The Commission on Population and Development (2024)

By Mary Kuira
NAIROBI, May 7 2025 (IPS)

Just a month ago, I found myself in a hospital, anxiously waiting for my son to be attended to. As we sat quietly in one of the waiting rooms, an emergency case was wheeled in — a young woman, barely out of her teens. Her face contorted in visible pain. Her dress was soaked with blood, which had begun to pool beneath the wheelchair and trickle onto the floor.

I couldn’t help but overhear the nurse asking the girl who had accompanied her, “What happened?” “She just started her periods,” the friend whispered, her voice laced with fear and confusion.

But from my own experience, I knew periods don’t arrive like this. The heavy bleeding, the extreme pain, the sheer urgency: something was terribly wrong. In a country where abortion is criminalized and conversations on reproductive health are often shrouded in silence, there are things you don’t say out loud, not even in a hospital.

Presentations were dominated by government departments and bureaucrats. I couldn’t help but wonder — where were the voices of the people these policies are meant to serve? Where was the civil society that brought these stories from their grassroots partners?
Later, I learned the young woman had been referred to a higher-level facility because the hospital couldn’t handle her case. I left that day with a prayer on my lips, hoping she lived to tell her story.

So why am I sharing this? Because last week, I sat in another room, far away from that hospital, attending the 58th Session of the Commission on Population and Development (CPD58) at the United Nations.

This was my first time attending the annual conference. The conversations were a sobering reminder of how precarious sexual and reproductive health and rights (SRHR) remain, especially for young women like the one I saw that day.

Despite the gravity of the global challenges, CPD58 felt like a more formal than interactive space. At many of the side events I attended, audiences sat silent, rarely given the chance to ask questions.

Presentations were dominated by government departments and bureaucrats. I couldn’t help but wonder — where were the voices of the people these policies are meant to serve? Where was the civil society that brought these stories from their grassroots partners?

Breaking the silence

One of the few spaces that broke this silence was a gathering organized by the International Sexual and Reproductive Rights Coalition (ISRRC), a coalition of organizations from all regions of the world dedicated to advancing SRHR. It offered a rare moment of authentic exchange, where the few CSO voices present could reflect on the battles we face both at home and on the global stage.

But overall, the opposition to SRHR remained stubborn and vocal. I listened as some delegations pushed back against terms that should be non-negotiable: Comprehensive Sexuality Education (CSE), safe abortion, gender equality.

These are not just words; they are lifelines for young women, especially those navigating complex realities in countries like mine, Kenya.

Ironically, many CPD58 conversations just wanted to focus on maternal health, not on teenage pregnancies or young mothers. Basically, addressing maternal health without discussing the process that leads to pregnancy (sex and sexuality) and therefore CSE.

I couldn’t help but think: How do we talk about preventing HIV without talking about sex? How do we address teenage pregnancy without speaking openly about reproductive health? How can we ignore child marriages when they remain a heartbreaking reality across many countries? And what do we say to survivors of rape — young or old — who become pregnant? Should they be forced to carry these pregnancies, regardless of the trauma or the risks?

As an advocate and a believer in the power of quality data to inform decisions, these questions weigh heavily on me. Are the policies we design grounded in real, lived experiences? Do we collect and use data to reflect the brutal realities so many young women face daily?

Combating anti-rights narratives

One clear takeaway from CPD58 was this: facts and stories must go hand in hand. Data alone can inform, but stories can transform. Both are essential to combating anti-rights narratives and creating spaces for conversations.

Another key take away is the critical need for civil society to maintain both its presence and momentum in these spaces. The CPD remains one of the least attended UN meetings, and its negotiation process is opaque.

The anti-rights movement’s growing clout risks reversing many SRHR gains by easily passing resolutions without push back. If civil society isn’t present and organized, no one will be the wiser. It is essential to occupy and safeguard this space.

We must train youth activists to counter opposition and challenge anti-gender, anti-abortion, and anti-CSE rhetoric not just with facts, but with human stories.

Tell the stories that humanize the data; stories like the one I witnessed in that hospital room. Digital spaces hold tremendous potential to advance SRHR, especially for marginalized communities.

Yet, with opportunity comes risk. The same platforms that can empower young women are breeding grounds for misinformation. Our efforts must include both creating digital solutions and equipping young women to navigate these spaces safely and wisely.

I was encouraged to see progressive voices from the European Union, Latin America, and parts of Africa and Asia stand firm in defending SRHR within the final negotiated text. But the fight doesn’t end there.

From Nigeria to Mozambique, from Jordan to Guatemala — and every corner in between — we must ensure young women in all their diversities are not left behind. Their voices, rights, and choices must be respected.

Finally, we must keep the pressure on at home. Advocacy for policies that protect and expand comprehensive sexuality education, safe abortion (where permitted), and youth-friendly SRH services must not stop at international commitments. We must hold our governments accountable and ensure those commitments translate into action.

The young woman in that hospital room deserved better. So do countless others like her.

And the only way forward is by standing up, speaking out, and refusing to let silence win.

Mary Kuira is Global DMEL Coordinator at Hivos East Africa

A group of youths in Machinga, Malawi. During the COVID-19 pandemic, young people, especially young girls, are facing many challenges regarding their sexual and reproductive health. The world’s population of young people between the ages of 10 and 24 is at a historic high, with the majority — nearly 90 percent — living in the developing world. Credit: Charles Mpaka/IPS

By Samira Sadeque
UNITED NATIONS, Feb 5 2021 (IPS)

With the COVID-19 pandemic adding complex layers of challenges to the issue of sexual and reproductive health for the youth, governments should prioritise documenting these effects for data collection purposes, Dr. Simon Binezero Mambo co-founder and team leader of the Youth Alliance for Reproductive Health in the Democratic Republic of the Congo, told IPS in an interview.

“There is a need for countries to document how COVID19 is affecting adolescent and young people for the time they have been out of school, which increases their risk for pre-marital sexual activities and sexual violence as they have less protection in community than in school,” Mambo said. “With data-based evidence, countries will be able to make a right plan and respond to this risk which is irreversible if not mitigating.”

Mambo spoke with IPS following the two-day virtual forum “Not Without FP”, organised by the International Conference on Family Planning. The forum hosted a wide array of panels with sessions on family planning, Universal Health Coverage and the coronavirus pandemic.

But there are challenges beyond the data collection, Sophia Sadinsky, of the Guttmacher Institute, told IPS. Sadinsky also spoke on the same panel with Mambo.

“Even with robust data, meeting sexual and reproductive health needs has been stymied by unrealised innovations in health care technologies and service delivery methods, including telehealth; the importance of these innovations has become far more pronounced in the context of the pandemic,” she told IPS.

“While digital tools and remote service delivery can overcome some barriers to high-quality care encountered in traditional health service settings — such as a perceived or real absence of privacy or confidentiality, stigma and provider biases — there remains a significant divide in online access, especially by gender and geography,” she added.

She was echoing an insight shared by Mambo at the panel where he pointed out that when the youth don’t have access to information on sexual and reproductive health and rights (SRHR), the results can slow the path towards attaining the Sustainable Development Goals (SDGs).

For example, Mambo said that a many young girls in refugee camps have very little information about menstrual health. “We may not achieve the SDGs if we do not support the powerhouse of young people,” he said.

Excerpts of his interview with IPS follow: 

Inter Press Service (IPS): You mentioned the mental health concerns that can arise from the issue of unwanted pregnancy. Can you share how that could have been affected further by COVID-19?

Simon Binezero Mambo (SBM): During the COVID-19 pandemic, young people — especially young girls — are facing many challenges regarding their sexual and reproductive health, including risky behaviour, sexual activity, drug use and alcoholism, sexual violence and unwanted pregnancies.

On top of that, add the significant levels of stress from the pandemic that led to increased mental health concerns. During this time, teenage mothers are facing any number of challenges, like no source of revenue, not being able to get a good job, not getting respect or support from friends and family members. Teen mothers often struggle with significant emotional trauma, with higher rates of suicidal ideation. COVID-19 is adding more pressure and stress to an already stressful situation. We must put in place more support mechanisms to avoid even more deaths during this pandemic.

IPS: In your panel, unintended pregnancy and unsafe abortion came up quite often. Sophia Sadinsky from the Guttmacher Institute brought up there’s 10 million unintended pregnancies each year because of the lack of use of modern contraceptives. How are unintended pregnancies an issue for youth SRHR?

