Women and girls around the world have an unmet need for reproductive health services.  In 2015, IPPF provided 175 million services, 82% of which went to poor and marginalised people.

Kate Gilmore, UNFPA Deputy Executive Director (Programme) addressed our High Level Side Event “Sexual and Reproductive Health and Rights: The key to gender equality and the empowerment of women and girls” at the 59th Commission on the Status of Women. Upholding human rights for sexual and reproductive health is key to ensuring that all people can be equal and free to make decisions in all spheres of their lives, without discrimination, without violence or coercion, and with the assurance of their dignity upheld. Together the outcomes of the Vienna human rights conference (1993) affirming indivisibility and universality of human rights,  the Cairo population and development conference (1994) putting the person at the centre of development and the Beijing women’s conference (1995) affirming that women’s rights are indeed human rights, set a complimentary agenda – defined by the international community and reaffirmed globally time and time again. This is the agenda by which rights in respect of sexual and reproductive health are made normative and the means by which these rights are to be protected universally.  It is on this foundation that women and girls, in particular, are reliant if they are to enjoy a life of choices, empowerment and equality, and this invokes the right to health throughout the life course inclusive of the right to make choices freely in marriage, family formation and determination of the number, timing and spacing of children.  For such rights to be exercised and enjoyed, people – and women and young people in particular - must be supported with quality access to information, to services and to the means by which to exercise their voluntary choices.  SRHR are rights in principle, upheld by international and universal norms and supported indivisibly, by all other human rights norms.  However, they are also rights that, in practice, save lives and reduce ill-health: If all pregnant women and their newborns were to receive care at WHO recommended standards, if all women who want to avoid a an unplanned pregnancy had access to modern contraceptives, the life-saving benefits would be substantial.  Maternal deaths would drop by 67%.  Newborn deaths would drop by 77%.  Unintended pregnancies would drop by 70%.  Women’s and newborns’ burden of disability related to pregnancy and childbirth would drop by 66%.  Transmission of HIV from mothers to newborns would be nearly eliminated—a 93% reduction. The correct thing to do in principle, upholding SRHR is just smart in practice. At its simplest, universal access to sexual and reproductive health is cost effective. With far fewer unintended pregnancies, the costs of improving pregnancy-, birth- and newborn-care, and of preventing mother-to-child transmission of HIV, are lowered.  For each dollar spent on contraceptive services, the cost of pregnancy-related care reduces by $1.47.  Expanding access to modern methods of contraception, and associated services, so that current rates of unmet need are met, would result in 163,000 fewer infants infected with HIV by 2015, while reducing total HIV treatment costs by $200 million.  The UNFPA and the Guttmacher Institute report Adding It Up calculates that to provide essential sexual and reproductive health services to all women and girls aged 15-49 in developing countries would cost a mere $25 per woman per year, which, incidentally, is the cost of a movie ticket with popcorn in New York city. When human rights in sexual and reproductive health are upheld total claims on a country’s health budget are reduced while economic productivity and growth are stimulated; promoting a demographic transition that boosts both economic growth and individual wellbeing.  When the number of dependent children in a country decreases, the ratio of productive workers to dependents increases, driving faster economic growth and reducing burdens on families. This window of opportunity is known as a  ‘demographic dividend’ and with more young people than ever before this promises both a “youth” and a “gender” dividend, generating broader, long-term benefits for women, young people, their children, partners and families, economies and societies. Preventing maternal deaths and disability also helps protect individuals and families from catastrophic health expenses and loss of income while preventing unintended pregnancy reduces poverty by increasing women’s and girls’ ability to both access education and employment opportunities and participate more fully in social, political and economic life.  A study conducted in 2013 in Kenya shows that families experiencing a maternal death spend more on medical care and funeral expenses than all other yearly expenses combined, including food, shelter, and education. The impact of complications of unsafe abortion and the expense of treating these are also substantial for households. Human rights associated with sexual and reproductive health matter for women’s economic, educational, and political empowerment and thus for their countries’ advance too.  The autonomy to decide whether, when and with whom to have children, and the opportunity to access quality health services whenever and wherever she needs, is essential to the realization of her other life opportunities and fulfilment.  