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Mdg 5


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Suggestions for global agenda post 2015 MDGs, vision for SRHR, public health policies and programmes, Maternal Health priorities in India

Suggestions for global agenda post 2015 MDGs, vision for SRHR, public health policies and programmes, Maternal Health priorities in India

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  • the SRHR agenda has been reduced primarily to a focus on maternalhealth. At the same time, maternal/women’s health has been linked to newborn, infant,child and in some cases even to adolescent health, leading to a confused and confusing setof objectives and targets. The way in which this narrowing has taken place does not evenserve the purpose of reducing maternal mortality, as this depends on provision of the fullrange of sexual and reproductive health services, a human rights framework, and takinginto consideration the underlying social and economic determinants of health.
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    • 1. MDG 5 : Whither Reproductive and Sexual Health and Rights? Renu Khanna Expert Group Meeting Structural and policy constraints in achieving the MDGs for women and girls (UN Women – ECLAC) Mexico City, Mexico 21-24 October 2013
    • 2. MDGs a betrayal of comprehensive SRHR commitments? • ICPD – 1994 – Human Rights based – Defined Reproductive Health – through the woman’s life cycle • Beijing PfA – Sexual Health and Rights • Millennium Development Goals – 2000 – Narrowed it to target oriented approaches – Technical solutions
    • 3. MDG 5 - Improve Maternal Health • Originally, Target 5a – Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio – Proportion of births attended by skilled health personnel • Revised in 2005 - Target 5b - Achieve, by 2015, universal access to reproductive health – Contraceptive prevalence rate – Adolescent birth rate – Antenatal care coverage (at least one visit and at least four visits) – Unmet need for family planning
    • 4. In India, gains after ICPD reduced to….. Reproductive health MMR Skilled birth attendant Institutional delivery Cash Incentive JSY
    • 5. Reporting on expanded list? Government of India response….. • decided to monitor only the MMR and proportion of births attended by Skilled Birth Attendants. • No explanation of why Contraceptive Prevalence Rate, Adolescent Birth Rate, ANC and Unmet Need for Family Planning are not actionable indicators or considered ‘strategic’ or ‘contextually relevant’ for India! Although we routinely collect data on these indicators… An accountability issue?
    • 6. Issues around Indicators • Skilled birth attendance, Institutional deliveries, or ‘Safe’ deliveries? • Post Natal Care? • Access to safe abortion services? • Access to Emergency Obstetric Care? • Universal access to reproductive health care – what about – – – – – Morbidities like fistulas, genital prolapses, Prevention and treatment of RTIs/STIs/HIV and AIDS Reproductive cancers Infertility Mental Health issues – PP depression, anxiety and depression around proving ‘right’ kind of fertility, violence – Comprehensive sexuality and relationship education
    • 7. Issues around ‘Siloisation’ • MDG 1 and MDG 5 – aggregates don’t reflect inequities, malnutrition, anaemia in women and girls a determinant of maternal health • MDG 3 and MDG 5 – women’s empowerment leads to better maternal health outcomes • MDG 6 and MDG 5 – Malaria in Pregnancy, TB in pregnant women can have fatal outcomes. Maternal health issues of women living with HIV? • MDG 8 and MDG 5 – women’s access to essential medicines? • Verticalisation – RH (no SRH) and HIV/AIDS (only SH no RH) !
    • 9. Principles (Langkawi Report 2010) • Locate SRHR within macroeconomic influences on Health – role of global capitalism, GHIs, increasing privatisation and commodification of health • Locate women’s health within a social determinants perspective • Emphasise economic and social justice perspective for service delivery • Emphasise strengthening of health systems to address SRHR within primary health care • Use General Comment 14 (Article 12 of ICESCR), UN HRC June 2009 on preventing maternal mortality and morbidity • Ensure participation of affected groups in agenda setting and holding duty bearers accountable
    • 10. ARROW - additional indicators for MDG 5. • • • • • • Adult lifetime risk of maternal death Maternal deaths due to violence against women Availability of Emergency Obstetric Care (EmOC) services Met need for EmOC services Legal age of marriage vs. Median age of marriage Accessibility and quality of adolescent - and youth - friendly SRH services • Reasons for non-use of contraception • Provision of informed choice • Percentage of women of reproductive age irrespective of marital status using a preferred contraceptive method of their choice
    • 11. Additional Recommendations for Policy and Programme • Include focus on maternal morbidity. Develop standard definitions and mechanisms of reporting. Improve data on incidence and prevalence of maternal morbidities through large surveys like NFHS, DLHS, AHS. Initiate maternal morbidity audits to obtain stronger burden of disease estimates. • Integrate Maternal Health, Reproductive Health, and Family Planning. Undertake a systematic analysis to remove the conceptual separation between these areas as well as to work out the operational aspects of integration. • Improve Post-partum care including provision of contraceptive services in a rights respecting manner.
    • 12. • Enhance male responsibility – contraceptives, prevention of VAW. Transformatory masculinities. • Ensure linkages between community level health care provision and women’s groups at the grassroots, with an aim of increasing health literacy, organising for prevention of violence against women, and increasing awareness of health entitlements. • Operationalise a rapid health care response for women affected by violence And most importantly • Ensure accountability at all levels – including of Global Health Initiatives and provision for community monitoring, grievance redressal
    • 13. Acknowledgements • This presentation derives from – MDG 5 in India: Whither reproductive and sexual rights? Expert paper prepared by Renu Khanna (SAHAJ – Society for Health Alternatives India). 2013. – Breaking Through the Development Silos: Sexual and Reproductive Health and Rights, Millennium Development Goals and Gender Equity: Experiences from Mexico, India and Nigeria. DAWN. 2012 – Repoliticizing sexual and reproductive health & rights: a global meeting, Langkawi, Malaysia 3–6 August 2010. Reproductive Health Matters and Asian-Pacific Resource & Research Centre for Women. 2011 – Women’s Health in India Post 2015 - Policy Brief (Draft), Renu Khanna, Dr. B SubhaSri, CommonHealth. 2013