Annual Performance Review 2005-06 by IPPF

From choice, a world of possibilities

ANNUAL PERFORMANCE REPORT

The International Planned Parenthood Federation (IPPF) is both a service provider and an advocate of sexual and reproductive health and rights. In 2005, IPPF was a worldwide network of 151 Member Associations and active in 183 countries. Published in December 2006 by International Planned Parenthood Federation (IPPF) 4 Newhams Row London SE1 3UZ United Kingdom Telephone: +44 (0)20 7939 8200 Fax: +44 (0)20 7939 8300 www.ippf.org info@ippf.org Registered Charity No: IPPF is incorporated by the UK Act of Parliament and is a UK Registered Charity No. 229476. Photo Disclaimer: Consent was given for all photographs presented in this publication. Environmental Statement: Printed on paper which conforms to ISO 14001 Environmental Certification. Totally chlorine free. Wood fibre from sustainable forests. Fully recyclable and biodegradable. Designed by Price Watkins Design Printed by Micropress Acknowledgements IPPF would like to express thanks to all who contributed to the Annual Performance Report 2005. We are especially grateful to those staff in our Member Associations and Regional Offices who provided the case studies that document IPPFâ&#x20AC;&#x2122;s important work in the field. We would also like to acknowledge our Central Office colleagues who assisted in the development of each of the chapters; in particular, Doortje Braeken and Upeka de Silva (Adolescents), Kevin Osborne and Tim Shand (HIV and AIDS), Upeka de Silva and Marcel Vekemans (Abortion), Naana Otoo-Oyortey, Kiran Asif, and Susanne Hamm (Access), and Stuart Halford and Jennifer Woodside (Advocacy). We would also like to thank the contributors to the Management chapter. We are grateful to the additional support provided by Mahua Sen, Sarah Shaw, Karla Fitzhugh and Chris Wells, and to the many others who provided important material and gave support and feedback. The production of the Annual Performance Report 2005 was coordinated by Heidi Marriott and Erin Barringer (Organizational Effectiveness and Governance Division, IPPF).

Front cover and frontispiece: IPPF firmly believes that access to sexual and reproductive health information and services is a basic human right that can mean the difference between health and sickness, living and dying. IPPF/Jenny Matthews Page 136: IPPF believes that by investing in young people, we invest not only in the present but also the future; this means addressing the needs and wants of the youngest age groups. IPPF/Mahua Sen Back cover: These are the 183 countries in which IPPF worked in 2005.

Foreword by the Director-General

It is a real privilege to introduce IPPF’s first Annual Performance Report to our volunteers, staff, and wider constituency of donors, partners, and supporters. Although it follows the concept of our previous Annual Programme Review, the change of title reflects our intention to provide a more comprehensive overview on our performance in 2005, as the results from our ‘Global Indicator Survey of Member Associations 2005’ and our electronic information system’s service data can now provide us with a number of benchmarks against which we can measure progress in the coming years while we continue to refine our monitoring and evaluation systems. These quantitative data illustrate our Member Associations’ implementation of IPPF’s Strategic Framework, and are supported by case studies which document some of the many ways in which Member Associations across the globe, their staff, members, and partners are working with communities to make a difference in people’s lives, in the belief that ‘a world of possibilities’ can become a reality. Behind each of these statistics are complex stories, the story of a woman, man, young person, or child denied a life of dignity, meaning, and respect, to which they were entitled, regardless of where they were born. It is for this reason that IPPF is so committed to its rights-based approach to sexual and reproductive health and human development in order to contribute to individual health and well-being, and to poverty reduction.

Behind these statistics are complex stories, the story of a woman, man, young person, or child denied a life of dignity, meaning, and respect, to which they were entitled, regardless of where they were born.

The achievements documented here owe much to the tireless and inspirational leadership of my predecessor, Dr Steven Sinding. In four years, supported by committed volunteers, staff, donors, and partners, he worked to build IPPF’s financial sustainability, refocused the organization on a new Strategic Framework, and led the development of ways to measure and evaluate progress against the Framework’s goals and objectives, the global agenda of ICPD, the Millennium Development Goals, and the outcome document of the 2005 World Summit. Indeed, his leadership of IPPF’s vigorous advocacy campaign, particularly in 2005, to restore the missing link of family planning and reproductive health to the global development agenda has had demonstrable success. Not only did the World Summit in September 2005 recognize the importance of reproductive health in reducing poverty, achieving women’s rights, and confronting the HIV and AIDS epidemic, but this has since been re-affirmed at a number of significant meetings of world leaders. The 2006 UNGASS Special Session on HIV and AIDS recognized the critical importance of linkages between reproductive health and HIV and AIDS prevention, care and treatment. Similarly, the recent Maputo meeting of African Ministers of Health, in which IPPF’s Africa Regional Office and Member Associations played a critical role, made major commitments to improve sexual and reproductive health. Finally, the decision of the UN General Assembly in October 2006 to support the Secretary General’s report, which included the new target of universal access to reproductive health by 2015, is a further sign of commitment. The challenge now is to implement these commitments at every level. We know that major progress can be made by coherent, strong delivery of IPPF’s Strategic Framework of Five A’s: meeting the needs of adolescents; combating HIV and AIDS; making abortion safe and IPPF Annual Performance Report 2005

IPPF recognizes that improving gender equity and eliminating discrimination are fundamental to guaranteeing sexual and reproductive health IPPF/Chloe Hall

accessible; increasing access, particularly for the poor and marginalized; and advocating for strong public, political, and financial commitment to sexual and reproductive health and rights. Many of the programmes described here demonstrate the innovative ways in which Member Associations are implementing this Strategic Framework, the differences that can be made, and the importance of ownership by countries, communities, and partners. They offer models which can be adapted, and opportunities for reflection on lessons learned and for the celebration of creative change. But the remaining challenges are huge, and stark statistics highlight the urgent need for action. For example, in Niger the chance of a woman dying from maternal causes, including childbirth, is one in seven, whereas in Sweden it is one in 29,800.1 High fertility rates and population growth continue to threaten many of

IPPF Annual Performance Report 2005

the poorest countries. An estimated 228 million women have an unmet need for effective contraceptive services and information.2 Inevitably this contributes to millions of women facing an unplanned and unwanted pregnancy, millions of whom will subsequently seek an abortion and nearly 68,000 will die annually as a result of unsafe abortion.3 Increasingly the HIV and AIDS epidemic has a woman’s face, and a young person is infected every 14 seconds4 often because of lack of knowledge and limited access to sexual and reproductive health services. Meeting these challenges requires a long term strategic plan of action with sustainable implementation, but the possibility of this is too often hampered by short-term funding which may prevent successful projects, like those described here, from being developed into ongoing programmes. Even before the Paris Declaration became so important in the development environment, IPPF was convinced of the need to demonstrate quality and effectiveness. We will continue to strengthen our monitoring and evaluation systems and build the effectiveness of our service delivery and management. Nevertheless, the meaningful measurement of outcomes which depend largely on attitude and behaviour changes that are related to the most intimate aspects of personal behaviour, remains a challenge. This year’s report is a landmark publication. It marks the culmination of a considerable period of development of our monitoring and evaluation tools, including the global survey. There is, therefore, considerable satisfaction in seeing this milestone achieved and cause to celebrate the hard work of those who have contributed to the survey’s development. The challenge now is to continue to work on our monitoring and evaluation processes in order to better demonstrate the difference made by IPPF and its Member Associations. This will include further technical and IT support to Member Associations, a review of the indicators, clarification of some terminology and further refinements related to data collection, in order to lessen the possibility of under or over reporting. We will also seek to increase both the response rate and harmonization of regional monitoring and evaluation systems. Some non-grant receiving Member Associations in donor countries have participated in the survey and we are exploring how best to convey their contribution as part of the wider global network, particularly in relation to their advocacy achievements and partnership with other Member Associations. IPPF’s accreditation system will continue to be implemented to build capacity and ensure that all our Member Associations comply with

IPPF has recognized the importance of learning from its own experiences and those of others, and of using this knowledge to better achieve the goals and objectives set out in the Strategic Framework.

FOREWORD

the standards and responsibilities of being an IPPF member, with a review in 2008. New initiatives are underway to strengthen governance at all levels, which should also contribute to governance capacity within the wider community. As a learning organization, IPPF has recognized the importance of learning from its own experiences and those of others, and of using this accumulated knowledge from across its global network to better achieve the goals and objectives set out in the Strategic Framework. We also recognize the remarkable diversity of Member Associations, and the country context in which they work that determines which of the Five A’s must be their first priority. For some this will be combating the high fertility rates which are so integral to the poverty cycle; for others the battle against HIV and AIDS will be an increasingly urgent priority, while for others high rates of maternal mortality will be the primary focus. For these contextual reasons, as well as each Member Association’s unique history, capacity and capability, we recognize that not all Member Associations can implement the same range of strategies for each of the Five A’s, and this is reflected in the data and findings published here. Nevertheless, it is our expectation that even the smallest, with two staff and few volunteers, can take some action on each, while focusing on their most urgent priority.

We hope that this report will provide insight into IPPF’s work and achievements over the last year. We acknowledge the support for the work of the Federation and its Member Associations from governments, foundations and individual donors, and thank them for their commitment, not only to IPPF, but to the improvement of sexual and reproductive health around the world. I would also like to thank all of IPPF’s volunteers and staff for their contribution and commitment to sexual and reproductive health and rights. As always, we very much welcome your feedback, and will be putting in place systems for this.

Dr Gill Greer Director-General, IPPF

Thanks to partners The Asia Pacific Alliance for Reproductive Health The Erik E. and Edith H. Bergstrom Foundation Big Lottery Fund The Contorer Foundation Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) Equilibres et Populations The European Commission Family Care International Ford Foundation Bill and Melinda Gates Foundation The Good Gifts Catalogue The Government of Australia The Government of Barbados The Government of Canada The Government of China The Government of Denmark The Government of Finland The Government of Germany The Government of Japan The Government of the States of Jersey The Government of the Republic of Korea The Government of Malaysia

The Government of the Netherlands The Government of New Zealand The Government of Norway The Government of Pakistan The Government of Sweden The Government of Switzerland The Government of Thailand The Government of the United Kingdom The William and Flora Hewlett Foundation Elton John AIDS Foundation Joint United Nations Programme on HIV/AIDS (UNAIDS) The Ernest Kleinwort Charitable Trust The John D. and Catherine T. MacArthur Foundation The David and Lucile Packard Foundation Population Action International The Louis and Harold Price Foundation The Summit Foundation United Nations Population Fund (UNFPA) The United Nations Foundation WestWind Foundation The World Bank Plus donations from anonymous friends IPPF Annual Performance Report 2005

Contents

FOREWORD BY THE DIRECTOR-GENERAL THANKS TO PARTNERS EXECUTIVE SUMMARY

5 7 11

CHAPTER 1 ADOLESCENTS AND YOUNG PEOPLE

17 17 18

Introduction Objective 1 To strengthen commitment to and support for the sexual and reproductive health and rights and needs of adolescents/young people Objective 2 To promote participation of adolescents/young people in governance and in the identification, development, and management of programmes that affect them Objective 3 To increase access to comprehensive, youth friendly, gender-sensitive sexuality education Objective 4 To increase access to a broad range of youth friendly services Objective 5 To reduce gender-related barriers and practices which affect the sexual and reproductive health and rights of young women Conclusions

CHAPTER 2 HIV AND AIDS Introduction Objective 1 To reduce social, religious, cultural, economic, legal, and political barriers that make people vulnerable to HIV and AIDS Objective 2 To increase access to interventions for the prevention of STIs and HIV through integrated, gender-sensitive sexual and reproductive health programmes Objective 3 To increase access to care, support, and treatment for people infected, and support for those affected by HIV and AIDS Objective 4 To strengthen the programmatic and policy linkages between sexual and reproductive health and HIV and AIDS Conclusions

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26 30

31 33 33 35

47 47 49

To strengthen public and political commitment for the right to choose and to have access to safe abortion

Objective 2

To increase access to safe abortion Objective 3 To expand the provision of abortion-related services as an integral part of sexual and reproductive health services Objective 4 To raise awareness among the general public, policy makers, and key professional groups on the public health and social justice impact of unsafe abortion Conclusions

CHAPTER 4 ACCESS Introduction Objective 1 To reduce socio-economic, cultural, religious, political, and legal barriers to accessing sexual and reproductive health information, education, and services Objective 2 To strengthen political commitment and support for reproductive health programmes Objective 3 To empower women to exercise their choices and rights in regard to their sexual and reproductive lives

Objective 4

59 61 61 63

65 66

To increase male commitment to sexual and reproductive health Objective 5 To improve access to sexual and reproductive health information and sexuality education using a rights-based approach Objective 6 To improve access to high quality sexual and reproductive health services using a rights-based approach Conclusions

CHAPTER 5 ADVOCACY Introduction Objective 1 To strengthen recognition of sexual and reproductive health and rights, including policy and legislation which promotes, respects, protects, and fulfils these rights Objective 2 To achieve greater public support for government commitment and accountability for sexual and reproductive health and rights Objective 3 To raise the priority of sexual and reproductive health and rights on the development agenda resulting in an increase in resources Conclusions

CHAPTER 6 MANAGEMENT

CONTENTS

CHAPTER 3 ABORTION Introduction Objective 1

77 79 79 80

Introduction Accreditation and governance Resource mobilization Capacity building Monitoring and evaluation, including knowledge management Financial review Conclusions

93 93 93 95 98 101 104 109

ANNEX A GLOBAL INDICATORS ANNEX B IPPFâ&#x20AC;&#x2122;S INCOME BY REGION REFERENCES KEY ABBREVIATIONS

111 123 133 135 IPPF Annual Performance Report 2005

Visuals and graphics Chapter 1 Box 1.1 Box 1.2 Box 1.3 Box 1.4 Box 1.5 Box 1.6 Figure 1.7

Figure 1.8

Box 1. 9 Table 1.10 Box 1.11

Adolescents and young people African youth in action Addressing the rights of gay, lesbian, bisexual, transgender, and questioning youth Youth-adult partnership in action Promoting the participation of young people living with HIV Providing sex education in new and innovative ways Empowering young people to make choices about sexual and reproductive health and rights Percentage of Member Associations providing sexual and reproductive health services to young people, by type of service Percentage of Member Associations providing sexual and reproductive health services to young people, by target group ‘Prevention-protection-provision’: Youth, sexual health, and HIV in the Balkans Number of services provided to young people, by type of service IPPF’s commitment to providing youth friendly clinics and services

19 20 21

Chapter 4 Box 4.1 Box 4.2 Box 4.3

22 24 25

Box 4.4 Box 4.5 Box 4.6 Box 4.7

26 Box 4.8 26

Figure 4.9

Figure 4.10

Figure 4.11

28 Table 4.12

Chapter 2 Box 2.1 Box 2.2 Figure 2.3 Box 2.4

Box 2.5 Table 2.6 Box 2.7 Box 2.8 Box 2.9 Table 2.10 Box 2.11

Chapter 3 Box 3.1 Figure 3.2 Box 3.3 Box 3.4 Box 3.5 Box 3.6 Figure 3.7 Table 3.8 Box 3.9 Figure 3.10 Box 3.11 Box 3.12

HIV and AIDS Promoting sexual rights and HIV prevention among men who have sex with men Empowering young women and girls Percentage of Member Associations providing HIV and AIDS services, by type of service Prevention of HIV and sexually transmitted infections among minority Badi female sex workers in Nepal Strengthening and expanding voluntary counselling and testing Number of HIV-related services provided, by type of service Increasing access to voluntary counselling and testing and sexually transmitted infection services Reaching people affected and infected by HIV and AIDS Providing anti-retrovirals in a sexual and reproductive health setting Number of clients served by FHOK’s integrated HIV and AIDS programme, by type of service From process to practice: Mainstreaming HIV and AIDS into regional programmes Abortion IPPF’s commitment to a woman’s right to choose IPPF’s Abortion Advocacy and Care Continuum Promoting a woman’s right to safe and legal abortion Increasing access to safe abortion in the Americas Ensuring the quality of abortion services Training health providers and pharmacists Proportion of Member Associations providing abortion-related services, by type of service Number of abortion-related services provided, by type of service Improving availability of access to safe abortion services in West Africa Percentage of Member Associations conducting IEC activities on abortion, by target group Highlighting the need for post-abortion care Mobilizing pro-choice youth advocates

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36 37

Box 4.13 Box 4.14

Chapter 5 Figure 5.1

Box 5.2

Box 5.3

41 Figure 5.4 41 42

Box 5.5

Box 5.6 Box 5.7

43 44

47 48 50 51 52 53 54 54 55 56 57 58

Chapter 6 Box 6.1 Figure 6.2 Table 6.3 Figure 6.4 Box 6.5 Box 6.6 Table 6.7 Table 6.8 Table 6.9 Table 6.10 Figure 6.11 Table 6.12

Figure 6.13 Figure 6.14

Access Working with community health providers to improve access to long-term contraception Building the capacity of health workers to work with Haitian communities Seeking justice for Linda Loaiza and others affected by gender-based violence Mobile health units bring health care to women in remote communities Gender mainstreaming initiative Including and involving men makes a difference Motivating medical professionals to provide high quality care Establishing a sexuality and reproductive health training centre Number of family planning services provided by Member Associations, by method Number of CYP provided by Member Associations, by method Number of non-family planning sexual and reproductive health services provided by Member Associations, by type Proportion of Member Associations with quality of care standards in place, by type of standard Confronting the human resources challenge Integrating sexual and reproductive health services into primary health care Advocacy Percentage of Member Associations counteracting opposition strategies, by type of opposition Examples of successful national policy initiatives and positive legislative changes from 2005 Counteracting conscientious objection to the provision of sexual and reproductive health services Percentage of Member Associations influencing public opinion on sexual and reproductive health and rights, by type of initiative Integrating sexual and reproductive health and rights in the African Union Building capacity for advocacy in the South Advancing sexual and reproductive health and the Millennium Development Goals Management Accreditation at work Donor population assistance by category, 1995 to 2004 Top five foundations supporting sexual and reproductive health, 2004 Unrestricted contribution per donor, 2005 Institutionalizing monitoring and evaluation Working with visually challenged youth Summary of income, 2003 to 2005 Summary of expenditure, 2003 to 2005 IPPF grant funding per region, 2003 to 2005 Commodity grants by type, 2005 Commodity grants by type, 2005 Percentage of resource allocation to Member Associations by UN category, 2001 to 2005 Actual total Member Association income in US$000, 2005 Percentage of total income by region, 2005

63 64 65 67 68 69 70 71 72 72

73 73 75 76

81 82

84 85 86 88

94 96 97 97 102 104 105 105 105 106 106

106 107 107

Executive summary

INTRODUCTION IPPF’s Annual Performance Report provides a comprehensive overview of our performance in 2005 and, for the first time, the results of our global indicators data. These give us a number of benchmarks against which we can measure IPPF’s performance in relation to the Five A’s: adolescents, HIV and AIDS, abortion, access, and advocacy (see ‘Global indicators 2005’ overleaf). Each chapter is structured according to the objectives set out in IPPF’s Strategic Framework 2005-2015 for each of the Five A’s, and global indicators data are supplemented with examples of case studies from the many different parts of IPPF’s global network. These examples describe key programmatic achievements and innovative and successful projects that reach the poorest, under-served, marginalized, and socially-excluded groups. The case studies also highlight partnerships with communities and other stakeholders that increase the scale and effectiveness of our work, and ultimately the difference we make in people’s lives.

CHAPTER ONE: ADOLESCENTS AND YOUNG PEOPLE IPPF’s goal for adolescents is that all young people are aware of their sexual and reproductive rights, are empowered to make informed choices and decisions regarding their sexual and reproductive health, and are able to act on them. There are more young people in the world today than ever before, the majority of whom live in developing countries, and the sexual and reproductive health needs of this group are significant. In a world where adolescent sexuality remains controversial and the needs of adolescents remain unmet, IPPF’s commitment to the sexual and reproductive health of young people is vital. The majority of our Member Associations advocate for improved access to services for

ABOUT IPPF Who we are The International Planned Parenthood Federation (IPPF) is the strongest global voice safeguarding sexual and reproductive health and rights for people everywhere. Today, as these important choices and freedoms are seriously threatened, we are needed now more than ever.

What we do IPPF is both a service provider and an advocate of sexual and reproductive health and rights. In 2005, IPPF was a worldwide network of 151 Member Associations and active in 183 countries.

What we believe We see a world where women, men, and young people everywhere have control over their own bodies, and therefore their destinies. A world where they are free to choose parenthood or not; free to decide how many children they’ll have and when; free to pursue healthy sexual lives without fear of unwanted pregnancies and sexually transmitted infections, including HIV. A world where gender or sexuality are no longer a source of inequality or stigma. We will not retreat from doing everything we can to safeguard these important choices and rights for current and future generations.

IPPF Annual Performance Report 2005

youth, and provide sexuality information and education and sexual and reproductive health services to young people. Protecting the sexual and reproductive health and rights of young people involves implementing programmes that empower youth to participate in the decisions that affect their lives, and this includes encouraging and supporting young people to participate in advocacy initiatives at the community level and beyond. As part of a rights-based approach, IPPF promotes non-judgmental comprehensive sexuality education that empowers young people to make informed choices. During 2005, this work has been set against a backdrop of conflicting messages from other sources, particularly groups that promote abstinence until marriage. One of IPPF’s key initiatives in 2005 was to host an international consultative meeting with a range of partner organizations to develop a ‘Framework for Comprehensive Sexuality Education’ that supports rights-based programmes, policies, and guidelines. IPPF is also increasing access to a wide range of youth friendly services, and in 2005 nearly eight million services were provided to

young people by our Member Associations. These services were provided to young men and women, married and unmarried youth living in rural and urban areas, as well as to more vulnerable groups including young people with special needs. With many years of experience of working with young people, one of the strengths of Member Associations is that they understand the diversity of needs of different groups of youth and are now reaching the most underserved and vulnerable groups such as sociallyexcluded young people, those under the age of 14 years, and young people living with HIV.

CHAPTER TWO: HIV AND AIDS IPPF’s goal on HIV and AIDS is to reduce the global incidence of HIV and AIDS and protect the rights of people infected and affected by HIV and AIDS. The number of people worldwide living with HIV continues to increase with the key determinants of the spread including poverty, gender inequity, illiteracy, stigma and discrimination, and a lack of information on prevention and treatment. The epidemic disproportionately affects the poorest, most stigmatized, disadvantaged, and under-served

GLOBAL INDICATORS 2005 For the first time in 2005, data on IPPF’s global indicators were collected from our Member Associations to measure IPPF’s performance in relation to its five priority areas of adolescents, HIV and AIDS, abortion, access, and advocacy. IPPF uses these data to monitor the progress we are making in implementing our Strategic Framework and to identify areas where increased investment needs to be focused. Because this is the first year of the Strategic Framework’s implementation, the results of the global indicators from 2005 will be used as baseline data against which we will measure our progress in the future. The collection of these data involves a significant collaborative effort among IPPF’s Member Associations, Regional Offices, and Central Office. All Member Associations, both grant-receiving and non-grant receiving, are requested to complete an online survey and an online service statistics module that provide the data that make up IPPF’s 30 global indicators. The data are then reviewed and checked by Regional Offices and Central Office, and subsequently, both regional and global analyses are conducted. In 2005, 84 per cent of IPPF’s Member Associations responded to the online survey (126 out of a total of 150 Associations*), including 14 non-grant receiving Associations. Sixty-four per cent of those

IPPF Annual Performance Report 2005

Associations that provide sexual and reproductive health services completed the service statistics module (87 out of 137 Associations that provide services). The 30 global indicators are divided between the five priority areas of adolescents (six indicators), HIV and AIDS (seven indicators), abortion (four indicators), access (eight indicators), and advocacy (five indicators). These data provide important information that can be used by Member Associations to improve programmes and by Regional Offices to identify where Associations may need technical support. The global indicators results presented in this Annual Performance Report confirm IPPF’s position as a powerful global voice that advocates for improved sexual and reproductive health and rights, and as a provider of high quality services that meet the needs of millions of poor, marginalized, under-served and socially-excluded groups around the world today. The detailed results of all 30 indicators are presented in each of the chapters in the Annual Performance Report, and a summary of the results and a regional breakdown are presented in Annex A. * The Member Association of Cuba was not included in this survey.

EXECUTIVE SUMMARY IPPF empowers women to exercise their choices and rights in regard to their sexual and reproductive lives IPPF/Chloe Hall

communities, and one of IPPF’s key strategies is to reduce the factors that make people vulnerable to HIV infection, including social, cultural, political, economic, and religious barriers. IPPF has successfully called for increased recognition that without the full support of the sexual and reproductive health community, HIV infection rates will continue to grow and treatment and care needs will not be met. As a result of IPPF’s work, the global debate on linking sexual and reproductive health and HIV is now progressing toward the practicalities of how to promote effective programmatic and policy linkages between sexual and reproductive health and HIV. IPPF has increased access to interventions for the prevention of sexually transmitted infections and HIV through integrated, gendersensitive sexual and reproductive health programmes, and many of our Member Associations now provide information on HIV prevention, condoms, voluntary counselling and testing, management of sexually transmitted infections, anti-retrovirals, and drugs to combat opportunistic illness. In 2005, IPPF has continued to address the complex nature of stigma and discrimination by

advocating for increased access to HIV prevention, treatment and care, and for a reduction in discriminatory policies and practices. Member Associations are encouraged to implement workplace policies to prevent discrimination against people with HIV, and to promote the full involvement of people living with HIV and AIDS. Our Member Associations are actively reducing stigma by promoting health-seeking behaviour among vulnerable groups including people living with HIV, sex workers, migrants, and newly married women. IPPF’s efforts increasingly focus on ‘positive prevention’ to help people living with HIV to protect their sexual health, avoid other sexually transmitted infections, delay progression of HIV and AIDS, and avoid passing HIV infection to others. We are now scaling up our most effective programmes, and will continue to lead the sexual and reproductive health community in the global response to HIV and AIDS.

CHAPTER THREE: ABORTION IPPF’s goal on abortion is a universal recognition of a woman’s right to choose and have access to safe abortion, and a reduction in the incidence of unsafe abortion. Millions of abortions take

IPPF Annual Performance Report 2005

IPPF aims to improve the quality of life of individuals by campaigning for sexual and reproductive health and rights through advocacy and services, especially for poor and vulnerable people. place every year, many of which are unsafe and result in an unacceptable loss of life that could be prevented by making abortion safe and legal. Restrictive laws, a lack of contraception and safe abortion services, prohibitive costs, and stigma mean that a woman’s right to choose and have a safe abortion is denied, especially in the developing world and among the poorest and most vulnerable. Abortion is one of the most controversial sexual and reproductive health issues in the world today. IPPF’s unwavering commitment to protect a woman’s right to access abortion is vital in reducing the incidence of unsafe abortion that leads to death, ill health, or lifelong disability for so many women. Increasing access to safe abortion is a priority for IPPF, and support and training in service delivery are essential to build the capacity of our Member Associations to provide sensitive, non-judgmental, affordable, and high quality abortion services to the fullest extent of the law. In 2005, a new chapter on abortion was included in the revised edition of ‘IPPF’s Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services’, and technical assistance provided by IPPF and partner organizations has enabled Member Associations to strengthen their capacity to provide safe abortion services. IPPF’s Member Associations are encouraged to undertake abortion-related activities that are most appropriate to their country’s particular situation. Although the majority of countries allow abortion for a wide range of reasons or without restriction, many others continue to impose certain restrictions, and anti-choice groups campaign fervently to make these laws more restrictive. IPPF’s work to strengthen political commitment and support for abortion is therefore critical. The dissemination of accurate information by our Member Associations raises awareness on the nature of abortion, the legal status of abortion, and the availability of abortion services. Many Member Associations are involved in advocacy work to reduce restrictions on safe, legal abortion, and this is particularly noteworthy as it demonstrates that our Associations are engaging in advocacy that leads to national policy and legislative change, supporting a woman’s right to choose and access safe abortion. 14

IPPF Annual Performance Report 2005

CHAPTER FOUR: ACCESS IPPF’s goal for access is that all people, particularly the poor, marginalized, sociallyexcluded, and under-served, are able to exercise their rights, make free and informed choices about their sexual and reproductive health, and have access to sexual and reproductive health information, sexuality education, and high quality services. Access to much-needed information and services is often especially difficult for people who are poor, marginalized, or vulnerable, and IPPF is constantly seeking new ways to reach these groups of people. IPPF’s service delivery statistics from Member Associations in countries ranked low on the Human Development Index show that almost three-quarters of their clients are disadvantaged. Nearly 70 per cent of our Member Associations provide subsidized services and adapted fee structures to remove any economic barrier to access. In addition to static clinics, the majority of Associations provide sexual and reproductive health services through community-based agents, physicians, volunteers, pharmacies, and mobile clinics to reduce the distance to service delivery points and make services much more available to a greater number of people. Increasing access to sexual and reproductive health information and services is a major priority area for IPPF, and quality of care, rights-based approaches, and gender equity are integral to all of these programmes. As well as empowering women, IPPF also works in partnership with men to meet their specific needs and to increase their understanding of gender issues and commitment to the sexual and reproductive health of their partners. IPPF is also tackling the complex issues of gender-based violence and child marriage which impact profoundly on the lives and health of women.

CHAPTER FIVE: ADVOCACY IPPF’s advocacy goal is for strong public, political, and financial commitment to and support for sexual and reproductive health and rights at national and international levels. IPPF plays a vital role in mobilizing support from within the political arena to raise awareness of the importance of sexual and reproductive health and rights and to promote progressive legislation and policies. In an increasingly difficult political and economic climate characterized by conservatism and a decline in official development assistance, IPPF’s global voice is critical in counteracting opposition and generating support for increased access to sexual and reproductive health for all. IPPF’s advocacy work occurs at all levels of the Federation. The majority of our Member Associations advocate for national policy and legislation that support sexual and reproductive

CHAPTER SIX: MANAGEMENT IPPF’s Strategic Framework focuses on the Five A’s and is supported by the four strategies of accreditation and governance, resource mobilization, capacity building, and monitoring and evaluation, including knowledge management. Chapter six provides updates on the key initiatives and developments in these four supporting strategies, as well as a financial review. All of these management systems contribute to increasing the organizational effectiveness of the Federation and ensuring that we learn from our own experiences and those of others. We are committed to remaining accountable to both the people we serve and to those who support our work. The four supporting strategies also ensure that the capacity of our Member Associations is strengthened in programme development,

EXECUTIVE SUMMARY

health and rights. In 2005, the work of our Associations resulted in 51 positive national policy or legislative changes. Examples include increased access to emergency contraception, new policies on HIV and AIDS, and the provision of sexual and reproductive health information and services to young people without the need for parental consent. Regional initiatives in 2005 involved reviewing progress in the implementation of the ICPD Programme of Action and assessing financial commitments to sexual and reproductive health made by governments and donors in the Arab World Region. In Africa, several meetings resulted in a comprehensive policy framework which was presented at a conference for African Ministers of Health, and resulted in an extraordinary session of Ministers dedicated to sexual and reproductive health. Advocacy by IPPF and other organizations has led to an increase in recognition that the failure to achieve universal access to sexual and reproductive health is a major barrier to poverty reduction. As a result, world leaders reaffirmed their commitment to providing universal access to reproductive health by 2015 at the United Nations World Summit in 2005. Funding and political engagement are crucial to achieving this goal. IPPF will continue to hold governments accountable to commitments made at the World Summit. We will also keep sexual and reproductive health and rights on the global development agenda and demonstrate that they are crucial to the achievement of the Millennium Development Goals.

IPPF envisages a world in which choices are fully respected and where stigma and discrimination have no place IPPF/Peter Caton

resource mobilization, monitoring and evaluation, quality of care, commodities and communication, and in the technical areas of the Five A’s, that effective programmes are implemented, and that we are making progress in achieving the goals and objectives outlined in our Strategic Framework.

ANNEX A: GLOBAL INDICATORS In Annex A, the results of IPPF’s 2005 global indicators are summarized, and regional breakdowns for each indicator are presented.

ANNEX B: IPPF’S INCOME BY REGION Annex B presents an analysis of IPPF’s income by region in 2005, according to the three sources of funding to Member Associations; IPPF, local, and international income. Information on IPPF’s publications and resources and further details of our work can be found on the IPPF website at www.ippf.org.

IPPF Annual Performance Report 2005

GOAL All adolescents and young people are aware of their sexual and reproductive rights, are empowered to make informed choices and decisions regarding their sexual and reproductive health, and are able to act on them

INTRODUCTION Nearly half of the world’s population – a group of more than three billion people – is under the age of 25. This is the largest generation of young people in history, and 85 per cent of this age group lives in developing countries.1 Throughout the world, sexual activity is starting earlier, and yet, despite hard evidence about the sexual behaviour of young people, many deny that young people have sex at all. The health implications for youth who do not have access to sexual and reproductive health information and services are staggering. The rates of sexually transmitted infections are increasing among young men and women, and an estimated 6,000 young people each day become infected with HIV, the majority of whom are young women.2 Fourteen million women aged 15 to 19 give birth each year,3 and the estimated maternal mortality rate for this group is twice as high than for those in their twenties.4 Pregnancy is a leading cause of death for young women in this age group, primarily because of complications during unsafe abortion and childbirth. Young pregnant Young girls attend an women risk being expelled from IPPF Member Association school, and others may even be clinic in Ethiopia to killed by their male relatives. access sexual Today, many young people and reproductive who want to use modern health information contraception do not because IPPF/Chloe Hall they lack the knowledge or skill

ADOLESCENTS

ADOLESCENTS AND YOUNG PEOPLE

to negotiate contraceptive use with their partners or because traditional family planning services often cater to the needs of married couples and fail to address the needs of young people, married or unmarried.

IPPF’S WORK WITH YOUNG PEOPLE Promoting the sexual and reproductive health and rights of young people is a core goal for IPPF. We view young people as sexual beings, and recognize that they have unique sexual and reproductive health needs. Most importantly, IPPF believes that young people have a right to youth friendly services, information, and sexuality education so that they may lead healthy, safe, and empowering sex lives. Some of the primary issues that IPPF’s Member Associations address with regard to young people are sexuality education, access to sexual and reproductive health services, and the right to sexual integrity. When young people are denied full respect of their sexual and reproductive rights, they often face discrimination and are at higher risk for sexually transmitted infections, HIV, and unwanted pregnancy. Research indicates that successful programmes for young people share several key elements. These include strong adult-youth partnerships and a clear, well-articulated philosophy that promotes the skills of young people, empowering them to lead healthy, sexual lives, and that responds to their sexual and reproductive health needs.

IPPF Annual Performance Report 2005

To ensure an effective response to the needs of young people, Member Associations strive to provide the kind of services and facilities that make young people feel comfortable enough to return for additional help, as well as encourage their friends to visit. Member Associations also support the participation of young people to ensure that services are gender-sensitive, non-discriminatory, and friendly to all young people, including the most vulnerable and under-served.

The information in this chapter provides an overview of the innovative programmes IPPF has implemented in 2005 to achieve these objectives.