These realities underscore why the promotion and protection of rights pertaining to sexual and reproductive health are instrumental to the achievement of all human rights including the right to education, the right to decent work, the right to food and the right to participation. While sexual and reproductive health are human rights in principle, they are also right the thing to do strategically and thus right in practice.  Yet, still many women and girls around the world are denied exercise of their rights. Therefore tackling harmful gender norms is a must, given they are at the core of why so many women and girls are deprived of their rights to sexual and reproductive health.  Female genital mutilation, child marriage, rape in marriage, wife inheritance and maltreatment of widows and son preference are all forms of gender based violence and each constitutes a grave impediment to the realization of human rights intrinsic to sexual and reproductive health.   At the same time, unless the grave discrimination and inequalities faced by specific population groups are addressed (i.e. those faced by adolescent girls, persons with disabilities, indigenous women and girls, persons living with HIV, displaced persons, the elderly, LGBT, sex workers and others) we will continue to leave millions of people far behind the sustainable development agenda. Nowhere is this clearer than in regards to adolescents and young person. Today’s youth are 1.8 billion strong, forming a quarter of the world’s population. They are shaping social and economic development, challenging social norms and values, and setting the terms of the world’s future.  While notable progress has been made under the Millennium Development Goals, many young people – especially adolescent girls – are still denied the investments and opportunities that they require to realize their full potential.  Instead, for millions of girl children around the world, puberty – the biological onset of adolescence – brings not only often incomprehensible changes to their bodies but – thanks to perverse gender norms – also new vulnerabilities to human rights abuses, particularly in the arenas of sexuality, marriage and child bearing.  The Beijing+20 review has highlighted that in the past 20 years much has been achieved.  Increasingly countries are removing discrimination from their laws and adopting laws to promote gender equality and address violence against women and girls.  There have been significant gains in girls’ enrolment in primary and – to some extent – in secondary education too. In some regions, women’s participation in the labour force has increased while some regions have made remarkable progress in increasing women’s access to contraception. There have been important gains in women’s representation in national parliaments and significant normative advances have been won in the global agenda on women, peace and security.  However, 20 years on from Beijing, we can see what for women amounts to a life-threatening disconnect between agreed normative frameworks and the reality on the ground.  Implementation, accountability and engaged must be strengthened. Without strong accountability mechanisms to enable women to hold decision makers answerable for their actions, substantial progress for human rights in sexual and reproductive health is unlikely.  To turn this around, commensurate financial resources and political support for key institutions and mechanisms that promote gender equality, and the human rights of women and girls more broadly is essential, including for such as national gender equality mechanisms and national human rights institutions.  Ensuring there are mechanisms for tracking and reporting on commitments made to human rights in sexual and reproductive health is also an essential part of building and fortifying accountability. UNFPA is undertaking bold and innovative measures to turn advance human rights. We are supporting countries to address gender and sexual based violence, for example, by working with sister UN agencies to support governments provide access to essential services for survivors and victims of gender based violence.  We are enabling South-South cooperation and learning between countries through ground-breaking initiatives like the VIRAVIDA programme in Brazil, which brings together the private sector, government and community organizations to empower, educate and employ marginalized young people who have been sexually violated.  By committing resources and action to support women and girls around the world to exercise autonomy over their bodies and fertility, including by enabling access to safe, voluntary family planning, we are ensuring realization of rights pertaining to their education and their labour force participation. Promoting the engagement of men as supportive partners in gender equality, we have established “husbands’ schools” that aim to promote better health for women and children. Implementing our Adolescent Girls Initiative, we are reaching the most marginalized adolescent girls, protecting their rights, particularly by delaying age at marriage and childbearing, by empowering them and by elevating their social status in their communities.  Right in principle, smart in practice and plain strategic for sustainable development: the most pressing question cannot be “why should governments invest in human rights for sexual and reproductive health?” but rather “why haven’t they?”