SBM: For one thing, the world’s population of young people (between the ages of 10 and 24) is at a historic high, with the majority — nearly 90 percent — living in the developing world. We know that approximately 16 million adolescent girls (15-19 years old), mostly in low and middle income countries, give birth each year. Complications during pregnancy and childbirth are a leading cause of death for girls in this age range and all are unwanted pregnancies due to lack of contraceptives information and services. It is an issue because when adolescent girls become pregnant, they often drop out of school and lose the chance to develop marketable skills and obtain good employment. This impacts the economic growth of girls and their families, their communities and their countries.

IPS: Can you share how family planning in your current city has been affected by the coronavirus pandemic?

SBM: Family planning services have been disrupted by the COVID-19 pandemic in Goma in Eastern DRC. This is not new; we faced similar challenges during the 10th Outbreak of Ebola, when sexual activities among young people increased due to school closures and lack of socioeconomic support. When there is no support, youth are more likely to engage in risky sexual activities and family planning is not prioritised since there is more focus on the pandemic itself. This exposes adolescents and young people to high risk of getting HIV and now we are seeing increased unplanned pregnancy among young girls who may miss the chance to go back to school after the COVID-19.

Young people need contraceptives services today more than ever but they are increasingly hard to access due to lockdowns, COVID-19 fear, distance, costs, poor service, and lack of support from governments and partners.

IPS: How can involvement of the youth be important in addressing these issues with sexual and reproductive health?

SBM: Youth participation means better decisions and increased efficiency. Evidence shows that policies and programmes designed after consultations with users are more likely to be effective. By using youth participation, you are more likely to get it right the first time and avoid wasting time and money on services young people don’t want to use.

Youth participation contributes to positive youth development and research shows that young people who are supported to participate in decision-making are more likely to have increased confidence, make positive career choices and have greater involvement and responsibility in the future.

Youth involvement not only enables individuals to thrive, it also brings economic and social benefits for countries, because a healthy population is more likely to be productive and prosperous. This cohort represents a powerhouse of human potential that could transform health and sustainable development.

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Ndiabou Niang was able to get access to prenatal care after her town’s mayor decided to finance the health membership of nearly 300 women and children. Courtesy: Réseau Siggil Jigéen

By Neena Bhandari
SYDNEY, Australia, Jul 14 2020 (IPS)

Pregnant with her second child, 30-year-old Ndiabou Niang was enduring pelvic pain, but couldn’t afford to access prenatal care in Diabe Salla, a village on the outskirts of the small town of Thilogne in north-east Senegal. Her husband was unemployed and her earnings of under CFAF 10,000 (17 USD) from selling seasonal fruits in the local market were insufficient to make ends meet.

During her last prenatal visit, she was prescribed some tests, an ultrasound and medicines that would cost CFAF 39,000 (USD 67). An astronomical amount for her meagre income. So she didn’t follow through with the treatment, opting to suffer in silence instead.

Many pregnant rural women, living below the poverty line, don’t follow through on their prescriptions and delay their prenatal visits till they are in their third trimester, which puts them at greater risk of pregnancy-related complications.

Senegal has integrated the United Nations’ Sustainable Development Goals (SDGs) into its national policies and plans, but socio-economic, cultural and religious norms and attitudes impede women’s and girls’ access to sexual and reproductive health services and rights, especially in remote and rural areas. The challenges include early marriage, unmet contraceptive needs, early pregnancy, unsafe abortions and female genital mutilation.

The country’s version of Universal Health Coverage is Maladie Universelle (CMU) rests on mutual health organisations (MHOs) that provide health insurance wherein each person contributes a yearly enrolment fee that is matched by the government. The annual member contribution to the mutual health insurance is CFAF 3,500 (USD 6).

People in remote and rural areas choose not to join the mutual health insurance because Health Posts, local facilities that dot the country, have limited drugs and treatment options. Consultations at these posts cost CFAF 1,000 (USD 1.70), but they are not equipped to provide advanced obstetric care – like caesarean sections or blood transfusions. So the distances from local health posts to a district or regional hospital, poor road infrastructure, and cost and shortage of ambulances are some of the other challenges rural women face in accessing healthcare.

Aware of this, Réseau Siggil Jigéen (RSJ), an NGO that aims to promote and protect women’s rights in Senegal, through the IntraHealth International-led Neema project, a consortium of seven health organisations working to extend reproductive health services to last-mile recipients, began extensive advocacy to mobilise the community and local authorities to promote MHO membership.

After several sustained advocacy meetings, the mayor of Thilogne decided to finance the MHO membership for nearly 300 women and children. Niang, was one of them.

“It helped me to get X-rays, prescription drugs and have a caesarian delivery at the Regional Hospital Center of Ourossogui. The cost was CFAF 75,000 (USD 129), but as a MHO member, I only had to pay CFAF 15,000 (USD 25). I am now committed to do everything for my own health and my children’s health, who are 3 months and 18 months old,” she told the local RSJ member. She is also making her family and friends aware of the benefits and urging them to join the MHO.

RSJ and IntraHealth International have been working together for a decade to reposition family planning in Senegal and in the sub-region.

“Together, we introduced the fight against gender-based violence and early pregnancies in schools, and we help health workers improve care in their communities. Now we’re advocating to local governments to mobilise more domestic resources, which make reproductive health services accessible for pregnant women and teenagers who otherwise couldn’t afford them,” IntraHealth International’s Senegal Country Director Dr Babacar Gueye told IPS.

Several other mayors have also followed suit and made financial commitments to reduce maternal and infant mortality in their communities.

In Senegal, a Least Developed Country with 16.7 million people and a fertility rate of 4.5 per woman (2020):

• maternal mortality ratio remains high at 315 deaths per 100,000 live births (2017);
• 74 percent births were attended by skilled health personnel during 2014-2019;
• and only seven percent of girls and women could make a decision on sexual and reproductive health and rights during 2007-2018 period, according to the United Nations Population Fund’s (UNFPA) World Population Dashboard Senegal.
• (Data to be read in context with technical notes and sources in the link above)

“Senegal can only embark on the path of development when young people and women are in good health, educated, well trained and equipped to seize development opportunities. Creating these conditions is a social, economic and political necessity,” UNFPA’s assistant representative in Senegal, Moussa Faye, told IPS.

Fifteen years after Senegal passed the 2005 Reproductive Health Law, the decrees to implement it have still not been ratified. The Deliver for Good Senegal campaign’s advocacy objective for 2020 is to get the decree on Family Planning enacted. It is part of a larger, global campaign powered by Women Deliver, a global advocacy organisation that champions gender equality and the health and rights of girls and women.

The Deliver for Good Senegal campaign’s steering committee, convened by RSJ and Energy 4 Impact, is working with other civil society organisations and ministers to roll out a roadmap to push the competent authority to sign the decree.

“The campaign is advocating at national and local level to reduce maternal and child mortality rates and mobilise financial resources to strengthen the access of women and young people to family planning services and information, whatever their purchasing power and their geographical location. The implementing decree on family planning would qualitatively strengthen the health of mothers and children and help Senegal achieve the SDGs related to women’s health and rights,” Fatou Ndiaye Turpin, executive director of RSJ and co-leader of the Deliver for Good Senegal campaign, told IPS.

An implementing decree is also needed to describe the modus operandi to allow non-medical workers to provide a wide range of family planning services to vulnerable rural, disadvantaged urban, poor and young people, in particular through community-based distribution.

To ensure women in disadvantaged areas have access to family planning services, there is a growing emphasis on primary health care. For example, the community-based health worker programme, the Bajenu Gox Initiative (which means paternal aunt or godmother in Wolof) to train women to be leaders in reproductive health. Local bajenu gox are enlisted by the government to provide support to women during prenatal, delivery and postpartum periods, and advice on caring for children under five years old in areas where trained medical professionals are not available. 

While family planning policies have been progressive, Ouagadougou Partnership Coordination Unit’s Director, Marie Ba told IPS, “One needs to balance this progress with the prevalent socio-cultural barriers, misconceptions and misinformation around contraception, reproductive rights and health, relatively high unmet contraceptive needs, inequality in terms of gender and social norms, especially in rural areas. For example, only 20 percent of married women aged 15 to 19 report making decisions alone or jointly with their husbands regarding their own health care.”

Many women still need to get permission from their husband or mothers-in-law to use a contraceptive and many young girls are unsure whether they are allowed to use contraceptives before they turn 18. According to UNFPA, the contraceptive prevalence rate for all women aged between 15 and 49 using any method of birth control was 22 percent (2020); and and 16 percent of all women aged between 15 and 49 had their need for family planning unmet (2020). 

