ARROW - Asian-Pacific Resource & Research Centre for Women http://arrow.org.my/newsletter/2013/jul/3/edm1.htm
This Asia-Pacific monitoring report is part of ARROW's Global South ICPD+20 monitoring initiative. ARROW has consistently monitored the implementation of sexual and reproductive health and rights in the Asia-Pacific region, to assess progress/lack of progress in select countries with the support of national level partners. As a result of this work over the years, ARROW has accumulated the experience in developing critical SRHR monitoring indicators; a methodology of carrying out monitoring and advocacy around the International Conference on Population and Development (ICPD) Programme of Action.
ARROW in the past has monitored the ICPD implementation in the Asia-Pacific region in 1999, 2005 and 2009. We had realised that in the lead up to 2014-2015, it is critical to bring together voices of a larger constituency, whose lives will be impacted by the proposed new development framework being negotiated in 2014-2015. Representing the global south voices and taking the agenda of monitoring SRHR beyond the Asia-Pacific region to include the larger global south voices is seen as critical at this time, especially to influence and enable the ownership of the SRHR agenda in such a way that any action plans around SRHR beyond 2014 will take into account the voices from the southern women and young people, and their lived realities.
This report looks at the status of sexual and reproductive health and rights across 21 countries in the region: Afghanistan, Bangladesh, Bhutan, Myanmar, Cambodia, China, Fiji, India, Indonesia, Kiribati, Lao PDR, Malaysia, Maldives, Nepal, Pakistan, Papua New Guinea, Philippines, Samoa, Sri Lanka, Thailand and Vietnam. It has found that given the status of uneven progress in the area of sexual and reproductive health and rights, it is imperative to continue political commitment and financial investment in the SRHR agenda by governments and donors in the Asia-Pacific region. Most of the 21 countries under review are signatories to major human rights instruments including the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). However, at least 10 out of the selected 21 countries have made reservations and/or general declarations on different articles in CEDAW especially on Article 16 relating to issues of marriage and family.
In the 21 countries reviewed, total expenditure on health as a percentage of GDP falls below 5% in 12 out of the 21 countries. The increasing trend of privatization of healthcare in Asia Pacific coupled with higher rates of out-of-pocket expenditures pose a significant barrier towards achieving universal access to health in general and women's SRH services in particular.
The region has shown some progress towards universal health coverage with three countries in South East Asia: Indonesia, the Philippines and Vietnam achieving 50% health coverage while two countries Malaysia and Thailand have achieved near universal coverage. China has reportedly provided nearly universal basic health insurance coverage. The challenge however remains with health care packages not being comprehensive and inclusive of all SRH services.
Universal access to SRH services seems to be difficult to achieve even in countries where there are efforts to promote universal health coverage with challenges in both supply and demand side barriers including cultural factors and gender power relations.
Socio-economic inequalities play a determining role in the access to contraception, maternal health services and other SRH services. This is validated by the DHS data showing women with lower or no education, poor women, women who lived in remote, hard-to-reach areas having less access to contraception and other SRH services.
Current national aggregate data on key SRHR indicators reported for MDG purposes hides disparities within countries. This is further validated by the available demographic and health surveys (DHS). In the region, women who are poor, less educated, live in remote areas and/or rural areas face greater difficulties in accessing sexual and reproductive health services and realising the autonomy of their bodies. Women from ethnic minorities, women from lower castes, and younger women are also marginalised.
The report calls for four major areas where urgent improvement is necessary in order to meet the targets and objectives of the ICPD PoA. These recommendations are: policy change with respect to reproductive rights and sexual rights; universal access to optimal sexual and reproductive health; continued, committed and sustained governmental and donor investment in women's sexual and reproductive health; and the concretisation of sexual and reproductive health and rights for adolescents and other marginalised groups.
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