When IPPF refocused efforts with the three Changes Goals – Unite, Deliver and Perform – an ambitious commitment was made to double the number of sexual and reproductive health services provided between 2010 and 2015. We are proud to announce that 175.3 million services were provided in 2015, only 1 per cent below the goal of 176.4 million. This is a remarkable achievement and a result of Member Associations’ unwavering efforts and commitment. More than eight in ten clients who received services from IPPF were poor and vulnerable, while 44 per cent of our services went to young people. In 2015, Member Associations and collaborative partners in 48 countries contributed to 82 legal and policy changes that support or defend sexual and reproductive health and rights. At the regional and global levels, IPPF’s advocacy contributed to 22 policy changes. The highlight of our advocacy achievements was the inclusion of gender equality and women’s empowerment, sexual and reproductive health, and reproductive rights in the 2030 Agenda for Sustainable Development. IPPF continued to invest in learning, business processes and information management systems to drive performance and value for money. We are increasingly using data to guide decision making and to ensure accountability to our clients, donors and partners.

by Doortje Braeken, Senior Advisor on Adolescents, Gender and Rights  Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and post-traumatic stress disorder. Adolescent mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behaviour outcomes for their children like was discussed before. I am not a midwife or an expert in Maternal Care Health (MCH). My background is in sexual and reproductive health programming for adolescents and young people, with a focus on girls. And I have to be honest, most colleagues who work in the area of Adolescent Sexual and Reproductive Health (ASRH) are not so focussed on young pregnant girls or mothers; we are more obsessed with the prevention of pregnancy and seem to lose interest the moment a girls gets pregnant. To the ASRH world, it seems that each young girl that becomes pregnant is a failure. Although we all believe in a life cycle or a life course approach it seems that we have made pregnancy as the cutting of point of work with young people. Most international discussion on adolescent childbearing focus mainly on the medically hazardous issues and complications and the emotional aspects of pregnancy are hardly ever mentioned. I remember in IPPF we organized an international meeting some years ago on girls’ empowerment under the title Girls decide. We had workshops and of course we discussed issues like gender inequity, education, prevention of pregnancy etc. We also had a workshop on girls: Who want to get pregnant. The reaction of some of the participants was astonishing. They said that this was not appropriate because girls shouldn’t get pregnant. And that tells us a lot. The Sexual and Reproductive Health (SRH) and Maternal Care Health programmers/providers are often in different worlds, with each their own professional values, standards and approaches and that doesn’t help the young pregnant girl or young mother, especially if she has mental health problems. Young girls are often unseen in their communities; are seen as a burden have little power over their own lives and their sexuality. Most adolescent girls who give birth for the first time,  do this with sparse knowledge, health care, and support. Too few young women are empowered enough to access critical sexual and reproductive health services. Compared to older women, many adolescent girls are more likely to give birth without a skilled attendant, which further compounds their risks and will certainly not help when they suffer emotional or mental health issues. In many predominantly patriarchal societies (South Asia and Africa), the customary thought of people is that "girls are born to be fed throughout their lives" and "boys are born to earn and support the whole family". This thought is reflected through discriminative behaviours of people towards girls, also during and after their pregnancy. We know that in some parts of the world suicide is one of the main causes of adolescence mortality; often caused by SRH issues including pregnancy. So there is a great need to address the emotional and mental health aspects of teenage pregnancy, not only for the young mothers but also for their children. But also in western societies young pregnant girls and teenage mothers face plenty of challenges, from dealing with the shame and stigma of an unplanned pregnancy to finishing school and finding employment. But many must also deal with the challenges of mental illness. Researchers have found that twice as many teen moms are at risk of developing postpartum depression (PPD) as their older counterparts. And nearly three times as many adolescent girls with mental illness get pregnant as adolescents without a disorder. According to a survey of 6,400 Canadian women published in the journal Paediatrics in May 2012, the highest incidence of postpartum depression occurred among girls age 15 to 19 – at a rate twice as high as PPD in mothers older than 25. The stigma of teenage pregnancy can be a barrier to recognition and treatment and we as adolescent SRH programmers should be much more aware of that.  