SustainableDevelopmentGoals&adolescentsexual&reproductive

healthandrights(ASRHR)

NepalscenarioDr Kiran Regmi,PhD

ChiefSpecialistMOH

StatementonhealthintheConstitutionofNepal(2072)•Clause35:RightsrelatedtoHealth

ü EverycitizenshallhavetherighttogetbasichealthservicesfreeofcostfromtheStateandnobodywillbedeniedfromemergencymedicalservices

ü Everypersonshallhavetherighttogetinformationforhis/hertreatment

ü Everycitizenshallhavetherighttoaccesshealthservicesü Everycitizenshallhavetherighttocleanwaterandhygiene

•Clause38:ReproductiveRightü Everywomanshallhavetherighttosafermotherhoodand

reproductivehealth

•Clause39:Rightsofthechildrenü Everychildshallhavetherighttoeducation,health,nurturing,

sports,entertainmentandoveralldevelopment

NationalHealthPolicy2071

ü VisionAllNepalicitizenswillhavethephysical,mental,socialandspiritualhealthtoleadproductiveandqualitylivesü GoalProvidehealthservicesthroughequitableandaccountablehealthsystemwhileincreasingaccessofeverycitizentoqualityhealthservicestoensurehealthasafundamentalhumanrighttocitizenNationalhealthpolicyrightlyaddressesinternationallysetindicators

GlobalRHindicatorsettingplatforms

SustainableDevelopmentGoals>aframeworkof17goalsand 169targets

Ensurehealthylivesandpromotewell-beingforallatallages

SDG3>Targets

ü 3.1By2030,reducetheglobalmaternalmortalityratiotolessthan70per100,000livebirths

ü 3.7By2030,ensureuniversalaccessto(SRH)services,includingforfamilyplanning,informationandeducation,andtheintegrationofreproductivehealthintonationalstrategiesandprograms,e.g.genderandempowermentprograms

Achievegenderequalityandempowerallwomenandgirls

SDG5>Targets

ü 5.1Endallformsofdiscriminationagainstallwomenandgirlseverywhere

ü 5.2Eliminateallformsofviolenceagainstallwomenandgirlsinthepublicandprivatespheres,includingtraffickingandsexualandothertypesofexploitation

ü 5.3Eliminateallharmfulpractices,suchaschild,earlyandforcedmarriageandfemalegenitalmutilation

ü 5.6UniversalaccesstosexualandreproductivehealthandreproductiverightsasagreedinaccordancewiththeProgramofActionoftheInternationalConferenceonPopulationandDevelopment(ICPD)andtheBeijingPlatformforActionandtheoutcomedocumentsoftheirreviewconferences

Majorindicators

KeyIndicators MDGTarget2015

Statusin

2014*

SDGTarget2030

Totalfertilityrate 2.5 2.3 2.0

AdolescentFertility Rate(ASFRofwomenaged15-19)

70 71 30

ContraceptivePrevalenceRate(modern%)

67 47.1 75

Unmetneedof familyplanning 18 25.2 10

*NMICS2014

ü Earlymarriage&initiationofearlysexualintercourse

ü Teenagepregnancyü FP&fertilityü STIs/HIV/AIDSü Abortionü SubstanceabuseüMentalhealthproblems

Adolescentmajorhealthissues

Adolescentmajorhealthissues>Earlymarriage&initiationofearlysexualintercourse

! Women!25)49!yrs.!

Men!25)49!!

Median!age!at!first!marriage!

17.5!yrs.!%!

21.6!yrs.!

Median!age!at!first!intercourse!

17.7!yrs.! 20.5!yrs.!!

Adolescentmajorhealthissues>FP&fertility

ü Useofanymodernmethodisloweramongyoungerwomen:14%(15-19);24%(20-24)– NDHS2011

ü 33%(15-19)&40%(20-24)malesagainst 59%(15-

19)& 72%(20-24)femalesdidnotusecontraceptive infirstsex

ü 17%ofadolescentwomenage15-19arealreadymothersorpregnantwiththeirfirstchild(NDHS2011EarlychildbearinginNepal,withalmostonequarterof women givingbirthbyage18&nearlyhalfbyage20(NDHS2011)

UnmetNeedinNepal

17 1715

17

14

119

10

1996 2001 2006 2011

Limiting Spacing

Totalunmetneed:27

Adolescentmajorhealthissues>FP&fertility>Accesstoinformation

! Women!15)19!yrs.!

Women!20)24!yrs.!

Have!not!heard!of!FP!from!radio,!TV,!newspaper,!poster!&!street!drama!

21!%! 23!%!

FP!non)user!women!did!not!discuss!FP!either!with!FCHV/RHV!or!at!health!facility!

95!%! 85!%!

!

TrendsofFamilyPlanningKnowledgeandCurrentUse:Nepal1976-2011

21.3

51.9 55.1

92.6 98.3 99.6 99.6 100

2.9 7.615.1

24.1 28.939

48 50

0

20

40

60

80

100

120

1976 1981 1986 1991 1996 2001 2006 2011

Year

Perc

ent

Knowledge Current use

Source: MoH: 1997, 1987, 1993; Risal & Shrestha: 1989 and Pradhan et al 1997 and DHS 2006

Widegapbetweenknowledgeanduse

Adolescentmajorhealthissues>STIs/HIV/AIDS

Achievements of MDG 6 (HIV and AIDS) indicators !!

SN! Indicators !

2005! 2014! 2015!Targets!

1! HIV prevalence among men and women aged 15–24 years (%) !

0.15 (2006) !

0.03c! Halt and reverse the trend!

2! Condom use at last high-risk sex: youth 15–24 years !

71.2! 65.8! 3!

3! Population aged 15–24 years with comprehensive knowledge of HIV and AIDS (%)

35.6 (2006)

36.4e !

3!

4! Proportion of population with advanced HIV infection receiving antiretroviral combination therapy (%)

21b (2010)

38.8c

80 !

!http://www.npc.gov.np/images/download/23rd_Jan_final_for_print_Sustainable_Development_Goals.pdf!!

Asof2013,2.1millionadolescentswerelivingwithHIV

Adolescentmajorhealthissues>Substanceabuse

Adolescentmajorhealthissues>Mentalhealthproblems

Amongtheyoungpeoplewhoreportedanytypesofpsychologicalproblems

28%(10-14),46%(15-19)&54%(20-24) ever felthopelessness

9%(10-14),14%(15-19)&15%(20-24)A&Y everthoughtofsuicide(NAYS2010/11)