致辞

Leaving no one behind: Universal sexual and reproductive health for all, in Asia and the Pacific

11 五月 2018
Speech given by Björn Andersson, UNFPA's Regional Director for Asia-Pacific at Peking University
UNFPA Asia-Pacific Regional Director Björn Andersson speaks at Peking University. Photo: UNFPA China

 

Address by Björn Andersson, UNFPA Regional Director for Asia and the Pacific

Health Science Centre, Peking University, Beijing. May 11, 2018

 

Xie-xie nin [Shi-ye shi-ye nin] – thank you for inviting me to speak today on behalf of the United Nations Population Fund, UNFPA, at China’s oldest institution of higher learning. 

Allow me, from all of us at UNFPA, to congratulate Peking University on its 120th anniversary, an auspicious occasion that occurred just last week!

For more than a century Peking University has helped shape the minds, careers and lives of the thousands upon thousands of students who have been fortunate enough to have studied here – including graduates from the Health Science Center

My visit here symbolizes the longstanding partnership between Peking University and UNFPA – a partnership in pursuit of the shared principle – “To seek truth from facts.”

This principle is all the more relevant in our interconnected world of today where young people in particular – in China and globally -- are faced with a barrage of information from all directions, creating a formidable challenge to determine what to keep and nurture as they go through the twists and turns of life.

This includes information and choices about some of the most important and personal rights and responsibilities any human being should enjoy and exercise – rights and responsibilities in the area of sexual and reproductive health – an area in which, along with child and adolescent health, the Health Science Center has made significant strides.

In this regard, I would like to recall that in 2010 the first Annual China Reproductive Youth Health Report was released at Peking University by the National Working Committee on Children and Women under the State Council, the Peking University Institute of Population Research and UNFPA.

I am truly pleased to speak with you today because you are the future leaders in the area of Public Health in China and in the Asia-Pacific region. In your future careers, you may have the opportunity to address some of the critical challenges China and the broader Asia-Pacific region face in the area of sexual and reproductive health.

With this in mind, over the next 45 minutes or so, I would like to discuss:

  • What UNFPA does, why our work is crucial, and how we carry out our mandate;
  • The progress achieved in Asia-Pacific as well as the remaining challenges in the context of sexual and reproductive health;
  • Achieving universal sexual and reproductive health and the realization of reproductive rights through eradicating poverty, achieving gender equality and promoting behavioural change; and
  • Lastly, the important opportunities for China and the Asia-Pacific Region to accelerate these efforts, guided by key global frameworks – the ICPD and the 2030 Agenda for Sustainable Development.

 

Introducing UNFPA, ICPD and the 2030 Agenda

 

First, allow me to briefly summarize what UNFPA is and does.

UNFPA is, to put it simply, the United Nations’ population and development organization. Sexual and reproductive health – through the lens of human rights and gender equality and supported by population data -- are at the core of our vision and mission.

Our overarching vision is of a world where every pregnancy is wanted, every childbirth is safe, and every young person’s potential is fulfilled.

Our mission is to achieve Three Transformational Results: Zero preventable maternal deaths, zero unmet need for family planning and zero gender-based violence and other harmful practices against women and girls.

The primary foundation for what we do is the Programme of Action of the ICPD – the International Conference on Population and Development which was held in Cairo, Egypt, in 1994. 

The ICPD Programme of Action is genuinely historic. It is the first United Nations document that recognizes the right of women and men to be informed of, and have access to, safe, effective, affordable and acceptable methods of family planning of their choice – in order to freely decide the number, timing and spacing of their children.

ICPD firmly places the individual – and her or his rights and choice – as the primary focus. ICPD also is among the first global frameworks that underscore the linkages between population dynamics, poverty, and patterns of production and consumption.

The ICPD Programme of Action aims to:

  • Ensure equality and rights of all people, including reproductive rights
  • Eradicate poverty
  • Increase the accessibility, availability, acceptability and affordability of healthcare services and facilities to all people;
  • Achieve universal access to quality education;
  • Ensure gender equality and the highest possible standards of sexual and reproductive health;
  • Harness the opportunities presented by migration and urbanization for development, and
  • Promote international cooperation, technology, research and development, to ensure effective progress for humankind.