Gloria Malone,  co-founder of #NoTeenShame, a social media campaign to raise awareness of the shame and stigma faced by teenage  mothers says ‘ According to society, pregnant and parenting teens must be punished and used for political prevention campaigns, instead of being treated as the fully human individuals that we are." Girls age 15 to 19 with a diagnosis of a major mental illness, such as bipolar disorder, depression and schizophrenia, are almost three times as likely to give birth as adolescents without mental health issues. When adolescent girls with mental illness become mothers, they may find it "very, very difficult to parent a child in a healthy way," especially if there's a history of trauma or abuse and breastfeeding may feel inappropriate and too intimate," according to Simone Vigod, researcher at Women's College Hospital in Toronto. - Supporting teenage mothers with mental health issues can also bring opportunities for prevention. A pilot study at Women & Infants Hospital of Rhode Island found that an intervention program which included good reproductive health counselling cut the incidence of postpartum depression in teen moms by half. What are recommendations for improvement? In the ASRHR community we are working hard to address the SRH rights of young people., and these should include the rights of young pregnant girls and young  mothers. We believe all young people under 18 years should enjoy the full range of human rights, including SRH rights. The importance and relevance of some rights change as a person transitions from infancy to childhood to adolescence; these are the dynamics between autonomy and protection Therefore, the rights of young people must be approached in a progressive and dynamic way. Often people talk about protection of young people more than autonomy.  A general and vague notion that children need ‘protection’, broadly, can be counterproductive. Protection is actually about challenging power – protection shouldn’t be about restricting young girls’ agency, but rather protecting and promoting their  agency by recognising and addressing the unequal social contexts in which children are embedded. It is the unequal social position of young girls in relation to adults that gives rise to protection needs. For us, it is about empowerment of young women and girls, whether they have chosen to prevent pregnancy, to end their pregnancy, or be pregnant or a young mother: they all need support to be literate about SRHR, have the confidence and competence to choose for prevention of pregnancy, abortion or for pregnancy. It is also about our own values as programmers ,educators  policy makers and health providers; what are our values on teenage pregnancy; we need to ask ourselves, how will we react  if our teenage daughter or cousin  gets pregnant when she is 15; what do we want for during and after her pregnancy? This will help us to from our ideas how can we prevent and/or address emotional and mental health issues during and after pregnancy; how can we work together to ensure that girls get pregnant when they choose to, without force because of early marriage, without being discriminated or neglected or without being forced into a transition from an adolescent world to an adult world . What will we do for young girls after pregnancy; even if there are policies they can go back to school, the reality is different; they often cannot go back at all or to another school they were in before their pregnancy, because again of fear of discrimination, bullying and self- stigmatization.   Some recommendations Individual: self- care/empowerment : young pregnant girls need to be well informed about protecting their own health and their babies to be; they need information and support to make a health plan; need post -natal care/information etc. on emotional and mental health issues.; prevent second pregnancy if they want Father/Intimate partner/Family: need information how to support adolescent; send her or accompany her to  health facilities; help to prepare child birth; support her when baby is there Community: need to support by addressing stigma and discrimination; arrange financial support during pregnancy; advocate having special facilities for young mothers; ensure that young mothers can go back to school etc. Health care providers; need to know the specific risks of early pregnancy; can arrange prompt transfer to emergency care; give medical , mental and emotional support  before, Policy makers; developing SRH policies for young people. It should not only address the risks of sexuality and young people, should not only look at prevention in education and service delivery; it is about giving equal attention to girls who choose to become pregnant or who are pregnant both in education and service delivery We need much better collaboration and synergy between professionals from the ASRHR, RH and MCH worlds; get rid of the pillars and start communicating and collaborating But most of all, listen  to young people, involve them and give them a voice to express their needs and wants   We need to support young pregnant girls and mothers helping to them in balancing parenthood with their own needs, and helping them create better chances for their children. We need encourage self-expression and help young parents deal with difficult emotions by challenging feelings of loss, low self-worth and lack of ability and give them back agency over their own lives for their own heath and that of their children.