ACHIEVING IPPF’S STRATEGIC FRAMEWORK: ADOLESCENTS AND YOUNG PEOPLE

IPPF embraces young people’s sexuality and believes that all young people have the right to comprehensive information and services and a healthy, safe, and empowering sex life. Adolescent sexuality is still a highly controversial topic and is often used by anti-choice and conservative opposition groups to fight against the broader sexual and reproductive health agenda. It is IPPF’s role to defend and promote a positive approach to adolescent sexuality and reproductive health and rights. Global indicators

IPPF’s Strategic Framework outlines five objectives for adolescents and young people: ● improving youth advocacy ● enabling youth participation ● providing comprehensive sexuality education ● promoting youth friendly services ● focusing on issues of gender, diversity, and vulnerability

OBJECTIVE 1 To strengthen commitment to and support for the sexual and reproductive health and rights and needs of adolescents/young people

These young people in Brazil benefit from IPPF’s belief that all young people should have access to youth friendly information and services IPPF/Gabriel Amadeus Cooney

IPPF Annual Performance Report 2005

BOX 1.1 AFRICAN YOUTH IN ACTION ■

Family Planning Association of Malawi (FPAM), Malawi

The Family Planning Association of Malawi (FPAM) designed the African Youth Action Movement, which was launched in July 2005. The programme allows young people at local, national, and regional levels to work on advocacy and capacity building exercises, voice opinions in decision and policy making, and share experiences about sexual and reproductive health and rights. One key strategy of the movement has been to work in partnership with other youth organizations both in and out of the sphere of sexual and reproductive health. The African Youth Action Movement is structured to include seven youth clubs coming together as a National Committee, with a young man and a young woman from the Committee sitting on the Member Association’s governing board. From the formal and well-recognized structure of the Association’s governing board, the Movement was able to strengthen partnerships with community-based youth organizations, nongovernmental organizations, the Ministry of Health, and religious groups – a highly effective method to boost the credibility and visibility of this youth programme.

ADOLESCENTS

data show that 98.4 per cent of Member Associations advocate for improved access to services for young people. Key target groups for advocacy include young people (addressed by 96.8 per cent of Member Associations), the media (90.5 per cent), teachers and parents (89.7 per cent), government decision makers (88.9 per cent), youth organizations (88.9 per cent), community and religious leaders (81.7 per cent), and lawyers or legal bodies (49.2 per cent). Protecting the sexual and reproductive health and rights of young people involves implementing programmes that empower young people to participate in decisions that affect their lives and that emphasize the importance of choice and non-discrimination. IPPF believes that young people should play a crucial role in promoting, defending, and advocating for their rights. IPPF therefore encourages and supports young people to participate in advocacy initiatives within their communities, families, and schools – an activity that provides them with the opportunity to shape their own lives and futures. The experience and support of other organizations is clearly beneficial when advocating for the sexual and reproductive health and rights of young people. Partnership with other youth friendly organizations promotes an environment in which young people are able to make decisions about their sexuality freely, enjoy their sexual orientation, and accept responsibility for their sexual behaviour. The advantages of partnerships with other organizations are evident in the experience of Sociedade Civil Bem-Estar Familiar no Brasil (BEMFAM). It developed partnerships with three other Brazilian nongovernmental organizations to create a strong network of advocates including Estudos e Comunicaçao em Sexualidade e Reproduçao Humana (ECOS), a sexual and reproductive rights organization; Grupo de Trabalho e Pesquisa em Orientaçao Sexual (GTPOS), an organization that conducts educational activities on sexuality and health; and Jovens Feministas de São Paulo (JFSP), an organization of young feminists. The partners co-convened a workshop entitled ‘Millennium Development Goals – What do they have to do with us? Adolescent and Youth Recommendations on Sexual and Reproductive Rights’. The network consisted of a group of young people with the leadership skills needed to defend sexual and reproductive rights, monitor the implementation of the Millennium Development Goals at the national level, and promote the discussion of sexual and reproductive health issues. The Family Planning Association of India (FPA India) is also developing effective partnerships to reach more young people, for example, with Nehru Yuvak Kendra Sangathan

Young peer educators in Malawi IPPF/Yuri Nakamura

(NYKS), an organization that operates under the umbrella of the Ministry of Youth Affairs and Sports. With more than 6.4 million youth volunteers enrolled in village-level youth clubs, NYKS is unrivalled in its reach to isolated parts of the country. The partnership between FPA India and NYKS has resulted in the integration of sexual and reproductive health awareness, counselling, and referral services into existing NYKS programmes across the country. IPPF Annual Performance Report 2005

BOX 1.2 ADDRESSING THE RIGHTS OF GAY, LESBIAN, BISEXUAL, TRANSGENDER, AND QUESTIONING YOUTH Fundación Mexicana para la Planeación Familiar, A.C. (MEXFAM), Mexico ■ Instituto Peruano de Paternidad Responsable (INPPARES), Peru ■

In 2005, Fundación Mexicana para la Planeación Familiar, A.C. (MEXFAM) and Instituto Peruano de Paternidad Responsable (INPPARES) implemented an initiative entitled ‘Developing and documenting a model for responding to the sexual and reproductive health needs of lesbian, gay, bisexual, transgender, and questioning youth’. The project aimed to improve sensitivity to sexual diversity in the sexual and reproductive health information and services provided to young people in clinics and community outreach programmes. It also sought to improve the awareness of MEXFAM and INPPARES staff, peer educators, and peer education beneficiaries to sexual health issues that affect sexually diverse young people. At the start of the project, INPPARES established links with organizations concerned with sexual diversity and the gay, lesbian, bisexual, transgender, and questioning (GLBTQ) community. INPPARES then conducted a baseline survey among staff members to assess attitudes and practices regarding youth. The survey revealed that an overwhelming majority of participants held positive attitudes about sexual diversity, but few reflected these attitudes in their practices. INPPARES then conducted sensitization workshops on sexual diversity with the police, community youth centres, and youth groups, including young people from the GLBTQ community. INPPARES also worked with young people to develop pamphlets on rights, gender identity, sexual diversity, and homophobia, participated in several GLBTQ events, and received radio exposure and coverage in periodicals. With the support of the Gender Studies programme of the Universidad Nacional Mayor de San Marcos, INPPARES organized a forum on homophobia in Peru, giving GLBTQ youth an opportunity to share their experiences. MEXFAM worked with its staff members to develop sensitivity to sexual diversity and ensure that all clients would be served fairly and respectfully. It hosted a workshop for 18 youth coordinators from each of MEXFAM’s youth programmes throughout the country and featured a bisexual and transgendered speaker. The coordinators emphasized the urgent need to integrate the topic of sexual diversity into all of MEXFAM’s programmes, rather than talking about it as an isolated topic. MEXFAM also

IPPF Annual Performance Report 2005

conducted a workshop for its board of directors, Executive Director, Director of Development, and a representative from the Mexican Institute of Social Security; the directors expressed support for the organization’s objective to ensure that services are friendly and accessible for sexuallydiverse youth. MEXFAM is currently developing an institutional policy that will address the norms and procedures regarding sexual diversity. This document will serve as a guide to all staff and will be shared with other Associations in the region. Like INPPARES, MEXFAM is also creating its own training manual on sexual diversity. MEXFAM has participated in various forums on GLBTQ rights and discrimination in Mexico City, and its youth committee participated in the Mexico City Gay Pride parade. Additionally, two members of the youth committee and members of the board of directors are working with a radio station called ROCKOLA – 90 per cent of whose listeners are GLBTQ youth – to reach the public and generate ideas. The project has allowed both INPPARES and MEXFAM to re-examine their programmes to better incorporate sexual diversity, gender, and rights. These programmes highlighted the need to sensitize all staff members to the importance of sexual diversity – not just those in their youth programmes. This enabled them to make sensitization an ongoing process that challenges internalized stereotypes and negative attitudes toward sexual diversity.

Our Member Associations in the Western Hemisphere Region address the rights of GLBTQ youth by ensuring access to sexual and reproductive health information and services IPPF/Jon Spaull

ADOLESCENTS

OBJECTIVE 2 To promote participation of adolescents/young people in governance and in the identification, development, and management of programmes that affect them There is growing international recognition that young people have a right to be involved in decisions that affect them. Yet, it is a challenge to identify appropriate tools and techniques that allow young people to participate in truly meaningful ways. IPPF views the participation of young people as a dynamic process, in which young people not only make decisions about their own personal lives but also serve as peer educators, counsellors, and partners in policy and decision making. These partnerships are based on respect and trust between adults and young people, and include clearly defined roles and responsibilities, an understanding of each other’s strengths and limitations, and clear lines of communication.

This young volunteer in India participates in a programme to disseminate information and distribute condoms to her peers IPPF/Peter Caton

BOX 1.3 YOUTH-ADULT PARTNERSHIP IN ACTION New Zealand Family Planning Association (NZFPA), New Zealand ■ IPPF Arab World Regional Office ■

In advocacy The New Zealand Family Planning Association (NZFPA) organized a youth forum as part of its ‘Sex Matters’ conference in New Zealand. Young people participated in discussions on a range of sexual, reproductive, population, and development issues that culminated in a range of recommendations, including: ● improving current sexual health services and sexuality education ● recognizing young people’s sexuality and diversity ● providing adequate and sustainable funding for youth programmes The list of recommendations was presented to the government Minister on the final day of the conference and media coverage of the conference ensured that the message was widely disseminated to the public. In programmes Young people in the Arab World Region were involved in writing a successful project proposal for the region’s 14 Member Associations. Young

people were also key in implementing the project, which included advocacy of sexual and reproductive health and rights for young people, youth participation and leadership, youth friendly information and services, and challenging genderrelated barriers to sexual and reproductive health and rights of young people. The IPPF Arab World Regional Office conducted a workshop aimed to foster meaningful youth participation in all of its decision making bodies and Member Association programmes. The workshop was held in collaboration with the Princess Basma Youth Resource Centre-ZENID in Jordan and supported by the IPPF Transition Fund. The event provided an opportunity to strengthen youth and adult partnerships, to share experiences, and to develop a Memorandum of Understanding on working together. A group of young people from the region was also involved in the development and introduction of a capacity building exercise in 2006 called ‘Winds of change’, which involved a training of trainers programme on the sexual and reproductive rights of young people. The programme is the first of its kind in the region and seeks to unite participants from Member Associations throughout the Gulf States, and to increase the participation of young people in the programmes that affect them.

IPPF Annual Performance Report 2005

According to one FHOK peer educator, “There is no ‘us’ and ‘them’. We are all peer educators supporting one another.”

Global indicators data show an increasing commitment to partnership between adults and young people. Sixty-eight per cent of IPPF’s Member Associations have staff under the age of 25, with the overall proportion of staff under the age of 25 at 4.0 per cent. In 2001, IPPF’s youth policy strongly recommended that at least 20 per cent of Member Association governing board members should be under 25 years of age and IPPF is progressing steadily in ensuring youth-adult partnership in its governing bodies.

Global indicators data show that 16.7 per cent of Member Associations have a governing board of which 20 per cent or more of the members are young people, with a higher proportion of female youth on governing boards (6.6 per cent) than male youth (3.5 per cent). Regional meetings to promote youth participation were held in 2005, with a focus on building the capacity of young volunteers using the IPPF self-assessment guide on youth participation.5 A number of Member Associations from the European Network are engaged in a regional project entitled ‘Are you on board?’ to increase the number of Member Associations that have young people on their governing boards. These Member Associations have used the IPPF self-assessment guide to develop initiatives that enhance meaningful youth participation in their governance structures.

BOX 1.4 PROMOTING THE PARTICIPATION OF YOUNG PEOPLE LIVING WITH HIV ■

Family Health Options of Kenya (FHOK), Kenya

Family Health Options of Kenya (FHOK) aims to involve a greater number of young people living with HIV in its programmes. The voluntary counselling and testing site of its youth centre in Nairobi was used as an entry point to set up a posttest club to meet the needs of young men and women who test for HIV, while also encouraging them to take part in peer education activities. The members, who are HIV positive and negative, first receive training to deliver peer education and then participate in mobile counselling and testing activities in local areas. FHOK’s objective for this programme is to promote voluntary counselling and testing, tackle stigma and discrimination, and educate young people about general sexual and reproductive health issues through the distribution of condoms and education materials. In addition, young people who are reached by the programme are referred to the FHOK youth centre or to other organizations to receive additional services. These outreach activities specifically target vulnerable groups – including taxi drivers and young injecting drug users – and include theatre and drama sessions. Each week, FHOK hosts a support meeting for all post-test club members and counsellors in the youth centre; the meetings are used to discuss sexual health topics, relationships and dating, drugs, and other issues, and also to boost participants’ skills in working

IPPF Annual Performance Report 2005

on HIV prevention and care. Club members receive ongoing counselling, and those members living with HIV receive support and referrals, including referral to a local hospital for free anti-retroviral treatment. The project reaffirmed the importance of involving young people living with HIV and developing a positive attitude when serving and working with HIV positive young people. As a result of FHOK’s efforts in this project, young people living with HIV now participate in youth centre activities. According to one FHOK peer educator, “There is no ‘us’ and ‘them’. We are all peer educators supporting one another.” The project also encouraged HIV positive young people to share their experiences with peers. This discourse contributed to an increase in the number of young people seeking the testing service, and prompted the youth centre clinic to offer free treatment of sexually transmitted infections and minor opportunistic infections. Although it presented many successes, the posttest club challenged FHOK to provide care, treatment, and support for young people living with HIV. FHOK found it difficult to maintain the involvement of young people living with HIV because they suffered from occasional illness and many had not yet disclosed their status to their families. From these challenges, however, FHOK learned the importance of addressing stigma, societal roles, and gender relations, and maintaining an understanding of the health needs of HIV positive people.

ADOLESCENTS

1 Our Member Association in Kyrgyzstan educates and empowers young people to exercise their choices and rights in their sexual and reproductive lives IPPF/Chloe Hall

These initiatives include: ● developing a mentoring scheme for young people involved in governance – Lithuania ● conducting joint meetings between the board and youth group – Georgia ● an innovative ‘volunteer green card’ system to track the contributions of youth members – Bulgaria ● a training scheme for the youth representatives on the board – Poland In addition, many Associations are planning to use the self-assessment guide to regularly track their progress. Youth participation in governance has shown steady progress among the Member Associations in the East and South East Asia and Oceania Region. As of August 2005, the Member Associations of the Cook Islands, Fiji, Tonga, and Vanuatu have achieved 20 per cent youth participation on their boards, and those of Cambodia, New Zealand, and the Philippines have achieved between 14 and 19 per cent. A handful of Member Associations in the region still do not have any young people on their governing boards, although some have different mechanisms (such as a youth committee) through which they obtain input from young people.

OBJECTIVE 3

To increase access to comprehensive, youth friendly, gender-sensitive sexuality education IPPF strongly believes that all young people are entitled to rights-based, comprehensive sexuality education. Global indicators data show that this commitment has indeed been translated into practice: 95.2 per cent of Member Associations provide sexuality education to young men and women, both in and out of school, and married or unmarried. Fewer programmes target youth under 12 years of age (64.3 per cent), young people living with or affected by HIV and AIDS (66.7 per cent), gay, lesbian and bisexual youth (46.8 per cent), and marginalized or sociallyexcluded groups of youth (69.0 per cent). These achievements are remarkable in light of the fierce opposition to comprehensive sexuality education that persists in both developed and developing countries, and in a world where there is increasing pressure for a return to more conservative forms of sexuality education that focuses mainly – or only – on abstinence. In 2005, IPPF hosted an international consultative meeting on sexuality education, bringing together the IPPF Central Office and

IPPF Annual Performance Report 2005

A young volunteer from our Member Association in Thailand educates her peers about sexual and reproductive health IPPF/Christian Schwetz

BOX 1.5 PROVIDING SEX EDUCATION IN NEW AND INNOVATIVE WAYS Family Planning Association of Hong Kong (FPAHK), Hong Kong ■ Association for Sexual and Reproductive Health XY (Association XY), Bosnia and Herzegovina ■

A number of Member Associations have developed innovative ways to promote access to and public awareness of sexuality education. The Family Planning Association of Hong Kong (FPAHK) developed a sexuality education website to facilitate access to information and services for young people and sex educators. As a result, the number of email questions grew steadily, reflecting young people’s willingness to use the website to share concerns about sexuality. The programme also enabled FPAHK to promote sexuality education for young people to government ministries. In Bosnia and Herzegovina, Association for Sexual and Reproductive Health XY (Association XY) organized a hip-hop concert in one of the most popular clubs in Sarajevo to remind young people of the importance of using condoms and dual protection. Association XY secured mass media coverage, and during the concert, volunteers ran a short educational programme and distributed educational materials and condoms. Rock singer and Association XY board member Elvis J. Kurtovic presented Association XY’s work, and then initiated a game called ‘sing a song on sexual and reproductive health’ to provide young people with the opportunity to sing or tell stories about their concerns or experiences, which were recorded for use in future awareness-raising activities.

IPPF Annual Performance Report 2005

Regional Offices, young volunteers from across the Federation, and partner organizations, including the United Nations Population Fund (UNFPA), World Health Organization, Population Council, and the International HIV/AIDS Alliance. The result of this meeting was the creation of the ‘Framework for Comprehensive Sexuality Education’, an initiative that supports the development of rights-based sexuality education programmes, policies, and guidelines. The framework outlines the essential components of a comprehensive approach to education in sexual and reproductive health and rights. It encourages an understanding of: ● gender ● sexual and reproductive health ● sexual citizenship ● pleasure ● violence ● diversity ● relationships When comprehensive sexuality education embodies these components, IPPF believes that it can effectively address the sexual and reproductive rights of young people as set out in the United Nations Convention on the Rights of the Child, improve the health and well-being of young people by reducing unwanted pregnancies, sexually transmitted infections, and HIV, and contribute to the Millennium Development Goals. To move this agenda forward, IPPF continues to collaborate with a number of organizations. In partnership with the Population Council, for example, IPPF is working to develop guidelines on sexuality, gender, and rights education, which will complement this framework. IPPF will produce separate guidelines for peer educators, providers, and parents. A sexuality education advocacy tool is being developed to articulate the Federation’s reasons to move toward a comprehensive approach to sexuality education. This tool is an essential addition to the framework, given that IPPF’s comprehensive approach to sexuality education continues to face opposition, particularly from those advocating for a more conservative focus.

INTEGRATING SEXUALITY EDUCATION INTO YOUTH FRIENDLY SERVICES One of the primary ways that IPPF provides comprehensive sexuality education is through its existing youth friendly services. This allows the Federation to promote the essential link between sexuality education and the improved sexual and reproductive health status of adolescents, particularly in under-served areas. The Family Planning Association of Sri Lanka (FPASL), for example, provides sexual and reproductive health counselling to young people

■

‘For Family and Health’ Pan-Armenian Association (PAFHA), Armenia

When young people want to make informed choices regarding their sexual and reproductive behaviour and health, one of the biggest challenges they face is the ability to get the information, education, and youth friendly services they need. This obstacle was recently identified in a survey on sexual and reproductive health and rights conducted by ‘For Family and Health’ PanArmenian Association (PAFHA) among 1,000 young people across Armenia. In response to these results, PAFHA created a project to improve access to these services among people aged 15 to 24 and to raise awareness about positive sexual and reproductive health attitudes and practices. The project recruited 250 peer educators who were trained on sexual and reproductive health and rights. The peer educators were also offered enhanced support through the creation of ‘Youth for Youth’, a national youth peer network. This network has websites in Armenian, Russian, and English to provide a platform through which peer educators can share sexual health and rights information. The peer educators conducted an internal and

external assessment on the youth friendliness of 50 health facilities. Protocols and guidelines on youth friendly services were then issued to the facilities, followed by orientation training for 210 health providers. These activities were supported by non-governmental organizations, foundations, and private companies, and equipped providers with appropriate knowledge and skills to improve access to high quality sexual and reproductive health services for young people, and particularly for vulnerable groups. In addition to training peer educators, PAFHA conducted advocacy meetings on the sexual and reproductive health and rights of young people for teachers, parents, and community leaders in targeted areas of the project. Finally, the survey findings were distributed to young people, educational and health authorities, non-governmental organizations, and United Nations agencies to support awareness-raising activities. The project increased young people’s use of relevant information, resources, and services, particularly among marginalized groups. PAFHA demonstrated excellent practice in empowering young people to adopt healthier lifestyles and make informed choices, which contributed to the prevention of unwanted pregnancies, sexually transmitted infections, and HIV.

ADOLESCENTS

BOX 1.6 EMPOWERING YOUNG PEOPLE TO MAKE CHOICES ABOUT SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS

in 18 districts, including schools and community forums. It addresses a wide range of topics, including relationships, pleasure, gender diversity, and HIV prevention. The Association also works to increase the supply of condoms for young people, particularly young unmarried people in under-served areas.

INTEGRATING ABORTION ISSUES A comprehensive approach to sexuality education embraces discussion of other elements of IPPF’s work. Fundación Mexicana para la Planeación Familiar, A.C. (MEXFAM) sought to strengthen young people’s access to information on abortion in Mexico by adding a module on abortion to its peer education curriculum. The module was developed in coordination with Catolicas por el Derecho a Decidir (CDD) and Ipas; it is now part of the regular curriculum on sexual health used by MEXFAM throughout the country. MEXFAM has learned that training on abortion is an ongoing process and will work to integrate young people into its existing abortion services.

Youth volunteers from Bulgaria discuss adolescent involvement in youth programmes IPPF/Chloe Hall

IPPF Annual Performance Report 2005

OBJECTIVE 4 To increase access to a broad range of youth friendly services The provision of services to young people is one of IPPFâ&#x20AC;&#x2122;s core activities. Global indicators data show that more than 90 per cent of Member Associations provide a wide range of sexual and reproductive health services to young people, and more than 50 per cent of Associations provide all of the services listed in Figure 1.7, with the exception of abortion. IPPFâ&#x20AC;&#x2122;s Member Associations provide sexual and reproductive health services equally to different client groups: 90.5 per cent provide services to

young men; 92.9 per cent to women; 91.3 per cent to married people and 92.1 per cent to unmarried people. A slightly greater number of Associations (92.1 per cent) provide urban youth with services than those that provide services to young people in rural areas (85.7 per cent). Significantly fewer Associations, however, provide sexual and reproductive health services to young people with special needs (55.6 per cent) and to those who are socially-excluded (63.5 per cent) (Figure 1.8). The data collected on sexual and reproductive health services show that 7,869,331 services were provided to young people by Member Associations in 2005 (Table 1.10).

Figure 1.7 Percentage of Member Associations providing sexual and reproductive health services to young people, by type of service 100%

80%

60%

40%

73.8%

69.8%

51.6%

82.5%

STI diagnosis

STI treatment

Services on sexual abuse

Sexuality counselling

76.2% Pregnancy test

77.8%

64.3% Post-abortion care

Relationship counselling

61.9% Pap smear test

85.7%

81.0% Other family planning methods

Referrals

73.0% Medical care

63.5% HIV testing/VCT

75.4% Gynaecology

83.3%

90.5% Family planning counselling

HIV counselling

71.4%

87.3% Condom distribution

Emergency contraception

23.0% Abortion

Abortion counselling

73.8%

20%

Figure 1.8 Percentage of Member Associations providing sexual and reproductive health services to young people, by target group 100%

80%

60%

91.3%

92.1%

92.9%

90.5%

92.1%

85.7%

55.6%

63.5%

Unmarried young people

Young women

Young men

Urban young people

Rural young people

Youth with special needs

Socially-excluded young people

20%

Married young people

40%

IPPF Annual Performance Report 2005

Association for Sexual and Reproductive Health XY (Association XY), Bosnia and Herzegovina ■ Health Education and Research Association (HERA), Macedonia ■ Yugoslav Youth Information Centre (OICS), Serbia ■

The post-war climate in the Balkans has resulted in a decline in educational and employment opportunities and an increase in substance abuse, violence, and human trafficking. Increased sexual activity among young people, coupled with a lack of access to sexual and reproductive health services, have resulted in a rapid spread of HIV and other sexually transmitted infections in recent years. Against this background, the ‘Prevention– Protection–Provision’ initiative was launched in the Balkans to improve young people’s access to services for preventing sexually transmitted infections and HIV, especially for poor and marginalized young people. The project included promoting safer sex practices such as condom use, a review of sexual and reproductive health and rights legislation and policies that support advocacy, awareness-raising efforts to gain public and political support, and training service providers in youth friendly services. In the summer of 2005, three youth friendly service centres were opened in Bosnia, Macedonia, and Serbia, and use of the services has been increasing steadily, indicating success in addressing previously unmet needs in these countries. Moreover, approval from the government ministries of health in Bosnia, Macedonia, and Serbia is evidence that the Member Associations are national leaders in providing sexual and reproductive health services to young people.

Reaching the under-served Within the ‘Prevention–Protection–Provision’ project, Association for Sexual and Reproductive Health XY (Association XY) focused on working with young men who have sex with men. One of its main activities was to conduct outreach workshops led by peer educators, who themselves are young men who have sex with men, that helped participants to feel relaxed and comfortable. The issues discussed concerned sexuality, sexually transmitted infections, anal sex, and condom and lubricant use. Association XY distributed condoms, lubricants, and educational materials (developed specifically for young men who have sex with men) at every meeting. The workshops were particularly successful because they gathered together young men who have sex with men from different parts of Bosnia and Herzegovina, including rural areas. Association XY’s initiative highlights the importance of adopting appropriate measures to reaching different target groups, especially those that are most vulnerable.

ADOLESCENTS

BOX 1.9 ‘PREVENTION–PROTECTION–PROVISION’: YOUTH, SEXUAL HEALTH, AND HIV IN THE BALKANS

Our Member Associations in the European Network provide sexual and reproductive health information and services for the under-served and most vulnerable IPPF/Chloe Hall

Table 1.10 Number of services provided to young people, by type of service Type of service provided to young people All family planning services (including family planning counselling) Emergency contraception services Abortion services Gynaecological services Maternal and child health services, including obstetrics and paediatrics Infertility services HIV and AIDS services Sexually transmitted infection/reproductive tract infection services Non-family planning sexual and reproductive health counselling services Urological services Other sexual and reproductive health medical services TOTAL

Number of services provided 4,478,837 28,809 60,102 956,945 1,236,701 33,458 135,080 251,229 304,474 33,194 350,502 7,869,331

IPPF Annual Performance Report 2005

BOX 1.11 IPPF’S COMMITMENT TO PROVIDING YOUTH FRIENDLY CLINICS AND SERVICES Egyptian Family Planning Association (EFPA), Egypt ■ Planned Parenthood Association of Ghana (PPAG), Ghana ■ Family Planning Association of Hong Kong (FPAHK), Hong Kong ■ Indonesian Planned Parenthood Association (IPPA), Indonesia ■ Association Marocaine de Planification Familiale (AMPF), Morocco ■

Egypt The youth friendly service projects run by the Egyptian Family Planning Association (EFPA) continue to expand, offering comprehensive sexual and reproductive health services that welcome young people and respond to their needs. One of EFPA’s key strategies involved working with people who are influential in adolescents’ lives at home and in their communities, an action that helped EFPA obtain community support for its work. As a result, the Association was able to strengthen its four youth clinics and dedicate a section on its website to youth sexual health issues. The young people involved in the project were also given the opportunity to participate at regional meetings and on the national board, which has further strengthened the credibility of the project. These efforts have increased the potential of the Association to receive further funding for youth friendly service initiatives. Ghana In Ghana, an integrated approach to sexual and reproductive health services for young people was adopted by the Planned Parenthood Association of Ghana (PPAG) to ensure that youth friendly services support young people’s wider development. Two youth clinics known as ‘Young and Wise Centres’ promote access to and use of youth friendly clinical services. PPAG also provides weekly outreach services to young people. In an effort to expand its services, PPAG established partnerships with the Ghana Education Service and Ghana Health Services. Nurses from Ghana Health Services were trained in youth friendliness, and their facilities are being used as referral points. The majority of services provided relate to testing and treating sexually transmitted infections and HIV. PPAG also provides support to young men and women from the community to enrol in trades of their choice, such as dressmaking, carpentry, and electronics.

IPPF Annual Performance Report 2005

IPPF’s Member Association in Egypt provides IEC materials specifically for young people IPPF/Ben Evenden

Hong Kong The commitment to integrated youth friendly counselling and clinical services is clear in the ‘Youth Health Care Centres’ of the Family Planning Association of Hong Kong (FPAHK). These are the only centres in Hong Kong dedicated to providing services that respect young people’s rights to privacy and confidentiality, help them to understand their sexuality, and motivate them to make safe choices. Supported by the government, the clinics offer family planning, emergency contraception, pregnancy termination services, and counselling on puberty, dating and relationships, sexual health, and other sexual and reproductive health issues. Counselling is also provided through the Association’s website, which has an e-booking service. One of the highlights of the initiative is the active involvement of peer counsellors who not only contribute to the delivery of services but also to programme planning. This helps ensure that services meet the real needs of young clients. Their efforts were rewarded by the Social Welfare Department of Hong Kong when it named two of the young people involved ‘Outstanding Youth Volunteers’.

Morocco The ‘Youth Friendly Services Project’ implemented by the Association Marocaine de Planification Familiale (AMPF) is the first of its kind in Morocco. Funded by the United Nations Population Fund (UNFPA) and approved by the Moroccan Ministry of Health, it seeks to meet the sexual and reproductive health needs of young people aged 14 to 24 by providing high quality, youth friendly sexual and reproductive health information and services in three youth clinics in Morocco. Building on the lessons learned from the IPPF ‘Quality of Care’ programme, AMPF works closely with young people to choose and implement services, such as family planning, emergency contraception, gynaecology, psycho-social counselling, HIV counselling, and a hotline. It also provides free condoms to young women and men. The initiative’s success prompted the Association to make plans to expand its coverage to more underserved areas and populations.

ADOLESCENTS

Indonesia The Indonesian Planned Parenthood Association (IPPA) aims to reduce the number of early marriages, sexually transmitted infections, HIV infections, unwanted pregnancies, unsafe abortion, and all forms of sexual violence and coercion among young Muslims in Bandar Lampung and South Kalimantan. This project was designed to reach young Muslims living in the dormitories of Islamic schools known as ‘pesantren’, where teachers and students have low levels of knowledge about sexual and reproductive health and where issues such as relationships and gender equity are rarely addressed. IPPA collaborated with local clinics to provide counselling and services to these young people by hosting educational activities, such as media events and youth forums, in the communities. These activities were especially targeted at the pesantren boards, community leaders, and Muslim youth leaders and helped to build support for the initiative. An evaluation of the programme found that the young people involved were keen to learn about sexual and reproductive health issues; they perceived this programme as one that meets their real needs, were more confident and ready to speak openly about sensitive issues, and were more likely to seek appropriate services when needed. While it is still a challenge to persuade young men to seek the services they need, the programme underscored the importance of networking with related institutions and religious bodies and raising awareness about the benefits of addressing sexual and reproductive health issues in a sensitive manner.

IPPF is focusing on increasing the quality of its services as well as increasing its coverage. This means respecting confidentiality, providing choices, raising awareness of rights, ensuring community acceptance of adolescent sexual and reproductive health, and reaching the most under-served populations. An essential component of this approach is the commitment to constantly reviewing who is being served, and also who is not being served, why, and what can be done to increase access. Youth friendly service delivery involves offering services that young people trust and that support their sexual and reproductive well-being and overall development. It also means providing services based on a comprehensive understanding of what young people in a particular community want and respecting the realities of young people’s diverse sexual and reproductive lives. To make these concepts a reality, IPPF staff and volunteers are developing a self-assessment tool for youth friendly services, based on the rights of the client and needs of the providers. The programme will be called ‘Provide’ and is intended to encourage staff and young people to reflect on existing programmes, and to identify obstacles to providing youth friendly services and ways to overcome them. Member Associations will be encouraged to use ‘Provide’ for furthering their work on comprehensive, high quality, youth friendly services in coming years.

EMPOWERING OUT-OF-SCHOOL YOUNG PEOPLE Family Planning Association of Uganda (FPAU), Uganda To address the sexual health needs of out-of-school young people in Uganda and empower them to cope with sexual and reproductive health challenges, the Family Planning Association of Uganda (FPAU) implemented the ‘Youth outof-school empowerment project’ (YOSEP). It brought together out-of-school young people to attend information sessions and participate in youth clubs. The clubs developed their own constitutions and registered to become community-based organizations, enabling them to access local donor resources so that they could engage in community development programmes. During the project, more than 1,000 young people sought sexual and reproductive health services, particularly treatment for sexually transmitted infections, contraceptive services, HIV testing services and treatment of minor ailments. In particular, there was continuous demand for services by under-served young people living in camps for internally displaced people. This highlights FPAU’s role in addressing the unmet needs of this group, while also raising the organization’s visibility as a leader in the provision of sexual and reproductive health services.

IPPF Annual Performance Report 2005

Young volunteers at a youth centre in Mauritania discuss an upcoming drama project that highlights sexual and reproductive health issues IPPF/Chloe Hall

OBJECTIVE 5 To reduce gender-related barriers and practices which affect the sexual and reproductive health and rights of young women IPPF seeks to empower young women and girls to overcome barriers to sexual and reproductive health and rights by increasing their awareness and negotiating skills and by addressing issues such as child marriage. In 2005, the Federation also engaged young men in promoting gender equality by identifying best practices, existing tools, and lessons learned from activities throughout the Federation that focus on young men.

ADDRESSING GENDER ISSUES IN TRADITIONAL CULTURES Palestinian Family Planning and Protection Association (PFPPA), Palestine

i Consanguineous marriage refers to marriage between relatives.

The Palestinian Family Planning and Protection Association (PFPPA) worked with Medical Aid for Palestinians (MAP-UK) on a project to empower young people and protect their rights. PFPPA conducted a number of activities for young people aged 18 to 25, including presentations about sexually transmitted infections, HIV, women’s rights, pregnancy, infertility, family relations, early and consanguineous marriage,i gender, and family planning methods. PFPPA also arranged more than 300 home visits to girls who could not attend the presentations for family and

IPPF Annual Performance Report 2005

cultural reasons. Sessions about sexual health issues for newly married couples were organized, and awareness-raising meetings for young men were also offered; these sessions allowed religious leaders to address issues concerning women’s rights to education and work, and to make decisions on family planning and sexual health. As a result of this project, PFPPA has established six support groups of youth leaders from both sexes, with the capacity and skills to educate their friends and families about gender equality and sexual and reproductive health. PFPPA faced a variety of challenges in implementing this project in Palestine. During Ramadan, a decrease in women’s attendance at awareness-raising activities prompted PFPPA to increase home visits. When men and women in the project areas refused to meet together, separate single-sex sessions were organized. PFPPA found that most young men involved in the project required intensive and ongoing support to understand gender and rights, family planning, and violence against women. The Association learned that both individual and group counselling can be truly beneficial for young women who lack access to information, and it found that activities promoting life skills education – to challenge common thinking on rights, roles, responsibilities, gender issues, and identity – are crucial for young people. PFPPA found that improving negotiation and communication skills helps young people face future choices about marriage, family planning, and religious rights.

