The Unfinished Sexual and Reproductive Health Agenda

Repositioning Latin America and the

Caribbean Women Deliver

London, October 2007

Latin America and the Caribbean:Better off than other developing regions?

Total Fertility Rate

Contraceptive prevalence (modern methods)

Skilled Attendance of Deliveries

HIV Prevalence

Sub-Saharan Africa

5.7 20% 41% 7.2%

South and East Asia 3.5 58% 37% .7%

Latin Latin America America and the and the CaribbeanCaribbean

2.6 63% 86% .7%

Source: UNFPA, 2006

Deceiving regional indicators

• Regional average indicators mask huge gaps– Population living under

the poverty line: 24%– Range: 6% in Uruguay -80% in Nicaragua

(Haiti a close second at 78%)

Deceiving regional reproductive health indicators: Maternal mortality

• Although average regional rates are lower than other regions’, some parts of LAC have higher MMR than some countries in Africa.

• Wide range of MMR – Chile: 31 deaths/100,000 live births – Haiti: 680 deaths/100,000 live births (World Bank 2007)

• For example, Namibia’s MMR is 300/100,000 live births and Botswana’s is 100 deaths/100,000 live births (World Bank, 2007)

Large inequalitieswithin countries

Average country indicators also mask important differences

In Guatemala:– Access to improved sanitation:

• 44% of rural populations• 84% of urban populations

– Indigenous and non-indigenous peoples: • 75% of Mayans vs. 27% of Ladinos live in poverty• 30% of Mayans vs. 11% of Ladinos are illiterate

Assistance during delivery by place of residency, Peru, DHS, 2000

0

10

20

30

40

50

60

 Urban  Rural

Doctor

Other healthprofessional Traditional birthattendant Relative or other

No one

Knowledge and utilization of modern contraceptive methods, Mayan vs. Ladino women, Guatemala, 2002

Source: ENSMI 2002

0

20

40

60

80

100

Knows Used

MayaLadina

– In Honduras, multiple strategies led by national commitment to address MM decreased it by 40% from 1990-1997

– In Nicaragua abortion was banned even when a woman’s life is threatened (2006)

Public policy and reproductive health: safe motherhood

Public policy and sexual andreproductive health: HIV and AIDS

– Government commitment to the fight against HIV and AIDS:• Brazil: with progressive policies and

widespread prevention efforts, AIDS mortality dropped by 50% since 1996

Deceiving regional sexual and reproductive health indicators: HIV and AIDS

• On average, the region has relatively low rates of HIV prevalence, but the Caribbean has the second-highest HIV infection rate after Sub-Saharan Africa

• Top 15 HIV and AIDS prevalence countries outside Africa (% of population, 2005):

– Haiti (3.8)– Bahamas (3.3)– Trinidad and Tobago (2.6)– Belize (2.5)– Guyana (2.4)– Suriname (1.9)– Papua New Guinea– Cambodia– Barbados (1.5)– Honduras (1.5)– Jamaica (1.5)– Thailand– Ukraine– Estonia – Myanmar

Asymmetries ininternational support

U.S. Government Support in LAC

• Resources for counter-narcotics and security assistance increased since 2002, especially in the Andean region• Aid levels to LAC did not significantly change in 10 years: 8.2% (94) 9% (04) of worldwide aid budget• RH: Most LAC countries have already “graduated” or will soon do so

U.S. Foundation Support in LAC

• Peak of 18.3% in 1994 decreased to 5.9% in 2004

• Foundation’s giving priorities for LAC have shifted from health to international development, disaster relief, environment and human rights

• Health grants : 8.3%; Reproductive health: 4.5% (2004)

U.S. Foundation Support in LAC

U.S. Foundation Support in LAC

• Mexico and Brazil consistently rank among top beneficiary countries

• Ford and Kellogg foundations provide biggest shares of support

• MacArthur Foundation, one of the few with still a LAC country inits priority list

Dwindling Support for Reproductive Health

Funding for reproductive health and family planning has decreased in the past decade with the exception of HIV/AIDS

Source: UNFPA. Financial resource flows for population activites in 2001 and UNFPA/NIDI Resource Flows project database. New York, USA: UN Population Fund, 2003

LAC faces great challenges but also offers unique opportunities!

• Commitment of governments with MDG • Functional health systems • Information on health• Committed and vocal civil society organizations• Robust health research institutions• Strong private sector with nascent social

responsibility arms• New philanthropic organizations• General awareness of health as a

human right and importance of health

for development

What needs to be done to raise regional visibility and attract more resources for SRHR?

• Advocate for Latin America and the Caribbean at the global level

• Advocate for Sexual and Reproductive Health and Rights globally and nationally

• Document needs and opportunities

• Educate donors about unmet needs, regional gaps and inequities

• Encourage regional philanthropy

• Network with “friends of LAC” in influential positions

• Expand South-to-South collaboration in LAC and across regions

Our goal: Make the right to safe and voluntary

reproduction a reality in Latin America and the Caribbean

Gracias!

www.engenderhealth.org