One month on the Cyclone Winston hit Fiji, IPPF-SPRINT is still providing sexual, reproductive and maternal care to cyclone-affected population. 

Julie was a midwife with the Ministry of Health for 20 years before she joined the Vanuatu Family Health Association (VFHA) as nurse and project manager for IPPF's SPRINT Initiative response in Vanuatu. When Cyclone Pam hit Vanuatu, the SPRINT Initiative and VHFA started providing life-saving services to the Island, Tanna, which was the population worst affected by the typhoon. Many communities there live remotely, in grass huts, with no immediate access to medical care.  Julie was there with the VFHA team. “When I first came here we used the kitchen to operate from. On my second trip, we created a clinic in our youth centre, and used the nearby health post for clinical procedures. Soon we saw more patients pouring in, which created a huge demand for space." Health conditions are very low. Even before the cyclone hit the island, it was reported that the average mother loses two pregnancies each, in her lifetime. Every person in the village knows at least one mother who has died during child birth. Access and knowledge to family planning is overlooked as traditional practices are used first. As Julie explains, advocating about family planning is a challenge in the area, also for language barriers. “Talking about birth-spacing and talking in the regional dialect of Tanna is a problem. Most of us in Vanuatu speak Bislama, but people here in Tanna aren’t well versed with it. However, we try our level best with all possible methods including sign language and demos to impart knowledge about family planning.” Family planning services are just a part of the IPPF-SPRINT Cyclone Pam response, that also included general health check-up, counselling and awareness about Sexual and Gender Based Violence, maternal care and awareness and prevention of HIV and Sexually Transmitted Infections (STI).  

IPPF’s medical mission team was first on the ground in Nataleira, after the Cyclone Winston hit Fiji thanks to the SPRINT initiative and additional funding from the Government of Australia. Here Ana and Kini talk about the aftermath, the importance of medical checks, dry clothes and dignity kits. Anasimeci Marama, a 44-year-old mother, lost everything during the Cyclone Winston that hit Fiji two weeks ago. Originally from Nalidi in the province of Ra, Ana moved to Nataleira after her marriage and lives in the village with her husband and their four children. She recalls the terrifying night when the cyclone hit as the ‘scariest of my life’. Their home was completely destroyed leaving them no option but to run for their lives. Carrying her nine-month old daughter, Ana, and her other three children she sought shelter at the village cemetery. After two days of what she describes as her ‘most heartbreaking experience’, Anasimeci finally managed to find dry clothes for her nine-month old daughter, while everyone else in her family waited until Monday to have a change of clothes. Thanks to the village chief, Ana learnt about the IPPF-SPRINT’s reproductive health medical mission, where she received health checks and reproductive health information. “The response of the IPPF medical mission team is a godsend”, the village chief told us.   Kinisimere Bote gave birth to her third child only a week before Cyclone Winston hit Nataleira, the village where she has lived since childhood. It destroyed her home. The whole family had to run from what Kini calls “the most horrific storm”. Soaking wet, she and her three children found refuge at another relative’s home, where they stayed until the storm died down. Like many other villagers they were stuck in wet clothes for days. IPPF medical mission were the first to offer Kini and her baby medical checks. In addition to the check-ups, Kini and her family received ‘dignity kits’. These essential kits contain basic, culturally-appropriate hygiene and protection that displaced women need, items such as a bucket, sanitary towels, maternity pads, toothbrush, soap, a sarong, slippers and torch and whistle. The torch and whistle are to reduce vulnerability. Women are especially vulnerable in camps  – often the paths to latrines are unlit at night, leaving women and girls vulnerable to sexual attack. If you want to help people like Ana and Kini who need shelter and healthcare after the cyclone, you can make a donation: http://www.ippf.org/donate I should be the last person to say so, but no social platform or technology will never beat the inner pleasure of a piece of paper and a pencil.   Since 2007, SPRINT (Sexual and Reproductive Health Program in Crisis and Post-Crisis Situations) has responded to 61 emergencies and has reached over 754,000 beneficiaries across 95 countries across Asia, Africa, and the Pacific.

