UNFPA The United Nations Population Fund

A joint event organized by UNAIDS and the United Nations Educational, Scientific and Cultural Organization held during the fifty-ninth session of the Commission on the Status of Women, in New York, United States of America, has shined the spotlight on the health, social and legal services available to women and girls in eastern and southern Africa.

Participants attending the session heard Sheila Tlou, UNAIDS Director for the Regional Support Team for Eastern and Southern Africa, highlight the progress made and challenges ahead in scaling up access to sexuality education and health services for women and girls in the region.

Professor Tlou said many countries had made notable progress in putting young people, particularly young women and girls, at the centre of their national health and development agendas. Adopted in December 2013, the Eastern and Southern Africa Ministerial Commitment brought together ministers of education and health from 20 countries to pledge acceleration of the delivery of sexuality education and sexual reproductive health programmes for young people.  

However, young women and girls in eastern and southern Africa continue to face a higher risk of HIV infection. In 2013, women in eastern and southern Africa accounted for 59% of all adults living with HIV. An estimated 230 000 young women between 15 and 24 years of age were newly infected with HIV in the same year. Violence against women, the high rate of teenage pregnancy, poverty and gender inequalities are some of the reasons that young women and girls are at risk of poor health outcomes, including HIV. 

Participants recommended that specific goals and targets for women and girls be included in the post-2015 agenda, including increasing access to education, ending child and forced marriage, and halting gender-based violence. 

Adolescents are being left behind in the global AIDS response. HIV is the number one contributor to adolescent mortality in sub-Saharan African and number two globally. Adolescents often lack access to proven, life-saving services, such as HIV treatment. To address this situation, a meeting was held in Geneva, Switzerland, from 3 to 5 December to design a strategy to address the challenges that adolescents face.

The global strategy consultation brought together around 50 activists from youth networks, governments, implementers, donors and UNAIDS cosponsors, all committed to making real progress through improving programmes, driving innovation and amplifying advocacy.

The participants took stock of ongoing efforts and reviewed a results framework to create accountability towards, and track progress for, the often neglected population. They looked at establishing milestones to measure progress and at what can be done to accelerate change for adolescents using innovative approaches and improved data. Critically, there was consensus among all partners that much more needs to be done to tap the inherent potential of adolescents and young people for progressive social change.

An action plan was developed outlining catalytic efforts in which partners could join to deliver results. Partners will now work together to finalize the All In agenda, which will be launched in February 2015.

The consultation was convened by UNAIDS and the United Nations Children’s Fund. The United Nations Population Fund and the World Health Organization were co-convenors, in collaboration with youth networks and other core members of the All In Leadership Group: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States President’s Emergency Plan for AIDS Relief and the MTV Staying Alive Foundation.

Condoms have had a transformative impact on the trajectory of HIV epidemics worldwide and today are an established, well-known and widely used prevention method. Recent findings show that condom use among young people is high and stable in many rich countries but much lower in low-income countries. Yet, global advocacy and social mobilization for condoms has become less prominent in recent years, with donor investments for male and female condoms and lubricants no longer increasing. 

To keep up the momentum and accelerate condom promotion and distribution as part of efforts to reduce sexual transmission of HIV by 90% by 2020, UNAIDS, UNFPA, USAID/Office of the Global AIDS Coordinator and the Bill & Melinda Gates Foundation co-convened a meeting from 6 to 7 November in Geneva, Switzerland, to identify opportunities for condom and lubricant programming in the fourth decade of the HIV epidemic.

Participants

The meeting brought together experts from civil society organizations, government and the United Nations system.

Key messages

• In 2013, about 1.9 million new adult HIV infections occurred, the vast majority of which were due to sexual transmission of HIV.
• Condoms remain a cornerstone of effective prevention and are a core basic programme activity under the UNAIDS Investment Framework approach.
• In 2012, the donor community supplied 3 billion male and 32 million female condoms. In sub-Saharan Africa, this translates into eight condoms per man per year and one condom per every 10 women per year.
• Condom stock-outs remain a critical challenge to HIV prevention. Innovative ways to alert and overcome stock-outs are urgently needed.
• Thirty years into the response, policy barriers still limit access to condoms and lubricants for key populations, particularly sex workers, men who have sex with men and young people.
• Condoms are still often associated with promiscuity. In several countries, carrying condoms is commonly used as evidence of being a sex worker and is associated with harassment, abuse and arrest.
• Condoms are an essential part of any HIV programme and should routinely be made available in all sexual and reproductive health efforts.
• The female condom has been long neglected, but it has a critical role to play in HIV prevention as the only proven effective method designed to be used by women. It must be globally brought to scale.