As a global Federation that advocates for and provides comprehensive sexual and reproductive health services, meeting the needs of young people is at the heart of IPPF’s mission. We are continuously reviewing our progress in working with and for young people so that we can improve our work in a number of ways. Although most Member Associations are involved in advocating for improved access to services for young people, there is also a need to address issues such as age of consent, early marriage, and advocacy at national, regional, and international levels. Development, implementation, and sustainability of adolescent policies require the participation of young people, their parents, and the community. This requires an understanding of the relevance of youth sexual and reproductive rights within youth health policy. IPPF increasingly shows that participation is a crucial prerequisite to promoting young people’s rights. Therefore, the sexual and reproductive health community needs to continue to work not only for but also with young people. While many Associations are committed to youth participation, greater emphasis needs to be placed on building capacity for working in real partnership with young people at all levels. One of the primary strengths of Member Associations is their understanding of the diversity of needs of different groups of young people. However, more attention must now be given to identifying the most underserved and vulnerable young people, particularly to address the needs and wants of the youngest age group (under 14 years), young people living with HIV, and young men. Although most Associations provide a variety of services, there is still a need to strengthen condom promotion and distribution, provision of contraceptives and emergency contraception, and access to safe and youth friendly abortion services. IPPF’s Member Associations, particularly in Africa, are responding to

the restrictions imposed by the Global Gag Rule, and the conflicting messages proffered by the ‘U.S. President’s Emergency Plan for AIDS Relief’ (PEPFAR). The latter, in particular, communicates ‘abstinence only until marriage’ rather than promoting rights and choices for young people. In response, greater attention needs to be placed on promoting non-judgemental, comprehensive safer sex messages. The comprehensive sexuality education framework will be one of the tools that IPPF will use to increase the focus on a positive approach to sexuality and to support young people to make their own choices. Since the introduction of the Strategic Framework, IPPF’s Central Office has been collaborating with young people and external experts to discuss ways to support Member Associations to improve the quality of youth programmes. The result is ‘Inspire’, a publication that includes guidelines, toolkits, training manuals, and self-assessment guides for each of the five youth objectives. It will support Member Associations to think differently about the ways in which they have been working for young people in the past, to assess their current work with youth, and to plan for making the Strategic Framework a reality. ‘Inspire’ will also encourage Member Associations to develop new programmes based on rights and to build the capacity of staff and young volunteers. Throughout the Federation, there is a consistent need to improve youth programmes. In 2006 and 2007, the IPPF Secretariat, in collaboration with selected Member Associations, will expand Federation-wide learning on youth programming by undertaking a review of youth programmes. The aim is to improve our understanding of our successes, opportunities, and gaps in youth programming, and this will feed into interventions targeted at supporting Member Associations in their efforts to increase access to high quality youth friendly services, especially for the most vulnerable and under-served groups.

IPPF Annual Performance Report 2005

ADOLESCENTS

CONCLUSIONS

HIV AND AIDS

GOAL Reduction in the global incidence of HIV and AIDS and the full protection of the rights of people infected and affected by HIV and AIDS

2 INTRODUCTION Every year, the number of people living with HIV worldwide continues to increase. In 2005, the number of HIV positive people grew to an estimated 38.6 million, 4.1 million of whom were newly infected in 2005.1 Despite additional prevention efforts, including improved access to anti-retrovirals, 2.8 million people died of AIDS in 2005.2 The HIV epidemic disproportionately affects the world’s poorest, and the most stigmatized, disadvantaged, and under-served communities. Currently, 40 per cent of all new infections occur among young people between the ages of 15 and 24,3 and in many parts of the world, it is young women who are particularly vulnerable to infection. The key determinants of the spread of HIV are poverty, economic insecurity, gender inequity, illiteracy, stigma and discrimination, and a lack of information on prevention and treatment. HIV has continued to expand from being a localized epidemic, concentrated in key vulnerable groups, to a more widespread epidemic firmly established in the general population. Our Member Association Sub-Saharan Africa remains in Colombia strives the global epicentre of the to expand HIV coverage epidemic, where there are now by extending its 25.8 million people living with services to the HIV – nearly one million more GLBTQ community since 2003 4 and two-thirds of all IPPF/Jon Spaull global cases.5 Women and girls

continue to be disproportionately affected by HIV in this region. In eastern Europe and central Asia, the epidemic continues to expand, and what was previously a very concentrated epidemic is now affecting larger sectors of societies. The number of people living with HIV in eastern Europe and central Asia is now an estimated 1.5 million – almost a twenty-fold increase in less than ten years.6 In 2005, the HIV epidemic continued to expand in China, India, and Russia, and the primary agent of the epidemic in many parts of these countries is injecting drug use.7 This is known as the ‘second wave’ of HIV, and it poses significant challenges. Increasingly, HIV is spreading from injecting drug users to their sexual partners and beyond, with more women becoming infected.8 Current estimates reveal that epidemics in these three countries alone could potentially account for between 66 and 259 million new HIV cases by 2025 – a figure that is more than six times the total number of people living with HIV today. 9 Political commitment from governments, civil society, donors, and the private sector remains essential to addressing the HIV epidemic. This commitment is crucial for mobilizing resources, ensuring that effective programmes are scaled up, and engaging the communities most vulnerable to infection. The linkages between sexual and reproductive health and HIV are key, and leadership from the sexual and reproductive health community

IPPF Annual Performance Report 2005

is vital to building and maintaining a committed and effective response to HIV and AIDS.

LEADING THE CHARGE TO MAINSTREAM HIV INTO SEXUAL AND REPRODUCTIVE HEALTH 2005 proved another successful year for IPPF’s work on HIV. In the year when the international community was called on to ‘Keep the Promise’ to its commitments and targets to tackle the spread and impact of HIV and AIDS (the theme for World AIDS Day 2005), there was increasing recognition that growing infection rates could not be averted nor could treatment and care needs be met without the full support of the sexual and reproductive health and rights community. In keeping ‘our’ promise, IPPF worked to highlight that this support was necessary, not only in promoting effective programmatic and policy linkages between sexual and reproductive health and HIV, but also in addressing the sexual and reproductive health needs of HIV positive people. Through the IPPF Central Office’s five-year implementation plan entitled ‘Community Links’, the Federation seeks to strengthen its mandate and work on HIV by expanding, documenting,

and sharing opportunities for mainstreaming HIV into our core business. IPPF selected 17 HIV countries in which to concentrate its efforts: Cambodia, Cameroon, China, Dominican Republic, Estonia, India, Indonesia, Kenya, Malawi, Mexico, Morocco, Nepal, Russia, Rwanda, South Africa, Sudan, and Thailand. By concentrating on these countries, the Federation will be able to consolidate efforts in a number of programmatic areas, build institutional capacity and skills, share lessons learned and best practice, and scale up innovative programmes and services. IPPF hosts a competency workshop every year to develop and monitor the capacity of these selected focus countries. This approach is not only proving highly effective in building capacity, it is also having catalytic effects, with focus countries themselves now supporting other Member Associations in their HIV work. In addition, the Federation’s quarterly HIV newsletter provides a mechanism through which best practice and lessons learned on HIV programming are shared across IPPF’s global network and beyond. Every two years, the international community gathers together to participate in the International AIDS Conference, and in the years between meetings, a number of regional conferences occur. IPPF has been actively involved in these events, reflecting the organization’s commitment to maintaining visibility. In 2005, IPPF hosted prominent satellite sessions at the 7th International Congress on AIDS in Asia and the Pacific (ICAAP) in Japan, focusing on the role of sexual and reproductive health organizations in providing HIV testing, treatment, prevention, and care, and the challenges of developing HIV prevention programmes for men who have sex with men. IPPF organized a satellite session on the female condom in collaboration with the United Nations Population Fund (UNFPA) and the Female Health Company. At the end of 2005, IPPF conducted a high-profile satellite session at the International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) in Nigeria, to highlight the importance of addressing the prevention needs of people living with HIV. These events provided the Federation with an opportunity to challenge existing approaches to HIV prevention and to demonstrate the breadth of experience and skill that the sexual and reproductive health and rights community can offer.

THE WAY FORWARD

A youth volunteer from IPPF’s Member Association in Bulgaria promotes condom use to her peers IPPF/Chloe Hall

IPPF Annual Performance Report 2005

Now more than ever, we understand the steps that must be taken to restrain the HIV epidemic, and to improve the lives of millions of people infected with and affected by HIV and AIDS. We must strengthen and scale up our efforts, increase access to treatment and prevention, and implement programmes effectively.

HIV AND AIDS

ACHIEVING IPPF’S STRATEGIC FRAMEWORK: HIV AND AIDS HIV and AIDS are essential parts of IPPF’s sexual and reproductive health and rights agenda, and the Federation continues to lead the sexual and reproductive health and rights community in the global response to HIV and AIDS. IPPF’s Strategic Framework identifies four objectives for HIV and AIDS, including: ● reducing the barriers to HIV information and services ● increasing access to prevention services ● providing care and support ● integrating HIV and sexual and reproductive health information and services Alongside these objectives and underpinning IPPF’s long-term commitment to the promotion of human rights, there are four guiding principles that serve as the foundation blocks for our HIV strategy. These are the meaningful involvement of people at the forefront of the epidemic with a specific focus on the involvement of people living with HIV, gender, strategic partnerships, and capacity development.

In Kenya, our Member Association cooperates with youth centres to provide youth friendly HIV and AIDS services IPPF/Paul Bell

OBJECTIVE 1 To reduce social, religious, cultural, economic, legal, and political barriers that make people vulnerable to HIV and AIDS Stigma and discrimination are significant barriers to an effective response to the HIV epidemic, and are driven by ignorance, fear, and prejudice. Although laws and policies may protect against acts of discrimination, they often do little to reduce the stigmatizing attitudes of family, friends, colleagues, health practitioners, or the community. Stigma toward people living with HIV may also overlap with the stigma faced by certain key marginal and vulnerable populations, making it more difficult to address the needs of those at the forefront of the epidemic. Above all, by creating fear, stigma affects the uptake of services and the ability of those most in need to protect and realize their sexual and reproductive health and rights. To address the complex nature of HIVrelated stigma and its impact on service provision, Member Associations are encouraged to: ● advocate for increased access to HIV prevention, treatment, and care ● advocate for a reduction in discriminatory policies and practices at all levels ● have a written workplace policy to prevent discrimination against people with HIV Global indicators data show that 31 per cent of Member Associations have all three components

in place, with proportionately more Associations advocating for increased access to HIV prevention, treatment, and care (70.6 per cent) than are advocating on discriminatory policies and practices (56.3 per cent). Key to supporting the greater involvement of people living with HIV (known as the ‘GIPA Principle’) are simple, practical steps, such as the implementation of policies to protect rights. HIV workplace policies and programmes – as updated and adopted by IPPF – are one example. They help to ensure that respect and support are formalized in contexts where many people previously faced discrimination or chose to remain silent. Although the workplace sector alone cannot end the spread of HIV, workplaces are well positioned to contribute resources and skills, to influence employee attitudes and sexual behaviours, and to provide clinical services and/or referrals. The workplace offers a structured environment for sharing information, implementing interventions, and supporting employees affected by HIV and AIDS. Currently, 47.6 per cent of Member Associations are advocating internally for or already have a written workplace policy to prevent discrimination against people with HIV. Global indicators data show that the proportion of Member Associations conducting behaviour change communication to reduce the stigma associated with HIV and AIDS and to promote health-seeking behaviour among vulnerable groups is 66.7 per cent. The IPPF Annual Performance Report 2005

BOX 2.1 PROMOTING SEXUAL RIGHTS AND HIV PREVENTION AMONG MEN WHO HAVE SEX WITH MEN ■

Asociación Pro-Bienestar de la Familia Colombiana (PROFAMILIA), Colombia

In many parts of Latin America, sex between men is a common means of HIV transmission. Frequently, however, stigma and discrimination prevent men who have sex with men from accessing high quality sexual and reproductive health and HIV prevention services. The Member Association in Colombia, Asociación Pro-Bienestar de la Familia Colombiana (PROFAMILIA), which has been working in HIV prevention since the 1980s, recently undertook a project to reach out to men who have sex with men and their male and female partners. The project sought to promote

Promotional material produced for the MSM (men who have sex with men) campaign by our Member Association in Colombia IPPF/PROFAMILIA

promotion of health-seeking behaviour is most common in people living with HIV (42.9 per cent), sex workers (41.3 per cent), newly married women (40.5 per cent), migrants (35.7 per cent), and internally displaced persons (28.6 per cent). Increasingly, IPPF’s behaviour change communication programmes target gay

IPPF Annual Performance Report 2005

the sexual and reproductive health and rights of this group of men to increase their access to high quality health services and HIV information, and to reduce stigma and discrimination in both PROFAMILIA’s clinic staff and the community at large. In collaboration with partner organizations, more than 200 PROFAMILIA clinical staff received training. The programme focused on integrating prevention of HIV and sexually transmitted infections into sexual and reproductive health services, promoting sexual rights, preventing HIV among men who have sex with men and their partners, and educating staff on sexual diversity, gender sensitivity, and the distinct needs of different populations of men who have sex with men. In addition, PROFAMILIA launched a new, interactive website and developed vivid and colourful promotional materials displaying the slogan ‘El hombre MAS hombre’ (Man plus man). This slogan encapsulates the phrase ‘for the most manly man’ and the website and materials were produced for three different audiences: gay men, men who have sex with men, and women (as the potential partners of men who have sex with men). PROFAMILIA also developed strong partnerships with the gay, lesbian, bisexual, and transgender (GLBT) populations and organizations, and conducted extensive outreach in several communities, including sex workers and the armed forces, which was critical to linking clients with its services. Through this project, PROFAMILIA was able to increase availability of information on HIV and sexually transmitted infections and to improve and expand the quality of service delivery in 35 of its health centres. PROFAMILIA has demonstrated how a sexual and reproductive health organization can, through effective alliances, successfully address the HIV prevention needs of men who have sex with men. Although challenges remain, this project offers important lessons that are crucial in both working with populations of men who have sex with men and addressing the HIV epidemic in Latin America. PROFAMILIA will continue to work to put these lessons into practice, and has since appointed a full-time gender coordinator to drive this work forward.

and bisexual men (22.2 per cent), injecting drug users (19.0 per cent), and men who have sex with men (18.3 per cent). These activities demonstrate our ability to work with both traditional sexual and reproductive health clientele, and progressively, with key vulnerable populations.

HIV AND AIDS

OBJECTIVE 2 To increase access to interventions for the prevention of STIs and HIV through integrated, gender-sensitive sexual and reproductive health programmes While rates of HIV infection remain high among men in some regions, women and girls represent an increasing proportion of the population living with HIV, and rates of female infection continue to rise.10 In sub-Saharan Africa, on average, three women are infected with HIV for every two men, and just under half of all adults living with HIV worldwide are now female.11 These trends indicate the direction in which global attention should be focused. Prevention information must be linked to services to ensure that everyone has the ability to make informed choices, and translating HIV awareness into individual action requires an enabling environment in which even the most vulnerable can access the services they require. Integrating HIV prevention efforts with sexual and reproductive health services gives access to a full range of choices to protect

This volunteer works with our Member Association in Ethiopia to provide vital information on HIV prevention to young people IPPF/Chloe Hall

BOX 2.2 EMPOWERING YOUNG WOMEN AND GIRLS ■

IPPF South Asia Regional Office

In many parts of South Asia, social, cultural, and economic factors such as stigma and sexual taboos can limit the ability of women and girls to control their own sexual and reproductive health, making them uniquely vulnerable to HIV. In 2005, the IPPF South Asia Regional Office invited ten young women between the ages of 16 and 20 to take part in ‘Passion & Portraits’, a unique initiative that combined HIV and AIDS awareness with photography. The ten women developed skills in HIV and AIDS peer education to transfer what they learned to their communities. For example, they were taught to use puppets and paper dolls to address issues and attitudes related to HIV. The women were also taught photography skills. After the training, they were asked to provide a collection of photographs representing support and empowerment, the status of girls and women, and the attitudes of adults in their communities. Madeeha, from Pakistan, was one of the ten participants. Since the training, she has been talking with her peers about what she calls

‘sensitive issues’, such as using condoms to prevent sexually transmitted infections. Sometimes, she says, they are “…shocked to hear such words, but slowly they get used to it and accept it because it is for their own safety.” Recently, Madeeha arranged a session at her local Youth Resource Centre to share information about HIV and AIDS using storytelling, plays, and puppets. Her friends also took part in developing and performing the plays. Overall, Madeeha says she enjoys being a peer educator. “A change came in my personality after I attended the workshop… I have more confidence, and my friends and family see it clearly in my behaviour.” She is now a photographer for the Pakistan Family Planning Association. ‘Passion & Portraits’ was an ideal opportunity to address both HIV and AIDS, and to empower young women. The women who participated returned to their home countries trained as photographers, puppeteers, and HIV and AIDS peer educators. The workshop afforded them a unique experience that will ultimately develop their confidence as peer educators within their communities, while also applying their new-found ability to use photography as a medium to communicate vital HIV-related messages.

IPPF Annual Performance Report 2005

from infection or decrease the chance of transmission. Condoms are the only way that people can protect themselves against the sexual transmission of HIV and other sexually transmitted infections, and “they are the mainstay of HIV prevention programmes.”12 In 2005, IPPF’s Member Associations distributed nearly 98 million condoms. Prevention programmes provide an ideal opportunity for people to access treatment and care for HIV. Integrated HIV services require Member Associations to provide information on HIV prevention, voluntary counselling and testing (VCT) services or referrals, anti-retrovirals, management of sexually transmitted infections, and drugs for opportunistic illness. In 2005, the majority of Member Associations provided information on HIV prevention (97.6 per cent), VCT services or referrals (82.5 per cent), and management of sexually transmitted infections (69.0 per cent). Thirty-four per cent provided drugs for opportunistic illness and 9.5 per cent provide anti-retrovirals. Nearly eight per cent of Member Associations provided all components of a fully integrated programme. Although this figure may seem low, it highlights the challenge of covering all aspects of integration. Overall, this represents significant progress in the Federation’s commitment to integrating HIV and AIDS services (Figure 2.3). Those groups considered to be particularly vulnerable to HIV infection include people living with HIV and AIDS, sex workers, men who have sex with men, gay and bisexual men, injecting drug users, newly married women, migrants, and

internally displaced persons. Strategies to reach vulnerable groups may include mobile clinics, VCT for specific populations, participation of people living with HIV in governance and advisory capacities, and partnerships with agencies focused on issues facing vulnerable groups. The proportion of Member Associations with strategies to reach at least one of these groups is 69.8 per cent. IPPF strives to give every individual access to vital HIV prevention information and services that meet his or her needs, and recognizes that this is a key element in our work to help reduce the incidence of HIV infection.

MEN AS PARTNERS: FULFILLING FATHERHOOD IN THE MIDST OF AN EPIDEMIC On World AIDS Day 2005, IPPF and the Global Network of People Living with HIV/AIDS (GNP+) launched a publication entitled ‘Fulfilling Fatherhood: Experiences from HIV Positive Fathers’, which explored the specific sexual and reproductive health issues facing HIV positive men. The book candidly reveals the lives of 13 HIV positive fathers from around the world, highlighting their role in addressing HIV stigma and discrimination. The experiences of these fathers offer insight into the complexities of family life when living with HIV. This joint IPPF and GNP+ publication provides a better understanding of the needs of HIV positive people and places more emphasis on positive prevention – an essential ingredient in linking HIV prevention and care. The document

Figure 2.3 Percentage of Member Associations providing HIV and AIDS services, by type of service 100%

80%

60%

69.0%

34.1%

Management of sexually transmitted infections

Opportunistic illness drugs

82.5%

97.6%

20%

9.5%

40%

IPPF Annual Performance Report 2005

Anti-retroviral treatment

Voluntary counselling and testing services or referrals

Information on HIV prevention

■

‘Fulfilling Fatherhood’ publication produced by IPPF’s Central Office and GNP+ IPPF

also provides the basis for the re-orientation of current services and a more effective response to the epidemic. It is a small step toward addressing the realities facing many men living with HIV, and reflects IPPF’s commitment to ensuring that those most vulnerable to infection remain at the forefront of our efforts.

OBJECTIVE 3 To increase access to care, support, and treatment for people infected, and support for those affected by HIV and AIDS Providing HIV treatment, care, and support services in a sexual and reproductive health setting offers a number of benefits to clients and service providers. In particular, it optimizes the use of existing sexual and reproductive health infrastructure, which is an especially valuable approach in resource-poor settings. Many people may be discouraged from visiting HIV-only clinics for fear of being stigmatized or discriminated against by their communities; offering treatment and care in sexual and reproductive health clinics can help to reduce this stigma. There is often more confidentiality in settings where other non-related services are provided, and this encourages individuals to seek treatment and care for HIV. The ability to access many services under one roof reduces the time, money, and effort that clients must invest to seek health care – as a result, this encourages the increased use of services. The prevention-to-care continuum reflects the mixture of different elements of prevention and care that IPPF encourages Member Associations to emphasize in their HIV programmes. These include behaviour change communication, condom distribution, management and treatment of sexually

HIV AND AIDS

BOX 2.4 PREVENTION OF HIV AND SEXUALLY TRANSMITTED INFECTIONS AMONG MINORITY BADI FEMALE SEX WORKERS IN NEPAL Family Planning Association of Nepal (FPAN), Nepal

In 2005, the Family Planning Association of Nepal (FPAN) undertook a project among minority Badi female sex workers in three districts to reduce HIV and sexually transmitted infections and improve sexual and reproductive health. This project focused on improving access to information on preventing HIV and sexually transmitted infections, diagnosis and treatment of reproductive tract and sexually transmitted infections, and HIV referral services. Because local communities hold negative attitudes toward Badi sex workers, FPAN sponsored an event to bridge the gap between sex workers and the community. This event sensitized participants to HIV prevention and vulnerability. FPAN also trained peer groups of 30 female sex workers who were then able to act as representatives for the sex workers in the three districts, addressing stigma and discrimination and contributing to district and national policy making. Meeting centres were established in three brothels to provide contraception and education on health issues, including HIV. Twenty orientation meetings were held with more than 500 sex workers, together with nine street dramas and ten video showings. These centres were also the site of weekly clinics, providing information on the prevention of HIV and sexually transmitted infections, counselling by peer educators, and referrals. Peer educators were involved in disseminating safer sex and HIV prevention information, and planning and organizing events such as a ‘Condom Day Celebration’. FPAN collaborated with organizations such as the Women Development Office to provide a skills development programme for sex workers. As a result of this project, FPAN has become a trusted partner in helping sex workers protect their health. The sex workers appreciate the treatment of sexually transmitted infections provided by the clinic and the training component, which has increased their commitment to use the skills they learned to educate their colleagues on the prevention of HIV and sexually transmitted infections. Indeed, they have asked for more peer group members to be involved with the project. A follow-up survey revealed that the project led to an overall increase in knowledge among Badi female sex workers about preventing HIV and sexually transmitted infections, as well as increased condom use. Moreover, a community that was once silent and whose sexual and reproductive health needs were neglected has been empowered to speak out.

IPPF Annual Performance Report 2005

BOX 2.5 STRENGTHENING AND EXPANDING VOLUNTARY COUNSELLING AND TESTING ■

Family Planning Association of Malawi (FPAM), Malawi

Increasing availability of and access to voluntary counselling and testing (VCT) services is an essential part of HIV prevention. When people have a greater awareness of their status, they can take steps to ensure that they continue to protect themselves and prevent future infections. VCT is also a key entry point for providing other sexual and reproductive health services. To recognize the importance of scaling up its VCT provision, the Family Planning Association of Malawi (FPAM) undertook a project to strengthen and expand the range and scope of services being provided through its existing ‘Youth Life Centres’ and outreach activities. The aim of the project was to reduce HIV prevalence rates among young people and under-served communities in the Dowa and Lilongwe districts, and to create a supportive environment for those living with HIV. To achieve this, FPAM strengthened its capacity to provide high quality services by providing additional training for its service providers and equipment and supplies for its youth centres and mobile services. FPAM also increased its provision of VCT and HIV services to include management of sexually transmitted and opportunistic infections

i This figure does not include VCT referrals.

transmitted infections, VCT, psycho-social support, prevention of mother-to-child transmission, treatment of opportunistic infection, anti-retroviral treatment, and palliative care. Services for the treatment of sexually transmitted infections can be accessed in 69.0 per cent of IPPF’s service delivery outlets, and VCT is provided by 70.6 per cent of our Associations.i HIV-related psycho-social support is available in 57.1 per cent, prevention of mother-to-child transmission in 25.4 per cent, treatment of opportunistic infections in 34.9 per cent, and palliative care in 15.9 per cent of our Associations. As anti-retroviral treatment becomes more available, it is essential to ensure the development of comprehensive responses to the epidemic that fully integrate prevention, care, and treatment. Currently, over nine per cent of Member Associations are providing anti-retroviral treatment. These figures illustrate how sexual and reproductive health service providers are well suited to provide integrated services, which often remain under-utilized as an entry point to HIV care. Global indicators show that three

IPPF Annual Performance Report 2005

and referral to anti-retroviral treatment clinics. As a result of this project, nine more VCT sites have been opened, and the total number of FPAM clinics providing VCT has increased from 29 to 56. With improved access to VCT, there has also been an increase in use of these services among young people. In 2005, 5,770 people used the VCT services – 30 per cent more than the previous year. At the same time, demand for condoms increased, and during 2005 over 220,000 condoms were distributed by FPAM, along with information on dual protection. This increased range of services, paired with better observance of privacy and confidentiality increased uptake and instilled trust and confidence in clients – essential components when encouraging people to seek VCT services. One of the greatest challenges faced by FPAM was ensuring adequate support services for young people who tested positive for HIV. Although increasing young people’s awareness of their status is essential, FPAM recognized that appropriate mechanisms must be in place to ensure follow-up, supportive care and provision of anti-retrovirals for those who test positive. FPAM embraced this challenge through effective referral mechanisms and the creation of post-test clubs, reflecting the Federation’s broader commitment to assisting HIV positive people to lead healthy sexual lives.

per cent of Member Associations provide all of these HIV-related services: Côte d’Ivoire, India, Kenya, and Thailand. The total number of HIV-related services provided by Member Associations in 2005 was 1,320,599. Table 2.6 shows the breakdown of these services by type of services provided.

OBJECTIVE 4 To strengthen the programmatic and policy linkages between sexual and reproductive health and HIV and AIDS IPPF works to integrate HIV treatment and care into sexual and reproductive health policies, programmes, and services so that people living with HIV can receive the comprehensive services they need. Integration focuses on maximizing the expertise of both the sexual and reproductive health and HIV fields through joint action and response. A defining aspect of IPPF’s leadership for 2005 involved moving beyond asking why we should mainstream HIV and what this means

Type of service provided HIV prevention counselling HIV voluntary counselling (pre- and post-test) HIV sero status lab tests Anti-retroviral treatment HIV opportunistic infection treatment HIV psycho-social support and post-exposure prophylaxis (PEP) AIDS home care treatment Other HIV treatment Other HIV lab tests Sexually transmitted and reproductive tract infection services* All other HIV and AIDS services ▲ TOTAL

Number of services provided 221,294 76,221 42,524 565 40,954 859 4,848 8,935 72,143 818,550 33,706 1,320,599

HIV AND AIDS

Table 2.6 Number of HIV-related services provided, by type of service

*Sexually transmitted and reproductive tract infection services are included under HIV-related services, as treatment of sexually transmitted and reproductive tract infections can contribute to reduced rates of HIV infection as well as negative reproductive health outcomes, including subfertility, ectopic pregnancy, and cervical cancer. ▲

Some Member Associations were unable to provide the breakdown of services by type for 2005, so these services were included in ‘all other HIV and AIDS services’.

BOX 2.7 INCREASING ACCESS TO VOLUNTARY COUNSELLING AND TESTING AND SEXUALLY TRANSMITTED INFECTION SERVICES ■

Reproductive Health Association of Cambodia (RHAC), Cambodia

The Reproductive Health Association of Cambodia (RHAC) currently provides integrated reproductive health care, including services for reproductive tract and sexually transmitted infections and voluntary counselling and testing (VCT) in 14 clinics throughout Cambodia. The RHAC clinic in the Siem Reap district was able to expand its HIV programme to vulnerable groups and increase VCT and the use of sexually transmitted infection services among young entertainers, men who have sex with men, and construction workers. This was a particularly important intervention, given the low levels of awareness within these groups about VCT and other available services. Working in partnership with a broad range of organizations, including the Provincial AIDS Office, the Cambodian Construction Workers Trade Union Federation, and Men’s Health Cambodia, RHAC developed training curriculum and a manual for VCT and sexually transmitted infections. These materials were then used by RHAC to orientate both their own clinical staff and government staff on providing high quality information on VCT, reproductive tract and sexually transmitted infections, education, and services to these vulnerable groups. In addition, around 380 young entertainers, men who have sex with men, and construction workers were trained as peer educators to disseminate information on the prevention of HIV

and sexually transmitted infections and provide referrals to RHAC and government services for HIV testing and treatment services among their peers. As a result of this project, over 20,000 promotional materials and booklets on VCT and 30,000 on reproductive tract and sexually transmitted infections were distributed to project partners to be disseminated to the target groups through RHAC counselling services and trained peer educators. In addition, around 2,200 young entertainers, 200 men who have sex with men, and 600 construction workers received VCT and sexually transmitted infection services at the RHAC clinic. Those who tested HIV positive received support to develop skills on how best to live with the infection. RHAC also held educational and support sessions with over 7,100 young entertainers, men who have sex with men, and construction workers. One of the key challenges to the overall success of this project was the retention of peer educators. To address this, RHAC held a meeting with its partner organizations and created an action plan for recruiting and training new peer educators. Ongoing quarterly partner meetings strengthened collaboration between these groups, improved project implementation, and ensured sustainability through the integration of promotion and referral networks for VCT and sexually transmitted infections into the routine package of services of all organizations. Following these successes, RHAC has been awarded a grant by the Global Fund to expand this project in 2007.

IPPF Annual Performance Report 2005

BOX 2.8 REACHING PEOPLE AFFECTED AND INFECTED BY HIV AND AIDS ■

Asociación Dominicana Pro-Bienestar de la Familia (PROFAMILIA), Dominican Republic

“Since I started on anti-retrovirals, my life has dramatically changed…I know that with these medicines, I can live a long life.” PROFAMILIA client on anti-retrovirals Expanding sexual and reproductive health care to meet the needs of people living with HIV requires services to embrace a more comprehensive model of care for HIV positive people. Asociación Dominicana Pro-Bienestar de la Familia (PROFAMILIA) in the Dominican Republic has embraced this challenge and through integrating HIV care, treatment, and support with other sexual and reproductive health services, it is making a real difference in people’s lives. To achieve this, PROFAMILIA strengthened the capacity of its clinics in Santiago and Santo Domingo to offer clinical services in the prevention and management of HIV. The project also promoted the rights of people living with HIV to high quality and timely care and access to anti-retroviral medicines by targeting key stakeholders in the community, including health sector decision makers. With the assistance of Columbia University and other partner organizations, PROFAMILIA designed a plan to integrate its HIV services directly into existing services, thus ensuring that clients receiving HIV services were not segregated from other clients and services. HIV positive clients were placed onto the anti-retroviral treatment programme, and those who agreed began a series of counselling and information sessions. Once clients were stable on their anti-retrovirals, they met on a monthly basis with a nurse, and many participated in individual counselling and peer-run support groups.

programmatically, to providing tangible tools and examples to enable organizations to understand how to achieve this. To this end, IPPF worked in collaboration with the United Nations Population Fund (UNFPA), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the World Health Organization to create a ‘Framework for Priority Linkages’, which outlines the key policy and programmatic actions needed to strengthen linkages between sexual and reproductive health and HIV. This framework recalls the ‘Glion Call to Action’13 and the ‘New

IPPF Annual Performance Report 2005

In any programme of this type, consistency in the supply of drugs is essential for ensuring adherence and avoiding viral resistance. PROFAMILIA has succeeded in maintaining its anti-retroviral treatment and comprehensive care programme despite the fact that access to these drugs has been inconsistent and costly. Of the 48 people who began anti-retroviral treatment in 2005, 44 remain on the programme today. A further 70 people were referred to support groups. The Dominican Republic government has subsequently agreed to provide PROFAMILIA with the necessary anti-retrovirals to meet the needs of its clients. A key achievement of this project was the change in behaviours and attitudes among sexual and reproductive health service providers. Staff received substantial training and sensitization to work with and provide treatment to people living with HIV, and pre- and posttraining surveys revealed significant improvements in staff knowledge and attitudes over the course of the project. Staff members who had previously held stigmatizing beliefs about people living with HIV now support the right of any woman living with HIV to become pregnant and the right of health care providers to keep their jobs after disclosing their HIV positive status. This project succeeded in building on existing infrastructure and developing capacity to provide a comprehensive range of HIV services within a traditional sexual and reproductive health setting. In fact, it was so successful that it was selected by the Dominican Republic government as the management model for replication at the national level. The IPPF Western Hemisphere Regional Office convened a regional workshop of the Spanish-speaking Member Associations in the region to share the lessons learned and to explore options for funding to provide these services in other Associations.

York Call to Commitment’14 to reinforce the recognition of the international community that action on sexual and reproductive health is fundamental to fighting the HIV epidemic – a message that is central to IPPF’s work on HIV. Throughout the past year, IPPF continued to strengthen and develop its strategic HIV partnerships at global, regional, and national levels, recognizing that maximizing effort and resources is key to the success of IPPF’s work and to effectively tackling the HIV epidemic. As a signatory and steering committee member of the

HIV AND AIDS

BOX 2.9 PROVIDING ANTI-RETROVIRALS IN A SEXUAL AND REPRODUCTIVE HEALTH SETTING ■

Family Health Options Kenya (FHOK), Kenya

“HIV affects almost every area of sexual and reproductive health work, so you can’t avoid dealing with it.” Dr Winifred Mwangi, Nakuru Clinic, Kenya Family Health Options Kenya (FHOK) undertook a project in four of its clinics (Eldoret, Nairobi West, Nakuru, and Thika) to strengthen its capacity to provide HIV and AIDS care and support services within a sexual and reproductive health setting. The Association increased use of HIV care and support services by people living with HIV by 20 per cent. The project also sought to build on FHOK’s existing HIV prevention and care work, particularly the provision of VCT and the prevention of mother-to-child transmission. Project activities included a site assessment to evaluate programme preparedness (strengths and gaps) and to develop site-specific strategies for starting, managing, and sustaining anti-retroviral treatment programmes, including a community component and home-based care. FHOK modified its existing services to accommodate anti-retroviral treatment, which included integrated counselling and psychological support, more sophisticated client monitoring, and additional equipment. FHOK sponsored awareness-raising activities and produced brochures and posters to increase visibility and demand for FHOK’s care and support services. Finally, people living with HIV were employed as paid staff, which reduced stigma and discrimination from other members of staff. Figure 2.10 shows the total number of clients served by this project between June and December 2005. One of the most innovative aspects of the project was the establishment of a system in all project sites to monitor side-effects after short- and long-term use of medicines. This involved ongoing review and documentation of emerging trends in using anti-retrovirals, including the use of antiretrovirals by pregnant women, potential interactions between anti-retrovirals and

An HIV and AIDS counselling session in our Member Association in Kenya IPPF/FHOK

contraceptives, and a lack of adherence to prescribed regimes. The project demonstrated that HIV care and support involves more than just antiretroviral treatment and the management of sexually transmitted and opportunistic infections. It was essential that FHOK address the full range of care and support needs, including psycho-social support, ongoing education including nutrition and promotion of positive living, treatment support groups, and home-based care visits. Through this project, FHOK has shown how HIV care and support can be an integral component of sexual and reproductive health. In doing so, FHOK has pioneered a model of integration, developed capacity to offer critical services, and increased its client base. Using sexual and reproductive health services as entry points to HIV care identifies the need for timely intervention and demonstrates how this can reduce HIV morbidity and mortality. Sexual and reproductive health facilities provide an opportunity to offer anti-retroviral treatment in resource-poor settings, and this innovative work has informed the development of a three-year project to consolidate the services in the four current sites, and to expand to five other sites in the future.

