This is the plenary presentation of Sai Jyothirmai Racherla of ARROW, which took place as part of Seventh session of 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR10) Virtual, on 14th September 2020, on the theme of "Population ageing and sexual and reproductive health and rights (SRHR) in Asia and the Pacific". CHAIR: Sono Aibe PLENARY SPEAKERS * Caitlin Littleton, Regional Programme Adviser, HelpAge International, Asia Pacific | "Sexual health of older people: an overview" * Sai Jyothirmai Racherla, Deputy Executive Director, ARROW | "Reclaiming and Redefining Rights -Older Women's Health and Well-Being in Asia and the Pacific Region at ICPD+25" * Krishna Gautam, founder and Chair of Ageing Nepal | "Not Leaving Older Adults Behind in the process of achieving SDG-2030" A B S T R A C T P R E S E N T A T I O N S * Dr Tey Nai Peng | Understanding the Sexual Behaviour of Older Men and Women in Malaysia * Prof Xiaoming Sun | Unmet Needs on Sexual and Reproductive Health among Women Aged 50-64 in Rural China For more information on this session go to www.bit.ly/apcrshr10virtual7 #SRHR #sexualhealth #reproductiverights #familyplanning #womenshealth #LGBT #genderequality #SDGs #ageing #elderly #olderpeople #IDOP2020 #InternationalDayOfOlderPersons

2. SAI JYOTHIRMAI RACHERLA
ASIAN PACIFIC RESOURCE AND RESEARCH CENTRE FOR WOMEN (ARROW)

3. Statistical Profile of Older Persons in the Asia Pacific region
• In 2019, an estimated that 60.1 per cent of 702.9 million world’s older
population (65 years or over)resided in the Asia-Pacific region.
• Women constituted 52.9 per cent of the persons within this equation.
• Declines in fertility and mortality in the region have resulted in these
fundamental changes in age structures of population in the region
Source https://www.unescap.org/our-work/social-development/ageing/about

4. Intersectionality
• Important to recognize- older persons are not a homogenous
group, and come from diverse socio- economic backgrounds,
immigrant and ethnic minorities, living in poverty and with
disability, living in emergencies, sexual and gender minorities,
indigenous persons, persons living with HIV and sex workers,
widows and single women.
• Discrimination based on age is combined with gender and the
above diversities , negatively affecting the enjoyment of full
range of human rights and dignity of older persons .

5. Implications
• Longevity revolution--- opportunities await to be harnessed?
• These demographic shifts have implications related to health ,
health care systems, health workforce, health care
technologies , social protection, employment, quality of life
and long term care of individuals including humanitarian and
disaster response.

6. International Commitments in Relation to Older persons – a chronology
Year Framework
1982 First World Assembly on Ageing
Vienna International Plan of Action on Ageing
1991 10th anniversary of Vienna International Plan of Action on Ageing and adopted UN Principles
for Older Persons…(independence, participation, care , dignity…)
1992 International Conference on Ageing and adopted the “ “Proclamation on Ageing”.
2002 Adopted Political Declaration and the Madrid International Plan of Action on Ageing
Member States in the Plan of Action, committed to promote and protect gender equality,
human rights and fundamental freedoms of older persons, and eliminate all forms of
discrimination including age-based discrimination and dignity enhancement, and eliminate
all forms of neglect , abuse and violence.

7. Other Human Rights Frameworks with Reference to Older Persons
Issues of ageing have also been prioritised in the treaty bodies, and the Human Rights Council
work.
• International obligations to older persons are implicit in most core human rights treaties, such as covenants, on
Economic, Social and Cultural Rights and on Civil and Political Rights, the Convention on the Elimination of All
Forms of Discrimination against Women and the Convention on the Rights of Persons with Disabilities.
• In 2010, at the 47th Session of the Committee on the Elimination of Discrimination Against
Women (CEDAW) adopted a General Recommendation no 27 on Older Women and the
Protection of their Rights. The Recommendation includes policy recommendations to
mainstream the concerns of older women into national strategies and development
initiatives. The Recommendation also recognizes the importance of maintaining
disaggregated statistics and will require States to report on the situation of older women
in their countries. It is an important step toward ensuring that older women can participate
fully in the political, social, cultural, civil and other fields in their societies.

8. International Conference on Population and Development
Programme of Action (ICPD-PoA)
International commitments such as,
• International Conference on Population and Development (ICPD)
Programme of Action (PoA);
• Beijing Platform for Action (BPfA);
• the General Assembly Resolution 70/1 – Transforming our World:
the 2030 Agenda for Sustainable Development;
• the Addis Ababa Action Agenda of the Third International
Conference on Financing for Development;
have all discussed ageing in the outcome documents.