Family planning options – birth control pills, implants, intrauterine devices, easy-to-use self-injectable contraception – are now becoming more readily available in regional health posts.

“However, three challenges remain. Stockouts at national and regional level – the stockout rate for injectables varies between 25 and 45 percent in key cities; the same is true for implants, where stockouts can reach 80 percent in the public sector. Secondly, problems with the supply of products to service delivery points. Thirdly, product quality control which remains variable and insufficient,” Turpin told IPS.

Child marriage is still prevalent. As many as 29 percent girls were married by age 18, according to UNFPA. It exposes girls to harmful consequences – sexual and psychological abuse and violence; early pregnancy, which has the risk of medical complications and even death.

Abortion is illegal in Senegal except when three doctors agree that the procedure is required to save a mother’s life.  It is also prohibited in cases of rape or incest. These strict abortion laws have forced many young women to resort to unsafe, illegal abortion services, which often put their health and lives at risk. The adolescent birth rate for girls aged 15 to 19 years was 78 per 1,000 births, according to UNFPA. 

“Abortion is the fifth-leading cause of maternal death in Senegal. It strongly influences maternal mortality with eight percent of maternal deaths linked to unsafe abortions and 50 percent of the reasons for emergency admission to referral maternities,” Turpin told IPS.

The COVID-19 restrictions have led to closure of many reproductive health and family planning services, disruption in supply chains of contraceptives, which are posing a significant risk to women and girls’ health.

At least 54 percent of sexually active adolescent women in Kenya who would like to postpone pregnancy have an unmet need for modern contraception. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, May 25 2020 (IPS)

It was only when 17-year-old Eva Muigai was in her final trimester that her family discovered she was pregnant. Muigai, a form three student who lives with her family in Gachie, Central Kenya, had spent her pregnancy wearing tight bodysuits and loose-fitting clothes that hid her growing baby bump.

“The plan was to have an abortion but I was too scared. My classmate had an abortion last year and she almost died, so I kept postponing the abortion.

“I gathered courage at five months and my cousin took me to a man who does abortions at the shopping centre. He refused to do the abortion because he preferred pregnancies that were not older than three months,” Muigai tells IPS.

Muigai says that one day, while seven months pregnant, she “just fainted and my mother tried to loosen my clothes so that I could get more air”.

“It then became clear that I was pregnant,” she recalls.

Last month, two weeks shy of her due date, Muigai was rushed to hospital with severe abdominal cramps. The attending doctor rushed Muigai into theatre for an emergency caesarian section.

Her newborn baby did not survive.

Last week, Muigai was re-admitted to hospital with further complications after first experiencing swelling in her stomach and then her entire body.

“Complications of pregnancy and child birth are a leading cause of preventable deaths and ill health among adolescent women, aged 15 to 19 years, in Kenya,” Angela Nguku, executive director of the White Ribbon Alliance for Safe Motherhood, Kenya, tells IPS.

The alliance has been at the forefront of advocating for adolescent health and universal access to sexual and reproductive health and rights (SRHR) and is a Deliver For Good partner organisation in Kenya.

• Deliver For Good is a “global campaign that applies a gender lens to the Sustainable Development Goals (SDGs) and promotes 12 critical investments in girls and women to power progress for all”. Powered by Women Deliver, a global advocacy organisation that champions gender equality and the health and rights of girls and women, more than 400 organisations have joined the Deliver for Good Campaign.

Tamara Windau-Melmer, a senior manager for Youth Engagement at Women Deliver, says that adolescent girls are often left behind because the policies, programmes, and investments meant to serve them are not designed in an inclusive, gender-responsive way.

“Adolescent girls must be meaningfully and authentically engaged in decision-making about their own lives, especially as it pertains to information about and access to contraception,” she tells IPS.

• According to the World Health Organisation (WHO), adolescent mothers face higher risks of eclampsia, uterine infection and systemic infections than women aged 20 to 24 years.
• Babies of adolescent mothers face higher risks of low birth weight, preterm delivery and severe neonatal conditions.

“Additionally, comprehensive sexuality education is critical as it offers the opportunity to reach adolescent girls with important information and skills to take control of their lives and pursue a brighter future for themselves, their families, and their communities,” Windau-Melmer says.

But the provision of comprehensive sex education in Kenya remains a hotly-contested issue by religious leaders, who hold great sway on such matters, and it is yet to be rolled out in line with National Adolescent Sexual and Reproductive Health policy.

Nguku says that despite a 2012 government commitment to provide affordable and accessible high quality reproductive health services to adolescents, this promise remains on paper in the form of the National Adolescent Sexual and Reproductive Health policy.

“The policy was updated in 2015 so that adolescents can have accurate, timely information and quality services but adolescent women still have many unmet needs,” she says.

• Adolescent women in Kenya account for an estimated one-fifth of the female population of over 26 million, and account for approximately 14 percent of all births, according to the most recent Kenya Demographic and Health Survey. 
• Statistics by the Guttmacher Institute, a leading global research organisation, show that 63 percent of pregnancies among adolescents in Kenya are unintended, as was the case with Muigai. 35 percent of these unintended pregnancies are aborted. 

But research by the Guttmacher Institute shows that at least 54 percent of sexually active adolescent women in this East African nation who would like to postpone pregnancy have an unmet need for modern contraception.

• The institute’s research further shows that satisfying the unmet need for modern contraceptives among adolescent women in Kenya would result in a 73 percent drop in unintended pregnancies. Currently, adolescent women account for an estimated 86 percent of all unintended pregnancies in the country. 
• Further, the Guttmacher Institute shows that a combination of modern contraceptives for all adolescents who need it, and adequate care for all pregnant adolescents and their newborns, would reduce adolescent maternal deaths by 76 percent. Currently maternal deaths stand at 450 per year.

Georgina Nyambura, the founder of Umoja Women Mobile Health Care, a registered, community-based organisation with over 6,000 members across the country, says that stigma and discrimination remain barriers to adolescent women seeking SRHR services. Credit: Miriam Gathigah/IPS

These grim statistics pale in comparison to the country’s impressive progress toward the increased uptake of modern contraceptives.

At the end of the 2012 Family Planning Summit in London, where governments and donors committed to ensure more women and girls could access modern family planning by 2020, Kenya committed to increasing the uptake of modern contraceptives by married women to 58 percent. 

By 2017, Kenya surpassed the set target, increasing the uptake of modern contraceptives for all women by a third. Statistics by the Ministry of Health show that contraceptive usage for all women now stands at 61 percent. But for adolescent women this usage stands at 40 percent.

As a result, nearly one in every five teenage girls has either had a live birth or is pregnant with their first child, according to the Ministry of Health.

“Our society is very religious and even where policies allow young girls to access all the sexual and reproductive health services all women are entitled to, the situation is very different on the ground,” says Georgina Nyambura, the founder of Umoja Women Mobile Health Care, a registered, community-based organisation with over 6,000 members across the country.

“It is a common saying that girls are more afraid of pregnancy and, therefore, evidence that they are having sex, than of HIV.”

• In Kenya, nearly half of new HIV infections occur among the country’s youth aged 15 to 24 years.

To address fears of stigma and discrimination towards adolescent women, Nyambura urges the government and actors in the health sector to re-evaluate the manner in which this cohort access services, including information on sexuality.

However, the current coronavirus pandemic is expected to reverse any gains that have already been made. Kenya has reported some 1,214 COVID-19 cases. The country has been in a nationwide lockdown since April, with a nighttime curfew still in place and schools and religious centres closed.

“A health pandemic such as COVID-19 will only widen the existing gap between adolescent women and all the SRHR services that they need. Human and financial resources have now been directed into fighting this health crisis.

“On the other hand, people themselves will only come to the hospital now if it is a matter of life and death. Pandemics affect our health service seeking behaviours and patterns,” Grace Kanini, a nurse at one of the country’s referral hospitals, tells IPS.

However, adolescent health challenges informed the government’s family planning commitments made in 2017 during the second Family Planning Summit in London.

Two of the three revised government commitments on family planning target adolescent women. 

• The first commitment is to scale up contraceptive uptake from 61 percent to 66 percent for all women by 2030.
• The second commitment is to increase contraceptive prevalence rate among adolescent women from 40 to 50 percent by 2020, and to 55 percent by 2025.
• And a further commitment to reduce teenage pregnancy among adolescent women from 18 to 12 percent by 2020, and to 10 percent by 2025.

