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The Unfinished Sexual and Reproductive Health Agenda
Repositioning Latin America and the
Caribbean Women Deliver
London, October 2007
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Latin America and the Caribbean:Better off than other developing regions?
Total Fertility Rate
Contraceptive prevalence (modern methods)
Skilled Attendance of Deliveries
HIV Prevalence
Sub-Saharan Africa
5.7 20% 41% 7.2%
South and East Asia 3.5 58% 37% .7%
Latin Latin America America and the and the CaribbeanCaribbean
2.6 63% 86% .7%
Source: UNFPA, 2006
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Deceiving regional indicators
• Regional average indicators mask huge gaps– Population living under
the poverty line: 24%– Range: 6% in Uruguay -80% in Nicaragua
(Haiti a close second at 78%)
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Deceiving regional reproductive health indicators: Maternal mortality
• Although average regional rates are lower than other regions’, some parts of LAC have higher MMR than some countries in Africa.
• Wide range of MMR – Chile: 31 deaths/100,000 live births – Haiti: 680 deaths/100,000 live births (World Bank 2007)
• For example, Namibia’s MMR is 300/100,000 live births and Botswana’s is 100 deaths/100,000 live births (World Bank, 2007)
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Large inequalitieswithin countries
Average country indicators also mask important differences
In Guatemala:– Access to improved sanitation:
• 44% of rural populations• 84% of urban populations
– Indigenous and non-indigenous peoples: • 75% of Mayans vs. 27% of Ladinos live in poverty• 30% of Mayans vs. 11% of Ladinos are illiterate
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Assistance during delivery by place of residency, Peru, DHS, 2000
0
10
20
30
40
50
60
Urban Rural
Doctor
Other healthprofessional Traditional birthattendant Relative or other
No one
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Knowledge and utilization of modern contraceptive methods, Mayan vs. Ladino women, Guatemala, 2002
Source: ENSMI 2002
0
20
40
60
80
100
Knows Used
MayaLadina
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– In Honduras, multiple strategies led by national commitment to address MM decreased it by 40% from 1990-1997
– In Nicaragua abortion was banned even when a woman’s life is threatened (2006)
Public policy and reproductive health: safe motherhood
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Public policy and sexual andreproductive health: HIV and AIDS
– Government commitment to the fight against HIV and AIDS:• Brazil: with progressive policies and
widespread prevention efforts, AIDS mortality dropped by 50% since 1996
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Deceiving regional sexual and reproductive health indicators: HIV and AIDS
• On average, the region has relatively low rates of HIV prevalence, but the Caribbean has the second-highest HIV infection rate after Sub-Saharan Africa
• Top 15 HIV and AIDS prevalence countries outside Africa (% of population, 2005):
– Haiti (3.8)– Bahamas (3.3)– Trinidad and Tobago (2.6)– Belize (2.5)– Guyana (2.4)– Suriname (1.9)– Papua New Guinea– Cambodia– Barbados (1.5)– Honduras (1.5)– Jamaica (1.5)– Thailand– Ukraine– Estonia – Myanmar
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Asymmetries ininternational support
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U.S. Government Support in LAC
• Resources for counter-narcotics and security assistance increased since 2002, especially in the Andean region• Aid levels to LAC did not significantly change in 10 years: 8.2% (94) 9% (04) of worldwide aid budget• RH: Most LAC countries have already “graduated” or will soon do so
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U.S. Foundation Support in LAC
• Peak of 18.3% in 1994 decreased to 5.9% in 2004
• Foundation’s giving priorities for LAC have shifted from health to international development, disaster relief, environment and human rights
• Health grants : 8.3%; Reproductive health: 4.5% (2004)
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U.S. Foundation Support in LAC
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U.S. Foundation Support in LAC
• Mexico and Brazil consistently rank among top beneficiary countries
• Ford and Kellogg foundations provide biggest shares of support
• MacArthur Foundation, one of the few with still a LAC country inits priority list
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Dwindling Support for Reproductive Health
Funding for reproductive health and family planning has decreased in the past decade with the exception of HIV/AIDS
Source: UNFPA. Financial resource flows for population activites in 2001 and UNFPA/NIDI Resource Flows project database. New York, USA: UN Population Fund, 2003
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LAC faces great challenges but also offers unique opportunities!
• Commitment of governments with MDG • Functional health systems • Information on health• Committed and vocal civil society organizations• Robust health research institutions• Strong private sector with nascent social
responsibility arms• New philanthropic organizations• General awareness of health as a
human right and importance of health
for development
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What needs to be done to raise regional visibility and attract more resources for SRHR?
• Advocate for Latin America and the Caribbean at the global level
• Advocate for Sexual and Reproductive Health and Rights globally and nationally
• Document needs and opportunities
• Educate donors about unmet needs, regional gaps and inequities
• Encourage regional philanthropy
• Network with “friends of LAC” in influential positions
• Expand South-to-South collaboration in LAC and across regions
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Our goal: Make the right to safe and voluntary
reproduction a reality in Latin America and the Caribbean