ICPD, when it was created, looked back – and looked ahead. 

It looked back to the very documents that created and strengthened the United Nations itself – the UN Charter which established this global body, and the Declaration of Human Rights, which enshrined the rights that were further expanded upon and spelled out in the ICPD itself.

And ICPD looked ahead to the eight Millennium Development Goals, or MDGs, which addressed formidable challenges – from cutting extreme poverty rates by half to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015.

The MDGs were born from a blueprint agreed to by all the world’s countries and all the world’s leading development institutions. They galvanized unprecedented efforts to meet the needs of the world’s poorest. Many countries made significant progress on the MDGs which primarily were focused on the developing world.  UNFPA’s mandate was reflected across the MDGs, with huge strides made in tackling maternal mortality, among other challenges.

The ICPD also looked ahead to what eventually replaced and superseded the MDGs – namely, the SDGs, the 17 Sustainable Development Goals that underpin the 2030 Agenda for Sustainable Development – an agenda and goals that concern each and every country of the world regardless of their socioeconomic status.  

The 2030 Agenda was adopted in 2015, a plan of action for people, planet and prosperity.  It is a transformative framework to achieve sustainable development across economic, social and environmental dimensions.

For China, the SDGs have been celebrated by President Xi Jinping who played a prominent role when he joined other world leaders at the United Nations to adopt the 2030 Agenda.  Since then, President Xi and China have reaffirmed their commitment to implement the 2030 Agenda and promote national development in a sustainable way.

The 2030 Agenda aspires to:

  • End poverty and hunger;
  • Achieve gender equality;
  • Ensure universal access to sexual and reproductive health and reproductive rights;
  • Combat inequalities within and among countries;
  • Build peaceful, just and inclusive societies;
  • Protect and promote human rights; and
  • Ensure the lasting protection of the planet and its natural resources by the year 2030.

The ultimate vision of the 2030 Agenda, the ultimate commitment by world leaders, is “to leave no one behind” and to reach the furthest behind first.

This means that governments, with the support of international organisations like UNFPA, should prioritise, develop and implement targeted measures to address the needs of specific populations that are the most vulnerable, the most marginalised.

The 17 SDGs are both separate and cross-cutting. Many of the goals have many of the same targets and indicators, underscoring how all of these are linked and must be achieved together.  Yet, there must be focus and strategy, with each UN organisation prioritizing certain goals above others to match its particular mandate.

For UNFPA, Goals 3, on Good Health and Well-Being, and Goal 5, on Gender Equality, are of particular relevance.  These are supported by Goal 10, on Reduced Inequalities; Goal 16, on Peace and Justice and Strong Institutions; and the ultimate goal, Goal 17, on Partnerships needed to achieve all of the SDGs.

In the area of sexual and reproductive health, the 2030 Agenda reaffirms that the ICPD laid a solid foundation for sustainable development.  The Agenda further commits to ensuring universal access to sexual and reproductive health, including two specific targets that all UN Member States, including those across Asia-Pacific, have committed to achieving:

  • SDG Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for voluntary family planning, information and education, and the integration of reproductive health into national strategies and programmes; and
  • SDG Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the ICPD and the Beijing Platform for Action.

 

Progress and challenges in China and Asia-Pacific in the context of Sexual and Reproductive Health

 

Progress:

I will return to ICPD and the SDGs shortly, for these are crucial to our discussion, but now let us briefly go back in time, to 30 or so years ago, when Asia-Pacific – and China -- were very different from what they are today.

In 1990, more than 50 per cent of the population in Asia-Pacific lived in extreme poverty. This proportion plunged to 15 per cent in 2012, below the global average of nearly 17 per cent.

In 1999, at the cusp of the new millennium, nearly 500 million people in China – about half the population – lived on less than a-dollar-ninety per day. However, the country had begun opening up to the outside world as never before. 