For the first seven months of her pregnancy, while she was hiding it from her family, Muigai did not have a single antenatal care checkup. And she is not an anomaly.

According to the Ministry of Health, 51 percent of pregnant adolescents have fewer than the four essential antenatal care visits recommended by the WHO, and 33 percent do not give birth in a health facility. 

Nguku says that the government will need to invest more into family planning programmes that target this cohort.

Fully meeting contraception, maternal and newborn health care needs for adolescents across the country would cost an estimated 89 million dollars each year.

But not meeting these needs will cost an estimated 114 million dollars annually, of which 63 million dollars would go to care related to unintended pregnancies, says the Guttmacher Institute.

The scenario speaks true to Muigai’s situation.

An ‘A’ student with dreams of becoming a neurosurgeon, she now lays in a referral hospital receiving medical treatment. 

Excerpt:

The $683 million will be used for efforts towards women’s reproductive and sexual health rights across 57 countries, of which about $300 million will be directed towards UNFPA’s projects in Arab state regions, including countries such as Syria, Yemen, Iraq, Sudan, and Somalia. Credit: Abdurrahman Warsameh/IPS

By Samira Sadeque
UNITED NATIONS, Feb 7 2020 (IPS)

The United Nations Population Fund (UNFPA) is appealing for $683million in their mission to address sexual and reproductive health services for women and girls in conflict areas in the world. 

At the Humanitarian Action Overview 2020, launched on Thursday, the sexual and reproductive health agency highlighted the urgency with which the issue should be treated. 

With more than 168 million people currently requiring humanitarian assistance in the world, UNFPA projects 45 million women, girls and young people will be affected by some kind of conflict this year. 

For women and girls, sexual and health reproductive health rights have often come as secondary priority in crisis situations, but experts say it’s time to make them a primary concern. 

“[These] types of service have long time been forgotten,” Arthur Erken, Director of UNFPA Division of Communications and Strategic Partnerships (DCS), told IPS. “It should not be an afterthought, it should be part and parcel of [the whole concern].”  

“We’re focusing on women and what they’re going through because they’re on the front lines,”  Ann Erb Leoncavallo of UNFPA told IPS. “They’re trying to take care of their children, they’re getting pregnant, they’re having babies, they’re getting bombed, they’re suffering from floods, high waters, you name it.”

Leoncavallo added that many of the women in areas of conflict might head single-parent households or have their own trauma. “They get depression, they get traumatised because they faced increased of gender-based violence,” she said.  

The $683 million will be used for efforts towards women’s reproductive and sexual health rights across 57 countries, of which about $300 million will be directed towards  UNFPA’s projects in Arab state regions, including countries such as Syria, Yemen, Iraq, Sudan, and Somalia. 

In order to help women reach out for help, unlearn their shame and stigma, UNFPA is currently working with a “safe space” for many women to take a break from their everyday activities. 

The “women and girl safe spaces” is dedicated space in the refugee camps where women can come and meet with other women, share notes, relax, and have a safe environment to discuss concerns and ask for help, Erken explained.

“It’s safe, men are not allowed,” Erken said, adding that the purpose of the space is to put a lot of attention to calming women, giving them breathing space, and often counselling services.

He says there doesn’t seem to be any stigma about women coming into these spaces, pointing out refugee camps in Jordan that have the facility. He learned from some of the service providers the women do visit, when their kids are in school and their husband occupied. 

Dr. Afrah Thabet Al-Ademi, a UNFPA medical doctor in Yemen who works with women who have escaped conflict, says education has a role to play in destigmatising these services for refugee population.

A staggering $100.5 million is being requested specifically for the crisis in Yemen, the highest on the list provided by UNFPA.

“A lot of women who are not educated, who feel targeted, and feel stigma to talk about their needs or family planning,” Al-Ademi told IPS. 

She recalls one time when she was meeting with a woman who had just given birth and who had covered her baby with a headscarf. 

“When she exposed the baby, I found that she covered the baby with a newsletter, she didn’t have clothes,” Al-Ademi told IPS. 

As a result, UNFPA in Yemen is now developing a kit specifically for mothers of new borns, to be put in “health facility for any woman who comes in for deliver”.

“The clothes is like a dignity for her,” said Al-Ademi.

The “Mama Kit” has clothes for the baby, pads for the mother, blankets, and diapers, among other things for the newborn. 

UNFPA is also allocating funds for Democratic Republic of Congo, Syria, Sudan, Bangladesh, and Venezuela to assist with sexual and reproductive health for the women in those countries.

Digitizing SRHR communication: some of the popular mobile phone apps currently used in India by the government and an NGO. Credit: Stella Paul/IPS

By Stella Paul
LONDON, Jul 17 2017 (IPS)

Online shopping may have its pros and cons, but when it comes to buying products that have an invisible morality tag, it’s the safest possible option, believes Franklin Paul.

One of India’s most vocal advocates for youth rights to sexual health, education and products, Paul has spent over two years studying and introducing digital technologies to India’s rural youths. “One day soon, nobody will have to walk into a store to buy condoms, face the nosey chemist and feel embarrassed. They will just order it from their mobile phone or tablet or laptop and and get it delivered on their doorstep,” he says ."Health workers themselves feel embarrassed to talk of sex and contraceptives, but if that information is available on the mobile screen, nobody will have to be embarrassed." --Kamla Mukhi

Talking to IPS on the sidelines of the London Family Planning Summit held last week, Paul shared his personal experiences of talking to youths in the East Champaran district of Bihar, one of India’s most underdeveloped states. The government has just introduced sex education in the state’s schools, but for young men and women, it is difficult to get the correct information on reproductive health.

To help them, Paul and his fellow youths launched a cellphone application called M Sathi. Available now on Google Play, the app provides information in a fun and interactive way where users can learn about sex and related issues through games and quizzes.

Digitizing SRHR

In India, the government is currently running a special campaign on expanding digital connectivity and providing quality e-Governance. Named “Digital India”, the campaign envisions transforming India into a digitally empowered society and knowledge economy.

The campaign aligns well with the government’s plan to advance and improve sexual and reproductive health and rights (SRHR) in the country, says Chandra Kumar Mishra, India’s secretary of health. “We are digitising our communication all along our supply chain,” he said, right after announcing that India would spend an additional one billion dollars in the next five years to provide better reproductive health care to its population.

With the new announcement, India’s commitment now stands at an impressive sum of three billion dollars.

There are 100 million women in India who use contraceptives, according to government data. But not every one receives what she needs. This causes not just an imbalance in the demand and supply system, but also becomes a hurdle in achieving the overall SRHR goal of the government: providing contraceptives to an additional 48 million women and also reduce and eradicate diseases and deaths.

Digital tools can help bridge the gap between the demand and the supply, says Mishra.

Citing the example of E-mitra, a mobile phone based communication service launched by the government, Mishra says that the rapid expansion of digital network in India is sparking greater use of internet phones, especially in the urban and semi-urban belt. Health service providers should leverage this opportunity to reach out more people and provide them with credible information through mobile phones and internet tools, he feels.

Cellphones for Better Information

Mishra’s words resonate with Kamla Mukhi, a 24-year-old young tribal woman community health campaigner in Daltongunj, a coal mining district in east India’s Jharkhand state. In Daltongunj, tribal women have to travel 20-25 kilometers to reach the nearest health center for their need – whether it is for information or a product.

A year ago, Mukhi visited one such health center. “An elderly woman health worker secretly slipped a box of condoms into a young woman’s hand. Later, the woman asked me, ‘Didi, how do I eat this? This is rubber.‘ I did not know whether to laugh or cry. The woman had earlier received cereals and birth control pills here, so she thought this new product was also for swallowing,“ Mukhi recalls.

With mobile phones, such situations would not occur because women can receive the information directly, without any added confusion, Mukhi says.“The health workers themselves feel embarrassed to talk of sex and contraceptives, but if that information is available on the mobile screen, nobody will have to be embarrassed.”

The digitized information system can also be a big boon for women and young people who live in conflict areas, says Mukhi, whose own village falls in an area partially controlled by Naxals, an ultra-communist rebel outfit fighting against the government.

“Women walk long miles to a health center. Then they find out it’s been closed because there was a security threat or an attack. If such information is shared on a mobile phone, they need not undergo such unnecessary hassles,“ says the young health activist.