Table 2.10 Number of clients served by FHOK’s integrated HIV and AIDS programme, by type of service Type of service Family planning (all methods) Non-family planning sexual and reproductive health services Voluntary counselling and treatment Prevention of mother-to-child transmission Anti-retroviral treatment

Number of clients served 5,750 1,550 2,422 (of which 315 tested positive) 412 (of which 31 had an HIV positive child) 63

IPPF Annual Performance Report 2005

‘Code of Good Practice for NGOs responding to HIV/AIDS’, IPPF is part of a collective voice working to ensure greater collaboration within the non-governmental organization sector. In 2005, IPPF’s key partners included GNP+, the International Community of Women Living with HIV/AIDS (ICW), Young Positives, UNFPA, and UNAIDS. In addition, the Federation remains an active member of the Global Campaign for Microbicides, continuing to highlight the importance of new HIV prevention technologies. IPPF is also heavily involved in the work of the UK

Consortium on AIDS and International Development, both as an active member of the Consortium’s Executive Committee and of its mainstreaming working group. IPPF is a partner in a research programme consortium that is funded by the UK Department for International Development and coordinated by the London School of Hygiene and Tropical Medicine. The consortium is undertaking research into sexual and reproductive health interventions that can act to reduce the HIV epidemic in Ghana, India, Pakistan, South Africa, and Tanzania.

BOX 2.11 FROM PROCESS TO PRACTICE: MAINSTREAMING HIV AND AIDS INTO REGIONAL PROGRAMMES ■

IPPF Arab World Regional Office

A key challenge for IPPF’s Member Associations when integrating HIV into the provision of sexual and reproductive health services is a lack of skills and knowledge among staff. To address this, the IPPF Arab World Regional Office organized a project to build capacity in its Member Associations to integrate HIV into their programmes and services. The initial element of this programme was a regional training of trainers workshop in Tunisia to bring together key HIV staff. The workshop focused on stigma reduction, preventive services, treatment, care and support, and policy linkages and partnerships. The participants learned skills for eliminating stigma and discrimination in their organizations and for developing prevention strategies for clients through campaigning for advocacy, promoting condom use, encouraging VCT, and providing youth education and information. They also gained knowledge in developing treatment protocols with antiretrovirals, managing opportunistic infections, and establishing effective referral mechanisms. The training involved methods to create partnerships and develop policy linkages with the public sector to ensure that HIV and AIDS are included in sexual and reproductive health packages. At the end of the workshop, participants developed action plans to mainstream

IPPF Annual Performance Report 2005

HIV into their programmes and services. Following this regional training, similar events were replicated in each Member Association in the Arab World Region. As a result, all Member Associations have developed new information, education, and communication materials that help raise awareness about prevention and stigma. They have conducted seminars for young people to promote HIV prevention, provided regular HIV prevention counselling for clients, and organized sensitization seminars with policy makers to promote the rights of people living with HIV and to address stigma and discrimination. In addition, all Member Associations in the region developed partnerships with national HIV programmes and other nongovernmental organizations working in HIV and AIDS. The Member Associations of Morocco, Sudan, and Syria introduced VCT services, and the Member Associations of Egypt, Palestine, Syria, and Tunisia now provide diagnosis and management of sexually transmitted infections. This programme successfully mainstreamed HIV services into existing programmes in all Member Associations in the Arab World Region. As a result, the culture of these Associations and the attitudes of staff have changed. Service providers are now promoting the use of condoms and acknowledging the value of partnerships with other non-governmental organizations and concerned groups in raising awareness about HIV prevention and stigma reduction.

IPPF’s work in 2005 set the stage for a reproductive health response to the HIV epidemic: we have gained the support of key stakeholders, achieved policy recognition, and witnessed an increase in capacity, technical ability, and commitment. As a result, the global debate around linking sexual and reproductive health and HIV is now progressing toward the practicalities of integration: the ‘what’ and ‘why’ are clear and largely agreed – the real issue now is ‘how?’ IPPF utilizes five key programmatic entry points for mainstreaming HIV into sexual and reproductive health: VCT, treatment of sexually transmitted infections, prevention of mother-to-child transmission of HIV, treatment of opportunistic infections, and provision of anti-retrovirals. We recognize that integration is not a panacea and should not be approached with a ‘one size fits all’ solution. As such, we continue to advocate for a response to HIV that not only links prevention, treatment, and care but also responds to the unique regional characteristics of the epidemic. In the future, there are several key areas that IPPF will focus on in its HIV and AIDS strategy. IPPF will continue to advocate for increased political commitment which is essential to ensuring an effective and mainstreamed response to the HIV epidemic. A number of major donors and governments are dealing with issues of HIV and sexual and reproductive health separately at the policy level, which can widen, rather than reduce, the gap between HIV and sexual and reproductive health. Until there is greater acceptance

of how HIV and sexual and reproductive health are directly related, real progress in our collective fight against HIV will be inhibited. It is crucial for IPPF to promote evidence-informed programming. The conservative policy environment in a growing number of countries is leading to an increasingly powerful lobby calling for ‘abstinence only’ as the solution to the HIV epidemic. This creates mixed messaging which undermines prevention efforts and continues to pose significant challenges to scaling up an effective sexual and reproductive health response to HIV. Traditional models of prevention fail to be effective when they are based on the assumption that people are HIV negative, as they do not meet the prevention needs of people living with HIV. Services and programmes must increasingly focus on ‘positive prevention’, a set of actions that help people living with HIV to protect their sexual health, avoid other sexually transmitted infections, delay HIV and AIDS progression, and avoid passing HIV infection on to others. This builds on the recognition that HIV positive people play an essential role in preventing new infections. IPPF faces significant challenges in addressing HIV stigma and discrimination, and efforts to reduce stigma and discrimination require the cooperation of all members of society. Most importantly, the meaningful involvement of people living with or affected by HIV and AIDS in all prevention, care and treatment efforts is a key factor in reducing stigma. IPPF will continue to work to overcome barriers to comprehensive services for those living with and affected by HIV and AIDS.

IPPF Annual Performance Report 2005

HIV AND AIDS

CONCLUSIONS

ABORTION

GOAL A universal recognition of a woman’s right to choose and have access to safe abortion, and a reduction in the incidence of unsafe abortion

INTRODUCTION Abortion is defined as the termination of a pregnancy before the fetus can sustain independent life.1

BOX 3.1 IPPF’S COMMITMENT TO A WOMAN’S RIGHT TO CHOOSE IPPF promotes a woman’s right to choose the number and spacing of her children, to use contraception to prevent unwanted pregnancy, and to have access to safe, legal abortion when an unwanted pregnancy has occurred.2 As a global network of pro-choice advocates and service providers, IPPF drives an agenda to increase access to high quality abortion services within a comprehensive and holistic framework of sexual and reproductive health and rights.

This couple attends a pre-abortion counselling session offered by one of our Member Association clinics in India to access information about safe abortion services IPPF/Peter Caton

Every year, 46 million abortions take place globally, and of these, 18 million are unsafe.3 Sixty-six per cent of unsafe abortions occur among women aged 15 to 30 years, and 14 per cent occur among young women under 20 years of age in developing countries.4 Every year, nearly 68,000 women die from unsafe abortion, and nearly all of these deaths occur in the developing world.5 The unmet need for comprehensive sexual and reproductive health services – including safe abortion services – results in an unacceptable loss of life, and despite the decade of progress made since the International Conference on Population and Development (ICPD) in 1994, there is still much to be done. These numbers reveal that although abortion is a global concern, death from unsafe abortion is primarily a developing world tragedy that could be prevented by making abortion safe and legal. Currently, more than 61 per cent of the world’s population lives in countries where induced abortion is permitted either for a wide range of reasons or without restriction, 26 per cent reside in countries where abortion is restricted and allowed only under certain conditions, and 13 per cent live in countries where access to legal abortion often requires a delicate interpretation of the law.6 Women may face an unwanted pregnancy for many reasons, including lack of information on contraception, limited access to contraception, contraceptive failure, poverty, lack of a supportive partner,

IPPF Annual Performance Report 2005

or the stigma associated with being sexually active. Sometimes pregnancy results from rape, incest, or coerced sex, and at times, pregnancy can threaten a woman’s health. As long as these situations exist, induced abortion will persist. Even in those countries where induced abortion is permitted either for a wide range of reasons or without restriction, access to safe abortion may be limited due to the high cost or unavailability of reproductive health services.

IMPLEMENTING IPPF’S STRATEGIC FRAMEWORK ON ABORTION It is within this diverse legislative and socioeconomic context that IPPF’s Member Associations strive toward the goal of ensuring access to safe abortion services for all. The Strategic Framework adopted by IPPF in November 2003 formally recognized abortion as an essential focus area for our work, and the Central Office Abortion Team worked with Regional Offices to develop a conceptual framework for abortion activities for the Federation called the ‘Abortion Advocacy and Care Continuum’ (Figure 3.2). This framework is based on the premise that every Member Association should engage in at least some form of abortion-related activity – ranging from data collection, research, and advocacy to the actual provision of abortion-related services – according to the fullest extent of the law. Since 2003, Member Associations have used this framework to identify what abortion-related activities they currently implement, what they would like to undertake in the future, and what support they need to do this. In countries where access to abortion services is severely restricted, IPPF works to raise awareness

among key stakeholders to create an environment that supports a woman’s right to choose and access safe abortion services. In countries where abortion is permitted for a wide range of reasons or without restriction, IPPF either provides abortion-related services itself or cooperates with other health care providers to ensure access to safe abortion services. In countries where safe abortion services are readily available, our Member Associations remain vigilant to oncoming threats that oppose a woman’s right to choose abortion, safeguarding past progress and ensuring the future of safe, legal abortion services. Based on the findings of a Federation-wide survey conducted in 2004, IPPF now has a clear understanding of the opportunities and challenges faced by each Member Association, and has used these results in 2005 to secure funding to implement projects that will increase access to safe abortion services around the world.

BUILDING STRATEGIC PARTNERSHIPS Although IPPF is one of the largest non-governmental organizations in the sexual and reproductive health field, it is essential to share experiences and learn from other international and grassroots agencies that advocate for and provide safe abortion services. Member Associations have consistently sought the support of government ministries and religious leaders, and also partnered with human rights organizations and health professionals. The IPPF South Asia Regional Office, for example, has participated in national-level meetings of the ‘Safe Abortion Providers Network’, supported by the Planned Parenthood Federation of America-International. Networks like these provide a valuable platform for public and private service providers to meet and share experiences

Figure 3.2 IPPF’s Abortion Advocacy and Care Continuum

Protect existing laws

Legal reform

Pre- and post- abortion counselling, information and referral

Informing decision makers

Limited abortion services

Complete range of high quality services up to full extent of the law Opinion gathering Data collection

IPPF Annual Performance Report 2005

Description of socio-cultural environment

ACHIEVING IPPF’S STRATEGIC FRAMEWORK: ABORTION IPPF’s Strategic Framework outlines four objectives for abortion: ● strengthening public and political commitment ● increasing access to safe abortion ● expanding provision of abortion services as part of sexual and reproductive health services ● raising awareness about the impact of unsafe abortion The case studies in the following sections illustrate the multi-faceted approach that the Federation takes to achieve these objectives and support the right to safe abortion services.

ABORTION

that strengthen the delivery of and advocacy for comprehensive and safe abortion services on a national level. The Western Hemisphere Regional Office has also sought to establish strategic partnerships as part of its efforts to ensure a woman’s right to choose and access safe abortion services. Every year, partners that are involved in abortion initiatives meet to strategize about coordinating and improving joint efforts. These meetings maximize the strengths of each individual organization and prevent the duplication of efforts. The most recent annual retreat included Católicas por el Derecho a Decidir (CDD), Catholics For Free Choice (CFFC), Centro de Atención Integral a la Pareja (CIPA), Cotidiano Mujer, Fundación Esar, Gynuity Health Projects, Mujer y Salud en Uruguay (MYSU), and Oriéntame, organizations that play a central role in supporting the region’s abortion-related activities. To expand medical abortion services, the Western Hemisphere Regional Office worked in collaboration with Gynuity Health Projects and the Member Associations of Barbados, Guyana, Puerto Rico, and Venezuela, and with further financial and technical assistance from Gynuity, more Associations will be supported to carry out feasibility and acceptability studies to introduce medical methods for abortion and post-abortion care. A ‘partnership approach’ allows IPPF to promote an agenda that protects a woman’s right to choose by fortifying alliances with other choice-minded organizations around the world. Working in partnership with a variety of organizations and stakeholders has also proven an effective method when dealing with restrictive political environments or threats from opposition groups. Partnership applies a coordinated response to these continuing challenges. Although there have been many successes, IPPF and other choice-minded organizations need to stay vigilant in ensuring access to safe abortion services.

Our Member Association in Thailand ensures that information about contraception is included in abortion and post-abortion services IPPF/Christian Schwetz

OBJECTIVE 1 To strengthen public and political commitment for the right to choose and to have access to safe abortion

Because safe abortion is one of the most politicized sexual and reproductive health issues, it is essential that IPPF secure public and political commitment to realizing a woman’s right to reproductive selfdetermination and move the agenda on safe abortion forward. Member Associations have initiated various advocacy initiatives to highlight the social and ethical responsibilities necessary to uphold women’s human rights to the highest attainable standard of health. IPPF’s Member Associations strive to facilitate progressive liberalization of national laws and attitudes on safe abortion. For example, the abortion strategy of the Algerian Member Associaton, Association Algérienne pour la Planification Familiale (AAPF), seeks to raise awareness of the impact of unsafe abortion, assess the magnitude of abortion and its consequences on maternal and child health, and to strengthen public and political commitment to eradicate unsafe abortion in Algeria. In April 2005, AAPF organized a conference on unsafe abortion in Algiers attended by representatives of the Ministries of Health and Population, Religious Affairs, Education, and Youth, as well as civil society organizations, donors, and service providers. The conference discussed abortion law in Algeria, religion and abortion, and teenage pregnancy, and it received extensive media coverage. Two recommendations were presented at IPPF Annual Performance Report 2005

BOX 3.3 PROMOTING A WOMAN’S RIGHT TO SAFE AND LEGAL ABORTION ■

Seimos Planavimo ir Seksualines Sveikatos Asociacija (FPSHA), Lithuania

Access to a complete range of reproductive health services is severely restricted in Lithuania, a Catholic country in which abortion is a highly sensitive issue. The most important factor influencing this situation is the strength of anti-choice organizations, which have strong moral and financial support from the Catholic Church and have succeeded in infiltrating the Ministries of Health, Education, and Justice. Moreover, journalists who actively oppose the legalization of medical abortion make it increasingly difficult to secure media support for strengthening public and political commitment to safe abortion. To challenge misinformation spread by anti-choice groups, Seimos Planavimo ir Seksualines Sveikatos Asociacija (FPSHA) initiated a project to promote a woman’s right to safe and legal abortion, and to reduce the number of unsafe abortions in Lithuania. The aim of the project is to strengthen partnerships between the FPSHA and non-governmental organizations working on women’s and youth issues, and to advocate collectively for a woman’s right to safe abortion services, particularly with human rights groups and the Society of Obstetrics and Gynaecologists. In one of its key activities, the project conducted seminars and published articles about a woman’s right to a safe sexual and reproductive life. However, the most remarkable achievement of the project was the establishment of the ‘REGINA’ network. REGINA is led by FPSHA and consists of eight non-governmental organizations concerned with women’s issues. It improves reproductive health services, promotes the right to sexual and reproductive health information, especially for young people, and improves legislation related to reproductive health and rights. Some of its recent successes include petitions to the parliament of the Republic of Lithuania against the draft law banning medical abortion and a resolution entitled ‘Critical use of contraception: puritanical viewpoint or lack of knowledge?’ which asks the government to improve access to contraception for Lithuanian women.

the end of the conference: the first reiterated the need for research on the incidence of unsafe abortion, and the second emphasized the need to implement abortion-related policies to combat unsafe abortion in Algeria. An expert group has been established to ensure that these recommendations are implemented. In Portugal, although abortion has been permitted under certain circumstances since

IPPF Annual Performance Report 2005

1984, a restrictive interpretation of the law makes access to legal abortion extremely difficult. As a result, the number of illegal abortions has remained high. In response, the Portuguese Member Association, Associação Para o Planeamento da Família (APF), advocates for an effective implementation of the law through a variety of ways, including a rigorous analysis of the current abortion situation in Portugal, a referral telephone helpline for women facing an unwanted pregnancy, the training of health professionals on safe abortion skills, and an increase in public awareness on the existing rights to abortion and availability of services within and outside of Portugal.

NEW INITIATIVES: SECURING POLITICAL SUPPORT FOR SAFE ABORTION At the beginning of 2006, IPPF published ‘Death and Denial: Unsafe Abortion and Poverty’ to coincide with the fifth anniversary of the reintroduction of the Global Gag Rule and the launch of the Global Safe Abortion Action Fund. The report argues that the public health impact of this policy has been ignored by the international community for too long and describes the lives of the women who are forced to put their health and lives at risk from unsafe abortion every year. It also provides a clear picture of the current public health and human rights impact of unsafe abortion. In February 2006, IPPF formally introduced the Global Safe Abortion Action Fund to support services and information to reduce unsafe abortion worldwide. The fund received an initial pledge of £3 million from the United Kingdom’s Department for International Development, with further pledges and commitments from Denmark, Norway, Sweden, and Switzerland. This is a targeted reserve of resources to enable the implementation of programmes and initiatives that increase access to safe abortion services. These will be provided within a comprehensive package of reproductive health services, with particular regard to the needs of marginalized and vulnerable women. The purpose of the fund is to attract, manage, and disburse resources to non-governmental organizations working on abortion-related activities. It seeks to make a sustainable and significant contribution to the reduction of morbidity and mortality associated with unsafe abortions across the world and, more specifically, in developing countries where the need is greatest. IPPF’s role is to administer the Global Safe Abortion Action Fund on behalf of in-country civil society groups, non-governmental organizations, and IPPF’s Member Associations. In addition, the IPPF Secretariat will continue to seek funding for abortion activities to compensate for the losses incurred as a result of the Global Gag Rule.

■ IPPF

Western Hemisphere Regional Office Asociación Puertorriqueña Pro-Bienestar de la Familia (PROFAMILIA), Puerto Rico ■ Fundación Mexicana para la Planeación Familiar, A.C. (MEXFAM), Mexico ■ Asociación Civil de Planificación Familiar (PLAFAM), Venezuela ■

Over the past year, the Western Hemisphere Regional Office continued to expand its regional initiative to contribute to the reduction of maternal morbidity and mortality in Latin America and the Caribbean by improving access to safe abortion and post-abortion care. This initiative has contributed to a clearer understanding of Member Associations’ roles in moving toward a broader approach to the complex issues related to sexual and reproductive health and rights. One of the most significant impacts of this project is that it has opened debate and discussion around the sensitive issue of abortion. The specific objectives of the project are to improve the knowledge, attitudes, and practices of Member Association staff, improve the skills of health providers in the provision of abortion and post-abortion care, and improve the capacity of Member Associations to defend themselves against opposition and offer positive communication related to safe abortion. Asociación Puertorriqueña Pro-Bienestar de la Familia (PROFAMILIA) in Puerto Rico hosted communication training led by Catholics for a Free Choice (CFFC) and Católicas para el Derecho a

Decidir (CDD) with participants from the Member Associations of the Dominican Republic, Mexico, Peru, St Lucia, Uruguay, and Venezuela. The twoday communication skills and media training included service providers, administrative staff, media staff, and representatives from partner organizations such as the Women’s Medical Center and the University of Puerto Rico Medical School. The training helped improve participants’ skills to communicate effectively and work with the media on abortion and women’s rights. It was also an opportunity to improve partnerships between Member Associations and nongovernmental organizations. The international day commemorating the decriminalization of abortion in Latin America and the Caribbean is 28 September. To publicly affirm its position on this issue, Fundación Mexicana para la Planeación Familiar, A.C. (MEXFAM) joined CDD, Grupo de Información en Reproducción Elegida (GIRE), and feminist organizations to host a number of activities, including booths at health fairs and radio interviews. The participation of MEXFAM’s Executive Director in an open forum on the decriminalization of abortion in Latin America was a landmark in the Association’s history, as well as a powerful public statement. It also helped improve collaboration between leading organizations, such as CDD, GIRE, the Population Council, and Ipas, as well as with representatives from the Universidad Nacional Autónoma de México, the leading educational institution in Mexico, and staff from the Ministry of Health. In 2005, Asociación Civil de Planificación Familiar (PLAFAM) in Venezuela collaborated with the local government of Caracas Municipality and the United Nations Population Fund (UNFPA) to organize the first of a series of seminars on sexual and reproductive health, quality of care, gender, and rights at the Maternidad Concepción Palacios. The seminar included physicians and nurses, as well as administrative and support personnel, and was held on the opening day of a hospital unit that serves women victims of violence.

ABORTION

BOX 3.4 INCREASING ACCESS TO SAFE ABORTION IN THE AMERICAS

Volunteers from our Member Association in Venezuela lobby for abortion law reform IPPF WHR/PLAFAM

IPPF Annual Performance Report 2005

OBJECTIVE 2 To increase access to safe abortion Providing high quality comprehensive sexual and reproductive health services is a fundamental part of IPPF’s mission, and our Member Associations work toward providing safe abortion services to the fullest extent of the law. The inclusion of a chapter on abortion in IPPF’s revised ‘Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services’ and the technical assistance provided by IPPF Central Office in collaboration with partner organizations such as Ipas, has enabled Member Associations to further strengthen their capacity to provide safe abortion services. In close collaboration with the government of Bangladesh, the Family Planning Association of Bangladesh (FPAB) is working to reduce maternal mortality and promote safe motherhood. FPAB initiated various advocacy activities and workshops targeting policy makers, service providers, and religious leaders to raise awareness on the impact of unsafe abortion on women of all ages and to strengthen commitment for increased access to high quality menstrual regulation services. This work enabled FPAB not only to discuss a culturally sensitive issue with a large and varied audience but also to develop valuable partnerships with key government departments and secure the commitment of religious leaders on the issue of menstrual regulation. Low contraceptive prevalence rates and high abortion rates are characteristic in central

Our Member Association in Uzbekistan ensures that all of its abortion services meet our quality of care standards IPPF/Chloe Hall

Asia and eastern Europe. The high cost of contraceptives makes abortion a less expensive alternative. The Member Associations of Armenia, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan have embarked on projects to collaborate with partner clinics to ensure that low-income women in these countries have access to high quality abortion and post-abortion services, pre- and postabortion counselling, and contraception.

BOX 3.5 ENSURING THE QUALITY OF ABORTION SERVICES ■

Mongolian Family Welfare Association (MFWA), Mongolia

Although abortion was legalized in Mongolia in 1989, access to high quality services remains a challenge for many women. A primary constraint to accessing abortion services is the current regulation that does not allow abortion – including menstrual regulation – to be performed in a setting without hospitalization facilities. The Mongolian Family Welfare Association (MFWA) is working to influence policy makers and government officials to allow MFWA’s trained staff to provide these services in its own clinics, with a referral system to hospitals if complications arise. One of the main activities in the programme

IPPF Annual Performance Report 2005

was a ‘knowledge, attitude and practice survey’, conducted among 1,796 participants and in collaboration with a number of academic institutions. The survey results were presented to representatives from the Ministry of Health, international donor agencies, public and private health service providers, scientific research institutions, and governmental and nongovernmental organizations. MFWA is encouraging a shift from the curettage method to vacuum aspiration and medical abortion techniques, and works with agencies such as the police to revise protocol about access to safe abortion services in situations of sexual violence. Moreover, MFWA runs a youth TV programme in collaboration with other organizations to reach young people with abortion-related information.

OBJECTIVE 3 To expand the provision of abortionrelated services as an integral part of sexual and reproductive health services The strength of IPPF as a provider and advocate of safe abortion reflects its long-standing commitment to comprehensive sexual and reproductive health services. As a result, many of its Member Associations are well equipped to support women – especially young women – on issues ranging from contraception and living with HIV, to sexual violence and abortion. Global indicators data show that 82.5 per cent of Member Associations provide abortionrelated services; of these, the most common include post-abortion care and counselling (73.0 per cent), pre-abortion counselling (61.9 per cent), referrals to external abortion services (57.1 per cent), and management of abortion-related complications and incomplete abortion (43.7 per cent). Seventeen per cent of Member Associations provide surgical abortions (vacuum aspiration), 11.1 per cent provide medical

BOX 3.6 TRAINING HEALTH PROVIDERS AND PHARMACISTS ■

ABORTION

The Member Association in Albania, Shoqata Shqiptare per Popullsine dhe Zhvillimin/Albanian Center for Population and Development (ACPD), is working to ensure that all women and young girls in Albania have the right to choose and access safe abortion services. ACPD has built on the partnerships already established with health professionals, women’s organizations, human rights groups, community leaders, the media, and the government to conduct interviews with women who have had abortions, midwives, and medical professionals in public and private clinics. These interviews allowed ACPD to collect data on the accessibility of abortion services in Albania. Some of the findings are particularly noteworthy: for instance, financial difficulty was listed as one of the main reasons why women seek abortion services, and most clients had not received pre- or post-abortion counselling, information on different abortion methods, or follow-up care. Also, most health professionals mentioned a lack of training, few copies of relevant abortion legislation or protocol posted within the clinics, and no standardized reporting format for documenting abortion services, particularly in private clinics. The results indicate that greater emphasis must be placed on improving the quality of abortion services, including pre- and postabortion counselling and post-abortion contraception. The affordability of services also needs to be addressed and data collection and reporting systems improved.

Family Planning Association of India (FPA India), India

The Family Planning Association of India (FPA India) plays a leading role in the provision of safe abortion services through its ‘Reproductive Health and Family Planning Centres’, which provide comprehensive abortion services, including post-abortion counselling and contraception. To maintain high standards of care, medical officers receive regular training on abortion techniques, non-judgemental counselling, and postabortion care, based on international service delivery protocols from the National Consortium for Medical Methods of Abortion. Some of FPA India’s service delivery points in Mumbai and Pune are approved by the state government as safe abortion training centres. To ensure the highest possible standards of service delivery and to bridge the gap in national-level protocol and standards, FPA India has developed a comprehensive protocol for service providers on medical abortion covering the detection of incomplete abortions, ectopic pregnancies, and post-abortion contraception. FPA India places special emphasis on offering a range of contraceptive options, including the advance provision of emergency contraception to clients who receive safe abortion services. Moreover, pharmacists across 16 branches have been trained to provide emergency contraception and counselling to clients, thereby increasing access to contraceptive services. Since public support is crucial for successful initiatives on safe abortion, FPA India conducted awareness-raising activities on medical abortion and the impact of unsafe abortion with medical practitioners from public and private sectors, community leaders, parents, and teachers. It also organized door-to-door visits and informal community meetings. The increased use of the manual vacuum aspiration method is evidence of a positive change in the uptake of abortion services, indicating that more clients are seeking services early in pregnancy and can choose less invasive methods.

Our Member Association in India provides confidential abortion services, free from stigma and discrimination IPPF/Peter Caton

IPPF Annual Performance Report 2005

Table 3.8 Number of abortion-related services provided, by type of service Pre-abortion counselling Abortion â&#x20AC;&#x201C; consultation/diagnostic Induced /surgical abortion Medical abortion Post-abortion care Post-abortion counselling Referrals to external abortion services TOTAL

53,707 13,684 16,964 13,047 9,651 109,638 2,538 219,229

The total number of abortion-related services provided by IPPFâ&#x20AC;&#x2122;s Member Associations in 2005 was 219,229 (Table 3.8). These data affirm that Member Associations around the world are working to ensure that safe abortion services are available and are integrated with other sexual and reproductive health services whenever possible. For example, abortion in Egypt is only legal to save a womanâ&#x20AC;&#x2122;s life, and because of this restriction, the rate of unsafe abortion is unacceptably high. In response, the Egyptian Family Planning Association (EFPA) has been working to integrate post-abortion care services within its clinics, increase public awareness of the dangers of unsafe abortion, and provide comprehensive contraceptive services. EFPA has signed an agreement with the High-Risk Pregnancy and Post-Abortion Care Unit of the Ain Shams Maternity Hospital to train its service providers on post-abortion care and manual vacuum aspiration. These services were offered in 11 clinics in six governorates, and following successful community awareness activities, the clinics saw a rise in service uptake in 2005.

Our Member Association in Ethiopia provides post-abortion counselling IPPF/Chloe Hall

abortion, and 7.9 per cent provide surgical abortion (dilatation and curettage, dilatation and evacuation) (Figure 3.7). These data reflect the strategic decision that IPPF has taken to build the capacity of Member Associations to advocate for and provide safe abortion services. However, not all Associations currently have their own clinics. Some operate in socio-legal environments that severely restrict the provision of abortion and many still do not have the capacity to provide safe abortion services, and this accounts for the relatively high rates of post-abortion care in comparison to the low rates of abortion provided by our Member Associations.

Figure 3.7 Proportion of Member Associations providing abortion-related services, by type of service 80% 70% 60% 50% 40%

73.0%

43.7%

57.1%

Post-abortion care and counselling

Management of complications and incomplete abortion

Referrals to external abortion services

11.1%

16.7%

10%

61.9%

20%

7.9%

30%

IPPF Annual Performance Report 2005

Medical abortion

Surgical abortion (vacuum aspiration)

Surgical abortion (dilation and curettage, dilation and evacuation)

Pre-abortion counselling

IPPF Africa Regional Office Association Béninoise pour la Promotion de la Famille (ABPF), Benin ■ Association Burkinabé pour le Bien-Etre Familial (ABBEF), Burkina Faso ■ Association Ivoirienne pour le Bien-Etre Familial (AIBEF), Côte d’Ivoire ■ Association Malienne pour la Promotion et la Protection de la Famille (AMPPF), Mali ■ Association Nigérienne pour le Bien-Etre Familial (ANBEF), Niger ■ Association Togolaise pour le Bien-Etre Familial (ATBEF), Togo ■ ■

The IPPF Africa Regional Office is committed to supporting Member Associations to increase access to safe abortion services to the fullest extent of the law. As a result, the IPPF Africa Regional Office recently initiated an innovative programme with six selected Member Associations. The aim was to review the laws and regulations governing the availability of and access to safe abortion care, the extent and level of services currently available, the quality of services available, the procedures used for inducing abortion and addressing complications of unsafe abortion, the characteristics of service users, and the attitudes and knowledge of health care providers in these countries. The abortion-related services provided by the selected Member Associations include the

The Family Planning Association of Hong Kong (FPAHK) is a renowned provider of comprehensive, safe abortion services. Women with unwanted pregnancies are offered counselling in its clinics and can choose to either undergo surgical abortion in its operating theatres or receive a hospital referral. FPAHK’s operating theatres are supported by the government and are the only facilities other than hospitals that are licensed to perform abortions in accordance with Hong Kong’s Abortion Ordinance. Clients are encouraged to make informed choices regarding their reproductive health during the counselling sessions, and contraceptive services are readily provided. FPAHK has proudly succeeded in providing relatively lowcost, safe abortion services that greatly reduce the incidence of unsafe abortion in the country. In Barbados, Mexico, Peru, and Uruguay, the Western Hemisphere Regional Office’s ‘Safe Abortion’ initiative is helping to further advance

management of incomplete abortion through dilation and evacuation or manual vacuum aspiration, management of haemorrhage from retained products or tissue injury, treatment of sepsis, counselling and psychological support, family planning, and management of long-term sequelae. The Associations provide referrals for both safe abortion services and the management of complications arising from unsafe abortion if they are unable to provide these services at their own clinics. In collaboration with Ipas and the West African Health Organization (WAHO), service providers from the Member Associations of Benin, Burkina Faso, Côte d’Ivoire, Mali, Niger, and Togo have been trained in the provision of abortion and abortion-related services, including post-abortion care, and received manual vacuum aspiration equipment for use in their own clinics. The participants were involved in sessions that discussed concerns and strategies on how to advocate for the transition from the provision of post-abortion care to comprehensive abortion care to the full extent of the law in their countries. The Africa Regional Office is working with Ipas to conduct research to better understand the magnitude and consequence of unsafe abortion. The findings will be widely disseminated to the public, policy makers, key professional groups, donors, non-governmental organizations, and international agencies, and will be used to initiate dialogue on various aspects of abortion, including legislation.

ABORTION

BOX 3.9 IMPROVING AVAILABILITY OF ACCESS TO SAFE ABORTION SERVICES IN WEST AFRICA

IPPF’s efforts to integrate safe abortion into sexual and reproductive health services. In collaboration with Fundación ESAR/Orientame Colombia, the initiative aims to strengthen the capacity of participating Member Associations to increase access to and quality of post-abortion care services and comprehensive management of unwanted pregnancies. ESAR/Orientame trainings were conducted for Association managers and health care providers, and the participants were introduced to service provision and management systems, learned how to implement a similar service within their clinics, and learned from ESAR’s experience on legal and security issues. This initiative demonstrated the need for health care providers to be selected carefully using standardized criteria, including interest in and commitment to the issue, to minimize staff turnover. It also showed that supportive supervision can help to reduce staff turnover and maintain morale and motivation. IPPF Annual Performance Report 2005

Mimoona, above, visits our clinic in Mauritania to access sexual and reproductive health information for herself and her two daughters IPPF/Chloe Hall

OBJECTIVE 4

To raise awareness among the general public, policy makers, and key professional groups on the public health and social justice impact of unsafe abortion Information, education, and communication (IEC) initiatives are a necessary component of a successful, safe abortion strategy. The general public, and particularly young women, must

have access to comprehensive information on abortion and related services. Decision makers need to have a clear understanding of the causes and consequences of unsafe abortions to make informed policy changes, and key professional groups need to have access to the latest information on safe abortion care. Although the need for information seems obvious, there are limited awareness-raising activities on abortion that promote accurate, comprehensive, and pro-choice messages.

Figure 3.10 Percentage of Member Associations conducting IEC activities on abortion, by target group 80% 70% 60% 50% 40% 30%

70.6% 53.2% 42.1%

47.6% 38.1% 27.0%

63.5% 48.4% 39.7%

Womenâ&#x20AC;&#x2122;s groups

50.0% 38.1% 27.0%

61.9% 46.0% 37.3%

Men

59.5% 45.2% 32.5%

72.2% 54.8% 48.4%

IEC on the legal status of abortion

Female clients

10%

71.4% 57.1% 49.2%

IEC on the nature of abortion

Young people

20%

IPPF Annual Performance Report 2005

Health professionals

Community leaders

Parents

Community groups

IEC on the availability of abortion services

programmes target women’s groups, community groups, men, parents, or community leaders – areas that need to be strengthened in the future. IPPF’s Central Office Abortion Team sends out weekly abstracts to the Federation and numerous external parties to share new learning on abortion-related issues. Since this initiative began in September 2004, IPPF has received much positive feedback that has led to valuable discussions on abortion, and the growing list of subscribers is evidence of this initiative’s success. The IPPF Arab World Regional Office recently organized a study tour to strengthen the capacity of Member Association staff and volunteers to become effective advocates of safe abortion. The tour enabled volunteers from the Member Associations of Algeria, Mauritania, and Morocco to visit the Member Association in Tunisia, Association Tunisienne de la Santé de la Reproduction (ATSR), to discuss Tunisia’s experience of legalizing abortion services with experts from Tunisian civil society, and to learn how to advocate for the legalization of abortion in their own countries. The visit included a workshop with other Member Associations, and participants had the opportunity to meet with an Imam who spoke about Islam and abortion. These South-to-South exchanges provide support to the Associations to confidently move the safe abortion agenda forward in their own countries.

