange leader, a Burmese migrant working in Bangkok, explained the obstacles migrant women face in bringing issues of sexual harassment from employers to the fore. Concerned about losing their jobs, divulging their undocumented status, or facing inaction from law enforcement officials, the women often feel as if nothing can be done. Also finding witnesses who can attest to the incidents can be extremely difficult.
The policy dialogue also included a panel, composed of Naw Khu Hser, Women’s Protection and Empowerment Senior Manager, International Rescue Committee; Dr. Kyoko Kusakabe, Associate Professor, Gender and Development Studies, Asian Institute of Technology; Dr. Sid Naing, Country Director, Marie Stopes International, Myanmar; and Anna Olsen, Technical Officer, GMS TRIANGLE Project, ILO.
During the panel it was noted how female migrants who serve as domestic workers are commonly confined to their workplaces, as employers are afraid that the women will go out and get pregnant or find themselves in other trouble, severely impeding their freedom of movement. Dr. Kusokabe presented a study undertaken by Mahidol University in Thailand in 2010, which found that while 67 percent of Cambodian migrants, 61 percent of Lao migrants, and 50 percent of Burmese migrants reported having children, only 8 percent of migrant workers reported that their pregnancies were unplanned. Dr. Sid Naing spoke of the pushback to comprehensive SRHR in Myanmar; activities typically must be pared down to RH.
The dialogue concluded with breakout sessions, in which participants once again highlighted the primary issues related to migrant workers’ SRHR in Thailand, as well as some of the main obstacles standing in the way of a full realization of SRHR. Groups offered some suggestions for how to move forward. These included calling on Thailand’s Ministry of Labour to inform migrant women about such labor violations as termination on the grounds of pregnancy and unpaid maternity leave. The Ministry of Labour should also actively pursue and punish employers who commit these transgressions. Since additional hindrances to accessing healthcare can come of being undocumented, employers should also be held responsible for not registering workers and obtaining the necessary documents. Migrant women should be informed of grievance redress mechanisms for sexual and reproductive health services, sexual harassment, and violence against women. This information should be made accessible in migrant languages and the selected mechanisms should ensure that a migrant’s physical security is not compromised in Thailand.
In order to keep the SRHR momentum going, at the end of May, MAP presented a workshop on “Making Universal Access to SRHR a Reality” at the 2nd Asia Pacific Feminist Forum in Chiang Mai, attended by nearly 300 feminists from around the region. MAP’s workshop complemented another SRHR workshop organized by ARROW at the conference. MAP’s workshop provided some background on SRHR and its grounding in international declarations. The country profile on universal access to SRR that MAP had recently published was also disseminated and discussions ensued on how to keep the SRHR agenda moving forward during this pivotal time for SRHR advocacy. Here’s to moving forward!