Investing in Data

But while it’s rather easy to share and give away information, collecting accurate statistics about how that knowledge is put to use remains a huge challenge.

“Credible data is a very crucial area,” says Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, who in 2016 had announced an 80-million-dollar fund for research and collection of reliable gender specific data. Such data, feels Gates, is vital to identify the economic and social issues affecting women and fulfill the UN Sustainable Development Goals, especially goals 3 and 5.

“When a woman health center worker uses and shares data with the women in her community, she knows its valuable because its credible,“ Gates says.

Mishra agrees: “One of the technologies that we are using is Supply Chain Management, a software that will track the purchases and supply of all the reproductive healthcare commodities. We also have a current database on levels of contraceptive use which we are now going to digitize. Soon we will have an enormous volume of data and most of it we will make available to the public,” he says.

Currently, the government is partnering with the Gates Foundation in developing Kilkari, a mobile application that will provide customized information to new mothers, including notifying them on next vaccination dates. The government also has two other mobile apps – Emitra and Anmol – that are used to give free information on family planning.

Youth-Friendly Technologies

None of the government’s technologies are specifically targeting youths, Mishra admits, but says that his department is planning to address it soon. Franklin Paul says that to encourage youths to use the technologies, they need to be ‘youth-friendly.‘

“The government apps are very text-heavy. But young people love something that is interactive and visually appealing and stimulating. This is why we are about to add videos to our Msathi apps. Just as we need to give them a basket of contraceptive products to choose from, we also need to give them a basket of technologies to pick. So, instead of just text messages, we should offer a bouquet of ecommerce, multimedia and social media that will help expand SRHR services among youths,“ says Paul.

Indonesian Vice President Jusuf Kalla and UNFPA Executive Director Dr. Babatunde Osotimehin discussed how Indonesia could harness its demographic dividend on the sidelines of the World Economic Forum on East Asia in Jakarta on Apr. 20. Credit: Courtesy of UNFPA Indonesia.

By Sandra Siagian
JAKARATA, May 2 2015 (IPS)

In a populous archipelago nation like Indonesia, where 250 million live spread across some 17,500 islands, speaking over 300 languages, the question of development is a tricky one.

A lower-middle-income country with a poverty rate of 11.4 percent – with a further 65 million people living just below the poverty line – the government is forced to make tough choices between where to invest limited funds: education or health, job creation or infrastructure development?

A demographic dividend arises when a high ratio of working people relative to population size frees up resources for private and public investment in human and physical capital.
These issues are further complicated by the fact that over 62 percent of the population – about 153 million people – lives in rural areas, largely cut off from easy access to hospitals, schools and job markets outside of the agricultural sector. About 27 percent of this population, roughly 66.1 million people, are women of reproductive age.

In addition, Indonesia currently has the highest rate of working-age people that it has ever had, both in absolute numbers – with 157 million potential workers – and as a proportion of the total population – accounting for 66 percent of all Indonesians.

While this puts a huge strain on the government to provide jobs, it also offers the country a chance to reap the benefits of its demographic dividend, defined by the International Labour Organisation (ILO) as a period in which the rising number of working people relative to population size frees up resources for private and public investment in human and physical capital.

This, in turn, allows the country to achieve far higher rates of income per capita, thus boosting the national economy.

At the recently concluded World Economic Forum on East Asia, which ran from Apr. 19-21 in Indonesia’s capital, Jakarta, experts from around the world urged the country to capitalise on its demographic dividend by investing heavily in its own people.

Among the nearly 700 participants in the conference was the executive director of the United Nations Population Fund (UNFPA), former Nigerian Health Minister Dr. Babatunde Osotimehin, who stressed throughout his three-day visit that “people need to be at the centre of development.”

While this may seem a simple recipe, it bears repeating in Indonesia, where half of the population falls into the ‘youth’ category (15-24 years), a demographic that also has one of the highest unemployment rates in the country.

With Indonesia’s population set to increase by 19 percent, to about 293 million people by 2030, according to the UNFPA, the country would be well advised to heed the words of population experts.

In the midst of his whirlwind visit to Jakarta, Osotimehin sat down with IPS to discuss how Indonesia can harness the potential of its people, and to share some strategies on how the young democracy can optimise on changing population dynamics.

Excerpts from the interview follow.

Q: Where is Indonesia in terms of its demographic dividend?

A: Indonesia needs to take advantage of its demographic window of opportunity, which is expected to peak between 2020 and 2030. I think that there is the consciousness in Indonesia that this [demographic dividend] is an important national planning process, which they must invest in.

I believe that Indonesia has both the analytics and the political commitment, but I believe that going forward, we will have to encourage Indonesia to investment [strategically] for the demographic dividend to succeed.

Q: What kinds of investments need to be made?

A: Investments in health, youth education and employment need to be scaled up considerably. I think that social systems need strengthening – we need to address the issue of early marriage and make sure that girls are allowed to go to school, stay in school and reach maturity. We want to make sure that girls and women can make choices for themselves going forward, that is a key point.

Every young person must be taught about themselves and their bodies, and every woman needs to have access to voluntary family planning and sexual reproductive health services so that they are empowered to make choices. Having comprehensive sexuality education would ensure that we could reduce things like HIV infections, sexually transmitted infections and teenage pregnancies.

I think that within the educational framework we also want a situation where the curriculum is diversified so that we can encourage vocational training and entrepreneurship training. We need to be able to inspire small and medium-sized enterprises, which usually form the basis of a thriving economy.

Q: Why is it particularly important for Indonesia to focus on young people?

A: It’s important for Indonesia to invest in young people for many reasons. It gives a sense of belonging [for] a young person and it ensures that they can participate in national development. Young people will be part of the demographic transition and fertility reduction needs to include them. So really, they have to be part of the process.

Once you realise the potential of young people and they enter employment they are then able to save and earn, which in turn will help the economy grow.

Q: Is Indonesia moving in the right direction?

I think Indonesia has always had some of the necessary policies in place; they just need to be revitalised. New investments and political leadership have to come into it.

In the past, Indonesia was the leader in family planning after they implemented a national family planning programme in the 1970s. But it fell off the radar after Indonesia’s democratic transition in the 2000s, when family planning services were decentralised.

I think this new government is committed to bringing it back and I hear from discussions with various government leaders that this is something that they are paying close attention to.

Indonesia should also consider working with the private sector to help create decent jobs. Making sure that everybody, from the youth to the elderly, has social protection that provides basic [services] will be most important.

Edited by Kanya D’Almeida

Excerpt:

Young girls in the village of Sonu Khan Almani in Pakistan's Sindh province perform most of the household chores, like making bread. Credit: Zofeen Ebrahim/IPS

By Preethi Sundaram and Fiona Salter
NEW YORK, Mar 16 2015 (IPS)

It is estimated that women account for two-thirds of the 1.4 billion people currently living in extreme poverty. They also make up 60 per cent of the world’s 572 million working poor.

Rapid global change has undoubtedly opened doors for women to participate in social, economic and political life but gender inequality still holds women back.If you can decide who you live with, what happens to your body and the size of your family, if you are free to make decision about these fundamental rights – only then are you able to participate fully in social, economic and political life.

Around the globe, women and girls continue to have subordinate status, fewer opportunities and lower income, less control over resources, and less power than men and boys.

Son preference continues to deny girls the education they have a right to. And the burden of care work that women face impinges and intrudes on their opportunities in terms of education and career.

Now a new report to be launched by the International Planned Parenthood Federation (IPPF) Mar. 16 in New York examines the links between SRHR and three core aspects of gender equality: social development, economic participation and participation in political and public life.

The report, Sexual and reproductive health and rights – the key to gender equality and women’s empowerment, provides specific recommendations to governments and to United Nations agencies to make sexual and reproductive health and rights and gender equality become a reality.

The reason for the report is to assess objectively what we have long suspected, namely that sexual and reproductive health and rights are critical to achieving equality.

Why? Because when women are able to maintain good health the trajectory of their lives can be transformed.

There are fewer maternal deaths and less reproductive illness; women and girls can realise their sexual and reproductive health and rights, they are free to participate in social, economic and political life.

Stark figures show that the denial of sexual and reproductive health and rights is a cause and consequence of deeply entrenched ideas about what it means to be a man or a woman.

Gender norms leave women and girls at risk and unable to reach their full potential. In some extreme cases, they can kill.