Massive migration from the countryside to the city was transforming the urban landscape not only in Beijing, Shanghai and other major metros, but in second-tier cities as well.  

Infrastructure was being revolutionized. The Internet exposed citizens to not only the world at large, but connected citizens to each other all the more as well.  

As economic reforms expanded, and China’s place in the global economy was solidified, hundreds of millions of citizens were lifted out of poverty.  By 2014, the number of people living on less than a-dollar-ninety per day had dropped from the 500 million of 1999 to 1.4 million – a stupendous achievement unparalleled in history.

As Asia-Pacific and China climbed out of poverty, key indicators – including those pertaining to sexual and reproductive health – improved significantly as well.

Maternal mortality rates, for example, dropped across the region in country after country.  In China, over the time span of the MDGs and leading into the era of the SDGs, the maternal mortality ratio also plunged -- from 94.7 per 100,000 live births in 1990 to 19.6 per 100,000 live births in 2017. 

In recent years, China and many other countries have embraced the principles of Universal Health Coverage for both urban and rural residents – expanding access to sexual and reproductive health services including family planning; healthcare during the life cycle, including puberty and menopause; health examinations prior to pregnancy; and men’s reproductive health.

Challenges:

However, despite this progress, the Asia-Pacific region and China still face significant development challenges, including those pertaining to sexual and reproductive health.

  • Poverty and inequalities

Approximately 400 million people still live in extreme poverty across Asia-Pacific, representing over 10 per cent of the region’s population. When it comes to multidimensional poverty, the figures rise to 25 per cent in the region. This figure further increases to 40 per cent when focused on rural areas. The region also continues to experience inequalities in access to healthcare services.

  • Unmet need for family planning

There are an estimated 140 million women that have an unmet need for family planning services in Asia-Pacific, a staggering figure.

Young people in this region are particularly vulnerable to unintended pregnancies. Out of all adolescent pregnancies in Asia-Pacific, 43 percent are unintended, which accounts for 6.3 million adolescent girls with an unmet need for family planning.

Also, as a result of this, far too many young women and girls resort to unsafe abortions. Urgent steps are needed to promote comprehensive sexuality education throughout the region – no country has achieved optimal progress in this crucial area.

  • Maternal mortality

In Asia and the Pacific, an estimated 85,000 women die from complications related to pregnancy and childbirth each year. Based on the current pace of progress, many countries in the Asia-Pacific region will not reach global targets under the SDGs to reduce the maternal mortality ratio by the year 2030. 

UNFPA has been addressing this challenge with governments and partners by helping strengthen the profession of midwifery and encouraging the deployment of midwives and skilled birth attendants to areas where they are needed the most.

  • Population ageing

Many Asian countries are also challenged by a rapidly ageing population. Asia-Pacific is currently home to over half the world’s population over 60 years of age, and by 2050, close to 1.3 billion of this age group will be living in the region.

Population ageing stems from a drop in fertility to below replacement level.  Lower fertility on one hand is an indicator of family planning success and economic empowerment, but on the other hand also reflects a lack of an enabling environment for families to balance both economic security and having children. 

Economic and social reforms are critically needed to ensure that older people can continue to make a valuable contribution to society for as long as they are able, and are able to exercise their rights to income security and essential health and social services.

  • Humanitarian disasters and response within the context of SRHR and GBV

Another key challenge stems from the fact that Asia-Pacific is also the most disaster-prone region in the world. 160 disasters were reported in 2015 alone.  As we know, natural disasters can, within moments, undo decades of development and progress. These calamities also undermine the health and wellbeing of women and girls in particular. 

A key part of UNFPA’s work involves responding to the sexual and reproductive health needs of women and girls amid disasters and conflicts – as well as responding to the heightened gender-based violence that occurs at such times.  

  • Gender inequality, violence against women and harmful practices

The broad issue of gender inequality which is a key trigger for gender-based violence and harmful practices, are also a major challenge in Asia-Pacific and globally. On average, one out of three women worldwide experiences some form of violence during her lifetime. 