ABORTION

As a result, IPPF works to raise awareness about the impact of unsafe abortion at a variety of levels. Global indicators data reveal that 53.2 per cent of Member Associations currently advocate for reduced restrictions on safe, legal abortion, and 72.2 per cent advocate for increased access to safe, legal abortion. Overall, 74.6 per cent of Associations advocate for either or both. These numbers are particularly noteworthy because they demonstrate Associations engaging in advocacy that leads to national policy and legislative change, supporting a woman’s right to choose and access safe abortion. Global indicators data reveal that 43.7 per cent of Member Associations conduct information, education, and communication activities on the nature of abortion, the legal status of abortion, and the availability of abortion services. Seventy-nine per cent of Member Associations are involved in information activities relating to the nature of abortion, 63.5 per cent disseminate information on the legal status of abortion, and 54.8 per cent provide information on the availability of abortion services. Figure 3.10 shows that the key target groups chosen by those Member Associations conducting information and education activities on abortion include young people, female clients, and health professionals. Fewer

BOX 3.11 HIGHLIGHTING THE NEED FOR POST-ABORTION CARE ■

Family Planning Association of the Islamic Republic of Iran (FPAIRI), Iran

Access to safe abortion services in Iran is permitted to save a woman’s life, and within the first four months if the fetus is mentally or physically handicapped. However, many women seek treatment for post-abortion complications, demonstrating that they resort to unsafe abortion when faced with an unwanted pregnancy. The Family Planning Association of the Islamic Republic of Iran (FPAIRI) launched a study to highlight the importance of ensuring women’s access to high quality post-abortion care and to accurate information on abortion. The study emphasized the importance of preventing unwanted pregnancies, as well as demonstrating the physical, psychological, and social consequences of unsafe abortion in Iran. Approximately 300 married women aged 15 to 49 who had been admitted to hospitals and clinics for abortion and post-abortion services were interviewed by trained female interviewers using a

structured questionnaire to gather sociodemographic and reproductive health information. Physicians in the hospitals and clinics were also interviewed to provide data on the physical and psychological effects on clients. The findings were analyzed and presented as briefing papers that support evidence-based advocacy activities on issues such as the importance of high quality postabortion care, and the need for comprehensive information and education activities for young women. The study shows that 40 per cent of women seeking abortions were aged 21 to 25, nearly 25 per cent of respondents induced their own abortions at home, and high quality post-abortion care and counselling reduced the psychological consequences of unsafe abortion. The initiative helped FPAIRI strengthen its partnership with government hospitals and institutions, particularly those associated with universities. It also enabled FPAIRI to contribute to national learning on the physical and psychological impact of unsafe abortion and increase its profile as a national-level advocate for safe abortion.

IPPF Annual Performance Report 2005

BOX 3.12 MOBILIZING PRO-CHOICE YOUTH ADVOCATES ■

Irish Family Planning Association (IFPA), Ireland

Building on the Irish Family Planning Association’s (IFPA) campaign for ‘Safe and legal abortion in Ireland’, the overall aim of this project was to build awareness and support for less restrictive abortion laws in Ireland. The project objectives aimed to increase and mobilize socially and politically active young people to advocate for a change in the Irish abortion laws, and to maintain a high level of activism among youth members of IFPA. The project focused on the idea that young people have a fundamental right to autonomy when making decisions about their sexual and reproductive lives.

Four capacity building workshops on issues related to abortion were held as part of the campaign, and the result was the formation of a group of 17 young pro-choice activists dedicated to promoting sexual and reproductive rights, including the provision of abortion services, in Ireland. The group is called ‘BODY’ – ‘Bold, Open, Decisive Youth’. BODY introduced itself with a demonstration outside the Dail (the Irish parliament) that featured 17 activists imprisoned in a cage made from coat-hangers, representing the estimated 17 Irish women forced to travel to Britain for an abortion every day. The demonstration called for the legalization of abortion in Ireland and was well attended, indicating public support for the provision of abortion services in Ireland. It is clear that young people can be mobilized and supported to drive the agenda and campaign for increased access to safe abortion in Ireland by advocating effectively on an issue that affects them so fundamentally.

Young advocates from the Irish Family Planning Association demonstrate for a change in Ireland’s abortion laws outside parliament IPPF/IFPA

PLACING YOUNG PEOPLE AND ABORTION ON THE AGENDA Indonesian Planned Parenthood Association (IPPA), Indonesia In 2005, the Indonesian Planned Parenthood Association (IPPA) participated in the ‘IPPF Young People and Abortion Initiative’. The study worked in collaboration with local universities to conduct focus group discussions with young people and groups of adults, including parents, teachers, and religious leaders to raise awareness on the importance of a young woman’s right to choose and access safe abortion services. The results of these discussions were then documented and presented at a seminar attended by representatives of government institutions, universities, partner non-governmental organizations, teachers, students, and IPPA staff and volunteers. The study encouraged frank dialogue between community leaders and IPPA and resulted in closer collaboration to improve

IPPF Annual Performance Report 2005

the status of adolescent sexual and reproductive health. After these discussions, participants attended an action planning and value clarification workshop and agreed upon the following priorities: ● develop IEC materials that provide comprehensive information about abortion to young people, parents, teachers, religious leaders, and government officials ● increase the capacity of peer educators, counsellors, and medical staff to address youthrelated and abortion-related issues ● advocate for increased support for young women who face unintended pregnancy IPPA produced a bilingual fact sheet on young people and abortion, and plans to host abortionrelated sensitization activities at parliamentary meetings. This project shows how, even in a severely restrictive context, evidence-based advocacy can be undertaken by pro-choice organizations to influence national debates on access to safe abortion services.

Promoting the right to access safe abortion services remains one of the most controversial sexual and reproductive health issues. The case studies and data in this chapter are evidence of IPPF’s unwavering commitment to protecting a woman’s fundamental right to reproductive selfdetermination. IPPF intends to build upon the lessons learned from examples both within and outside the Federation to drive this agenda forward. In almost every country, safe abortion is legally permitted under certain circumstances. As advocates and providers of comprehensive sexual and reproductive health services, IPPF’s Member Associations have a responsibility to fully understand the legislation and policies relating to safe abortion and to translate these into practice within their clinics. Additionally, understanding the opportunities and challenges that the abortion laws and policies present is crucial for informing advocacy initiatives aimed at expanding access to safe abortion services – a core component of IPPF’s abortion strategy. A self-assessment tool for exploring national laws and policies relating to abortion is being developed by IPPF Central Office to guide this work over the coming years. As global indicators data reveal, the majority of Member Associations are involved in abortion-related information and education activities. Strengthening these initiatives is essential if we are to

provide accurate and comprehensive rightsbased information on abortion, particularly to young people, while counteracting the myths and misconceptions spread by the anti-choice movement. IPPF is committed to providing high quality, safe abortion services to the fullest extent of the law. In addition to service delivery protocols and equipment, this requires motivated staff. By promoting the principles of IPPF’s ‘Quality of Care’ programme, providers become confident in providing comprehensive, non-judgemental, safe abortion services that respect a woman’s right to choose. These important principles include respecting clients’ rights, meeting providers’ needs, and giving supportive supervision to providers. IPPF Member Associations remain at the forefront of comprehensive sexual and reproductive health services, and every effort will be made to ensure that all clients who seek abortion services – particularly the most under-served – will also have access to other complementary sexual and reproductive health services. Making links with the IPPF strategies related to adolescents and AIDS will continue to be a priority. As we strive toward a universal realization of a woman’s right to choose and access safe abortion services, IPPF will continue to affirm that access to safe, legal abortion is a public health and human rights issue, and frame it in respect of a woman’s choice, dignity, and right to confidentiality.

IPPF Annual Performance Report 2005

ABORTION

CONCLUSIONS

ACCESS

GOAL All people, particularly the poor, marginalized, the socially-excluded, and under-served are able to exercise their rights, to make free and informed choices about their sexual and reproductive health, and have access to sexual and reproductive health information, sexuality education, and high quality services including family planning

INTRODUCTION At the United Nations 2005 World Summit in New York, world leaders reaffirmed the 1994 International Conference on Population and Development (ICPD) agenda, and called for universal access to reproductive health by 2015.1 Prior to the Summit, civil society and international non-governmental organizations, including IPPF, alerted governments to the link between sexual and reproductive ill health and poverty. A report prepared by the United Nations Millennium Project before the Summit highlighted that sexual and reproductive health had not been given adequate priority in the Millennium Development Goals. As a result of the important advocacy work being undertaken by many on this issue, a new target of ‘universal access to reproductive health by 2015’ was presented to the UN General Assembly by the Secretary General in October 2006 in his ‘Report on the Work of the Organization for this year’s General Assembly’ (GA Official Records Supplement No 1 A/61/1). This new target, one of four, was adopted by the General Assembly shortly after. This woman received At the global level, the information and implementation of the Millennium support throughout her Development Goals and the goals pregnancy from a of the ICPD Programme of Action traditional birth attendant has illuminated an emerging trained by our Member dilemma with regard to access: Association in Ethiopia IPPF/Chloe Hall macroeconomic measures,

including debt servicing and other cost measures, have increased health service costs for many poor families. Subsidies and user fee exemptions do not always benefit the poorest people who need them most.2 In essence, health system reform has reversed gains that were made in health access equity. Despite landmark agreements and numerous affirmations on sexual and reproductive health and women’s rights as critical development priorities in the last decade, major challenges to universal access to sexual and reproductive health remain. There is an urgent need to provide young people with better access to services, and to reduce the spread of HIV, the impact of AIDS, and the prevalence of unsafe abortion.3 The absence of an international consensus on sexual rights and sexuality and the persistent focus on risks and disease in relation to sexual and reproductive health have resulted in a failure to address the sexuality aspects of service provision. Sexual rights provide the basis for sexual health and sexuality, and include human rights that have been recognized in national laws, international human rights documents, and other major consensus agreements. They include the right of all people to be free from coercion, discrimination, and violence and to express their sexual orientation without fear of persecution, denial of liberty, or social interference. In addition, many key aspects of sexuality are neglected, including pleasure, sensuality, sexual diversity, and intimacy.

IPPF Annual Performance Report 2005

Women wait for the opening of the market day clinic organized by our Member Association in Ethiopia IPPF/Chloe Hall

TAKING A RIGHTS-BASED APPROACH TO IMPROVING UNIVERSAL ACCESS All of IPPF’s services and programmes take a rights-based approach to sexual and reproductive health to increase access to high quality sexual and reproductive health information and services. In 2005, IPPF provided 17.3 million family planning services and over 13.4 million other sexual and reproductive health services through more than 58,000 service delivery points. Recent estimates reveal that at least 56.6 per cent of IPPF’s clients are from poor, marginalized, and sociallyexcluded populations. This is a clear manifestation of IPPF’s vision of a world where all individuals have the right to access the essential information and services that enable them to make safe sexual and reproductive health choices, and to pursue healthy sexual and reproductive lives. This vision provides a solid mandate for our aim to reach out to people who live on less than US$2 per day, those marginalized due to a combination of social, economic, and political factors, and the under-served, who often carry the burden of sexual and reproductive ill health, morbidity, and mortality. There is increasing global recognition that the failure to achieve universal access to comprehensive sexual and reproductive health information and services is a major barrier to

IPPF Annual Performance Report 2005

poverty reduction, as well as a violation of human rights. In developing countries, many women of reproductive age continue to bear the cost, danger, and burden of sexual and reproductive ill health and mortality. Without renewed commitment to ensuring that all individuals – especially women and young people – have the ability to make informed choices about their sexual and reproductive lives, it will be impossible to achieve the international goals of reducing poverty and improving women’s empowerment. IPPF recognizes that improving gender equity, valuing diversity, and eliminating discrimination are fundamental to guaranteeing sexual and reproductive well-being and improving quality of life for all people. IPPF firmly believes that attainment of sexual and reproductive health requires not only a focus on reproductive rights, but also fulfilment of sexual rights, gender equality, and respect for sexuality without stigma or discrimination.

ACHIEVING IPPF’S STRATEGIC FRAMEWORK: ACCESS IPPF’s Strategic Framework identifies six objectives for access, including: ● reducing specific barriers to access ● strengthening political commitment and support for sexual and reproductive health and rights

ACCESS

● empowering women ● increasing male commitment ● taking a rights-based approach to providing

information ● taking a rights-based approach to providing

services The following sections offer an overview of the programmes and services that IPPF provided in 2005 to increase access to sexual and reproductive health information, sexuality education, and services, particularly for the poor, marginalized, the socially-excluded, and under-served.

OBJECTIVE 1 To reduce socio-economic, cultural, religious, political, and legal barriers to accessing sexual and reproductive health information, education, and services Access to sexual and reproductive health information, sexuality education, and high quality services is a basic human right that empowers people to make informed choices and can mean the difference between health and sickness, living and dying. Yet, it remains beyond the reach of many. Reducing barriers to access for those with the greatest unmet need is addressed by implementing programmes specifically for poor, marginalized, socially-excluded, and under-served groups, and advocating for and with these

A young woman receives an ultrasound scan at a Member Association clinic in Mauritania IPPF/Chloe Hall

groups. Global indicators data show that in 2005, more than three-quarters of IPPF’s Member Associations implemented programmes to increase access to sexual and reproductive health services for vulnerable groups, and 82.4 per cent advocated on behalf of these groups. Seventy nine per cent of Associations did both. To increase access to sexual and reproductive health services to the poor, nearly 70 per cent of our Member Associations provided subsidized services and adapted fee structures, and to reach under-served groups, 79.4 per cent provided services through community-based agents, physicians, volunteers, and in pharmacies and mobile clinics.

BOX 4.1 WORKING WITH COMMUNITY HEALTH PROVIDERS TO IMPROVE ACCESS TO LONG-TERM CONTRACEPTION ■

Association Marocaine de Planification Familiale (AMPF), Morocco

For people in rural and under-served areas of Morocco, local community volunteers and midwives are essential sources of health information and services. When the Association Marocaine de Planification Familiale (AMPF) recognized the need to improve women’s access to long-term hormonal contraception in these communities, it began working with community volunteers and midwives through existing community-based projects. In eight regions of the country, AMPF trained community health workers to provide women with information and referrals for three-month injectable hormonal contraception. AMPF also trained local midwives to provide the injectables

and to counsel women on the possible sideeffects. Women were asked to pay a modest fee for the injectables, and all income from the fees was used to buy future supplies to ensure the sustainability of the service. AMPF found that improving the communication skills of community health workers and midwives helped to dispel myths about the safety and effectiveness of injectable contraception. Improving the interaction between clients and service providers also gave clients a better understanding of all the family planning methods that were available to them. Since the beginning of the project, AMPF has achieved a 40 per cent cost recovery for the injectable contraception, and has provided the equivalent of 207 couple years of protection to these rural and under-served communities.

IPPF Annual Performance Report 2005

BOX 4.2 BUILDING THE CAPACITY OF HEALTH WORKERS TO WORK WITH HAITIAN COMMUNITIES Asociación Dominicana Pro-Bienestar de la Familia (PROFAMILIA), Dominican Republic

The Haitian and Dominico-Haitian populations are the most marginalized groups in the Dominican Republic. Haitian descendants who are born in the Dominican Republic are not given the right to citizenship, and therefore do not have any access to education or health services. To meet the needs of these populations, Asociación Dominicana Pro-Bienestar de la Familia (PROFAMILIA) initiated a five-year project to build the capacity of non-governmental organizations with links to the Haitian population to work in sexual and reproductive health and HIV prevention. In this project, it was essential that services be delivered with respect for and understanding of the culture and beliefs of Haitian communities.

needs-based training, educational materials, contraceptives, and pre-paid coupons for medical referrals. PROFAMILIA also worked to strengthen alliances between the participating organizations so that they could optimize resources, while also improving the cultural sensitivity and counselling skills among PROFAMILIA staff to meet the special needs of these under-served populations. The success of the project depended on the collaboration and coordination of both peer educators in the communities and service providers in the mobile health teams. In cases that required advanced testing or care, service providers distributed pre-paid coupons for PROFAMILIA’s clinic. The use of pre-paid coupons and cooperation between clinic staff, mobile medical teams, and community outreach workers ensured that the population received the care it needed.

Activities undertaken PROFAMILIA analyzed the profiles of organizations working in select communities and developed plans to strengthen each one of the collaborating organizations. The customized plans were based on each organization’s needs, strengths, and weaknesses, with special regard to monitoring and evaluation, the management and distribution of contraceptives, and financial management and reporting. The organizations involved in this project were selected for their ties to Haitian communities and had little sexual and reproductive health knowledge. PROFAMILIA provided service training in contraceptive distribution, referrals, communication techniques, and documentation of project activities and results. Activities in each of the target communities included provision of

Key achievements There has been an increase in demand for sexual and reproductive health and HIV prevention services among the 39 Dominico-Haitian communities involved. However, the ongoing project has done more than just provide high quality sexual and reproductive health information and services to the Haitian and Dominico-Haitian people in the region. It has also sensitized service providers to the needs of these vulnerable communities and improved language skills, which helped advance an understanding of the target population. PROFAMILIA’s work strengthened the institutional capacity of the participating organizations in the type and quality of information and services delivered, and improved the way they manage information, finances, and commodities.

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Our Member Association in the Dominican Republic uses a variety of mediums to educate about sexual and reproductive health, such as the TV programme depicted in this mural IPPF WHR/Debra Jones

IPPF Annual Performance Report 2005

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Asociación Civil de Planificación Familiar (PLAFAM), Venezuela

In Venezuela, an advocacy and media campaign supported by the Asociación Civil de Planificación Familiar (PLAFAM) is proving how drawing national attention to an individual case of genderbased violence can successfully force action at multiple levels of government. The extraordinary story of Linda Loaiza is an example not only of the physical and sexual violence experienced by women all over the world but also of the stigma, financial, and psychological burdens they suffer when seeking justice from state institutions. PLAFAM’s work, in partnership with Venezuelan women’s organizations, shows how protecting sexual and reproductive rights has wide-reaching impact in society, the justice system, and in individual lives. In July 2001, 18-year-old Linda Loaiza was rescued by the Caracas police from an apartment where she had been forcibly held for four months, repeatedly raped, and brutally tortured. She was severely malnourished and had horrendous injuries, including cigarette burns all over her body, multiple cranial fractures, and bruises and cuts on her face and genital area. The lifelong physical effects of her ordeal include cataracts, impaired hearing, reduced mobility, facial scarring, and an inability to bear children. The accused perpetrator is the son of the president of a major university in Caracas. After being detained and placed under house arrest, he attempted to flee with the help of his father. He was captured and his father was later charged with obstructing judicial process. In an attempt to exploit a section of the Venezuelan penal code that calls for a reduced sentence for crimes

OBJECTIVE 2 To strengthen political commitment and support for reproductive health programmes IPPF believes that protecting and ensuring the sexual and reproductive rights of the most vulnerable requires working with advocacy networks and building strategic alliances with other non-governmental organizations and government agencies. This is especially true when it comes to protecting the individual’s right to control his or her own fertility and to make decisions about sexuality, free of coercion, violence, and discrimination.

against sex workers, the perpetrator’s defence claimed that Loaiza was part of a prostitution ring, and therefore, if sentenced to jail time, he would only have had to serve one-fifth of the normal sentence. No evidence was presented in support of these claims, and Loaiza has consistently denied them. However, the judge acquitted the accused and his father of all charges, and ordered an investigation of Loaiza, her father, and her sister for prostitution. Loaiza’s case was deferred by the justice system 29 times, and 59 judges declined to prosecute the man accused of torturing her. Nearly three years after the trial began, the case approached its statute of limitations, after which the accused would walk free of charges. In response, Loaiza staged a hunger strike on the steps of the Supreme Court. After 13 days on the steps, the media attention and social pressure she generated convinced the Supreme Tribunal for Justice to call for a trial. PLAFAM was one of many groups and activists supporting justice for Loaiza. Their efforts contributed to the publicity surrounding the case. PLAFAM, together with other Venezuelan women’s organizations, raised awareness of the case and provided legal and emotional support to Loaiza in her fight for a new trial. As a result, the seventh court of appeals annulled the verdict that acquitted her attacker and called for a new trial. PLAFAM continues to raise awareness in the media and in public forums so that the corruption of Loaiza’s case will not occur again. At present, PLAFAM and Loaiza are holding off on future action, pending publication of the sentence with the judge’s comments, which will determine if the perpetrator will be released on parole, or will face imprisonment. PLAFAM is also now working closely with Loaiza on a project to develop her own foundation.

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BOX 4.3 SEEKING JUSTICE FOR LINDA LOAIZA AND OTHERS AFFECTED BY GENDER-BASED VIOLENCE

ADDRESSING GAPS IN SEXUAL AND REPRODUCTIVE HEALTH LEGISLATION AND SERVICES Seimos Planavimo ir Seksualines Sveikatos Asociacija (FPSHA), Lithuania Conservative, anti-choice opposition groups frequently and vocally oppose sexual and reproductive rights and access to services in Lithuania. Current legislation does not adequately ensure access to sexual and reproductive health services or protection of people’s sexual and reproductive rights, particularly for women in rural areas, for adolescents, and for people from vulnerable groups. There is no national

IPPF Annual Performance Report 2005

IPPF views young people as sexual beings and recognizes that they have unique sexual and reproductive health needs IPPF/Gabriel Amadeus Cooney

reproductive health law, policy, or programme, and there are no sexual and reproductive health services for young people. Moreover, curricula for sexuality education do not adequately address issues related to contraception or protection from sexually transmitted infections or HIV. Abortion rates are high in some areas of Lithuania, especially among young women under the age of 19, and yet in rural areas abortion services are virtually inaccessible. The rate of unplanned pregnancy is growing, as are rates of infanticide and sexually transmitted infections. To address these gaps in legislation and services, Seimos Planavimo ir Seksualines Sveikatos Asociacija (FPSHA) has undertaken a variety of successful activities during the past year.

Creating a draft law for reproductive health FPSHA convened a group of lawyers to prepare a draft law for reproductive health to convince the Ministry of Health to implement a national law on reproductive health, as recommended by the World Health Organization.

different education levels and incomes. The survey revealed that 60.9 per cent of the population does not use any method of contraception, while 20.5 per cent of women between the ages of 16 and 49 use oral contraceptive pills. Condom use was shown to be 13.9 per cent, use of the IUD was 5.0 per cent, and use of spermicides was 0.7 per cent. Data gathered from the survey have been used as an advocacy tool for FPSHA, and the survey itself attracted media attention. In light of the survey results, FPSHA held a roundtable discussion with members of other women’s groups in Lithuania, and a petition was drawn up and signed by many organizations asking the government to improve access to contraception for Lithuanian women, especially in rural areas.

OBJECTIVE 3 To empower women to exercise their choices and rights in regard to their sexual and reproductive lives

Surveying women’s access to contraception FPSHA conducted a survey on access to contraception to confirm the need for better access to contraceptive services in Lithuania, to assess the contraceptive preference among women, and to examine the factors affecting women’s choice of contraception. The survey involved 1,087 Lithuanians aged 16 to 74 with

IPPF Annual Performance Report 2005

IPPF has had a Gender Equity Policy in place since 1995, which promotes affirmative action to increase women’s representation in decisionmaking bodies within the Federation. The policy requires that sexual and reproductive health programmes are both accountable to women’s special needs and that they address equity issues.

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Centro de Investigación, Educación y Servicios (CIES), Bolivia

IPPF’s Member Association in Bolivia, Centro de Investigación, Educación y Servicios (CIES), took action to support the sexual and reproductive health and rights of women of reproductive age in the remote Chuquisaca region by launching a three-year mobile health unit project in 2002 that has served nearly 12,000 women to date. The project consisted of two components: providing access to health services, and providing education on sexual and reproductive health and rights. Two vehicles with medical supplies and equipment were used as mobile health units. Two drivers, eight educators, and two physicians visited about 20 remote communities each month in the vehicles, often driving up to 12 hours at a time on precarious mountain roads. All staff members spoke the local Guaraní language, and many of the educators came from the communities that were being served. At the start of the project, CIES met with local health authorities and indigenous leaders to discuss cultural considerations and the health needs of residents, to map out the services that were already available, and to identify those still in demand. Providing health consultations Due to the paucity of medical services in the region, many people initially visited the mobile health unit services for general medical care. The majority (60 per cent) of client visits for sexual and reproductive health services were for gynaecological services such as pap smears, pelvic examinations, and tests for sexually transmitted infections. Contraceptive services and consultations were the second most requested services. The medical staff performed routine prenatal screenings, referred high-risk pregnancy cases to the Department of Health Services, and performed tubal ligations. To improve project sustainability, CIES staff worked closely with the Ministry of Health to avoid duplicating efforts and to transfer services to the public sector whenever possible. Spreading the word through information and education To strengthen service provision, CIES trained volunteers from the community to conduct educational activities. These activities were based on a standardized curriculum that used materials created with community input and activities designed according to the cultural context of the

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BOX 4.4 MOBILE HEALTH UNITS BRING HEALTH CARE TO WOMEN IN REMOTE COMMUNITIES indigenous communities. The curriculum addressed basic reproductive health, anatomy and physiology, contraceptive methods, sexually transmitted infections, HIV and AIDS, cancer prevention, rights, and violence. Emphasis was placed on the joint responsibility of men and women in sexual and reproductive health, and sessions for men and women were held separately to allow for more open discussion. Given the sensitive nature of the subject matter, the participation of community volunteers helped to establish trust. Promising results from the mobile health unit project During the project period, Bolivia’s national database of health statistics showed an impressive increase in access to services in the Chuquisaca region, and because of the geographical isolation of people in the region, these increases can be directly attributed to the CIES mobile health unit and education project. From 2001 to 2003, the total number of births in the project area decreased by 21 per cent, and births attended by a trained professional increased by 39 per cent. National data show that the types of services used by people in the region remained consistent throughout the three-year project period, while the number of clients increased dramatically by 359 per cent. The number of contraceptive services provided increased by 470 per cent (157 services during the first semester, and 896 services per semester toward the end of the project). Depo Provera was the most frequently requested method of contraception (58 per cent), and IUDs were also regularly requested by women (25 per cent).

Important lessons learned An evaluation of the project showed that problems such as lack of food and shelter are often more urgent for isolated communities than reproductive health services. Because of this, sexual and reproductive health service providers need to establish parameters for addressing multiple needs. Additionally, project leaders indicated the importance of making woman-controlled methods of contraception available, given the resistance of male partners and the culture at large to condom use and contraceptives. Overall, this project showed that in hard-toreach communities where access to sexual and reproductive health services is severely limited, mobile health units can make significant positive change in as little as three years.

IPPF Annual Performance Report 2005

BOX 4.5 GENDER MAINSTREAMING INITIATIVE ■

IPPF Arab World Regional Office

The IPPF Arab World Regional Office launched an initiative to help its Member Associations integrate gender issues into their institutional policies, systems, and practices. The aim was to ensure more effective and equitable programmes that enhance the quality of life of their beneficiaries. In June 2005, the Arab World Regional Office conducted a training workshop on gender mainstreaming in Jordan with 11 Member Associations from Bahrain, Djibouti, Egypt, Iraq, Lebanon, Mauritania, Morocco, Palestine, Sudan, Syria, and Yemen. In preparation for the workshop, a gender situation and needs assessment questionnaire was sent to the Member Associations to help them review and assess their gender responsiveness at governance, institutional, and programmatic levels. The questionnaire revealed confusion among Member Associations about the differences between approaches to women and development and approaches to gender and development. It was clear from the responses that Associations achieved gender equity at the governance level, but fell short at the programmatic level. The main topics covered at the workshop included principles and approaches to gender mainstreaming, gender analysis frameworks, mainstreaming gender at the project level, and rights-based programming. The workshop used different participatory approaches with a special focus on practical application exercises, and Member Associations were supported to develop their own plans of action. Since the workshop, the participating Member Associations have implemented gender mainstreaming initiatives in their respective countries with support from the Regional Office.

Demonstration of IUD fitting at a Member Association clinic in Egypt IPPF/Ben Evenden

IPPF Annual Performance Report 2005

In 2005, 72.2 per cent of IPPF’s Member Associations had a gender equity policy in place and were implementing at least one genderfocused programme. These programmes include women’s empowerment, women’s participation, women’s rights in clinics, men’s needs, addressing gender-based violence, or capacity building with regard to gender. IPPF’s commitment to gender equity and equality is illustrated by our policy that requires at least 50 per cent representation by women on Member Association governing boards. In 2005, 67.5 per cent of Association boards were made up of at least 50 per cent women, with the overall proportion of women on governing boards of Member Associations at 54.3 per cent. Seventy-one per cent of all staff in management positions in Member Associations in 2005 were female. Another important aspect of empowering women is addressing gender-based violence. In the Western Hemisphere Region, results from a three-year project on gender-based violence that was implemented in the Dominican Republic, Peru, and Venezuela are being shared with Associations in other parts of the region, and with Associations in South Asia. In Ethiopia, the Family Guidance Association of Ethiopia has now expanded its rape crisis and forensic services, which were piloted in a model clinic in Addis Ababa, and then implemented in two other regions.

Child marriage IPPF is tackling the widespread and complex issue of child marriage, including its effects on the lives and health of girls and young women. IPPF organized a consultation meeting on child marriage in Kenya in October 2005 to share information about successful initiatives and useful resources for ending child marriage with policy makers, researchers, academics, health and education programmers, donors, legal practitioners, and media representatives. Participants discussed advocacy activities taking place in Yemen and the United States, education programmes in Ethiopia, legal mechanisms used to address child marriage in India, and community mobilization action in Kenya. They also discussed the results of recent interviews conducted with married girls and young women, which showed that most girls have little knowledge of the implications of marriage and most found their first sexual encounter to be traumatic. As a result, IPPF and the ‘Forum on the Marriage and the Rights of Women and Girls’ are producing two key publications: ‘A programme guide for advocacy action to end child marriage’ (forthcoming) and ‘Ending child marriage: a guide for global policy action’ (2006).

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BOX 4.6 INCLUDING AND INVOLVING MEN MAKES A DIFFERENCE Family Planning Association of India (FPA India), India

The Family Planning Association of India (FPA India) launched a unique programme to improve men’s sexual and reproductive health. The project researched men’s perspectives on sexual and reproductive health, and then designed appropriate programmes to support men in their roles as responsible parents and partners. The study revealed that because men have been excluded from sexual and reproductive health programmes in the past, many feel unwelcome at reproductive health clinics; some also feel that the number of contraceptive methods for men is limited. Policy makers and service providers may have negative attitudes toward men, seeing them as part of the problem instead of clients in need of sexual and reproductive health care. FPA India also identified logistical constraints, such as the lack of trained male staff, male-friendly clinics, convenient opening hours, and separate waiting and service areas for men and women. To address these concerns, five branches of FPA India ran special clinical sessions for men that provided counselling, treatment, and referral services on issues related to reproductive health. The project served a population of 250,000 and organized a variety of successful initiatives, including: ● 130 counselling activities ● awareness-raising seminars and educational workshops that reached 4,748 people ● 195 information and educational activities, including group discussions, video shows, competitions, cultural events, and street rallies that reached 4,556 people ● health check-ups benefiting 678 people ● family planning services for 3,947 men and other services such as infertility treatment, urogenital treatment, and testing for sexually transmitted infection for 2,195 men ● non-scalpel vasectomy for 60 men Making sexual and reproductive health services available to men At the start of this project, the attitude of many men was that sexual and reproductive health is a

OBJECTIVE 4 To increase male commitment to sexual and reproductive health Throughout 2005, IPPF continued to implement a number of programmes on the essential role of men in the promotion of sexual and reproductive

Volunteers from FPA India educate migrant workers about sexually transmitted infections IPPF/Peter Caton

woman’s problem. FPA India’s project demonstrated that this attitude can change when an effort is made to include and involve men in reproductive health decision making and services. Clinics noticed a marked increase in the number of men seeking reproductive health services, and many women have reported a change in the attitudes and behaviours of their husbands, including increased willingness to participate in bringing up children and concern for the needs of women during pregnancy. The project also changed the way that service providers approach the field of sexual and reproductive health – those who were involved in the project now understand the importance of including men. FPA India is planning to focus more on men’s involvement as part of its ongoing activities. Clinics will hold sessions exclusively for men with convenient evening hours. The project has also highlighted the importance of having male doctors and staff available to ensure that men feel comfortable discussing their sexual and reproductive health issues.

health. The Federation is taking a broader approach to explore men’s interests, including their motivations for and potential benefits of engaging in efforts to promote gender equity. It recognizes that addressing men’s sexual and reproductive health needs and working with men as partners in promoting the health of others are not mutually exclusive.

IPPF Annual Performance Report 2005

Dr Romanov works with a clinic in Bulgaria to provide services for the Roma IPPF/Chloe Hall

OBJECTIVE 5 To improve access to sexual and reproductive health information and sexuality education using a rights-based approach The provision of accurate, factual information is essential for empowering individuals to make choices concerning their sexual and reproductive health, and IPPF’s rights-based approach ensures that the poor, marginalized, socially-excluded, and under-served are not neglected in the provision of much-needed sexual and reproductive health services and information. Comprehensive training for providers is fundamental to the success and quality of sexual

and reproductive health services. A new edition of IPPF’s ‘Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services’ was published in 2005 to ensure that professionals receive the information they need to serve their clients and improve access to sexual and reproductive health and services. As with previous editions, this document was prepared under the supervision of IPPF’s International Medical Advisory Panel. Four of the 15 chapters in the latest edition are new; they address the menstrual cycle, reproductive health screening for well women, safe abortion, and HIV infection. Although originally published in English, it is now available in Arabic, Armenian, Bulgarian, French, Nepali, Polish, Russian, Spanish, and Urdu.

BOX 4.7 MOTIVATING MEDICAL PROFESSIONALS TO PROVIDE HIGH QUALITY CARE ■

Shoqata Shqiptare per Popullsine dhe Zhvillimin/Albanian Centre for Population and Development (ACPD), Albania

In 2005, the Albanian Centre for Population and Development (ACPD) launched a project to improve the quality of services provided in the district of Elbasan by training health care providers working in a maternity hospital and in 12 primary health care centres in the district. Three-day workshops were organized for 33 participants, including nurses, midwives, sexual and reproductive health specialists, and counsellors. Training addressed a range of sexual

IPPF Annual Performance Report 2005

and reproductive health topics based on IPPF’s ‘Medical and Service Delivery Guidelines’ and documents from the World Health Organization. The project provided post-workshop supervision visits to assess the practice of new skills by the service providers, and to provide follow-up support as needed. Guided by technical checklists, supervisors were able to identify and resolve any problems. Supervision reports showed that the providers did indeed adopt the skills they learned and put them into practice. The project demonstrated that providing professionals with up-to-date information and high quality support is an effective way to improve the quality of services and staff motivation.