Women die because they cannot access the abortion services they need. Women die of preventable causes in childbirth. Women die at the hands of their violent partners. We see examples of this in all corners of the world.

Globally, one in three women experience either intimate partner violence or non-partner sexual violence during their lifetime. And, shockingly, women how have experienced intimate partner violence are 50 per cent more likely to contract HIV.

Sexual and gender-based violence is a major public health concern in all corners of the world. It’s a barrier to women’s empowerment and gender equality, and a constraint on development, with high economic costs.

And then there’s work. The percentage of women working in formal wage employment has increased over the last half century but a striking number of women are still likely to work in the informal economy due to gender inequality.

Across cultures and in all economies, women continue to do the bulk of unpaid care work. Women make up the majority of workers in the informal economy – 83 per cent of domestic workers worldwide are women.

Work in the informal economy can be more insecure and precarious, and can have specific impacts on the sexual and reproductive health and rights of women. For example, lack of regulations can make women more vulnerable to lower wages, limited access to health care, maternity leave or child care and workplace discrimination, including sexual assault.

In virtually every country, men spend more time on leisure each day while women spend more time doing unpaid housework. Women devote 1 to 3 hours more a day to housework than men; 2 to 10 times the amount of time a day to care (for children, elderly, and the sick), and 1 to 4 hours less a day to market activities.

Globally, female labour force participation decreases 10-15 per cent with each additional child for women aged 25-39.

Women also tend to have less access to formal financial institutions and saving mechanisms. While 55 per cent of men report have an account at a formal financial institution, the figure is just 47 per cent for women .

Here, too, women’s sexual and reproductive health and rights are key – true economic empowerment and stability comes from ensuring that regulatory frameworks across both the formal and informal economies take into consideration women’s reproductive lives.

In the political realm gender norms limit women’s opportunities to participate in decision making. As a result, women’s domestic roles are over-emphasised, they have less time to engage in activities outside of the home. This then restricts their influence to informal decision making, which tends to be hidden, or not respected.

Hardly surprising, then, only 1 in 5 parliamentarians is female.

One reason for women’s low participation in public and political life is because party politics and strategic resources are dominated by men.

In addition, women also have to overcome barriers that men don’t, such as poor networking, limits on whether they can travel.

Women voters are four times as likely as men to be targeted for intimidation in elections in fragile states. After all, would you vote if you faced threats on your way to the polling station?

What this report shows is that gender inequality prevents girls and women from reaping benefits and contributing to social, economic and political life.

So what’s the answer? Truth be told, no single approach will work. We have to look at solutions that work for women’s varied and complex lives.

But there is something that we can change – something that goes to the very heart of poverty eradication and development goals. We can uphold sexual and reproductive rights.

Because if you can decide who you live with, what happens to your body and the size of your family, if you are free to make decision about these fundamental rights – only then are you able to participate fully in social, economic and political life.

It’s the freedom from which all other freedoms flow.

Women and girls should have the right and ability to make decisions about their reproductive lives and sexuality, free from violence, coercion and discrimination.

That’s what equality is all about.

Edited by Kitty Stapp

Excerpt:

‘Joginis’, otherwise known as India’s ‘temple slaves’, dance outside a temple during a religious festival. Credit: Stella Paul/IPS

By Lyndal Rowlands
NEW YORK, Mar 6 2015 (IPS)

Media coverage of maternal, sexual and reproductive health rights is crucial to achieving international development goals, yet journalists covering these issues often face significant challenges.

“When I was a baby, I got sick and some of my family members decided that I should die because I was not a boy. Decades later, I’m inspired by the courage of my mother - and countless other women – to expose and end gender-based violence and inequality.” -- IPS correspondent Stella Paul
Recognising the contributions these journalists make to advancing women and girls’ rights, international advocacy organisation Women Deliver have named 15 journalists for their dedication to gender issues ahead of International Women’s Day 2015.

Among the journalists Women Deliver recognised for their work is IPS correspondent Stella Paul from India.

Paul was honoured for her reporting on women’s rights abuses through articles on such issues as India’s ‘temple slaves’ and bonded labourers.

Paul’s dedication to women’s rights is not only shown through her journalism. When she interviews communities, she also teaches them how to report abuses to the authorities and hold them accountable for breaking the cycle of violence.

Paul is herself a survivor of infanticide.

She told Women Deliver, “When I was a baby, I got sick and some of my family members decided that I should die because I was not a boy.

“Decades later, I’m inspired by the courage of my mother – and countless other women – to expose and end gender-based violence and inequality.”

Among others, Paul’s story on bonded labour in the southern Indian city of Hyderabad has had a tangible impact on the lives of those she interviewed.

In July she blogged about how one woman featured in the article ‘No Choice but to Work Without Pay‘, Sri Lakshmi, was released from bonded labour by her employer after a local citizen read the article on IPS and took action.

Lakshmi’s daughter Amlu, who once performed domestic labour while her parents went off to work, is now enrolled in a local elementary school.

Women’s issues aren’t ‘soft news’

Another journalist honoured was Mae Azango from Liberia.

Women Deliver CEO Katja Iversen told IPS, “Mae Azango deserves a Pulitzer. She went undercover to investigate female genital mutilation in Liberia.

“After her story was published she received death threats and [she] and her daughter were forced into hiding. Mae’s bravery paid off though, as her story garnered international attention and encouraged the Liberian government to ban the licensing of institutions where this horrific practice is performed,” Iversen added.

Azango told Women Deliver, “Speaking the truth about female genital cutting in my country has long been a dangerous thing to do. But I thought it was worth risking my life because cutting has claimed the lives of so many women and girls, some as young as two.”

Iversen said that many of the honourees had shown incredible dedication, through their work.

“For some of our journalists, simply covering topics deemed culturally taboo – like reproductive rights, domestic violence or sexual assault – can be enough to put them in danger,” she said.

However despite their dedication, journalists still also face obstacles in the newsroom.

“One of the questions we asked the journalists was: what will it take to move girls’ and women’s health issues to the front pages?” Iversen said.

“Almost all of them said: we need more female journalists in leadership and decision-making positions in our newsrooms. Journalism, like many other industries, remains a male dominated field, which can be a major obstacle to publishing stories on women’s health and rights.”

But the issue also runs deeper. There is also a lack of recognition that women and girls’ health rights abuses and neglect are also abuses of human rights, and combatting these issues is essential to achieving development for everyone, not just women and girls.

This means that women’s health is often seen as ‘soft news’ not political or economic news worthy of a front-page headline.

“Unfortunately women’s health and wellbeing is still, for the most part, treated as ‘soft’ news, despite the fact that when women struggle to survive, so do their families, communities and nations,” Iversen said.

“Every day, an estimated 800 women die in pregnancy or childbirth, 31 million girls are not enrolled in primary school and early marriage remains a pervasive problem in many countries. These are not just women’s issues, these are everyone’s issues – and our honorees are helping readers understand this link.”

As journalist Catherine Mwesigwa from Uganda told Women Deliver, “Women’s health issues will make it to the front pages when political leaders and the media make the connection between girls’ and women’s health and socio-economic development and productivity, children’s education outcomes and nations’ political stability.”

Male journalists also have a role to play and two of the fifteen journalists honoured for their contribution to raising awareness on these crucial rights were men.

Besides India and Liberia, other honorees hailed from Argentina, Cameroon, Bangladesh, Kenya, Pakistan, the Philippines, Senegal, Tanzania, Uganda, and the United States.

Online Vote

Readers have the opportunity to vote for their favourite journalists from the fifteen journalists selected by Women Deliver.

The three winners will receive scholarships to attend Women Deliver’s 2016 conference, which will be held in Copenhagen, Denmark.

Voting is open until 20 March 2015.

Edited by Kanya D’Almeida

Srun Srorn, trainer for the E-learning project, shows teachers at Koh Kong High School how the sexual education curriculum works. Credit: Michelle Tolson/IPS

By Michelle Tolson
KOH KONG PROVINCE, Cambodia, Nov 5 2014 (IPS)

The transition to puberty can be an awkward experience for youth to navigate. In Cambodia, sex education is moving increasingly into the virtual realm, with the Internet and mobile phones providing welcome spaces for young people to learn, seek help and stay safe.

Cambodia is classified as one of the world’s Least Developed Countries (LDCs), with 20 percent of the population living below the poverty line, while another 20 percent are just 0.30 dollars a day above the poverty line, according to the World Food Programme (WFP).