In our region, physical and sexual violence affects up to 68 per cent of women in their lifetime. Harmful practices -- such as gender-biased sex selection which is linked to son preference, as well as child, early and forced marriage -- are also prevalent in many countries.

  • UHC and expanding insurance and SRHR coverage

In the context of China, despite the expansion of Universal Health Coverage, including the New Rural Cooperative Medical Scheme, much more work is needed to ensure that basic health insurance meets all of the sexual and reproductive health needs of Chinese citizens.

According to UNFPA-supported research in Sichuan and Fujian provinces by the China National Health Development Research Center in 2016, sexual and reproductive health related expenses accounted for around 40 per cent of household out-of-pocket health expenditures. 

This is another significant challenge that I urge all of you, as public health practitioners and advocates, to address in conjunction with government and civil society partners.  These services are central to the well-being and prosperity of individuals, families and communities – and must be encompassed within a larger basket of healthcare services for all.

  • Young people’s needs and comprehensive sexuality education

Also, according to a UNFPA-supported national survey on sexual and reproductive health in 2009, roughly one in four young people aged 15-24 in China are sexually active -- yet less than half of them know how to practice safe sex, including the use of contraception.  

In far too many countries, comprehensive sexuality education may be in the books, but it is seldom taught in an optimal way, if at all, both in and out of school settings.  

Comprehensive sexuality education, which goes well beyond biology, strengthens respect for oneself and others, strengthens gender equality and a respect for diversity. And, of course, it reduces unintended pregnancies – as I mentioned earlier – and, by extension, it reduces abortion. 

We at UNFPA, along with our partners at UNESCO and UNICEF, emphasize that

it is crucial to equip adolescents and young people with the knowledge, skills, attitudes and values for making informed decisions and developing a positive view of their sexuality.

 

Addressing the challenges of achieving universal sexual and reproductive health in Asia-Pacific through the implementation of global frameworks

 

All of the issues I have mentioned in one way or another fall under the umbrella of sexual and reproductive health, and as I have mentioned, significant progress has been made on this front – even as significant challenges remain.

From UNFPA’s experience, we know that progress toward achieving universal access to sexual and reproductive health requires concerted attention to eradicating poverty, achieving gender equality and promoting behavioural change. 

To reiterate:

  • Poverty is often accompanied by unemployment and limited access to social and health services, including reproductive health services, which can contribute to high levels of fertility, morbidity and mortality, as well as to low economic productivity.  Reducing poverty and raising the quality of life for all people, including their incomes, is therefore a prerequisite for achieving universal sexual and reproductive health. 
  • Gender-based violence, including harmful practices, is not only a violation of human rights, but it negatively impacts women’s access to sexual and reproductive health. When women are subjected to violence and harmful practices, their voice, agency and autonomy of their own bodies are often constrained. This creates an environment where they have limited access to maternal health and family planning services, which undermines their rights.

Countries have begun to address these issues – but a lot more needs to be done to bring about effective, lasting change.

This is why UNFPA works with countries in the Asia and the Pacific region and around the world to support them in their efforts to implement national policies and strategies, and internationally-agreed recommendations on sexual and reproductive health, in an integrated manner.

This, of course, brings us back full circle to the ICPD Programme of Action and the 2030 Agenda for Sustainable Development, under both of which sexual and reproductive health and rights form an integral component.

Using both the ICPD and the SDGs, and applying the principle of ‘leaving no one behind,’ UNFPA supports countries to ensure universal access to sexual and reproductive health-care services by promoting voluntary family planning and comprehensive sexuality education, as well as tackling maternal mortality, gender-based violence and harmful practices, and – increasingly in our region - addressing population ageing.

UNFPA also produces data, research and evidence in all of these areas to ensure that we promote evidence-based policies and strategies.

  • We work to support rights-based and voluntary family planning by advocating for a steady, reliable supply of modern contraceptives and for strengthening national health systems to make sexual and reproductive health a priority.
  • We are also on the forefront of collecting and analysing data as evidence to support this work. In the past few years, we have increased capacity in data collection in the area of health economics and have used this data to show that investing in family planning saves both lives and money.