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Latvijas Ìimenes plâno anas un seksuâlâs veselîbas asociâcija “Papardes zieds” (LAFPSH), Latvia

The level of sexual and reproductive health knowledge among the general public in Latvia is generally low. As a result, high rates of sexually transmitted infection and abortion persist, especially among young people. To address this situation, Latvijas Ìimenes plâno∂anas un seksuâlâs veselîbas asociâcija “Papardes zieds” (LAFPSH) established a sexuality and reproductive health training centre for professionals and for the general public. The aim of the centre is to improve the quality of services provided by professionals such as teachers, medical workers, and social workers. It also seeks to promote informed decision making among professionals and the public by increasing access to high quality information. Since its opening, the centre has received many requests for assistance, especially from local schools; several successful programmes have resulted, including two training courses designed for teachers to use in schools, two parent meetings at schools, and one training course for young women. The centre extended its programme to three summer camps for

OBJECTIVE 6 To improve access to high quality sexual and reproductive health services using a rights-based approach Ensuring access to high quality sexual and reproductive health services is central to IPPF’s work and ensures that individuals receive services that respect their right to make informed, confidential, and timely decisions about their own health. It also means that service providers gain the support, knowledge, and skills they need to uphold those rights. High quality of care results not only in the enhanced health of clients, but also in increased use of services. IPPF aims to provide integrated and comprehensive services that meet the full spectrum of clients’ needs through the different stages of their sexual and reproductive lives. These services include: ● sexual and reproductive health counselling ● prenatal and post-natal care

mentally disabled children and hosted group discussions for the children and their parents about sexual and reproductive health issues. After the trainings and discussions, LAFPSH distributed questionnaires to assess participant satisfaction. They have received 15 recommendations about the content of the training programme, and these suggestions will be incorporated into the programme. In addition to trainings and discussions, three planning meetings have been organized in collaboration with the Latvian University Family Health Institute to enhance the capacity of health care professionals. A meeting with the Ministry of Education and Science has also been planned to address the translation of sexual and reproductive health information into educational programmes for school children. LAFPSH staff members have attended a meeting for social workers on the integration of sexual and reproductive health issues into social work in schools. In the first year of the project, LAFPSH focused on lobbying and advocacy, and the increased awareness of sexual and reproductive health information among professionals demonstrates the success of its efforts. LAFPSH hopes that this information will continue to spread to the general public and create a positive impact in Latvian society.

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BOX 4.8 ESTABLISHING A SEXUALITY AND REPRODUCTIVE HEALTH TRAINING CENTRE

In 2005, IPPF provided over 17.3 million family planning services and 6.1 million couple years of protection worldwide. ● sexually transmitted infections: prevention,

diagnosis, and treatment ● HIV and AIDS: prevention, testing, counselling,

treatment, and care ● contraceptive provision, including emergency

contraception ● safe abortion services (where legal) and post-

abortion care ● breast and cervical cancer screening

In 2005, IPPF provided over 17.3 million family planning services (Figure 4.9) and 6.1 million couple years of protection (CYP) worldwide (Figure 4.10). (See Annex A for a full breakdown by method and region.)

IPPF Annual Performance Report 2005

Figure 4.9 Number of family planning services provided by Member Associations, by type*, ▲ Oral contraceptives

5,822,981

Family planning counselling

4,270,856

Condoms

3,350,427

Injectables

2,016,048

IUD

898,066

Sterilization

286,691

Family planning referrals

255,888

Awareness-based methods

183,974

Implants

156,767 0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6000000

Figure 4.10 Number of CYP provided by Member Associations, by method * IUD

1,932,999

Sterilization

1,344,690 1,174,253

Oral contraceptives 812,202

Condoms 568,029

Injectables 277,861

Implants Other barrier methods

8,797

Other hormonal methods

2,246 0

500,000

1,000,000

1,500,000

2000000

* Emergency contraception is not included in family planning services and CYP as it currently does not have an internationally agreed CYP value attached to it. ▲

Other hormonal and barrier methods (93,910) are not included in this figure.

Our Member Association in Indonesia provided reproductive health services to people displaced by the tsunami in 2004 IPPF/ESEAOR

IPPF Annual Performance Report 2005

In 2005, Member Associations provided over 13.4 million non-family planning sexual and reproductive health services, including gynaecological services, maternal and child health services, and services for sexually transmitted infections, abortion, infertility, urology, and other medical treatments. More than five million gynaecological services and nearly four million maternal and child health services were provided in 2005 (Figure 4.11). Global indicators data from 2005 also measured Member Associations’ adherence to a range of quality of care standards. Table 4.12 highlights the proportion of Member Associations with the relevant standards in place. The proportion of Associations that adhere to all of these standards is 65.0 per cent. Overall, the estimated number of clients served by Member Associations in 2005 was more than 35.6 million. About 56.6 per cent of IPPF’s clients were from poor, marginalized, and socially-excluded groups, but in those countries

Gynaecological services

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Figure 4.11 Number of non-family planning sexual and reproductive health services provided by Member Associations, by type 5,318,594

Maternal and child health services

3,731,107

Other sexual and reproductive health medical services

1,452,579

Non-family planning sexual and reproductive health counselling services Sexually transmitted infection/ reproductive tract infection services

918,622 818,550

HIV and AIDS services

502,049

Abortion services

219,229 193,272

Infertility services

139,041

Urological services Emergency contraceptive services *

123,331 0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

* Emergency contraception is not included in family planning services and CYP as it currently does not have an internationally agreed CYP value attached to it.

Table 4.12 Proportion of Member Associations with quality of care standards in place, by type of standard Quality of care standards

Proportion of Member Assocations with standards in place

Written standards/protocols/norms consistent with IPPF’s ‘Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services’ in all service delivery points

88.9

Client views are collected in all service delivery points Mechanisms in place to implement client recommendations in all service delivery points Orientation and ongoing training provided to staff in all service delivery points on contraceptive technology

78.6 72.2 83.3

Orientation and ongoing training provided to staff in all service delivery points on detection/diagnosis/treatment of sexually transmitted infections

79.4

Orientation and ongoing training provided to staff in all service delivery points on infection prevention and control Orientation and ongoing training provided to staff in all service delivery points on ‘IPPF’s Rights of the Client’

78.6 76.2

Systems to regularly assess the technical competence of service providers in delivering sexual and reproductive health services

77.0

Systems to regularly assess the technical competence of service providers in infection prevention Systems to regularly assess the technical competence of service providers in client-provider interaction Implementing strategies to assess the quality of care provided

74.6 73.8 76.2

All service delivery points with the right conditions to deliver sexual and reproductive health services – adequate privacy and comfort for clients

85.7

All service delivery points with the right conditions to deliver sexual and reproductive health services – essential supplies and equipment

84.1

All service delivery points with the right conditions to deliver sexual and reproductive health services – cleanliness, running water and electricity

86.5

All service delivery points with the right conditions to deliver sexual and reproductive health services – accessibility, opening hours, location

88.9

ranked ‘low’ on the Human Development Index,4 73.0 per cent of those served by Member Associations were from the poorest, marginalized, and excluded groups. Extending access to these groups often entails innovative service delivery models, such as mobile health units, home visits, and other community-based delivery models. For example, the Indonesian Planned Parenthood Association (IPPA) has coordinated efforts to provide sexual and reproductive health services to people displaced by the tsunami that struck Banda Aceh, Indonesia, in December 2004. IPPA established

strong partnerships with the Indonesian government, international and local nongovernmental organizations, local authorities, and United Nations agencies so that it could provide both general health services and reproductive health services and information in its clinics and mobile facilities. IPPA also developed female empowerment programmes that provided funds to women to support economic activities, such as pastry-making and sewing. All of the women who received seed money are IPPA ‘motivators’, empowering people in their communities to take care of their own reproductive health.

IPPF Annual Performance Report 2005

Women waiting for sterilizations in a Member Association clinic in Colombia IPPF/Jon Spaull

‘STRENGTHENING THE QUALITY OF REPRODUCTIVE HEALTH CARE’ PROGRAMME AND ASSESSING ADHERENCE TO STANDARDS OF QUALITY IPPF’s ‘Strengthening the Quality of Reproductive Health Care’ programme was launched in 2001 as a five-year, multi-country initiative to improve the quality of sexual and reproductive health services provided at service delivery points. Essential quality of care standards and criteria were developed which define a quality benchmark to which all Member Associations should aspire. Based on these standards, participating Associations undertook selfassessment to identify gaps in their service provisions and management systems, and

Essential quality of care standards and criteria were developed which define a quality benchmark to which all Member Associations should aspire. 74

IPPF Annual Performance Report 2005

then developed action plans to address these gaps. After implementing the action plan for one to two years, Member Associations were assessed to measure the extent to which they had implemented their action plans to meet the essential quality of care standards. Following a successful assessment (at least 85 per cent of standards met), Member Associations were eligible to receive a ‘Quality of Care Certificate’ to affirm their commitment to high quality sexual and reproductive health services. The certificate gives recognition and visibility to Member Associations that deliver high quality services, and perhaps most importantly, it provides an opportunity for staff to take pride in their achievements and to raise awareness in the wider community about their services. In 2005, there were 22 Quality of Care assessments across IPPF’s six regions. The assessment methodology was comprehensive and integrated; it included record-checking, staff interviews, observation of clinical procedures using standardized checklists, checking management procedures at Association headquarters, and assigning scores to each service delivery point.

â&#x2013;

Family Planning Association of Nepal (FPAN), Nepal

According to the World Health Organization, there is an estimated shortage of approximately 4.3 million doctors, midwives, nurses, and support workers worldwide, and the shortage is most severe in the poorest countries, especially in subSaharan Africa.5 IPPF faces serious challenges in recruiting and retaining well-qualified health professionals, and although it is recognized that a multilateral and global approach will be needed to address the situation, local solutions must form part of the response. Member Associations are addressing this with measures such as increasing pay and benefit structures for staff, upgrading clinic infrastructure and protocol, organizing ongoing training for staff, and offering supportive supervision. A project initiated by the Family Planning Association of Nepal (FPAN) highlights some of these strategies. Investing in communities to improve access to high quality services in Nepal In Nepal, maternal mortality rates are among the highest in South Asia â&#x20AC;&#x201C; there are approximately 740 deaths per 100,000 live births.6 Moreover, there are large discrepancies in sexual and reproductive health indicators. Ongoing civil conflict in Nepal has worsened conditions in rural areas, and reaching scattered and under-served groups for health service delivery is a major challenge. Access to sexual and reproductive health information is low due to weak awareness raising and education programmes among rural populations, and trained health personnel tend to leave rural areas, resulting in a high turnover of providers.

To address the situation, FPAN launched an initiative to increase access to sexual and reproductive health services in five rural and mountainous districts by mobilizing and training local volunteers and counsellors. The initiative reached 49,851 clients and provided 101,949 maternal and child health services. One hundred and twenty-five female reproductive health volunteers were trained, and they made between 75 and 125 home visits per month to provide counselling, motivation, and service site information and follow-up. There were also eight antenatal and post-natal care programmes for 200 mother groups, 11 one-day orientation programmes for 220 pregnant women, and 13 orientation programmes for men on their responsibilities in antenatal and post-natal care. To safeguard the rights and privileges of marginalized and disadvantaged groups in the region, 26 local pressure groups were formed. Additionally, 12 mobile health clinics were organized, benefiting a total of 3,397 people. Existing clinics were upgraded to improve client access, and signboards were repaired to inform the community about the exact location of FPAN service outlets. An innovative aspect of the programme was to provide prizes and letters of appreciation to community workers as a means of maintaining their motivation and commitment to the programme. Comprehensive training also motivated local staff and enhanced their skills and knowledge. The project demonstrated that community counsellors and volunteers are key communicators on sexual and reproductive health among rural people, and organizing mobile clinics and home visits were effective strategies to increase access to marginalized and underserved people.

ACCESS

BOX 4.13 CONFRONTING THE HUMAN RESOURCES CHALLENGE

Our Member Association in Nepal strives to bring sexual and reproductive health information and services into rural communities IPPF/Jenny Matthews

IPPF Annual Performance Report 2005

Results of the assessment process

BOX 4.14 INTEGRATING SEXUAL AND REPRODUCTIVE HEALTH SERVICES INTO PRIMARY HEALTH CARE ■

Federation of Family Planning Associations of Malaysia (FFPAM), Malaysia

The Federation of Family Planning Associations of Malaysia (FFPAM) reorganized its services to provide high quality antenatal and post-natal services as part of a comprehensive package of sexual and reproductive health services. The package of services includes a physical check-up, ultrasound scan, electrocardiogram, routine blood and urine tests, HIV testing and counselling, immunization, antenatal classes and counselling, post-natal examination, family planning counselling, and breast and cervical cancer screening. This extensive package of services means that clients attending the clinic can have a variety of their needs met during the same visit. The clinic operates every Saturday and is attended by four volunteer specialists from the local university hospital. The programme has provided affordable services, shorter waiting times compared to government hospitals, and referrals to the same doctor for delivery and follow-up. The programme has shown that it is feasible to provide high quality antenatal and post-natal care services in resource-limited settings if there is strong support from local doctors and hospitals. In addition, the project demonstrated that antenatal care can serve as an entry point to providing other sexual and reproductive health services.

A woman and her children attend a clinic operated by our Member Association in Malaysia IPPF/Alison Lowe

IPPF Annual Performance Report 2005

The process of self-assessment assisted Member Associations to establish achievable and realistic action plans that address their quality of care needs. The methodology used for the assessment enhanced staff participation and motivation at all levels. Overall, the assessments showed significant improvements in the quality of care provided, including: ● the institutionalization of quality of care standards and criteria ● the number of trained and motivated providers ● the dissemination of service delivery guidelines ● the supervision processes and standardized infection prevention procedures

Lessons learned Self-assessment is effective in generating a range of achievable, low-cost, realistic solutions to improving quality of care. The process need not be complex and, in fact, relatively simple and straightforward approaches were found to be more valuable than external assessment. Improving the quality of reproductive health care can be achieved with very little financial input. It is a long-term, continuous process that requires a commitment in all aspects of service delivery management, and all members of staff – cleaners, drivers, nurses, doctors, and managers – can make valuable contributions and help to identify quality of care gaps and solutions.

Providing high quality comprehensive sexual and reproductive health services is a major part of IPPF’s work, and in 2005, more than 17.3 million family planning services and 13.4 million non-family planning sexual and reproductive health services were provided by our Member Associations. Those Associations that provide sexual and reproductive services abide by the ‘IPPF standards and responsibilities of Membership’ to “pay special attention in their country to the needs of the under-served, the poor, and young people”. 7 The estimated number of clients reached by Member Associations in 2005 was more than 35.6 million, with almost six in ten of these from poor, marginalized, under-served, and socially-excluded groups. Moreover, nearly eight million sexual and reproductive health services were provided to young people in 2005, and 93.7 per cent of our Member Associations provide a broad range of services to those under 25 years of age. Examples presented in this chapter have demonstrated how IPPF’s innovative and rights-based approaches to increasing access to services have reached many marginalized, poor, under-served, and vulnerable communities in Bolivia, the Dominican Republic, India, Morocco, and Nepal. IPPF has also focused in the last few years on improving the quality of care in service provision, and the multi-country

initiative ‘Strengthening the Quality of Reproductive Health Care’ programme has increased the quality of sexual and reproductive health services in many of IPPF’s clinics. The programme has led to a culture of ‘quality of care’, and improved standards, norms, and knowledge. It is now being expanded to more Member Associations throughout the Federation with support from Regional Offices, and the quality of care model is being applied to other programmes that address IPPF’s five strategic priorities. Advocating for improved access has been a key strategy for many Member Associations, particularly as they strive to reduce socio-economic, religious, and policy barriers to information and services. Ongoing advocacy is also needed to confront the challenges to universal access to sexual and reproductive health on a global level, and IPPF will continue to hold governments accountable for commitments made at the United Nations 2005 World Summit to increase access and protect the right to sexual and reproductive health services. The Federation will strive to keep the issue of access on the agenda as an essential means to achieving the Millennium Development Goals, reducing poverty and improving quality of life for all people.

IPPF Annual Performance Report 2005

ACCESS

CONCLUSIONS

ADVOCACY

GOAL Strong public, political and financial commitment to and support for sexual and reproductive health and rights at the national and international level

INTRODUCTION In today’s political and economic climate, it is increasingly difficult to gain support for sexual and reproductive health and rights for a number of reasons, including the strength of the opposition movement and its close ties to the current United States administration, a financial environment that makes it difficult to fund advocacy activities to advance sexual and reproductive health and rights, and the fact that governments continue to view HIV and AIDS as separate issues from sexual and reproductive health. Moreover, a general decline in official development assistance and a shift from multilateral funding to bilateral funding has meant that advocacy for sexual and reproductive health and rights is more important than ever. To address these challenges, IPPF continues to increase its capacity for advocacy. We are actively mobilizing support from within the political arena to promote progressive legislation and policies on sexual and reproductive health and rights. We have been highly effective in advocating for positive change and raising awareness about the IPPF encourages the importance of sexual and advocates of tomorrow reproductive health and rights at by teaching young people community, national, and about sexual and international levels. With the help reproductive health of our volunteers and activists, IPPF/Christian Schwetz IPPF has been able to advance the

Programme of Action from the International Conference on Population and Development (ICPD) and make significant progress to ensure that the Millennium Development Goals reflect the importance of sexual and reproductive health and rights in reducing poverty. In 2005, IPPF sponsored and presented at numerous events around the world, and this work resulted in much positive change. Parliamentarians and key decision makers understand IPPF’s goals, are committed to helping us achieve them, and have themselves advocated to bring about real improvement in the sexual and reproductive lives of people in their countries.

RAISING THE PROFILE OF IPPF WITH KEY DECISION MAKERS AND THE MEDIA In 2005, IPPF organized a reception at the House of Lords in London on World Population Day. The event presented an important advocacy opportunity to increase support for sexual and reproductive health and rights during both the UK’s presidency of the European Union and its chairing of the G8. Attendees included ambassadors from key donor countries, parliamentarians, and international nongovernmental organizations working in the field of sexual and reproductive health. Baroness Royall of Blaisdon, the UK government spokesperson for Health, for International Development, and for the Foreign and

IPPF Annual Performance Report 2005

Commonwealth Office, gave the keynote speech. The reception allowed IPPF to strengthen its relationships with key parliamentarians, embassies, and other sexual and reproductive health organizations. IPPF’s Central Office also co-hosted a reception with the Scottish branch of the UK Family Planning Association (FPA) prior to the G8 international parliamentarians’ ‘Conference on Development in Africa 2005’, organized by the Inter European Parliamentary Forum on Population and Development (IEPFPD), Interact Worldwide, the World Bank, and its Parliamentary Network. Delegates at the conference analyzed the agenda for the G8 summit, debated the findings of the Commission for Africa report, and focused on proposals related to HIV and AIDS and sexual and reproductive health issues in Africa. More than 80 parliamentarians from G8, African, and European countries participated and made recommendations for the G8 leaders.

ACHIEVING IPPF’S STRATEGIC FRAMEWORK: ADVOCACY IPPF’s Strategic Framework identifies three key objectives for advocacy, including: ● strengthening recognition of sexual and reproductive health, especially in policy and legislation ● achieving greater public support for government commitment and accountability ● raising the priority of sexual and reproductive health and rights on the development agenda These objectives emphasize IPPF’s commitment to address advocacy objectives and keep sexual and reproductive health and rights at the top of the global agenda, and the case studies in this chapter highlight IPPF’s advocacy work and successes in 2005.

OBJECTIVE 1 To strengthen recognition of sexual and reproductive health and rights, including policy and legislation which promotes, respects, protects, and fulfils these rights Global indicators data show that 90.4 per cent of all Member Associations conduct advocacy

The World Population Day event organized by IPPF presented an important advocacy opportunity to increase support for sexual and reproductive health and rights. 80

IPPF Annual Performance Report 2005

A volunteer from our Member Association in Sudan provides counselling on HIV and condom use IPPF/Neil Thomas

activities to advance national policy and legislation on sexual and reproductive health and rights. Some of the key methods used for this advocacy include public education (86.5 per cent of Member Associations), working with the media (83.3 per cent), and direct lobbying (71.4 per cent). The target groups for these activities include government decision makers (84.1 per cent), the general public (82.5 per cent), mass media (81.0 per cent), and community and religious leaders (66.7 per cent). Member Associations collaborated with various decision making bodies and coalitions to advance policy and legislation, including other non-governmental organizations (87.3 per cent), governments (84.1 per cent), international organizations (78.6 per cent), and mass media (75.4 per cent). Eighty per cent of Member Associations counteract opposition to sexual and reproductive health. Several types of opposition strategies were confronted, including misinformation or misrepresentation of sexual and reproductive health and rights (75.4 per cent), defunding or reducing funds for sexual and reproductive health and rights (44.4 per cent), undermining existing policy or legislation (43.7 per cent), and blocking or opposing new policy and legislation (42.1 per cent) (Figure 5.1). Sources of opposition included religious leaders (encountered by 77.8 per cent of Member Associations), community leaders (38.9 per cent), government (25.4 per cent), and the media (22.2 per cent).

ADVOCACY

Figure 5.1 Percentage of Member Associations counteracting opposition strategies, by type of opposition 80% 70% 60% 50% 40% 30%

44.4%

54.8%

42.1%

69.0%

43.7%

38.1%

10%

75.4%

20%

In 2005, Member Association advocacy efforts contributed to 51 successful national policy initiatives or legislative changes in support of sexual and reproductive health and rights (Box 5.2). These are significant achievements at the national level that will undoubtedly improve the sexual and reproductive lives of many.

ASSESSING PROGRESS AND CHALLENGES AHEAD FOR THE ICPD PROGRAMME OF ACTION IN MOROCCO AND SYRIA IPPF Arab World Regional Office In collaboration with the United Nations Population Fund (UNFPA), the Arab World Regional Office sponsored two sub-regional conferences in Morocco and Syria, following on from meetings it held in 2004 in Lebanon, Tunisia, and Yemen. The conferences were entitled ‘From recommendations to engagement: a civil society perspective on progress to date and challenges for the next decade’, and encouraged participants to review progress of regional implementation of the ICPD Programme of Action, as well as assess financial commitments made by governments and donors. Attendees identified unfinished business and priority action areas for the next decade, and proposed a regional action plan. The Morocco conference was organized and conducted under the patronage of the King of Morocco, Mohammed VI, and attracted over 100 participants, including senior delegates from civil society, donor agencies, governments, the religious community, and the media. The Syria

Fund reduction

Opposing new policies

Undermining policy/legislation

Misinformation/ misrepresentation

conference was attended by more than 300 people, and featured a youth forum that culminated in a number of young people participating in a televised session with Arab parliamentarians. This session involved discussion of legal reform for family planning, gender discrimination, ICPD commitments, and youth rights to sexual and reproductive health and education. The sub-regional conferences proved to be effective capacity building opportunities, leading to various Arab world governments promising support and accountability. This suggests further positive developments to follow in the region.

IPPF’s Member Association in Yemen hosts an advocacy workshop to share ideas and build capacity IPPF/AWR

IPPF Annual Performance Report 2005

BOX 5.2 EXAMPLES OF SUCCESSFUL NATIONAL POLICY INITIATIVES AND POSITIVE LEGISLATIVE CHANGES FROM 2005 Member Associations contributed to the following successful national policy initiatives and positive legislative changes that occurred in 2005. These successes encompass all of IPPF’s Five A’s: adolescents, HIV and AIDS, abortion, access, and advocacy. ADOLESCENTS ● The Planned Parenthood Association of Thailand (PPAT) organized successful meetings between parliamentarians and Islamic councils in the provinces of Narathiwas, Pattani, and Yala to ensure that sexual and reproductive health information could be provided in schools. ● Uzazi na Malezi Bora Tanzania (UMATI) responded to a law in Tanzania that prevents pregnant school girls from continuing their education by campaigning for their readmittance. ● The Palestinian Family Planning and Protection Association (PFPPA), in partnership with the National Committee for Reproductive Health, convinced the Ministry of Health to include sexual and reproductive health education at fourth and ninth school grade levels. ● The Bahrain Family Planning Association (BFPA), in collaboration with the World Health Organization, provided workshops to teachers on introducing sexual and reproductive health issues into the curricula of government schools at all levels. As a result, the Ministry of Education agreed to provide sexuality education in schools. ● In the UK, the Family Planning Association (FPA) helped maintain the rights and legal status of young people under the age of 16 to confidentiality in accessing sexual health services. ● Before 2005, Malaysia lacked any policy initiatives on sexuality education. The Federation of Family Planning Associations of Malaysia (FFPAM) has been a key partner in drafting the National Guidelines on Sexuality Education, to be presented by the Ministry of Women, Family, and Community Development and the Ministry of Education to the Cabinet for endorsement in 2006. ● In the United States, the Planned Parenthood Federation of America (PPFA) played a key role in defeating legislation that would have required parental notification for young people seeking abortion or contraceptive services. HIV and AIDS The Reproductive Health Alliance of Kyrgyzstan (RHAK) raised the importance of updating the national HIV and AIDS law to reflect the steep increase of people now infected. It also participated in a working group that developed a new law entitled ‘About HIV/AIDS in Kyrgyz Republic’ which was adopted in June 2005.

●

IPPF Annual Performance Report 2005

IPPF believes in involving young people in advocacy work to ensure that their rights are upheld IPPF/Christian Schwetz

In Estonia, Eesti Seksuaaltervise Liit (ESTL) participated in the strategy-building process for the Estonian national ‘HIV and AIDS Strategy for 2006–2015’. ● The Belize Family Life Association (BFLA) worked on the national HIV and AIDS policy, which included a component on HIV and AIDS in the workplace. ●

ABORTION The Irish Family Planning Association (IFPA) highlighted misinformation and sensational claims about abortion on a website that belongs to LIFE, a group funded by the Crisis Pregnancy Agency (CPA). Following IFPA’s interventions, the CPA issued guidelines on the accuracy of displayed material and the website was changed accordingly. IFPA also launched a campaign aimed at state broadcaster Radio Telefís Éireann (RTE) to overturn its ban on advertising condoms. ● Associação Para o Planeamento da Família (APF) worked with parliamentarians in Portugal to advocate for a motion on the provision of safe abortion, access to sexual and reproductive health services, and school sexuality education. ● ‘The Draft Law on Prohibition of Abortion’ was not approved in Latvia due to vigorous lobbying by Latvijas Ìimenes plâno anas un seksuâlâs veselîbas asociâcija “Papardes zieds” (LAFPSH) and its collaboration with other women’s groups, non-governmental organizations, and the Parliamentary Group for Development and Population, Reproductive Health, and Rights. ● The Family Planning Association of India (FPA India) helped to reverse a resolution of the Maharashtra state government about the provision of abortion services. Maharashtra’s government tried to prohibit service providers from offering female sterilization procedures and ●

ADVOCACY abortion in the same session; this would have forced millions of women to visit the clinic twice, undergo two surgical interventions, and pay twice. By using evidence-based data from over 5,000 cases, FPA India mobilized professional groups and policy makers to ensure the reversal of the state government’s resolution. ACCESS ● The Israel Family Planning Association (IFPA) lobbied successfully with Israeli civil rights organizations for contraceptive pills to be included in the government’s official list of prescription medicines. Contraceptives for women under the age of 20 are now available free. ● Successful lobbying by ‘For Family and Health’ Pan-Armenian Association (PAFHA) ensured all Armenians access to free outpatient primary health care services in clinics run by the Ministry of Health. ● Association Marocaine de Planification Familiale (AMPF) contributed to the revision of the new ‘code de la famille’ in Morocco that grants Moroccans the right to contraception and other sexual and reproductive health services. ● In the Czech Republic, Spolecnost pro plánování rodiny a sexuální v y´ chovu (SPRSV) successfully lobbied the Czech Gynaecological Association to make the emergency contraceptive Postinor available without prescription. ● After six years of lobbying decision makers and the government by the Canadian Federation for Sexual Health (PPFC), emergency contraception is now available as a non-prescription drug in Canada and is readily available in pharmacies. ● As a result of the efforts of Fundación Mexicana para la Planeación Familiar, A.C. (MEXFAM) in Mexico, the Mexican Official Standard for Family Planning was modified to include emergency contraception and the female condom as family

Volunteers set up a youth centre in Ghana IPPF/Dale Cooper

planning methods. To achieve this, MEXFAM provided advocacy-related technical support and participated in public advocacy efforts to counter resistance from conservatives. Emergency contraception was also incorporated into the Health Sector Essential Drug List. ● Until recently, victims of sex crime in Japan have been obliged to pay for all expenses related to emergency contraception, testing and treatment for sexually transmitted infections, and abortionrelated services. Through the activities of the Japan Family Planning Association (JFPA), the police department and national health insurance will now cover all of these expenses to address the needs of sex crime victims.

Pro-choice poster at a rally in Washington D.C. IPPF/Erin Barringer

ADVOCACY ● Foreningen Sex og Samfund successfully advocated for a new strategy on sexual and reproductive health in Denmark and had calls realized for increased official development assistance for sexual and reproductive health. ● The Planned Parenthood Association of Ghana (PPAG) participated in the revision and update of Ghana’s reproductive health policy. ● The Family Planning Association (FPA) was involved in discussions at the national level in the UK to ensure that sexual health is given higher priority and that the National Health Service includes sexual health as one of its top six priority areas. ● The Belize Family Life Association (BFLA) has been an active member of the committee responsible for drafting the national sexual and reproductive health policy and is now also a member of the Sexual and Reproductive Health Policy Committee, the body responsible for developing a strategic plan for the policy’s implementation.

IPPF Annual Performance Report 2005

BOX 5.3 COUNTERACTING CONSCIENTIOUS OBJECTION TO THE PROVISION OF SEXUAL AND REPRODUCTIVE HEALTH SERVICES ■

Spolocˇnost’ pre plánované rodicˇovstvo (SPR), Slovak Republic

The Slovakian government attempted to sign a treaty with the Vatican regarding the right to exercise conscientious objection. This would have allowed hospitals and doctors to use religious grounds to refuse the provision of sexual and reproductive health services, including abortionrelated services, contraception, and sexuality

ENDORSING THE ICPD PROGRAMME OF ACTION IN SOUTH ASIA IPPF South Asia Regional Office IPPF’s South Asia Regional Office provided its Member Associations with funds to advocate for the government endorsement of ICPD’s Programme of Action. Most Member Associations organized a range of innovative activities focusing on media advocacy, including setting up a media network in Pakistan, conducting a media survey in Iran (in partnership with UNFPA), mentoring journalists and publishing a book in Sri Lanka, and organizing media fellowships in Bangladesh, India, and Sri Lanka. These activities led to positive discourse on

information. Our Member Association in the Slovak Republic worked with pro-choice parliamentarians to galvanize the support of the European Union Network of Independent Experts on Fundamental Rights, which reported on the incompatibility between the draft treaty and European Union laws on discrimination and fundamental rights. The resulting rift in the government led to a major party leaving the coalition government, forcing new elections and effectively stopping the treaty.

the ICPD Programme of Action and included crosslinkages between projects and countries, including collaborative capacity building initiatives between Member Associations in the Maldives and Sri Lanka. The Family Planning Association of the Islamic Republic of Iran (FPAIRI) raised awareness of the ICPD among government departments, the media, the general public, and the development community to renew and revitalize the Iranian government’s commitment to the ICPD Programme of Action. FPAIRI worked with journalists in an effort to profile its work, highlight the ICPD agenda, and keep issues related to the Programme of Action in the public domain. FPAIRI offered workshops and fellowships for journalists, resulting in an increase in articles

Figure 5.4 Percentage of Member Associations influencing public opinion on sexual and reproductive health and rights, by type of initiative 100%

80%

60%

40%

38.1%

61.1%

69.0%

81.7%

54.8%

73.8%

Academic peerreviewed journals

Advertising

Television

Radio

Web-based media

Community outreach

61.9%

82.5% Newspapers and magazines

20%

IPPF Annual Performance Report 2005

Religious and community leaders

ADVOCACY

published on sexual and reproductive health and rights in the mainstream media. FPAIRI’s work with journalists helped to develop a professional library of digital photographs. The South Asia Regional Office has documented these ICPD-related activities in a special report entitled ‘ICPD to MDGs: SARO Explores’.1

OBJECTIVE 2 To achieve greater public support for government commitment and accountability for sexual and reproductive health and rights IPPF measures its progress toward achieving greater public support for sexual and reproductive health services with two indicators: a review of Member Association efforts to influence public opinion by supporting policies and legislation that are favourable to sexual and reproductive health and rights, and a review of Member Association communications strategies. In 2005, 73.8 per cent of Member Associations had a communications strategy in place and 94.4 per cent engaged in initiatives to influence public opinion; these initiatives included outreach through newspaper and magazine articles (82.5 per cent), radio (81.7 per cent), community outreach (73.8 per cent), television (69.0 per cent), work with religious and

IPPF believes in sensitizing the public on critical reproductive health issues IPPF/Chloe Hall

community leaders (61.9 per cent), advertising campaigns on issues (61.1 per cent), web-based media (54.8 per cent), and peer-reviewed journals (38.1 per cent) (Figure 5.4). Seventy-one per cent of Member Associations had both components (public opinion initiatives and communications strategies) in place during 2005.

BOX 5.5 INTEGRATING SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS IN THE AFRICAN UNION ■

IPPF Africa Regional Office

In 2005, IPPF’s Africa Regional Office focused its attention on an initiative to sensitize and inform policy makers, opinion leaders, and the public about critical reproductive health issues. These include the need for meaningful action and investment and for issues related to sexual and reproductive health and population to be incorporated into the overall development agenda. In collaboration with the African Union and the UNFPA Africa Division, the Regional Office continued to build on the initiative originally begun in 2003. Sub-regional meetings held in Kenya, Namibia, Nigeria, and Tunisia helped to build consensus on the integration of a sexual and reproductive health component into the New Partnership for Africa’s Development (NEPAD) framework and African Union institutions. This followed sub-regional meetings in 2004 in central Africa and francophone west Africa.

The outcomes and recommendations from the sub-regional meetings were consolidated into a comprehensive sexual and reproductive health policy framework, and were presented at the ‘Second Ordinary Session of the Conference of African Ministers of Health’ in October 2005 in Botswana. At the meeting, ministers adopted the ‘Continental policy framework for the promotion of sexual and reproductive health and rights in Africa’, calling for an extraordinary session of the African Health Ministers in 2006 to be dedicated to sexual and reproductive health. This initiative to sensitize and inform policy makers, opinion leaders, and the public about critical reproductive health issues assisted the Africa Regional Office to develop and refine its advocacy skills. Ensuring government support by involving relevant ministries and agencies in the sub-regional meetings, as well as establishing good working relationships with stakeholders, were key components to the success of the project.