9. WHAT DOES THE INTERNATIONAL CONFERENCE ON POPULATION AND
DEVELOPMENT (ICPD) PROGRAMME OF ACTION (POA) SAY ?
The ICPD Programme of Action, calls upon governments to :
• Enhance through appropriate mechanisms the self-reliance of elderly persons and create
conditions that improve the quality of life… (6.17.a);
• Develop systems of health care, economic and social security paying special attention to
the needs of women… (6.17.b);
• Enable elderly people to lead self-determined, healthy and productive lives (6.19);
• Eliminate all forms of violence and discrimination against elderly people paying special
attention to the needs of elderly women (6.19).

10. 6th Asia Pacific Population Conference Ministerial Declaration
• Closer to home the 6th Asia Pacific Population Conference ministerial
declaration, stressed the need to adapt health and social systems in
response to the rising demand for elder care and support, with particular
attention to the specific needs of older women. …Implement and monitor
laws and regulations on the basis of gender equity and equality to
strengthen the protection of the rights of older persons with a view to
eliminating all forms of discrimination, abuse and violence against older
persons, including ageism in employment, health care and other
settings(161) , and Strengthen health and social protection systems to
prepare for and respond to the needs of older persons by adopting a life
course approach and by providing an integrated continuum of care,
including preventive care, acute care, chronic disease management, long-
term care and end-of-life care, and palliative care.

11. Key Trends in which the Ageing Phenomenon is occurring in the Region
a) an increase in the proportion of older persons
In 2016, approximately 12.4 per cent of the population in the
region was 60 years or older, but this is projected to increase to
more than a quarter — or 1.3 billion— people by 2050.
b) an increase in the pace of ageing- The pace of ageing in the
Asia Pacific region is also rapid. While countries such as China,
Thailand and Vietnam will take 25 years, 22 years and 19 years
only for moving from ageing to aged societies, countries such as
France have taken 115 years.

12. Key Trends in which the Ageing Phenomenon is occurring in the Region
c) Even in countries with low proportion of older persons, the absolute
numbers of older persons can be quite significant,- While the proportion of
persons aged 60 years, in the region shows South and South-West Asia sub
region having the lowest proportion of persons aged 60 years, in absolute
terms the number of older persons in the same sub-regions is 168 million
(2016), which is 33% of all persons over 60 years of age living the Asia
Pacific (ESCAP) region.
These demographic shifts have huge implications, as stated earlier but also in
the provision of SRHR information and services without stigma ,
discrimination and violence

13. Monitoring Progress at ICPD+25: Where are we
• Gender dimension of ageing
• Social protection for elderly/older persons
• Elder abuse/ older persons abuse
• Health of elderly/ older persons

14. Gender Dimensions of Ageing
• In the Asian and Pacific region, women outlive men by at least four years on
average. This difference is as high as 13.2 years in Republic of Korea and 12.7
years in the Russian Federation.
• Women’s longer life expectancies and the consequent larger proportion of older
women living alone throws challenges on a number of issues, as older women
have lesser income security, and are often discriminated against due to limited
access to resources and opportunities including health care, adequate housing,
social protection and legal justice.
• These challenges are further aggravated for women in cases of widowhood and
divorce. With the death and disability causes changing from infectious to non-
communicable diseases, these are other health challenges that need focus.

15. Gender Dimensions of Ageing
• Older women face greater risk of physical and psychological abuse due to
discriminatory societal attitudes and the non-realisation of the human rights of
women. Some harmful traditional and customary practices result in abuse and
violence directed at older women, often exacerbated by poverty and lack of
access to legal protection.
• Women’s poverty is directly related to the absence of economic opportunities
and autonomy, lack of access to economic resources, including credit, land
ownership and inheritance, lack of access to education and support services and
their minimal participation in the decision-making process.
• Poverty can also force women into situations in which they are vulnerable to
violence and discrimination including sexual exploitation.

16. Gender Dimensions of Ageing
• Although living longer, evidence points to prevalence of poor
health conditions among older women such as urinary
inconsistence, vaginal fistula, pelvic infections, cancers of
reproductive systems, mental health issues including
depression, dementia, cardiovascular diseases.. Which have
impact on dignity and well-being of women, but also many of
these conditions are results of lifelong gender discrimination
faced by women

17. Social Protection for Older Persons
• All countries in the region face major challenges to ensure that their health
and social systems are ready to make the most of this demographic shift in
ageing, and enable an environment of opportunities for older persons in
the region.
Some good practices in the region include:
• Japan has integrated long -term care insurance to protect people from the
costs of care;
• Thailand is strengthening the integration of health and social care as close
as possible to where people live;
• The Ministry of Health in Vietnam will build on its comprehensive health
care system and the large number of elderly health care clubs to better
meet the needs of older people in their communities.