Let me provide some concrete examples.

  • In the People’s Democratic Republic of Laos, UNFPA worked with the Ministry of Health to provide training in family planning and contraception to health care workers in isolated and remote communities. This has enabled community-based health-care distributors to play a major role in supporting individuals and couples in their family planning needs.
  • In the Philippines and elsewhere, UNFPA has worked with private sector garment factories to demonstrate how investing in family planning services for staff, including women, empowers individuals to make their own choices as well as increases productivity.
  • In recent years UNFPA has adopted innovative approaches to providing sexuality education to young people in the Asia-Pacific region, including through youth-led dialogues, phone apps and other technology – all of which put young persons in charge of their own lives, empowering them to make the right choices.

In the Maldives, for example, UNFPA has worked with the ‘Society for Health Education’ to provide information for young people on sexual and reproductive health in group sessions. Following the initial success of a pilot programme, we are looking to roll-out a module nationwide to help ensure all young people have the information they need to guide them on the road ahead.

  • Across the region UNFPA has placed attention on expanding midwifery as a means to ending preventable maternal deaths. For example, we have worked with the School of Nursing at Peking University to conduct a national research study on the midwifery workforce. Based on our research and analysis we have also supported both China and India to reintroduce midwifery programmes, and have also helped professionalize midwifery in Bangladesh, Cambodia, Indonesia and Nepal.
  • UNFPA works on strengthening the capacity of health systems to address violence against women, viewing reproductive health services as a critical entry point for violence-related information, services and referrals.

UNFPA also supports countries in the Asia-Pacific region in making national data on violence against women available to develop evidence-based programmes to promote and protect women's rights.

UNFPA has developed a landmark initiative called kNOwVAWdata, which supports countries in training researchers and field workers to collect and analyse data on the extent and the nature of violence that women experience. This in turn helps countries use the data to bring about policy and behaviour change to address violence against women.

Increasingly, and particularly in the Asia-Pacific region, governments are turning to UNFPA for policy advice on population ageing and low fertility. UNFPA sees ageing as a triumph of development. People are living longer because of better nutrition, sanitation, health care, education and economic well-being, along with expanded sexual and reproductive health and reproductive rights symbolized by greater access to family planning. However, the right set of policies can equip individuals, families and societies to address these challenges and to reap the benefits.

UNFPA is a key player in humanitarian response through our focus on responding to the needs of women and girls amid disaster and conflict; needs that are far too often ignored. We have worked to ensure health and protection systems are resilient, and life-saving sexual and reproductive health and gender-based violence prevention and response interventions are fully integrated in emergency preparedness. Within the past three years, UNFPA in the Asia and the Pacific region has worked in 15 countries, reaching over 2.5 million people with sexual and reproductive health services and responses related to gender-based violence during humanitarian situations and disasters.

In Bangladesh, UNFPA is working with the 700,000 Rohingya refugees, more than half of them women and girls, that have fled Myanmar. Since August 2017, UNFPA has delivered over 110,000 Dignity Kits and have screened more than 250,000 women and girls by midwives and reproductive health care workers.

 

The way forward: accelerating efforts to achieve universal sexual and reproductive health

 

As we move forward to ensure that no one is left behind, we need to accelerate progress on existing commitments and be innovative and establish new approaches to address emerging issues. This will require reinvigorated political commitment at the highest levels to the right to sexual and reproductive health, in line with the ICPD and the 2030 Agenda.

In the coming year, there are key opportunities to express this reinvigorated commitment.

First, in November of this year, Asia-Pacific Member States of the United Nations will conduct of a mid-term review of the implementation of the Asian and Pacific Ministerial Declaration on Population and Development, which outlines specific priority actions countries in the Asia-Pacific region should take to accelerate implementation of the ICPD.

This mid-term review will provide the opportunity to identify achievements, as well as gaps in the implementation of ICPD, and also explore lessons learned and good practices to address gaps and challenges.  It will also serve as the region’s contribution to a global review and evaluation of the ICPD Programme of Action next year, which marks the 25th anniversary of ICPD as well.