IPPF Annual Performance Report 2005

BOX 5.6 BUILDING CAPACITY FOR ADVOCACY IN THE SOUTH IPPF South Asia Regional Office Family Planning Association of India (FPA India), India ■ Family Planning Association of Pakistan (FPAP), Pakistan ■ Family Planning Organization of the Philippines (FPOP), The Philippines ■ ■

The three-year ‘Southern Advocacy Project’ (2004 to 2007) aims to consolidate and strengthen the capacity of Member Associations in Ethiopia, India, Nigeria, Pakistan, and the Philippines to develop and extend effective advocacy programmes to increase funding for sexual and reproductive health. In each country, 50 per cent of the project is being funded by donors, and the remaining funds are provided by Member Associations. The programme aims to increase the capacity of Member Associations to undertake sustainable resource mobilization through effective advocacy and fundraising strategies, develop a national leadership role in each country to safeguard financial commitments made at the ICPD, and galvanize commitment and support from international and national donors and national policy makers for sexual and reproductive health. To increase the capacity of the Member Associations to deliver effective advocacy and resource mobilization activities for the ‘Southern Advocacy Project’, the South Asia Regional Office organized a capacity building workshop for the Family Planning Association of India (FPA India) and the Family Planning Association of Pakistan (FPAP) which led to the development of an advocacy and resource mobilization plan in each Association. Significant progress has been made in recruiting and training advocacy and resource mobilization specialists by engaging in ‘strength, weakness, opportunity, and threat’ (SWOT) analyses, capacity assessments, and implementation of three-year advocacy and resource mobilization plans. Each Member Association has developed a strong niche in key areas of resource mobilization and has developed successful strategic partnerships with government and international agencies, voluntary sector organizations, the private sector, and the media. Many of these advocacy and resource mobilization plans have resulted in increased donor and political interest, leading to a number of substantial grants. India FPA India launched a series of activities at branch level as well as at its headquarters to ensure longterm financial sustainability. These activities included fundraising programmes, developing

IPPF Annual Performance Report 2005

networks and partnerships for fostering resource mobilization, and strengthening the capacity of staff and volunteers. FPA India improved its profile among key audiences, including the media, the general public, and other stakeholders. Media events involving journalists and policy makers were organized in Ahmedabad, Bhopal, and Mumbai, generating numerous media articles on sexual and reproductive health and rights that highlighted the work of FPA India. Journalists were given briefing notes on the two-child family, the girl child, sex selection issues, and women’s empowerment. FPA India also developed audio-visual material for image building and fundraising that included a CD on IPPF’s Five A’s, which has become an extremely effective tool for highlighting FPA India’s work. The action plans for these activities included developing a directory of health providers and providing expertise to nongovernmental organizations on a consultancy basis. FPA India branches also carried out fundraising programmes to generate unrestricted core funding that ranged from organizing donation drives to selling table calendars. The Bellary and Shimoga branches were able to raise enough funds to build a clinic and an office. The Mumbai branch was able to fund two clinics in Bhiwandi and Thane, and the Gomia branch built an office and an additional ward. FPA India sponsored a number of corporate events and submitted more than 20 proposals to donors relating to the programme areas of adolescents, HIV and AIDS, training, safe abortion, and maternal health. Two proposals received funding approval by the private sector and several additional proposals on adolescent sexual and reproductive health received approval from the Japan Trust Fund and the West Wind Foundation. Pakistan FPAP carried out a number of activities to increase and strengthen its capacity to deliver effective advocacy and to mobilize resources. FPAP set up its own media network to galvanize the support of international and national donors and national policy makers for sexual and reproductive health programming and to create strong links with journalists in Pakistan. During a series of orientation meetings, media representatives discussed a partnership proposal, developed terms of reference, and formed a plan of action for the network, which was formally launched at the Lahore Press Club in 2005. FPAP also organized two workshops entitled ‘ICPD +10: Challenges & Solutions’ for non-governmental organizations, federal government representatives, and the media. During the first workshop, journalists established a working

The Philippines The Family Planning Organization of the Philippines (FPOP) is the Secretariat of the Reproductive Health Advocacy Network (RHAN), and in recent years has become a leader in reproductive health initiatives. A national-level strategic partnership has been developed with other agencies, and three locallevel strategic partnerships have been created to advance sexual and reproductive health and rights. To increase capacity for mobilizing resources, FPOP plans to train volunteers and staff in advocacy and fundraising. To increase its capacity for delivering effective advocacy, a SWOT analysis was carried out at the local level in Cebu, Davao, and Samar and the volunteer database was updated. To increase media coverage, FPOP held a workshop on its advocacy toolkit – ‘Advokit’ – attended by members of the Media Advocates on Reproductive Health Empowerment. As a result,

seven articles were published in major national newspapers, and 15 were printed in local newspapers. FPOP published newspaper columns in ‘Banat News’ and ‘Freeman Mindanao’, and also produced a quarterly newsletter entitled ‘Newsbreak’ for distribution to the media and other key stakeholders. FPOP contacted a number of businesses with corporate social responsibility programmes to gain private sector support. To galvanize the commitment and support from international and national donors and national policy makers, FPOP developed a strategy for increasing the number of partners in the donor and non-traditional donor communities, and sponsored meetings with national and local business and socio-civic organizations. Proposals were submitted to Metro Bacolod and the Tarlac Chamber of Commerce and Industry, raising PHP100,000 (US$2,000) for reproductive health. Three meetings with the Philippine Chamber of Commerce and Industry and the Employers’ Confederation of the Philippines were held. FPOP also organized eight meetings to gain the support of policy makers and parliamentarians, and at these conferences, 15 national and 20 local policy makers demonstrated support for FPOP’s work, and an additional five issued public statements supporting sexual and reproductive health. FPOP’s successful advocacy led to the drafting and tabling of reproductive health bills.

ADVOCACY

group for population and development. A seminar on the theme ‘Save Mother, Save Family’ and a visit to a family health hospital and family health clinics led to extensive media coverage. FPAP also co-organized a national policy dialogue called ‘MDGs: Expanding the Agenda’ in Islamabad featuring the Federal Minister of Health as the key guest. The event attracted over 100 participants, including parliamentarians and government officials, demonstrating FPAP’s ability to secure the attention of key decision makers.

A women’s group in India discusses income-generating activities to encourage financial sustainability IPPF/Peter Caton

IPPF Annual Performance Report 2005

BOX 5.7 ADVANCING SEXUAL AND REPRODUCTIVE HEALTH AND THE MILLENNIUM DEVELOPMENT GOALS IPPF Central Office ■ IPPF Western Hemisphere Regional Office ■ Sociedade Civil Bem-Estar Familiar no Brasil (BEMFAM), Brazil ■

IPPF has consistently demonstrated that reproductive health and rights are crucial to the achievement of the Millennium Development Goals and considers the omission of the ICPD goal of ‘universal access to reproductive health services’ to be both serious and costly in terms of poverty reduction and women’s health. The September 2005 United Nations review meeting of the Millennium Summit (World Summit) provided the opportunity for readdressing this omission. IPPF Central Office participated in strategy meetings with Regional Offices and other sexual and reproductive health organizations to prioritize and target member state governments. A resource pack was produced containing a list of suggested advocacy opportunities for Member Associations, who were then encouraged to lobby their relevant ministries before the Summit, to urge governments to include at least one line about sexual and reproductive health in their summit statements, and to encourage parliamentarians to ask relevant questions in parliamentary sessions about the linkages between sexual and reproductive health and rights and the Millennium Development Goals. Member Associations were also asked to secure positions in their government delegations to attend the Summit, and IPPF’s Central Office covered the participation costs of a number of Member Associations from G77 nations.

Extensive lobbying led to the inclusion in the World Summit outcome document of important references to the ICPD goal of universal access to reproductive health. Despite political stand-offs by world leaders prior to the World Summit, many member states supported IPPF’s call for the inclusion of the ICPD goal. In total, there were four references to ‘sexual and reproductive health’, 29 references to ‘reproductive health’, and 58 instances of ‘HIV and AIDS’ in statements from member states. Extensive lobbying led to the inclusion in the World Summit outcome document of important references to the ICPD goal of universal access to reproductive health. These references were under

IPPF Annual Performance Report 2005

the sections entitled ‘HIV/AIDS, malaria, tuberculosis and other health issues’ in Paragraph 57(g) and ‘Gender equality and empowerment of women’ in Paragraph 58(c). The new target of ‘universal access to reproductive health by 2015’ was presented to the General Assembly by the Secretary General in October 2006 in his ‘Report on the Work of the Organization for this year’s General Assembly’ (GA Official Records Supplement No 1 A/61/1). This target was adopted by the General Assembly shortly after. The Brasilia Declaration The Western Hemisphere Regional Office worked with its Member Associations on a regional advocacy initiative before the 2005 World Summit to promote the inclusion of the ICPD agenda within the Millennium Development Goals. The Regional Office also sought to build key partnerships and gain the support of policy makers and parliamentarians. A meeting entitled ‘The Millennium Development Goals, Proposals for the Summit’ was organized by the Sociedade Civil Bem-Estar Familiar no Brasil (BEMFAM) and the Western Hemisphere Regional Office, in collaboration with the United Nations Population Fund (UNFPA), the United Nations Development Fund for Women (UNIFEM), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Inter-American Parliamentary Group on Population and Development (IAPG), and the Minister of External Affairs and the Federal Senate of Brazil. The aim of the meeting was to ensure that government delegations recognized the importance of advancing sexual and reproductive health and rights within the Millennium Development Goals. It was attended by nearly 200 participants, including ministers, parliamentarians, and government representatives from Argentina, Bolivia, Brazil, Chile, Mexico, Paraguay, and Uruguay, in addition to youth representatives and civil society organizations. The participants unanimously adopted the ‘Brasilia Declaration’, a document formalizing a sub-regional commitment to universal access to sexual and reproductive health and its inclusion within the framework of the Millennium Development Goals. The Declaration committed participants to building political commitment to advance sexual and reproductive health and rights at the World Summit, supporting the recommendations of Millennium Project Task Forces, prioritizing investment in sexual and reproductive health in development programmes, sectoral and national budgets, ensuring that financial commitments adopted in the ICPD Programme of Action are fulfilled, and increasing official development assistance.

ADVOCACY

OBJECTIVE 3 To raise the priority of sexual and reproductive health and rights on the development agenda resulting in an increase in resources Global indicators data show that the proportion of Member Associations advocating with governments for specific financial commitment in government budget lines for sexual and reproductive health is 67.5 per cent. Sixty-five per cent of Associations advocate for governments to meet their financial commitments under international agreements such as the ICPD Programme of Action and the Platform for Action from the Beijing conference. Overall, the proportion of Member Associations advocating for national governments to commit more financial resources to sexual and reproductive health and rights is 86.5 per cent.

MAKING AND STRENGTHENING BONDS AT THE DONORS’ ANNUAL CONSULTATIVE MEETING IPPF Arab World Regional Office In October 2005, the Arab World Regional Office organized its first donors’ consultative meeting, attended by the embassies of Japan, the United Kingdom, and the United States, and the Japanese International Cooperation Agency. The meeting gave the Regional Office an opportunity to provide donors with an overview of its Strategic Plan and to inform them about its regional activities. Regional Office staff met with partners to discuss critical issues and challenges relating to sexual and reproductive health in the region, and to discuss funding opportunities. As a result of the donors’ meeting and further discussions, the Embassy of the United Kingdom in Tunisia funded a project in Gabes and Mednine to provide young people living in rural and under-served areas with access to information-sharing technology and information on sexual and reproductive health and rights. Representatives of the British Embassy, Association Tunisienne de la Santé de la Reproduction (ATSR), local institutions, and the Regional Office participated at an event to mark the inauguration of the ‘Youth Information Corners’ in both locations. The British Embassy also funded the purchase of specialized Braille technologies for the ‘Braille Materials Production Centre for Visually Challenged Youth’. Visually challenged young people will be responsible for the design, production, and sharing of information on youth issues, with a focus on sexual and reproductive health and rights.

A staff member in Mauritania providing sexual and reproductive health counselling IPPF/Chloe Hall

Advocacy material from our Member Association in Mauritania IPPF/Chloe Hall

IPPF Annual Performance Report 2005

A young woman in Denmark receives family planning services and counselling from a Member Association clinic IPPF/Chloe Hall

EUROPEAN CHAMPIONS FOR REPRODUCTIVE HEALTH WORLDWIDE IPPF European Network Regional Office Historically, the European Union has taken a progressive stance on reproductive health and has been one of the world’s leading donors. Such funding, however, has been subject to challenges, and the policy environment in the region has become increasingly difficult. The past year has been pivotal for European Union policies affecting reproductive health because the new European Commission and Parliament will be making decisions affecting the European Union’s future development policies and funding, including reproductive health and HIV and AIDS programmes. Newly proposed financial regulations may also eliminate dozens of budget lines, affecting development cooperation spending in specific sectoral and thematic areas. The European Network Regional Office organized a series of activities to ensure that the European

IPPF Annual Performance Report 2005

Union maintains its commitment to sexual and reproductive health. To increase civil society support for sexual and reproductive health and rights, the Regional Office worked closely with CONCORD to mobilize its members and organize meetings between various Member Associations, Members of the European Parliament, and permanent representatives. The European Network Regional Office organized a high level meeting with 170 participants in Luxembourg just before the country took on the European presidency. The meeting increased the visibility of the Mouvement Luxembourgeois pour le Planning Familial et l’Education Sexuelle (MLPFES), the Luxembourg Member Association, in the media. The Regional Office organized meetings between project partners and Member Associations from the countries involved in the past, present, and future presidencies of the European Union to advance sexual and reproductive health and rights knowledge and information within each country’s presidency team.

The past year proved to be exciting and productive for IPPF’s advocacy programmes. Global indicators data show that 90.4 per cent of all Member Associations conducted advocacy activities to advance national policy and legislation on sexual and reproductive health and rights in 2005, and these advocacy efforts contributed to 51 successful national policy initiatives and legislative changes in support of sexual and reproductive health and rights. These ranged from revising Ghana’s reproductive health policy and drafting the national policy in Belize, to assisting with the revision of Yemeni laws on women’s rights and gender equality and defeating a draft law to prohibit abortion in Latvia. As existing partnerships were strengthened, new partnerships were created and our voice was heard at the highest levels of decision and policy making. Not only is IPPF’s expertise being called upon to influence advocacy and policy, but we are also seen by many as the world’s leaders in sexual and reproductive health and rights. To continue this vital work, IPPF has taken key steps toward strengthening its brand identity during the past year. Consistent branding will help to visually

unite the Federation under one strong identity, while a flexible branding guide will allow Regional Offices and Member Associations to maintain regional flavour in their publications. Branding also helps to aid recognition of our work among governments and to differentiate us from other non-governmental organizations working in the sexual and reproductive health field. Strong brand recognition will help us to advance our advocacy goals by being able to communicate our values, build upon existing goodwill, and reinforce trust in our messages. After sponsoring workshops in 2004 to establish core values, a branding strategy, and IPPF language, the Federation decided on a new logo and strapline. These were approved by Governing Council in May 2005, and over the past year IPPF has been working to implement the brand throughout the Federation. This reinforced brand identity, along with the unwavering commitment of our Member Associations, will equip the Federation with the strength and energy necessary to tackle new challenges in the year ahead. We look forward to working with renewed vigour to make sexual and reproductive health and rights accessible for all.

IPPF Annual Performance Report 2005

ADVOCACY

CONCLUSIONS

INTRODUCTION

“The IPPF Strategic Framework represents a flexible framework of opportunity which our Member Associations can use to help them in addressing the specific sexual and reproductive health challenges in their own societies.”

IPPF’s Strategic Framework focuses on the Five A’s of adolescents, HIV and AIDS, abortion, access, and advocacy, and is supported by four strategies to ensure that the Federation has strong governance, raises the resources essential for its work, builds the capacity of its Member Associations to implement their programmes effectively, and monitors and evaluates its work at all levels. This chapter reviews work conducted during 2005 in the areas of these four supporting strategies to put the processes and systems in place to improve organizational effectiveness, to increase accountability, and to ensure that the goals and objectives of the Strategic Framework are achieved. This work ensures that Member Associations receive focused technical support to build their capacity in programme IPPF strives to provide development and implementation, sexual and reproductive monitoring and evaluation, health information resource mobilization, financial and services to the management, commodities, marginalized and communications, and in the under-served, such as this thematic areas of the Five A’s. Roma man from Bulgaria A financial review for 2005 is IPPF/Chloe Hall also presented in this chapter.

MANAGEMENT

ACCREDITATION AND GOVERNANCE GOAL IPPF PRACTICES GOOD GOVERNANCE THROUGHOUT THE FEDERATION AND IS MADE UP OF EFFECTIVE AND DEMOCRATIC MEMBER ASSOCIATIONS Objective 1 To promote and enhance the provision of equitable, efficient, and cost-effective governance at all levels in the Federation With current membership in 150 countries, IPPF’s Associations operate in a variety of political and cultural settings. Despite this diversity, IPPF believes that there are certain principles and practices concerned with good governance which are universal. In 2005, IPPF’s Secretariat increased support to the governing bodies of its Members Associations to raise their capacity and efficiency and to ensure that they are well equipped to meet future demands. The Western Hemisphere Regional Office developed a governance strategy for its Member Associations which includes clarifying the role of the trustees, developing systematic processes for selecting Executive Directors, supporting plans for the work of the governing bodies in relation to the Five A’s, and increasing the diversity and capacity of volunteers. The Regional Office prepared a number of case studies showing how the boards of some Associations have been successful in mobilizing resources, advocating on sexual and reproductive health and rights, establishing a good partnership with the Executive Director, involving young people, and creating diversity in its membership. The Africa Regional Office also provides support in the field of governance. In 2005,

IPPF Annual Performance Report 2005

BOX 6.1 ACCREDITATION AT WORK ■

Lesotho Planned Parenthood Association (LPPA), Lesotho

The accreditation visit to the Lesotho Planned Parenthood Association (LPPA) took place in November 2004. After the review visit, the Association reported that the process helped recognize the need for the board to be more involved in resource mobilization and advocacy. In particular, the accreditation process has helped strengthen the ability of LPPA to identify training needs in programme implementation. Technical assistance has since been provided, resulting in competent and motivated service providers and staff. In terms of governance, the accreditation review team recommended that a number of policies and procedures be developed to help volunteers and staff in their daily business. As a result, the LPPA has developed a set of policies and a schedule of regulations, and has streamlined roles and responsibilities of staff and volunteers. LPPA also established a volunteers’ orientation programme to help create strong partnership between volunteers and staff. The accreditation team recommended that LPPA improve documentation and record management at all levels of its organization, and LPPA began to develop various systems covering both governance and programme implementation. Nine months after the review visit, LPPA had implemented all the follow-up activities agreed with the review team, and in November 2005, LPPA became an accredited member of IPPF.

the boards of ten Member Associations in the region benefited from trainings designed to increase their capacity as trustees of their Associations and to clarify their roles and responsibilities. The Africa Regional Office has initiated a strategy for its Member Associations to recruit and retain volunteers and is developing guidelines on how this can be done in practice. An important part of this work is the emphasis given to recruiting people from a variety of backgrounds and with a diversity of skills of use to the African Member Associations.

Objective 2 To assure IPPF’s stakeholders of its commitment to maintaining high standards of constitutional integrity, programmes and services, governance, and management through periodic accreditation of Member Associations The accreditation system Member Associations advocate on behalf of

IPPF Annual Performance Report 2005

sexual and reproductive health and rights in their own countries and in their own ways, and yet they are united by core values, shared principles and policies, and a strong sense of solidarity. Each Association is committed to essential standards and the responsibilities that come with membership of the Federation. Accreditation is a tool for assessing and reviewing the work of Associations. It ensures that Member Associations adhere to the Federation’s mission and commitment to quality, effectiveness, and accountability. This allows universally-agreed principles to be embedded in the day-to-day culture, ethos, and activities of each Member Association. There are 65 essential standards that the Federation has a right to expect of each Member Association on their constitution, programmes and services, governance, and management. Once an Association is able to demonstrate that it meets all 65 standards, it is recommended to IPPF’s Governing Council for accreditation. Accreditation in 2005 By the end of 2005, mid-way through the first cycle of the accreditation system, a total of 71 reviews had been carried out. Twenty-five of these reviews took place in 2005. This included the Associations in Albania, Austria, Burkina Faso, Burundi, Chad, Chile, Comoros, Czech Republic, Democratic People’s Republic of Korea, Dominican Republic, Ethiopia, Guyana, Honduras, India, Iran, Kyrgyzstan, Moldova, New Zealand, Paraguay, Peru, Republic of Korea, Spain, Sri Lanka, Tanzania, and Turkey. At the time of the review, 75 per cent of the standards were upheld. The Member Association in New Zealand was the only Association that met all 65 Membership Standards at the time of the review, and was accredited in May 2005. Post-accreditation follow-up support In 2004, IPPF provided grants to Member Associations to address areas of weakness identified during their accreditation reviews. Fourteen applications for grants were approved between June 2005 and May 2006. Eight Associations (Austria, Burkina Faso, Burundi, Cameroon, Chad, Comoros, Rwanda, and Tanzania) organized a variety of workshops for staff and volunteers, covering topics such as advocacy, resource mobilization, strategic planning, and policy development to assist Associations in meeting IPPF standards. The Associations in Barbados, the Czech Republic, Madagascar, and Syria used the funds to develop key plans and policies to address areas of non-compliance. Funds were used by the Member Association in the Democratic People’s Republic of Korea to modify its constitutional amendments, and by the Member Association

Associations accredited A record number of Associations received accreditation in 2005. Eighteen of the 31 Associations that have attained accreditation did so in 2005. The following 11 Member Associations were accredited at the November 2005 Governing Council meeting: Albania, Bahrain, Denmark, Georgia, Lesotho, Malaysia, Mongolia, Poland, Sweden, Tunisia, and Uzbekistan. The trend looks set to continue as a further eight Associations were accredited at the May 2006 Governing Council meeting: Honduras, Iran, Jamaica, Kenya, Maldives, Paraguay, Sri Lanka, and Suriname. This means that 44 per cent of the Member Associations reviewed thus far have been accredited.

RESOURCE MOBILIZATION GOAL IPPF HAS A SUSTAINABLE AND DIVERSIFIED INCOME AT ALL LEVELS Aid flows and sexual and reproductive health in 2005 Overall spending on population assistance, including reproductive health, sexual health, HIV and AIDS, family planning, research, and development has increased significantly in the past five years. Donor assistance for population, which came to US$2.6 billion in 2000, increased to an estimated US$5.3 billion in 2004, and is estimated to have further increased to US$6.1 billion in 2005.1 These are significant increases and are proportionally greater than official development assistance (ODA) spending increases. However, when population assistance is broken down, it is revealed that the majority

MANAGEMENT

in Syria to revise its policy handbook and to develop personnel policies, financial systems and procedures, and an internal control system.

IPPFâ&#x20AC;&#x2122;s accreditation process ensures that young people are involved in governance and sexual and reproductive health programming IPPF/Christian Schwetz

IPPF Annual Performance Report 2005

of this funding – up to 60 per cent – is targeted at HIV and AIDS, with reproductive health and family planning receiving only 25 per cent and 10 per cent of funding respectively (Figure 6.2).2 This means that there have been impressive increases in funding for HIV and AIDS, but funding has decreased for reproductive health and family planning.

In 2005, ODA/GNI still lies at 0.3 per cent for the member countries of the Organization for Economic Co-operation and Development’s Development Assistance Committee (DAC). However, this masks an absolute increase in ODA to developing countries from DAC member countries with funds rising to a record high of US$106.5 billion in 2005.5 The relative success of many EU countries in achieving 0.3 per cent has stimulated agreement on a new target of 5.1 per cent by 2010 for these countries.

Government spending Since the Millennium Summit, international development funding mechanisms and targets have been included on the agenda of international forums. At the Monterrey Conference in March 2002, representatives from 178 states and numerous international institutions drew up a consensus on ‘Financing for development’. They defended the commitments made by EU countries at the Barcelona European Council, and called for: ● an increase in average ODA from the European Union from 0.3 per cent of gross national income (GNI) in 2002 to 0.4 per cent by 2006, a step toward the 0.7 per cent target set by the United Nations ● improvement in aid effectiveness through better coordination and harmonization ● efforts to restore debt sustainability in the context of the enhanced Heavily Indebted Poor Countries (HIPC) initiative 3

Other sexual and reproductive health funding Funding from the major US charitable foundations and trusts for sexual and reproductive health reached a low of US$329.5 million in 2004. The steady decline since 2001 has been attributed to difficult investment conditions, such as the stock market downturn in the early 2000s, affecting the amount of money that larger foundations are able to distribute. A concern is that just a few foundations provide the majority of the funds for population activities. The top five US foundations provided over 70 per cent of the total donated in 2004 6 (Table 6.3), and they continue to make an invaluable contribution to sexual and reproductive health activities and to IPPF. Previous experience has shown that the priorities of grant-making foundations can change, and if this were to happen among one of the top five, the sexual and reproductive health community would experience severe and adverse effects.

The consensus strongly encouraged developed countries to follow the example set by the EU countries of achieving the 0.7 per cent ODA/GNI. It also pushed for the harmonization of aid, promoted international trade as an engine for development, and supported reforms of international finance systems.

Recent developments in funding In 2005, commitment to the ‘Paris Declaration on Aid Effectiveness’ 7 was reaffirmed by 91 countries and donor organizations, and at a country level,

Figure 6.2 Donor population assistance by category, 1995 to 2004 4 80% 70% 60% 50% 40% 30% 20% 10%

Family planning

IPPF Annual Performance Report 2005

Reproductive health

HIV/AIDS

Basic research

2004

2003

2002

2001

2000

1999

1998

1997

1996

1995

Rank Foundation 1 Bill and Melinda Gates Foundation 2 Ford Foundation 3 William and Flora Hewlett Foundation 4 David and Lucile Packard Foundation 5 John D. and Catherine T. MacArthur Foundation Total donated by ALL foundations

efforts will be made to harmonize funding mechanisms and avoid duplication of activities, thus helping to increase the effectiveness of the aid provided. In addition to this, the declaration reaffirmed the focus on providing budgetary support to recipient countries, and it is likely that the predicted increase in ODA will be channelled through governments and institutions in recipient nations, and not through donor country capitals. 2005 also saw the signing of the ‘European Consensus on Development’ by EU members and the European Commission. This will provide a framework of objectives, values, and principles to guide the provision of development assistance by the EU. Sexual and reproductive health was referred to twice in the consensus, the second reference offering full support for the promotion of sexual and reproductive health and rights and the linkage of sexual and reproductive health with HIV and AIDS. Despite the clear support for sexual and reproductive health on a policy level and an increase year on year in ODA, we can see from our analysis of funding streams that this support is not being translated into financial backing for sexual and reproductive health, with the obvious exception of HIV and AIDS. Additionally, many countries are including debt relief, housing of refugees, and educating foreign students in their calculation of ODA. In fact, when these components are taken into account, the assistance given by some European countries is significantly less than gross figures suggest.9 A significant proportion of ODA, US$22.9 billion, came in the form of debt relief. However, the overall ODA net of inflated figures still represents an 8.7 per cent increase on 2004.10

Funding (in million US$) 122.0 38.6 35.0 31.7 13.8 329.5

MANAGEMENT

Table 6.3 Top five foundations supporting sexual and reproductive health, 2004

overall national budget year on year, and the unexpected decrease in the contribution from the government of Sweden. In early 2006, the governments of Norway and Sweden commissioned an evaluation of IPPF which focused on the relevance, effectiveness, and extent to which IPPF’s Member Associations in Bangladesh, Ethiopia, and Uganda are meeting the needs of poor and marginalized people. We anticipate that the results of this evaluation will form the basis of multi-year funding agreements with the governments of Norway and Sweden. It is reassuring to note that during 2005, IPPF received increased contributions from the governments of Australia, Finland, Germany, New Zealand, and the Hewlett Foundation, while the government of Canada announced its first-ever multi-year agreement with IPPF. In 2006, an increase from the government of the United Kingdom will ensure the continued, sound financial viability of the Federation.

Figure 6.4 Unrestricted contribution per donor, 2005

44 5 17 16

% 9

10 5 21

Objective 1 To increase overall income to the Federation In 2005, there was a modest decrease in IPPF’s overall income from US$96.4 million to US$92.9 million (-3.6 per cent), the result of a decrease in unrestricted funding received from donor governments. This is disappointing given high donor confidence in IPPF and increases in non-governmental and restricted governmental funding, and the decrease is attributed to the continuing difficult funding environment in Japan where tight fiscal policy has decreased the

Australia

Norway

Canada

Sweden

Denmark

United Kingdom

Germany

Other countries *

Japan

Hewlett Foundation

The Netherlands

* Others include: governments of Barbados, China, Finland, Malaysia, New Zealand, Pakistan, the Republic of Korea, Switzerland, and Thailand.

IPPF Annual Performance Report 2005

Effective capacity building changes the way an organization works by installing new systems, encouraging innovative practices, setting up new activities and approaches, and challenging prevailing values.

Objective 2 To diversify income sources at all levels In 2005, IPPF’s funding base expanded to include a wider and more diverse range of donors. Increased funding from existing donor governments and private foundations, combined with securing restricted funding for the first time from the government of the Republic of Korea and a number of US-based foundations, have all assisted IPPF in reducing its dependence on a limited number of supportive governments. In the longer term, negotiations commenced with existing and new donor governments and foundations, and it is envisaged that a number of these will come to fruition in 2006.

Objective 3 To increase the capacity of staff and volunteers in resource mobilization at all levels of the Federation In the long term, the changing funding paradigm that occurs when funding is increasingly directed via bilateral mechanisms to the country level will place pressure on funding to IPPF. In 2005, IPPF supported the implementation of a five-day ‘Resource mobilization and fundraising’ workshop in Nairobi. The workshop focused on increasing the capacity of Member Associations to develop and implement resource mobilization strategic plans. Representatives from IPPF’s Africa Regional Office and staff from eight African Member Associations attended the workshop. In 2005, IPPF finalized a training curriculum for Member Associations on building a comprehensive resource mobilization programme. This curriculum was piloted at a South Asia regional training session in September 2005. Based on the feedback and outcomes, the curriculum will be broken into a number of standalone sections that together form a toolkit that can be used by staff at Member Associations. This, combined with training and support, will provide a platform from which Member Associations can increase their knowledge and skills so that they are better equipped to engage in the new funding environment that is devolving decision making to the national level.

IPPF Annual Performance Report 2005

CAPACITY BUILDING GOAL IPPF HAS THE CAPACITY TO EFFECTIVELY IMPLEMENT THE STRATEGIC FRAMEWORK Capacity building is the development of IPPF’s core skills to enable organizations and individuals to increase effectiveness, to address weaknesses, and to bring about change. Increased effectiveness will enable optimum performance in the focus areas of our Strategic Framework and more sustainable services will be an outcome of the process. Increasing access to high quality medical and technical information is an important element of capacity building within the Federation. IPPF’s Central Office provides quality materials for the Regional Offices and Member Associations, including a ‘Resource Bank’ CD-ROM, which contains all our recent publications and is being distributed around the world. The translation and production of IPPF’s ‘Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services’ in Arabic, French, and Spanish were major activites in 2005. The Federation printed and disseminated 4,000 Spanish, 2,000 French and 1,000 Arabic copies to Regional Offices, Member Associations, and other organizations and individuals. The Guidelines offer up-to-date, evidence-based guidance on all aspects of sexual and reproductive health care service delivery. They include information on contraceptive methods, sexually transmitted infections, HIV and AIDS, emergency contraception, safe abortion, counselling, and infection prevention and control. Another important technical resource is the ‘IPPF Medical Bulletin’, IPPF’s long-running quarterly publication that provides medical guidance and updates on sexual and reproductive health issues. In 2005, IPPF distributed approximately 30,000 English, 6,000 French, and 8,300 Spanish copies to Regional Offices, Member Associations, and other organizations and individuals in more than 190 countries. The Central Office Abortion Team sends out weekly abortion abstracts to the Federation and other interested parties on the latest news and research relating to abortion. Since this initiative began in September 2004, IPPF has received much positive feedback that has led to valuable discussions on abortion and has contributed to the knowledge and understanding of abortionrelated issues.

Objective 1 To ensure that Regional Offices have the information and support they need to enable them to become hubs of capacity building within the Federation Capacity building is fundamentally about change and the transformation of both the individual and

MANAGEMENT This woman from Mauritania attends an educational session held in the home of a volunteer from our Member Association IPPF/Chloe Hall

the organization. Effective capacity building changes the way an organization works by installing new systems, encouraging innovative practices, setting up new activities and approaches, and challenging prevailing values. One example is the ‘Winds of change’ initiative, a capacity building programme that promotes a rights-based approach to young people’s sexual and reproductive health. This initiative was started in May 2005 by the Arab World Regional Office with the principal aim of strengthening the capacity of staff and young volunteers across the region to rejuvenate youth programmes, keeping in mind IPPF’s strategic focus of increasing quality and meeting the needs of the under-served. The objectives of the initiative were: ● to establish a pool of young volunteers and adults with skills and expertise on implementing a rights-based approach to young people’s sexual and reproductive health ● to share experiences in developing strategies and implementing youth sexual and reproductive health and rights programmes ● to identify innovative means of strengthening youth sexual and reproductive health and rights activities with the region’s Member Associations

The strategy for building regional capacity to adopt a rights-based approach to youth sexual and reproductive health was developed and will be implemented entirely through a partnership between young people from the Arab World Region and staff from the Regional and Central Offices. This partnership ensures that the strategy reflects the realities of the Arab World Region and that the lessons learned from youth-related initiatives across the Federation are shared. It has also reflected an institutionalization of meaningful youth participation which is a fundamental principle of IPPF’s youth policy. A preparatory meeting was held in October with young people from the region and staff from the Regional and Central Offices to further develop the capacity building strategy. An easy-to-use facilitators’ guide on rights-based programming for young people’s sexual and reproductive health is now available in English and Arabic, and it is expected that similar ‘Winds of change’ initiatives will be conducted across the Federation.

Objective 2 To build and upgrade skills to achieve IPPF’s strategic goals IPPF has been at the forefront of efforts to ensure that a comprehensive response to HIV is situated

IPPF Annual Performance Report 2005

how to address the specific sexual and reproductive health needs of populations uniquely vulnerable to HIV: sex workers, injecting drug users, and men who have sex with men. The workshop was hosted in the East and South East Asia and Oceania Region by the Member Association in Cambodia and provided an opportunity to reflect on many of these questions. Sharing both our accomplishments and challenges, while also providing technical updates on the latest HIV and AIDS trends and issues, ensures that the process of building HIV and AIDS competency becomes a reality for the Federation.

Objective 3 To improve successful existing working models of capacity building

Our Member Association in Ghana holds a training session for peer educators on sexual and reproductive health and rights IPPF/Dale Cooper

within a larger sexual and reproductive health framework. IPPF’s work is part of a coherent global response to HIV and AIDS that links prevention with care and treatment and responds to the unique regional and national characteristics of the epidemic. A primary aspect of this commitment is to ensure that the capacity of Regional Offices and Member Associations is increased to ensure that work done at each level is of the highest calibre. In 2004, the first HIV and AIDS competency workshop was held in London. Since then these workshops have offered a valuable opportunity for staff from across the Federation to meet, share ideas, and learn about the latest developments in the global response to HIV. In 2004, the workshop focused on mainstreaming HIV into our sexual and reproductive health agenda. In 2005, the focus of the workshop was on human rights and vulnerability to HIV, and

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IPPF Annual Performance Report 2005

Improving existing working models for service providers and Member Association staff is a key strategy within IPPF’s ‘Strengthening the Quality of Reproductive Health Care’ programme. Within this initiative, training sessions are designed to pass on specific knowledge in key technical areas, such as quality of care and infection prevention, as well as new skills in training and facilitation techniques. Ultimately, the aim is to enable Member Association and clinic staff to become local experts in these areas. The training methodology follows the ‘cascade model’, whereby core groups are instructed in functional skills and these ‘master trainers’ then train more staff. Typically, the process begins with interregional training and then cascades to regional and in-country levels. In 2005, training was provided on the ‘Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services’, counselling and inter-personal communication, sexually transmitted infections, and HIV and AIDS. This included one inter-regional, four regional, and 14 in-country trainings. These sessions trained more than 145 participants on the IPPF ‘Medical and Service Delivery Guidelines for Sexual and Reproductive Health Services’, 282 participants in counselling and inter-personal communication skills, and 256 participants in sexually transmitted infections and HIV and AIDS. As a result of these trainings, Regional Offices and Member Associations have increased their training capacity and skills in important technical areas. A number of Associations have begun offering similar trainings to local partner organizations, including ministry of health service centres. In the Western Hemisphere Region, Associations trained through the programme have developed a South-to-South technical assistance strategy that has become the model for expanding quality of care to new Associations in that region.