On International Women’s Day, the International Planned Parenthood Federation (IPPF) has welcomed a new commentary from UN experts which says that the right to sexual and reproductive health is indivisible from other human rights. “It is absolutely right for the Committee to address the issue of sexual and reproductive health specifically, today of all days,” said Tewodros Melesse, IPPF’s Director General. “Sadly millions of women are still denied their basic rights because they are poor, because they suffer discrimination or because they lack legal protection.”  The 18 independent members of the Committee on Economic, Social and Cultural Rights said that the right to sexual and reproductive health was not only an integral part of the general right to health, but fundamentally linked to the enjoyment of many other human rights, including the rights to education, work and equality. They said that a lack of care for mothers in childbirth or a lack of access to safe abortion, often leading to maternal death, constitutes a violation of the right to life, and in certain circumstances can amount to torture. “No woman should die in childbirth in 2016 because of a lack of adequate care,” said Mr Melesse. “We know that access to safe abortion saves women’s lives, yet millions are denied that right.” IPPF is a network of sexual and reproductive health and rights organisations in 170 countries that are equipped to monitor and respond to any member of the public who wants information, services, contraception and access to abortion and are available to serve at the first point of response. For further information and interviews contact press office 02079398227 

“I have never experienced such a strong cyclone in my 77 years of life.” Jokaveti Bavou lives in the village of Drauniivi, in the Fijian province of Ra. It was right in the path of Cyclone Winston, the strongest storm to ever strike the Southern Hemisphere. A week on from the disaster, Jokaveti, her son Jim and her grandchildren are safe. But there is no longer a roof on her house, and precious little left inside. In a village of 910 people, 75 houses were completed destroyed and about 65 damaged. Jokaveti was in her house with her grandchildren when Cyclone Winston arrived. “On Saturday night the winds started to increase. I told Jim that I was not sure of the house; I didn’t believe that it would be able to keep us safe. I told him that if the house started to collapse, we would run to his house for safety.” “The wind was getting stronger and when I looked at the back door, it had blown open. I took a hammer and nail to it. But when I got back to the other room, the main door had blown open and the wind was really strong. Then the wind took the roof off my house.”  “I told my granddaughter that everything was terrifying and we needed to go and hide somewhere. It was not safe to be in the house because of the flying debris.” “I got out and my son called out from his house and told us that we should go and hide underneath our house. He tried to come out of his house to save us, but the wind was so strong and roofing iron was flying around.” “I went underneath my house with my grandchildren holding a lamp and stayed there until the wind died. My son’s eyes never left us. Luckily for us a corrugated roofing iron flew and covered where we were hiding. I just cried and continued to thank God for keeping us safe.” “I could sense fear from all of us including my grandchildren. They were crying too. My son kept on calling to check on us until the wind died down.” Miraculously, no-one from Jokaveti’s family or the village was killed or seriously injured. IPPF is establishing centers in the Northern and Western parts of Fiji to provide medical services, especially those that deal with maternal and child health and sexual and reproductive health.  It is working closely with the Reproductive and Family Health Association of Fiji (IPPF’s member in Fiji), UNFPA Pacific, Empower Pacific, Fiji’s Ministry of Health and Medical Services. Donate now!