This global review is a key moment for governments, international organizations, including the United Nations system, and other stakeholders to recommit to the human rights-based principles of population and development enshrined in the ICPD, to achieve universal access to sexual and reproductive health.

This recommitment is absolutely crucial, particularly as we witness growing global and regional trends that undermine or jeopardize evidence-based and rights-based health-care approaches. These trends threaten the progress countries have made toward achieving universal access to sexual and reproductive health. “Seeking truth from facts” has rarely been more important in this regard.

Also in 2019, the High-level Political Forum on Sustainable Development, which is the global body that provides recommendations and addresses new and emerging challenges in the context of the implementation of the 2030 Agenda, will meet at the level of Heads of State and Government.

Ladies and gentlemen, some of you may have read an excellent editorial in the prestigious medical and health journal The Lancet this week, from UNFPA’s Executive Director Dr Natalia Kanem and Dr Tedros, the Director-General of the World Health Organisation.  The title of the piece is “Defining sexual and reproductive health and rights for all.”  The editorial is a commentary on a truly important report from the Guttmacher Institute and Lancet Commission on sexual and reproductive health.

In this commentary, WHO and UNFPA sound an alarm. Our organisations note the report’s conclusion that almost all 4-point-3 billion people of reproductive age worldwide will have inadequate reproductive health services over the course of their reproductive years. This includes the more than 200 million women today in developing regions who want to avoid pregnancy but are not using modern contraception.

WHO and UNFPA summarize the need for Governments to act urgently with one simple sentence: “The most important reforms are those that promote gender equality and give women and girls greater control over their bodies and lives.”

 

The Role of China in supporting national, regional and global efforts to achieve universal sexual and reproductive health for all in Asia and the Pacific

 

Friends, allow me here to say that “with great power comes great responsibility.”

As both a global and regional leader, China is in a unique position to accelerate global progress in the implementation of ICPD and the 2030 Agenda, not only through strengthening its own national policies, but also through its international cooperation at the regional and global levels – including via the route of South-South Cooperation and other networks being established via the Belt and Road Initiative.

China has increasingly been playing a key role in promoting comprehensive approaches to sexual and reproductive health. 

From the perspective of UNFPA’s mandate, enshrined by ICPD and the SDGs, it is vital that health and development policies include voluntary family planning, improved maternal health, prevention and treatment of sexually transmitted infections, reproductive cancers, and the promotion of gender equality and the elimination of harmful practices.

In all of this, UNFPA counts on China’s support.  

If China – currently the world’s most populous nation - succeeds in achieving universal access to sexual and reproductive health and reproductive rights, it will transform the global landscape in this regard – moving us closer to achieving the SDGs’ vision of leaving no one behind.

 

Individual actions for universal sexual and reproductive health

 

Although the actions I have just highlighted are primarily focused on what governments can do, there are also many things we can all do as individuals to achieve universal sexual and reproductive health.

As public health care professionals, you all have a responsibility to pursue policies and strategies that are scientific and evidence-based – including in the area of sexual and reproductive health.

As development and health-care professionals, we have a duty to ensure that all people – including the most marginalized and vulnerable -- are provided with the highest attainable standard of physical and mental health – without discrimination.

And ultimately as human beings, we must work towards a world where empowerment and choice for all people are paramount – if we are to achieve a prosperous planet where rights, respect and responsibility are key to our shared humanity.

 

Closing

 

In conclusion, achieving universal sexual and reproductive health is a pre-requisite for sustainable development. It requires that we place focused attention on eradicating poverty, achieving gender equality and promoting behavioural change.

We must ensure that the principle of ‘leaving no one behind’ is fully integrated into public health policies, strategies and programmes so we can truly achieve the vision of ICPD and the SDGs in this new century.

Ladies and Gentlemen, it has been a genuine honor to be with you all today.

On behalf of UNFPA - which celebrates its 50th birthday next year, as well as our 40th year in the People’s Republic of China - we look forward to continuing our work together and forging new paths in China, across Asia-Pacific and around the world.

Xie xie nin - Thank you.