Illiteracy has been linked with poverty and only 74 percent of rural communities are literate. Cambodia has been heavily influenced by the NGO culture, which has helped bring about some improvements, yet when it comes to sexual and reproductive health and rights (SRHR), these organisations have tended to focus on addressing poor maternal health or at-risk groups, such as entertainment workers.

"This is the difficulty that we experience [in Cambodia: making people aware that counseling is a way of providing emotional support and empowerment as well as exploring options without judgment or assumption.” -- Sean Sok Phay, executive director of Child Helpline Cambodia
Youth, on the other hand, particularly those from poorer families and in rural areas, have not received much attention, particularly those who engage in romantic relationships outside of marriage.

Now, a wave of online learning is filling crucial gaps in the knowledge system.

One such initiative is a major E-learning platform being rolled out with support from the ministry of education, youth and sport (MoEYS), aimed at improving young people’s access to vital information.

“NGOs focus on the population in general, birth spacing, maternal health, but not sweetheart relationships that youth have,” Kuth Sovanno, administrative officer in the school health department of the MoEYS said recently to a roomful of teachers at Koh Kong High School during the launch of the E-learning initiative.

It is being piloted in 24 secondary schools in the provinces of Bantey Meanchey, Battambong, Pursat, Kampong Chhnang, Takeo, Kampot, Koh Kong and Sihanoukville (Kampong Som province) and Phnom Penh. At present, the plan is to expand the programme to reach 100 schools.

Sovanno tells IPS that tapping into social media is a way to get the information out to youth who flock to Facebook to socialise. Youth are beginning to see online access as an important source of information, so the MoEYS maintains an up-to-date website, which is not always the case with the other ministries.

Cambodia’s mobile phone sales have mushroomed, resulting in an estimated 134-percent mobile phone penetration, with cell phones being cheaper than land lines, while social media – accessed through Internet cafes and mobile devices – was believed to have played a major role in the 2013 elections.

In this same way, youth are breaking away from traditional restrictions on sexual and reproductive health education, says Srun Srorn, advisor to One World UK, partnering with the MoEYS to launch the E-learning programme.

Srorn is an activist who uses social media to reach marginalised youth, including the LGBT community, drug users, sex workers and migrant workers. His volunteer-led organisation, CamASEAN, reaches 2,000 members through social media.

Chheon Rachana, a 28-year-old female activist for LGBT issues who teaches about sexual orientation, gender identity and expression for Rainbow Community Kampuchea (RoCK) and CamASEAN, tells IPS that many girls do not talk to their parents or female teachers for advice on seemingly basic topics like menstruation; instead, most reach out to friends.

While some schools make use of NGO support to supply poor rural students with feminine products at school, many girls continue to face challenges in acquiring the most essential products and services.

“Poor girls ask for money from their parents or from someone close to them in their family,” explains Rachana. She herself did not tell her parents when she started menstruating, but had a sympathetic relative help buy her monthly feminine products.

Things become even more challenging for teens learning about safer sex, abortions and sexual orientation.

“The traditional Cambodian style of reproductive and sexual health education means that most youth have to find out by themselves by book, [and] share [this information] with their friends because they don’t learn this at school,” Rachana says.

She thinkx the Internet is changing this, though she maintains the importance of accurate information – something that is not always possible given the very nature of the Web.

NGOs such as the Reproductive Health Association of Cambodia (RHAC), which also supports the E-learning initiative, trains peer educators to provide accurate information and emotional support in several provinces but adolescents without access to this especially benefit from mobile, SMS and online counseling.

Sean Sok Phay, executive director of Child Helpline Cambodia, which, along with Inthanou, provides counselors for the new website www.youthchhlat.org, tells IPS, “Online and phone counseling is a new concept in Cambodia. Many people often refer [to] counseling as giving advice or instructing people to do certain thing. This is the difficulty that we experience: making people aware that counseling is a way of providing emotional support and empowerment as well as exploring options without judgment or assumption.”

He describes the service as “pro-poor” and especially helpful for youth in rural areas, as one-on-one counseling can be expensive, while this service is free. The use of mobile phones allows for privacy to talk about these topics either online, by calling or through SMS.

The MoEYS recently published a life skills book for youth that tackles changes in adolescents’ bodies, but also social issues such as drug use and learning about sexually transmitted infections (STIs), which is paired with the E-learning project that has its own curriculum as well.

“Each student has time at the computer already so it will be easier because they are shy to learn [about sexual reproductive health],” Theary, a high school teacher who has taught grades 7-9 at Koh Kong High for the past seven years, tells IPS.

Computer labs, such as the one in Koh Kong High School, will introduce the website’s lessons to students offline first because of the school’s slow Internet connection but they can also access the lessons online at Internet cafes or through mobile phones.

The new website was launched in March of this year.

“Many youth have sex before marriage now, compared to traditional times,” adds Srorn of One World UK, who trains teachers on how to use the E-learning platform.

“Girls already learn by themselves and use porn videos for this. Internet cafes are not expensive, just 1000 riels [0.24 dollars] an hour so poor girls can learn this way. Males use karaoke bars, beer gardens, massage parlors.”

Koh Kong town, situated close to the Thai border, has many massage parlors and some casinos.

“Middle-class and [upper]-class girls can walk or take a moto bike along the riverside in cities [to meet potential sex partners], while high-class girls go to hip-hop clubs where they can meet a guy. But youth also use the Internet for this. They can use Skype, Facebook messenger and phone sex to hook up.”

Chheon agrees that meeting girlfriends and boyfriends online is common these days. But she says it is important that they meet in public places first and not away from other people for safety reasons.

According to a 2013 U.N. report, 20 percent of men in Cambodia said they had forced a woman to have sex, half of whom claimed to have done so as a teenager.

For those surviving an assault, phone and online counseling can be a lifesaver.

“A girl in a village [who has] been raped … will not only face discrimination, she will have a very difficult time in terms of trauma, stress, and feelings of suicide. Phone counseling, online and text message counseling is playing a role to create the means or opportunity for such a community,” points out Sok Phay from the Child Helpline.

But perhaps what is most urgently needed is information about practicing safer sex.

Monyl Loun, executive director of Inthanou, the other counseling service supporting the project, tells IPS that while love and relationships are “natural” at the age of puberty, the important thing is to learn about the “responsibilities of love, and information to prevent … unintended pregnancy, HIVs and STIs.”

Karaoke videos that play on televisions in buses and even the simplest cafes show romantic partners ending their lives over relationship problems.

“KTV songs and dances are about love, broken hearts and marriage,” explains Srun, adding that most music videos depict couples killing or hurting themselves as a solution to their problems.

But counselors working round the clock in Cambodia hope the new technology-savvy mode of sex education will remind youth that love does not have to end in tragedy.

Edited by Kanya D’Almeida

There has been an increase in pregnancies among Zimbabwean adolescents aged 15-19 years, from 21 percent between 2005 and 2006 to 24 percent between 2010 and 2011. Credit: Credit: Jeffrey Moyo/IPS

By Ignatius Banda
BULAWAYO, Zimbabwe, Oct 1 2014 (IPS)

Pregnant at 15, Samantha Yakubu* is in a fix. The 16-year-old boy she claims was responsible for her pregnancy has refused to accept her version of events, insisting that he was “not the only one who slept with her”.

Now Yakubu has dropped out of school and, like many sexually active youth in Zimbabwe, faces an uncertain future.

The issue of contraceptive use remains controversial and divisive in this country of 13.72 million people.

Parents and educators are agreed on one thing: that levels of sexual activity among high-school students are on the rise. What they do not agree on, however, is how to deal with the corresponding inrcrease in teenage pregnancies.

“Lack of adequate, medically accurate information on puberty leaves young people dependent on uninformed peer sources and unguided Internet searches for information." -- Stewart Muchapera, communications analyst with the UNFPA in Zimbabwe.
While Zimbabwe has made huge gains in some areas of reproductive health, including stemming new HIV infections, according to the Health Ministry, various United Nations agencies have raised concerns about the growing number of adolescent pregnancies, which experts say point to a low use of prophylactics and a dearth of other family planning methods.

According to the U.N. Population Fund (UNFPA), contraceptive use in Zimbabwe stands at 59 percent, one of the highest in sub-Saharan Africa. Still, this is lower than the 68 percent mark that the government pledged to achieve by 2020 at the 2012 London Summit on Family Planning.

A proposal last year by a senior government official to introduce contraceptives into schools, allowing condoms to be distributed free of charge, was met with disbelief and anger among parents, who insisted this was tantamount to promoting promiscuity among learners.