18. Social Protection for Older Persons
• Pension funds in the region often only provide coverage for public sector,
in some instances, formal private sector, but not informal sector. The
coverage of women by the labor based social protection schemes is
significantly less in comparison to men.
• Republic of Korea has reformed its pension for all older persons in 2015, to
guarantee a basic pension for all older persons.
• It is understood that all Member States report some form of non-
contributory pension scheme for older persons, however it is understood
that the coverage of these pension schemes , size and frequency do not
provide for minimum subsistence level income.
• Governments of Nepal, Samoa and Thailand provide universal social
pension schemes for all persons above a certain age

19. Policies to provide healthcare for older persons
• The Government of Vietnam – Decision No. 7618/2016 on health
of older persons.
• Some Member States in the region have put in place policies to
provide healthcare for older persons, many member states have
reported free or subsidized healthcare through public health
insurance, universal free health care, discounted medication and
supplies…
• However the details of the health care programmes,
implementation, coverage of older persons, coverage, reach and
range of services is a huge question.

20. Abuse of Older Persons
• The WHO defines “elder abuse” as “harm to an older person through a single or repeated act or lack of
appropriate action, occurring within any relationship where there is an expectation of trust, which causes
harm or distress to an older person” (WHO, 2016d). Abuse may be physical, psychological, sexual, emotional
or financial, including neglect and abandonment.
• Estimates note one in six older persons experience some form of abuse worldwide. This
is a gross human rights abuse.
• Understanding the prevalence and a situational analysis is the first step towards
developing a public health, and community approach. Data among women beyond the
reproductive age (15-49) is neglected, DHS for example, and this is a huge barrier to
inform progress/ lack of progress on older person issues.
• The other gap is also a lack of consensus in defining and measuring elder abuse and
its major subtypes (psychological, physical, sexual, and financial abuse and neglect),
as a result there are variations in prevalence reporting.
• There are dearth of studies on elder abuse. Most of the Dong did a small-scale
systematic review of prevalence studies and grouped estimates by continents, including
Asia with a range from 14% in India 23 to 36·2% in China.

21. Abuse of Older Persons
• It is widely known that older women are at lesser risk for sexual violence than
younger women, but current inattention to older women in the gender-based
violence (GBV) field has minimized the experiences of older women survivors at
great detriment to their health and rights. For example, health providers seldom
ask older women about their sexual activity and relationships, a neglect that
leads to older women being excluded from necessary HIV testing and care as
well as support services for abuse.
• This oversight is increasingly worrisome given the rise in new HIV infections
among adults age 50 and older in recent years, with the majority of
transmissions stemming from individuals unaware of their HIV-positive status.
• Approaches are required in public health interventions for GBV and HIV that
acknowledges older women – their sexuality, sexual agency, and activity – so that
health providers and advocates acknowledge and serve older survivors

22. Recommendations
• Reclaiming the framework suggested by the International Conference on Population and
Development and the Beijing Platform for Action, it is important to relook at the global
health policies to incorporate a life course approach to women’s health as a matter of
human rights.
• A concerted research effort is needed to provide a basis for developing policy guidance and
for pinpointing essential indicators and establishing necessary data systems to enable a
routine tracking of progress and strengthen the capacity to mainstream gender, age and
age-related disability analysis
• Strengthen the development and implementation of comprehensive and integrated policy
frameworks that address and mainstream population ageing into national development
strategies and plans, heath and gender equality plans in line with the Madrid International
Plan of Action on Ageing;
• Ensure that no older persons are left behind, including, in particular, older persons living
in rural and urban areas, indigenous and ethnic minority older persons, older migrants
and older women and vulnerable older persons in general;

23. Recommendations
• Ensure the inclusion of older persons, and their specific requirements,
vulnerabilities and capacities, in policymaking processes, including in
humanitarian contexts and in particular in disaster risk reduction policies,
strategies and practices and in emergency response;
• Align disease prevention and health systems and to advance universal
health coverage, as appropriate, as a platform for bringing together
various health and development efforts, so that all older persons have
access to quality health services locally without suffering the financial
hardship associated with paying for care;
• Develop health and social long-term care systems, including palliative care,
that can deliver high-quality integrated care, while recognizing and
enhancing the capacity of formal and informal caregivers and volunteers;

24. Recommendations
• Health services for older persons need to ensure mental as well as physical
health, address violence, neglect and abuse of older persons, promote
positive images of ageing, prevent ageism and age-related discrimination
at the workplace.
• Currently data for persons beyond the reproductive years is not available,
and data on population ageing and age-disaggregated statistics as key
elements in formulating evidence-based policies and of supporting
monitoring and evaluation of programme delivery to assure their efficiency
and effectiveness
• Human rights and gender equality are central to address the issue of
ageing in Asia Pacific, and policies to take into account a lifecycle approach

25. Reference
https://arrow.org.my/publication/older-womens-
health-and-well-being-in-asia-and-the-pacific-
region/
This brief is part of ARROW’s State of the Region
Report on Sexual and Reproductive Health and
Rights: International Conference on Population and
Development (ICPD+25), developed as a result of
monitoring of 25 years of implementing the ICPD
programme of Action in the region by ARROW and
our partners.