If developing countries harness the potential of young people by promoting their health, education, employment and human rights, their economies can be radically transformed and strengthened, says a flagship report by the United Nations Population Fund published on 18 November.

According to State of world population 2014, with the right policies nations can benefit from a “demographic dividend” as decreasing mortality and fertility rates lead to a larger working population and greater social and economic prosperity. 

However, the report contends that too many countries are not investing sufficiently in the future of the globe’s 1.8 billion young people aged 10–24 years, with their needs and concerns too often overlooked. For example, in two out of three countries they are excluded from national development plans and poverty reduction strategies; for many, human rights violations are the norm and sexual and reproductive health and rights, seen as essential for young people to realize their full potential, are frequently unattainable because of gaps in information and services. 

State of world population 2014 highlights the serious repercussions of such gaps in relation to HIV. Today, more than 2 million people aged 10–19 years old are living with the virus and young people account for about one in seven of all new HIV infections. AIDS-related deaths are increasing among adolescents, while falling in other age groups, and young people still lack comprehensive knowledge of how to keep themselves safe from HIV.

There are a number of recommendations given to empower young people, especially girls, and to promote healthier and more successful individuals and societies. These include ensuring equal access to sexual and reproductive health services, such as HIV prevention and treatment services, keeping more girls and adolescents in secondary school and ending child marriage. 

The vital role of faith-based organizations in putting sexual and reproductive health firmly on the post-2015 development agenda was explored during a high-level side event at the United Nations General Assembly in New York.

Described as a “call to action”, the meeting, held on 18 and 19 September, brought together members of a broad range of faith communities from around the world, who were joined by representatives of the United Nations Population Fund, the Norwegian Agency for Development Cooperation and UNAIDS.

Participants discussed how to harness the influence of faith-based organizations and work with the United Nations system to help ensure that sexual and reproductive health and rights are central to the post-2015 sustainable development goals being debated by the General Assembly. This, it was argued, would build on the already active part many such organizations play in offering support in this critical sphere. Delegates agreed, for example, that the AIDS response has benefited tremendously from faith-based programmes in health service provision and community-based care, as well as in advocacy, the championing of human rights, gender equality and challenging stigma and discrimination.

It was acknowledged that the area of sexual and reproductive health and rights raises some contentious issues for a number of faith-based organizations, such as gender equality, contraception and sexuality education.

The lives of millions of women and their newborn babies are being needlessly lost due to chronic lack of investment in midwife services, a new landmark report claims.

In the State of the World's Midwifery 2014: A universal pathway, a woman’s right to health, 73 countries in Africa, Asia and Latin America are shown to account for 96% of the global burden of maternal deaths, 91% of stillbirths and 93% of newborn deaths. Yet they have only 42% of the world’s midwives, nurses and doctors. The report urges these countries to invest in enhancing midwifery services, including education and training, to close this life-threatening gap. 

"Midwives make enormous contributions to the health of mothers and newborns and the well-being of entire communities. Access to quality health care is a basic human right. Greater investment in midwifery is key to making this right a reality for women everywhere," said UNFPA Executive Director, Babatunde Osotimehin.

According to the report, the range of midwifery services needed to care for women and newborn babies includes maternal and reproductive health activities such as obstetric services, family planning and services to preventing mother-to-child transmission of HIV.

The State of the World's Midwifery 2014 highlights progress made since the first 2011 report and examines four critical areas of provision: availability, accessibility, acceptability and quality of midwifery services. Since 2011 a number of countries have made considerable improvements. For example, nearly a third of the 73 nations have increased recruitment and deployment of midwives. However, there still remains a critical shortage of trained personnel which is taking an unacceptable death toll among women and children, says the report. In 2013 alone an estimated 289 000 women and 2.9 million newborn babies died.

There are a series of recommendations set out under the Midwifery2030 vision expounded in the publication which call for all women of reproductive age to have universal access to midwife services. Key planning and policy measures include professional, supportive and preventative midwifery and at least four care visits where birth preparedness and emergency planning are discussed; access to emergency care when needed;  maintaining a women’s health while pregnant; ensuring the availability of HIV-related services; comprehensive sex education and delaying marriage.

United Nations Secretary-General Ban Ki-moon, in the report’s foreword, fully commends Midwifery2030. “This vision is within reach of all countries…..Its implementation will help governments to deliver on women’s right to health, ensure that women and newborn infants obtain the care they need, and contribute to our shared, global ambition to end preventable maternal and newborn deaths.”   

The report was released by UNFPA, the United Nations Population Fund together with the International Confederation of Midwives (ICM), the World Health Organization (WHO) and partners and was launched on 3 June during the 30th ICM Triennial Congress in Prague, Czech Republic.