There is still no agreement between parents and educators about the stage at which students can be introduced to sex education.

“Lack of adequate, medically accurate information on puberty leaves young people dependent on uninformed peer sources and unguided Internet searches for information,” says Stewart Muchapera, a communications analyst with the UNFPA in Zimbabwe.

“The fertility rate among teenage girls aged 15-19 in 2010/11 was 115 per 1,000 girls, a significant increase from 99 per 1,000 girls in 2005/6,” Muchapera tells IPS, adding that geographic location also determines the likelihood of early pregnancy, with girls living in rural areas twice as likely to be affected than their urban counterparts.

In fact, the rate of adolescent pregnancies is just 70 per 1,000 girls in urban areas, compared to 144 per 1,000 girls in rural areas, he adds.

The Zimbabwe Demographic and Health Survey (ZDHS) reports that nine out of 10 sexually active girls aged 15 to 19 are in some form of a marriage, and that for two out of three girls who first had sex before age the of 15, sex was forced against their will.

The risk of maternal death is twice as high for girls aged 15 to 19 as for women in their twenties, experts say, and five times higher for girls aged 10 to 14 years.

Currently, Zimbabwe has a maternal mortality ratio of 790 deaths per 100,000 live births and an under-five mortality rate of 93 deaths per 1,000 live births.

Janet Siziba, a peer educator with the Matabeleland Aids Council, says there is a stigma attached to early pregnancy, with many forced to drop out of school or endure financial hardships after the birth of a child, particularly after the disappearance of an adolescent father.

“You can escape both pregnancy and HIV by increased condom use and, perhaps more importantly, by using other female contraceptives [such as the female condom and oral contraceptives],” Siziba tells IPS.

But with young people getting mixed messages on contraceptives, the trend is unlikely to change anytime soon. In fact, the country’s registrar-general Tobaiwa Mudede has actually warned women against using contraceptives, on the grounds that they cause cancer and are a ploy by developed countries to stem population growth in Africa.

Family planning advocates including the Zimbabwe National Family Planning Council (ZNFPC) called his comments retrogressive especially at a time when the country’s health system is struggling to stem maternal mortality and also provide adequate antenatal care.

Through its National Adolescent Sexual and Reproductive Health Strategy (ASRH), the Ministry of Health now allows adolescents to access contraceptives at public institutions such as clinics and hospitals, but peer educators are concerned that youth are not too eager to collect contraceptives in full view of the public.

The result is an increase in pregnancies among adolescents in the 15-19 age group from 21 percent between 2005 and 2006 to 24 percent between 2010 and 2011.

Experts say that conservative attitudes towards contraceptive use could slow down global efforts under the multi-sector Family Planning 2020 (FP2020) initiative, which seeks to increase access to contraception for women and girls between 15 and 49 years of age in developing countries.

According to the Bill and Melinda Gates Foundation–supported FP2020 project, 260 million people from developing countries had access to contraceptives in 2012, and the initiative aims to add 120 million more by the year 2020.

*Names have been changed

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Kanya D’Almeida

Increasing levels of violence across India due to ethnic tensions and armed insurgencies are taking their toll on women and cutting off access to crucial reproductive health services. Credit: Stella Paul/IPS

By Stella Paul
BASTAR, India, Sep 26 2014 (IPS)

Twenty-five-year-old Khemwanti Pradhan is a ‘Mitanin’ – a trained and accredited community health worker – based in the Nagarbeda village of the Bastar region in the central Indian state of Chhattisgarh.

Since 2007, Pradhan has been informing local women about government health schemes and urging them to deliver their babies at a hospital instead of in their own homes.

Ironically, when Pradhan gave birth to her first child in 2012, she herself was unable to visit a hospital because government security forces chose that very day to conduct a raid on her village, which is believed to be a hub of armed communist insurgents.

“I have seen women trying to use home remedies like poultices to cure sepsis just because they don’t want to run into either an army man or a rebel." -- Daniel Mate, a youth activist from the town of Tengnoupal, on the India-Myanmar border
In the panic and chaos that ensued, the village all but shut down, leaving Pradhan to manage on her own.

“Security men were carrying out a door-to-door search for Maoist rebels. They arrested many young men from our village. My husband and my brother-in-law were scared and both fled to the nearby forest.

“When my labour pains began, there was nobody around. I boiled some water and delivered my own baby,” she said.

Thanks to her training as a Mitanin, which simply means ‘friend’ in the local language, Pradhan had a smooth and safe delivery.

But not everyone is so lucky. Increasing levels of violence across India due to ethnic tensions and armed insurgencies are taking their toll on women and cutting off access to crucial reproductive health services.

This past June, for instance, 22-year-old Anita Reang, a Bru tribal refugee woman in the conflict-ridden Mamit district of the northeastern state of Mizoram, began haemorrhaging while giving birth at home.

The young girl eventually bled to death, Anita’s mother Malati told IPS, adding that they couldn’t leave the house because they were surrounded by Mizo neighbours, who were hostile to the Bru family.

According to Doctors Without Borders (MSF), a global charity that provides healthcare in conflict situations and disaster zones across the world, gender-based violence, sexually transmitted infections including HIV, and maternal and neonatal mortality and morbidity all increase during times of conflict.

This could have huge repercussions in India, home to over 31 million women in the reproductive age group according to the United Nations Population Fund (UNFPA).

The country is a long way from achieving the Millennium Development Goal (MDG) target of 103 deaths per 100,000 live births by 2015, and is still nursing a maternal mortality rate of 230 deaths per 100,000 births.

There is a dearth of comprehensive nationwide data on the impact of conflict on maternal health but experts are agreed that it exacerbates the issue of access to clinics and facilities.

MSF’s country medical coordinator, Simon Jones, told IPS that in India the “most common causes of neonatal death are […] prematurity and low birth weight, neonatal infections and birth asphyxia and trauma.”

The government runs nationwide maternal and child health schemes such as Janani Suraksha Yojana and Janani Shishu Suraksha Karykram that provide free medicine, free healthcare, nutritional supplements and also monetary incentives to women who give birth at government facilities.

But according to Waliullah Ahmed Laskar, an advocate in the Guwahati High Court in the northeastern state of Assam, who also leads a rights protection group called the Barak Human Rights Protection Committee, women wishing to access government programmes must travel to an official health centre – an arduous task for those who reside in conflict-prone regions.

In central and eastern India alone, this amounts to some 22 million women.

There is also a trust deficit between women in a conflict area and the health workers, Laskar told IPS. “Women are [often] scared of health workers, who they think hold a bias against them and might ill-treat them.”

For Jomila Bibi, a 31-year-old Muslim refugee woman from Assam’s Kokrajhar district, such fears were not unfounded; the young woman’s newborn daughter died last October after doctors belonging to a rival ethnic group allegedly declined to attend to her.

Bibi was on the run following ethnic clashes between Bengali Muslims and members of the Bodo tribal community in Assam that have left nearly half a million people displaced across the region.

Daniel Mate, a youth activist in the town of Tengnoupal, which lies on India’s conflicted border with Myanmar, recounted several cases of women refusing to seek professional help, despite having severe post-delivery complications, due to compromised security around them.

“When there is more than one armed group [as in the case of the armed insurgency in Tengnoupal and surrounding areas in northeast India’s Manipur state], it is difficult to know who is a friend and who is an enemy,” he told IPS.

“I have seen women trying to use home remedies like poultices to cure sepsis just because they don’t want to run into either an army man or a rebel,” added Mate, who campaigns for crowd-funded medical supplies for the remotest villages in the region, which are plagued by the presence of over a dozen militant groups.

The solution, according to MSF’s Jones, is an overall improvement in comprehensive maternal care including services like Caesarean sections and blood transfusions.

Equally important is the sensitisation of health workers and security personnel, who could persuade more women to seek healthcare, even in troubled times.

Other experts suggest regular mobile healthcare services and on-the-spot midwifery training to women in remote and sensitive regions.

According to Kaushalendra Kukku, a doctor in the Kanker government hospital in Bastar, “When violence erupts, all systems collapse. The best way to minimise the risk of maternal death in such a situation is to take the services to a woman, instead of expecting her to come to [the services].”

Pradhan, who has now resumed her duties as a community health worker, agrees. “I was able to deliver safely because I was trained. If other women receive the same training, they can also help themselves.”

Edited by Kanya D’Almeida

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.