GOAL IPPF HAS A KNOWLEDGE CULTURE AND INFRASTRUCTURE WHICH IDENTIFIES, CREATES, CAPTURES, SHARES, AND USES INFORMATION AND EXPERIENCES Objective 1 To ensure systematic and meaningful monitoring and evaluation of IPPF’s programmes The most important work of IPPF takes place at the country level where Member Associations influence their governments and serve their clients through the implementation of sexual and reproductive health and rights programmes. IPPF’s Strategic Framework sets out IPPF’s plans for the next ten years, and refocuses the Federation’s direction and goals on its five strategic priorities, the Five A’s. This Framework is now being implemented across the global network, and there is a need to monitor progress and measure performance to increase accountability to those we serve and to those who support our work, to understand what works well and not so well, and to continuously improve what we do. The approval in May 2006 of a revised policy on monitoring, evaluation, and learning by IPPF’s highest decision making body, the Governing Council, is an important step forward in developing a results-based culture throughout the Federation, and paves the way for the IPPF Secretariat to provide Member Associations with focused technical support and training in these areas in the future.

cent of IPPF’s Member Associations completed the online survey and 63.5 per cent provided service statistics that make up the global indicators data for 2005. These results provide IPPF with baseline data against which IPPF’s progress in implementing the Strategic Framework will be monitored. The results of the global indicators survey are discussed at Regional and Governing Councils, and are presented in IPPF’s Annual Performance Report every year. There are a number of global indicators which are based on service statistics data, and work is underway to build capacity throughout the Federation to collect data on services. The data are now collected online from Member Associations and analyzed both regionally and globally. Training is being provided to both Regional Office and Member Association staff to increase the quality and quantity of data collected on the provision of both contraceptive and non-contraceptive sexual and reproductive health services.

Secretariat evaluation focal point group In 2005, IPPF established a Secretariat-wide evaluation focal point group. This group is composed of dedicated evaluation staff from each of IPPF’s six Regional Offices and the Central Office. The group meets twice a year and communicates regularly through an online forum to share knowledge and best practice in the field of monitoring, evaluation, and learning. A quarterly publication entitled ‘e-learning’ has been produced and disseminated throughout IPPF to share resources, tools, and good practices on monitoring, evaluation, and learning. Data collection and analysis of IPPF’s global indicators In 2005, IPPF started collecting data from Member Associations in relation to 30 global indicators on adolescents, HIV and AIDS, abortion, access, and advocacy. Eighty-four per

MANAGEMENT

MONITORING AND EVALUATION, INCLUDING KNOWLEDGE MANAGEMENT

Our Member Association in Dominica educates young people about the importance of accessing sexual and reproductive health information and services IPPF/Philip Wolmuth

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BOX 6.5 INSTITUTIONALIZING MONITORING AND EVALUATION ■ European

Network Regional Office

One of the key aspects of the European Network Regional Office’s mission is to support Member Associations in the implementation of their strategic plans to ensure achievement of their objectives. This is done by providing both technical and financial assistance to Member Associations. The Regional Office has recently undertaken a review of the support it provides to its Member Associations to ensure that the latter is both effective and efficient, and truly builds capacity. IPPF’s newly revised policy on monitoring and evaluation highlights the key principles and commitments that guide both volunteers and staff. IPPF is currently giving high priority to capacity building in monitoring and evaluation across the Federation to ensure that Member Associations have the information and systems they need to monitor progress and make sound programme and management decisions. Strengthened monitoring, evaluation, and learning from our programmes will also increase accountability to the clients that we serve, and the partners and donors who support our work. Within this context, the Regional Office has initiated a multi-year project entitled ‘Institutionalizing monitoring and evaluation systems, processes and tools in the European Network’. Its main objective is to build the capacities of both Regional Office staff and Member Associations in programme monitoring and evaluation through training, monitoring visits, project development, and technical support. The project will introduce strong monitoring and evaluation systems in both the European Network Regional Office and its 13 grant-receiving Member Associations. It will contribute to ensuring programme effectiveness and will promote an organizational learning culture throughout the region. The project is being implemented in several phases. The first phase has involved developing monitoring tools and building the capacity of the

Objective 2 To improve systematic approaches and processes for making decisions using the full knowledge base available IPPF’s electronic Integrated Management System Implemented in 2000, the electronic Integrated Management System (eIMS) provides IPPF with a results-based management tool that supports the Federation’s complex planning and reporting

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Regional Office staff in participatory monitoring and evaluation. The next phase will be to build capacity of the Member Associations in monitoring and evaluation and provide them with tools to conduct self-evaluation. The third phase will be to sustain participatory monitoring and evaluation at the Regional Office and Member Associations levels. The first stage of the project involved developing monitoring tools that include general monitoring questions on strategic planning, programme implementation and organizational development, and specific thematic questions based on each of IPPF’s five priority areas. Regional Office staff received training in monitoring and evaluation, and they then conducted monitoring missions to ten Member Associations to assess progress in implementing their strategic plans and annual programme budgets. A participatory methodology was used, based on discussions with the Member Association staff and volunteers, meetings with partners and primary stakeholders, and field visits. The general monitoring questions facilitated the collection of information on strategic orientation, project development (design, implementation, and participation of primary stakeholders), lessons learnt from restricted projects, planning, management, monitoring and evaluation, financial systems, resource mobilization, and organizational development. Data collected through the monitoring missions have also been used to assess the technical assistance needs of Member Associations, and to inform resource allocation. To compare and analyze the results of the missions, the Regional Office monitoring team developed criteria and a scoring system, and after thorough review of the mission reports, the team assessed each Member Association according to the following criteria: ● strategic plan indicates that the Member Association has a strategic plan based on the Five A’s with a good situation analysis

requirements and that promotes knowledge sharing across IPPF’s global network. In addition to ongoing training support on the eIMS that was provided to Member Associations, several planned modules were implemented in 2005, including: Commodities module Based on stock levels and historic consumption data, this module provides Member Associations with a tool to plan commodity requirements for their clinics. In 2005, the system was tested in the Western

developed using adequate information sources, clearly defined vulnerable groups, and strategic partnerships; the plan needs to be appropriate to the country situation and to build on the Member Association’s comparative advantage in the country ● progress in implementing Annual Programme Budgets indicates that project objectives are relevant to the situation analysis, that suitable strategies are used to achieve project objectives, that primary stakeholders are involved in the project development and implementation, and that the anticipated project outputs for each of the Five A’s are achieved ● knowledge management indicates that the Member Association has systematic quantitative and narrative reporting at all levels, that functioning monitoring and evaluation systems are in place, and that lessons learned are used in decision making ● resource allocation and mobilization indicates that the Member Association has funding from restricted and other donor sources, that resources are allocated in a balanced way among the Five A’s, and that a fundraising strategy is in place ● branch development shows that the Member Association has a clearly defined branch development strategy ● capacity indicates that the Member Association has sound capacity in monitoring and evaluation, in each of the Five A’s, and in project development The monitoring team conducted a comparative analysis of the results, and these were crosschecked with data from the global indicators survey and accreditation reviews and shared with the Member Associations. Participatory monitoring using standardized monitoring tools and a scoring system is a new experience for the Regional Office, and has made it possible to conduct a comprehensive and systematic review of the Member Associations’ programme performance and use of resources.

Hemisphere and Africa Regions and used for annual programme budgeting for 2006. Service statistics module Data on IPPF’s 30 global performance indicators are collected through an online survey (22 indicators) and the service statistics module (eight indicators). This module was finalized in 2005 and used for the data collection cycle in early 2006. System reports have been developed to support data analysis at global, regional, and national levels,

Travel and events module This is currently being used by Central Office and Western Hemisphere Regional Office staff to assist in planning, sharing, and reporting on duty trips. In addition, the Western Hemisphere Region successfully implemented the events sub-module that effectively manages trips, meetings, and conferences by linking itineraries and group travel. Training on the travel module is planned for other regions in 2006.

MANAGEMENT

and information on the global indicators is currently one of the Federation’s most important resources.

To ensure sustainability of the eIMS system in the future, IPPF implemented an exciting initiative in collaboration with other organizations. The NonProfit Organization Knowledge Initiative (NPOKI) was formed to assess the feasibility of developing a generic, next-generation integrated management system that would be a freely available and accessible worldwide system to meet the information management needs of more than one organization. The system would support programme and financial reporting in multiple organizations working in the sexual and reproductive sector, including donors, and avoid duplicating the expenditure and human resources involved in developing customized systems for each individual organization. In addition, it would benefit from its various members by providing a range of donor and grantee reports that suit the needs of all parties by setting reporting standards and data exchange protocols.

Objective 3 To strengthen the capacity of IPPF by developing a culture of trust, openness, sharing, and learning Raising the profile of organizational learning in IPPF To achieve the objectives in the Strategic Framework, IPPF recognizes the importance of learning from its own experience and from the experience of others, and of using its accumulated knowledge to strengthen its capacity. IPPF worked with a leading expert in the field of organizational learning to conduct a review of our approach to organizational learning. The conclusions from the study resulted in recommendations that will contribute to the development of IPPF’s organizational learning strategy. The review allowed IPPF to identify areas where the Federation is successful in promoting organizational learning, and others where this has been less successful. The organizational learning strategy will be completed in March 2007, following an extensive consultative process.

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The Innovation Fund The goal of the Innovation Fund is to foster, pilot, and promote ground-breaking initiatives in support of IPPF’s strategic priorities that enhance learning and contribute to the increased relevance and effectiveness of sexual and reproductive health programmes throughout the Federation and beyond. The launch of the Innovation Fund in May 2005 resulted in a strong interest from Member Associations with 88 concept papers received in the first two calls for proposals. The concept papers were reviewed by a technical committee, and selection criteria focused on the innovative nature, the potential for learning, and the technical strength of the concept. Twenty concept papers were selected for funding and are currently being developed and approved as full project proposals. Nine projects have begun implementation in 2006, and a further 11 are expected to start in 2007. Projects were submitted around three themes: addressing diversity among young people, the provision of anti-retrovirals (ARVs), and abortion (either advocacy or the provision of abortion-related services). The use of these specific themes encouraged Member Associations to adapt cutting-edge issues identified at the global level to their local context. In addition, ‘wild card’ submissions on any of IPPF’s strategic priority areas resulted in a variety of innovative concept papers from Member Associations. Examples of the projects selected include advocating for greater access to abortion in Portugal, working with gay, lesbian, bisexual and transgender youth in Venezuela, providing ARVs

in Kenya and India, working to end child marriage in Ethiopia, and increasing access to services for the prevention of mother to child transmission (MTCT) of HIV in Burkina Faso. An example of a project supported by the Innovation Fund in Tunisia is summarized in Box 6.6. In the first year of operation, the Fund identified interesting lessons for IPPF. The volume and range of concept papers received reflects the diversity and creativity of IPPF’s Member Associations. However, the variable quality of the proposals also highlights the need to strengthen capacity in programme development, especially in issues such as sexual diversity, and gender and rights.

FINANCIAL REVIEW IPPF’s income The overall income received by IPPF in 2005 was US$92.9 million. Compared with the previous year there was a small decrease of 3.6 per cent (Table 6.7). However, since 2000 our income has increased by 27 per cent from US$73.1 million. IPPF’s main source of funding is government contributions which account for 74 per cent of its overall income. Unrestricted government grants dropped by five per cent due to a small decrease in the support of two large donors, the governments of Japan and Sweden. These decreases were slightly offset by the further weakening of the US dollar against European currencies which increased the value of local currency contributions. Restricted government grants increased from US$2.6 million to US$4 million. The Japanese

BOX 6.6 WORKING WITH VISUALLY CHALLENGED YOUTH ■

Association Tunisienne de la Santé de la Reproduction (ATSR), Tunisia

The purpose of this project is to fulfil the rights of visually challenged young people in Tunisia by providing access to sexual and reproductive health information and services. The Member Association in Tunisia, Association Tunisienne de la Santé de la Reproduction (ATSR), will work with the National Union of Blind People of Tunisia to integrate sexual and reproductive health into centres that currently provide social, educational, and economic development activities for visually challenged youth. This marks the first time that ATPF will address the specific sexual and reproductive health needs of young people with disabilities. Sexual and reproductive health information

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will be provided through ‘corners’ at each of the centres where young people can access specially developed IEC materials in Braille and through the internet. Visually challenged young people will be trained as peer educators to provide education on sexual and reproductive health and rights, and sexual and reproductive health services will be available through specially trained service providers. Participation of the target group is a key aspect of the programme, and visually challenged youth will be involved in needs assessment, proposal development, IEC material development, monitoring and evaluation, and governance of this project.

2003 US$000

2004 US$000

2005 US$000

60,524 7,562 3,308

68,542 8,489 4,737

64,994 6,448 2,650

2,914 12,442 295 87,045

2,609 11,786 239 96,402

4,006 14,615 227 92,940

Unrestricted Government Multilaterals, etc. Other Restricted Government Multilaterals, etc. Other Total ▲

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Table 6.7 Summary of income, 2003 to 2005 ▲

Source: IPPF Financial Statements 2003, 2004, 2005.

government provided a further US$1 million for the HIV and AIDS Trust Fund, and the Danish government provided US$850,000 to pilot capacity building initiatives. The government of the Republic of Korea also generously supported our tsunami response with a dedicated grant of US$500,000. Grants from multilaterals and other income sources amounted to US$21.1 million, an increase of US$800,000. The support of a number of US foundations which provide unrestricted funding along with support from the European Commission, the UK Big Lottery Fund,

UNFPA, and income raised by the IPPF private sector fundraising programme from the general public have allowed IPPF to diversify funding and support a number of innovative projects.

IPPF’s expenditure The overall expenditure in 2005 was US$95.8 million (Table 6.8); the previous year’s overall expenditure was US$82.2 million. Grants to Member Associations increased by 25 per cent to US$56.3 million (Table 6.9) due to an increase in unrestricted grants by 16 per cent, from $37.3 million to U$43.1 million. Restricted grant

Table 6.8 Summary of expenditure, 2003 to 2005 ▲

Grants to Member Associations and partners Programme activities Programme support Support costs Fundraising Governance* Trading company Total ▲

2003 US$000 41,772 12,705 4,297 13,475 1,524 1,075 74,848

2004 US$000 45,226 13,699 6,913 10,652 2,257 1,610 1,900 82,257

2005 US$000 56,358 10,986 6,724 14,629 2,558 2,285 2,314 95,854

Source: IPPF Financial Statements 2003, 2004, 2005.

* The definitions for expenditure were updated from 2004. Governance costs in 2003 are included within support costs.

Table 6.9 IPPF grant funding per region, 2003 to 2005 ▲

Africa Arab World East and South East Asia and Oceania Europe South Asia Western Hemisphere Total ▲

2003 US$000 15,944 3,352 5,389 1,629 6,986 8,472 41,772

2004 US$000 16,989 4,370 6,121 1,627 6,598 9,521 45,226

2005 US$000 20,790 5,343 6,781 3,946 8,850 10,648 56,358

Source: IPPF Financial Statements 2003, 2004, 2005.

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Table 6.10 Commodity grants by type, 2005 US 1,444,573 6,130 264,325 77,720 63,688 850,929 2,655 125,276 327,647 45,934 257,574 606,549 312,038 4,385,038

Oral contraceptives Diaphragms Condoms Spermicides IUDs Injectable contraceptives Emergency contraceptives Implantable contraceptives Medical and clinical equipment and consumables Audio-visual equipment Office equipment Vehicles Freight, handling, etc. TOTAL

Figure 6.11 Commodity grants by type, 2005

7 14 6

6 19

Oral contraceptives

Office equipment

Condoms

Vehicles

Injectable contraceptives

Freight, handling, etc.

Implantable contraceptives

Other (including diaphragms, emergency contraceptives, audio-visual equipment, IUDs, and spermicides)

Medical and clinical equipment and consumables

expenditure increased by 67 per cent, from US$7.9 million to $13.2 million. Restricted expenditure was greater than income received in 2005 reflecting multi-year agreements where funding is received at the start of a project with expenditure continuing for a number of subsequent years. IPPF provided nearly US$4.4 million in commodities to Member Associations as part of their grant allocation (Table 6.10 and Figure 6.11). Grants to Member Associations and partners can be classified according to the UNFPA country methodology which IPPF used as part of its resource allocation model up to 2004. In 2005, IPPF allocated 91.1 per cent of unrestricted funding to category A and B countries (Table 6.12). The allocation of funding to countries classified as â&#x20AC;&#x2DC;in transitionâ&#x20AC;&#x2122; increased in 2005, reflecting a revision to the resource allocation model and a need to provide additional funds to eastern European countries in particular. This ensures that IPPF fulfils its mission to meet the needs of people living in the poorest countries.

Table 6.12 Percentage of resource allocation to Member Associations by UN category, 2001 to 2005 Country classification A Highest need B High need C Low need O Other T In transition Total

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IPPF Annual Performance Report 2005

2001 67.0 26.0 3.6 1.4 1.9 100

2002 67.0 27.1 2.7 0.7 2.5 100

2003 64.4 29.5 3.0 0.7 2.3 100

2004 64.2 30.9 2.4 1.4 1.2 100

2005 64.3 26.8 2.6 1.4 4.9 100

42,021

Figure 6.14 Percentage of total income by region, 2005

56,357

4 2

264,364

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Figure 6.13 Actual total Member Association income in US$000, 2005

165,986

Grant from IPPF

Africa

Local income

Arab World

International income

European Network South Asia East and South East Asia and Oceania Western Hemisphere

Member Association income The IPPF financial results do not include the income and expenditure of the individual Member Associations. Full details of IPPF’s 2005 financial results are provided in a separate document entitled ‘IPPF Financial Statements 2005’. These have been prepared according to UK accounting standards and are in compliance

with the UK Charity Commission accounting requirements. The financial statements were audited by KPMG LLP who provided an unqualified audit opinion (clean opinion) on 12 May 2006. Figure 6.13 illustrates the actual total Member Association income for 2005, and Figure 6.14 presents the percentage of total

Our Member Association in India encourages young people to advocate for their right to sexual and reproductive health information and services IPPF/Peter Caton

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income by region for 2005. (Annex B presents a summary of grant-receiving Member Association income comprising IPPF, local, and international sources.) IPPFâ&#x20AC;&#x2122;s total income has increased over the last five years from US$215.6 million to US$264.4 million, or by 23 per cent. Regional comparisons show considerable differences among Member Associations in terms of relying on IPPF for the majority of their funding. IPPF encourages self-sufficiency and diversity of income sources but also recognizes that in meeting the needs of the poorest of the poor and working with marginalized groups, it is not always possible to achieve this whilst providing free services.

The internal audit function (controls assurance)

IPPF implements programmes that address the essential role of men in the promotion of sexual and reproductive health IPPF/Chloe Hall

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The aim of the audit function is to evaluate and provide independent, objective assurance on the effectiveness of risk management, control, and governance processes in IPPF. It also provides consulting services designed to add value by recommending changes to improve control, value for money, and organizational effectiveness. Authority and independence are key requirements if the function is to meet its objective. These are set out in the IPPF Regulations and Audit Committee terms of reference. The scope of the internal audit function is concentrated on, but not limited to, the work of IPPFâ&#x20AC;&#x2122;s Secretariat. It considers all controls within IPPF, not just financial controls, as well as risk management and governance. The function uses risk assessment to determine the critical areas for carrying out its own reviews but also draws on the work of other assurance providers such as the IPPF accreditation system, external auditors, management reports and self-assessments, external regulators, and audit activity in the Secretariat and Member Associations.

In 2005, IPPF implemented a number of initiatives within each of its four supporting strategies of accreditation and governance, resource mobilization, capacity building, and monitoring and evaluation. All of these contribute significantly to effective management systems that ensure IPPF remains accountable and support Member Associations to implement successful programmes that meet the sexual and reproductive health needs of millions of people around the world. In accreditation and governance, a record number of Associations were accredited in 2005, and to date, 44 per cent of IPPF’s Member Associations have been accredited. IPPF’s Secretariat also increased support to the governing bodies of its Members Associations to raise their capacity and efficiency and to ensure that they are well equipped to meet future demands. IPPF’s resource mobilization has involved diversifying and expanding its funding base to ensure sustainability of IPPF’s programmes and to minimize the negative effects on its clients of a difficult global funding environment for sexual and reproductive health. IPPF has also built capacity to increase both effectiveness and

sustainability, and in 2005, focused on building Member Association skills in programme development, quality of care, advocacy, and in the technical areas of the Five A’s. IPPF’s electronic Integrated Management System continues to be strengthened with several new modules implemented in 2005. The approval in May 2006 of a revised policy on monitoring, evaluation, and learning by IPPF’s highest decision making body, the Governing Council, is another important step forward in developing a resultsbased culture throughout the Federation, and paves the way for the IPPF Secretariat to provide Member Associations with focused technical support and training in these areas in the future. Finally in 2005, IPPF began collecting data from Member Associations in relation to 30 global indicators on adolescents, HIV and AIDS, abortion, access, and advocacy. These results have been presented in this Annual Performance Report and provide IPPF with baseline data against which IPPF’s progress in implementing the Strategic Framework will be monitored in the future.

MANAGEMENT

CONCLUSIONS

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GLOBAL INDICATORS

ANNEX A Global indicators

Table A.1 Online survey response rate, 2005

Table A.2 Service statistics module response rate, 2005 Table A.3 Summary of adolescents indicators, 2005 Table A.4 Summary of HIV and AIDS indicators, 2005 Table A.5 Summary of abortion indicators, 2005 Table A.6 Summary of access indicators, 2005 Table A.7 Summary of advocacy indicators, 2005 Table A.8 Number of non-family planning sexual and reproductive health services provided by region and service type, 2005 Table A.9 Number of family planning services provided by region and method, 2005 Table A.10 Couple years of protection (CYP) provided by region and method, 2005

Table A.11 Number of Member Association service delivery points by region, 2005 IPPF improves the health and well-being of mothers and their children by providing sexual and reproductive health services in its clinics around the world IPPF/Chloe Hall

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Table A.1 Online survey response rate, 2005 Region

Total number of Member Associations

Complete response

No response/ incomplete response

% response rate

77%

AWR

86%

78%

ESEAOR

85%

SAR

100%

WHR

97%

84%

Total number of Member Associations that provide services

Number of Member Associations that provided service statistic data

% response rate

76%

AWR

82%

EN*

ESEAOR

74%

SAR

100%

WHR

89%

TOTAL

▲

150*

126

* The Member Association of Cuba was not included in this survey. ▲

Of these Member Associations, 14 do not receive income from IPPF.

Table A.2 Service statistics module response rate, 2005 Region

TOTAL

137

▲

64%

* Two grant-receiving Member Associations in the European Network provided information on service statistics for the first time in 2005. More European Members Associations will provide service statistics data in the future. ▲ Of

these Member Associations, one does not receive income from IPPF.

Table A.3 Summary of adolescents indicators, 2005 (n = number of Member Associations that provided data)* Indicator

AWR

23.3%

16.7%

(n=30)

(n=12)

4.1%

4.3%

(n=30)

(n=12)

Proportion of Member Associations providing sexuality information and education to young people

93.3%

83.3%

(n=30)

(n=12)

Proportion of Member Associations providing sexual and reproductive health services to young people

93.3%

83.3%

(n=30)

(n=12)

Proportion of Member Associations advocating for improved access to services for young people

100.0%

91.7%

(n=30)

(n=12)

Number of sexual and reproductive health services (including family planning) provided to young people under 25 years of age

379,922

74,947

(n=29)

(n=9)

Proportion of Member Associations with 20 per cent or more young people under 25 years of age on their governing board, by sex Percentage of Member Association staff who are under 25 years of age, by sex

* Refer to Tables A.1 and A.2 for a summary of Member Association response rates.

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GLOBAL INDICATORS EN

ESEAOR

SAR

WHR

Overall

16.1%

17.6%

0.0%

14.3%

16.7%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

3.1%

8.1%

4.6%

3.3%

4.0%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

96.8%

100.0%

87.5%

100.0%

95.2%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

93.5%

100.0%

92.9%

93.7%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

96.8%

100.0%

98.4%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

7,582▲

253,787

3,075,344

4,077,749

7,869,331

(n=2)

(n=14)

(n=8)

(n=25)

(n=87)

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Table A.4 Summary of HIV and AIDS indicators, 2005 (n = number of Member Associations that provided data)*

Indicator

AWR

10.0%

16.7%

(n=30)

(n=12)

6.7%

0.0%

(n=30)

(n=12)

Proportion of Member Associations advocating for increased access to HIV and AIDS prevention, treatment and care, and reduced discriminatory policies and practices for those affected by HIV and AIDS

40.0%

25.0%

(n=30)

(n=12)

Proportion of Member Associations with strategies to reach people particularly vulnerable to HIV and AIDS infection

93.3%

58.3%

(n=30)

(n=12)

Proportion of Member Associations conducting behaviour change communication activities to reduce stigma and promote health-seeking behaviours

96.7%

58.3%

(n=30)

(n=12)

254,814

35,903

(n=29)

(n=9)

5,970,411

718,437

(n=29)

(n=9)

AWR

Proportion of Member Associations advocating for reduced restrictions and/or increased access to safe legal abortion

83.3%

66.7%

(n=30)

(n=12)

Proportion of Member Associations conducting IEC activities on the nature of abortion, abortion legal status, and the availability of abortion services

36.7%

16.7%

(n=30)

(n=12)

Proportion of Member Associations providing abortion-related services

90.0%

75.0%

(n=30)

(n=12)

25,044

3,333

(n=29)

(n=9)

▲

Proportion of Member Associations with integrated HIV and AIDS services Proportion of Member Associations providing HIV-related services along the prevention to care continuum▲

Number of HIV-related services provided Number of condoms distributed * Refer to Tables A.1 and A.2 for a summary of Member Association response rates. ▲

For definitions of these terms, see pages 38 and 39 respectively.

Table A.5 Summary of abortion indicators, 2005 (n = number of Member Associations that provided data)*

Indicator

Number of abortion-related services provided * Refer to Tables A.1 and A.2 for a summary of Member Association response rates.

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IPPF Annual Performance Report 2005

ESEAOR

SAR

WHR

Overall

3.2%

0.0%

12.5%

10.7%

7.9%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

0.0%

5.9%

12.5%

0.0%

3.2%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

25.8%

29.4%

37.5%

28.6%

31.0%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

64.5%

64.7%

75.0%

57.1%

69.8%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

58.1%

58.8%

75.0%

50.0%

66.7%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

8,931

27,792

323,659

669,500

1,320,599

(n=2)

(n=14)

(n=8)

(n=25)

(n=87)

67,370

9,549,970

20,623,889

60,925,614

97,855,691

(n=2)

(n=14)

(n=8)

(n=25)

(n=87)

ESEAOR

SAR

WHR

Overall

87.1%

76.5%

62.5%

57.1%

74.6%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

67.7%

52.9%

37.5%

32.1%

43.7%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

83.9%

88.2%

87.5%

71.4%

82.5%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

339

39,797

137,142

13,574

219,229

(n=2)

(n=14)

(n=8)

(n=25)

(n=87)

GLOBAL INDICATORS

IPPF Annual Performance Report 2005

115

Table A.6 Summary of access indicators, 2005 (n = number of Member Associations that provided data)*

Indicator

AWR

Proportion of Member Associations conducting programmes aimed at increased access to sexual and reproductive health services by poor, marginalized, socially-excluded, and/or under-served groups

86.7%

75.0%

(n=30)

(n=12)

Estimated percentage of Member Association clients who are poor, marginalized, and/or socially-excluded

71.9%

76.8%

(n=30)

(n=12)

510,458

318,959

(n=29)

(n=9)

2,917,141

1,152,855

(n=29)

(n=9)

598,725

662,208

(n=29)

(n=9)

2,329

1,591

(n=29)

(n=9)

63.3%

91.7%

(n=30)

(n=12)

66.7%

(n=30)

(n=12)

Number of couple years of protection (CYP), by method Number of family planning services provided, by type Number of sexual and reproductive health services (excluding family planning) provided, by type Number of service delivery points, by type Proportion of Member Associations with gender-focused policies and programmes Proportion of Member Associations with quality of care assurance systems, using a rights-based approach * Refer to Tables A.1 and A.2 for a summary of Member Association response rates. â&#x2013;˛

5,286 clinical outlets and 53,184 non-clinical outlets, which include community-based volunteers, social marketing outlets, private physicians, pharmacies, government clinics, and other agencies.

Table A.7 Summary of advocacy indicators, 2005 (n = number of Member Associations that provided data)*

Indicator Proportion of Member Associations involved in influencing public opinion on sexual and reproductive health and rights Proportion of Member Associations involved in advancing national policy and legislation on sexual and reproductive health and rights Number of successful national policy initiatives and/or positive legislative changes in support of sexual and reproductive health and rights to which the Member Associationâ&#x20AC;&#x2122;s advocacy efforts have contributed Proportion of Member Associations involved in counteracting opposition to sexual and reproductive health and rights Proportion of Member Associations advocating for national governments to commit more financial resources to sexual and reproductive health and rights * Refer to Tables A.1 and A.2 for a summary of Member Association response rates.

116

IPPF Annual Performance Report 2005

AR 60.0%

AWR 91.7%

(n=30)

(n=12)

86.2%

100.0%

(n=30)

(n=12)

(n=30)

(n=12)

83.3%

66.7%

(n=30)

(n=12)

93.3%

66.7%

(n=30)

(n=12)

ESEAOR

SAR

WHR

Overall

67.7%

82.4%

100.0%

75.0%

78.6%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

24.1%

26.7%

81.3%

52.7%

56.6%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

4,801

460,043

1,761,903

3,064,913

6,121,077

(n=2)

(n=14)

(n=8)

(n=25)

(n=87)

31,350

1,120,341

4,376,771

7,737,150

17,335,608

(n=2)

(n=14)

(n=8)

(n=25)

(n=87)

47,181

1,099,299

2,952,146

8,057,815

13,416,374

(n=2)

(n=14)

(n=8)

(n=25)

(n=87)

2,689

30,118

21,727

58,470▲

(n=2)

(n=14)

(n=8)

(n=25)

(n=87)

71.0%

82.4%

75.0%

67.9%

72.2%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

48.4%

64.7%

62.5%

82.1%

65.0%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

EN 80.6%

ESEAOR 70.6%

SAR 62.5%

WHR 67.9%

Overall 71.4%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

93.5%

94.1%

87.5%

85.7%

90.4%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

87.1%

82.4%

87.5%

71.4%

80.2%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

90.3%

94.1%

75.0%

82.1%

86.5%

(n=31)

(n=17)

(n=8)

(n=28)

(n=126)

IPPF Annual Performance Report 2005

GLOBAL INDICATORS

117

Table A.8 Number of non-family planning sexual and reproductive health services provided by region and service type, 2005 (n = number of Member Associations that provided data)* Type of service

AWR

(n=29)

(n=9)

(n=2)

Gynecological services

40,251

186,848

19,574

Obstetrics services

90,330

234,384

8,376

6,047

45,524

115,399

117,808

Other specialized counselling services

20,237

31,591

4,859

STI/RTI services

34,723

27,371

2,200

HIV/AIDS services

220,091

8,532

6,731

Abortion services

25,044

3,333

339

Infertility services

17,748

4,304

4,878

429

28,855

1,084

155

598,725

661,208

47,181

Other SRH medical services Pediatrics services

Urological services Emergency contraceptive services

▲

TOTAL * Refer to Tables A.1 and A.2 for a summary of Member Association response rates. ▲

Emergency contraception is not included in family planning services and CYP as it currently does not have an internationally agreed CYP value attached to it.

Table A.9 Number of family planning services provided by region and service type, 2005 (n=number of Member Associations that provided data)*, ▲

Type of service

AWR

(n=29)

(n=9)

(n=2)

Oral contraceptives

811,168

510,600

10,974

Family planning counselling

318,702

251,165

17,600

1,097,377

422

187

574,773

35,371

690

41,388

191,294

1,175

147

592

268

2,327

9,052

Awareness-based methods

55,112

114,539

Implants

16,137

381

39,439

242

114

2,917,141

1,152,855

31,350

Condoms Injectables IUD Sterilization Family planning referrals

Other barrier methods Other hormonal methods TOTAL

* Refer to Tables A.1 and A.2 for a summary of Member Association response rates. ▲

118

Emergency contraception is not included in family planning services and CYP as it currently does not have an internationally agreed CYP value attached to it.

IPPF Annual Performance Report 2005

SAR

WHR

TOTAL

(n=14)

(n=8)

(n=25)

(n=87)

268,416

307,972

4,495,533

5,318,594

208,030

778,263

1,466,688

2,786,071

337,589

780,728

282,657

1,452,579

149,644

285,503

276,682

945,036

45,446

264,425

552,064

918,622

15,445

264,699

474,112

818,550

12,347

58,960

195,388

502,049

39,797

137,142

13,574

219,229

17,899

65,912

82,531

193,272

4,019

4,656

129,902

139,041

667

3,886

88,684

123,331

1,099,299

2,952,146

8,057,815

13,416,374

ESEAOR

SAR

WHR

TOTAL

(n=14)

(n=8)

(n=25)

(n=87)

178,329

1,244,762

3,067,148

5,822,981

374,766

1,196,998

2,111,625

4,270,856

375,801

677,444

1,199,196

3,350,427

55,499

746,425

603,290

2,016,048

110,962

280,026

273,221

898,066

14,705

131,697

139,282

286,691

1,006

16,746

226,666

255,888

1,481

12,842

183,974

1,633

82,517

56,090

156,767

6,159

156

44,486

90,492

3,304

3,418

1,120,341

4,376,771

7,737,150

17,335,608

IPPF Annual Performance Report 2005

GLOBAL INDICATORS

ESEAOR

119

Table A.10 Couple years of protection (CYP) provided by region and method, 2005 (n=number of Member Associations that provided data)*, ▲ CYP by Method

AWR

(n=29)

(n=9)

(n=2)

116,991

260,117

3,115

570

1,920

490

153,177

43,956

549

Condoms

49,554

5,963

559

Injectables

186,277

4,860

460

154

3,429

1,989

510,458

318,959

4,801

IUD Sterilization Oral contraceptives

Implants Other barrier methods Other hormonal methods TOTAL * Refer to Tables A.1 and A.2 for a summary of Member Association response rates. ▲

Emergency contraception is not included in family planning services and CYP as it currently does not have an internationally agreed CYP value attached to it.

Table A.11 Number of Member Association service delivery points by region, 2005 (n=number of Member Associations that provided data)* Service delivery points Clinical Per cent ▲

Non-clinical Per cent TOTAL

AWR

(n=29)

(n=9)

(n=2)

535

252

1,794

1,339

2,329

1,591

* Refer to Tables A.1 and A.2 for a summary of Member Association response rates. ▲

120

Non-clinical outlets include community-based volunteers, social marketing outlets, private physicians, pharmacies, government clinics, and other agencies.

IPPF Annual Performance Report 2005

SAR

WHR

TOTAL

(n=14)

(n=8)

(n=25)

(n=87)

209,969

422,618

920,189

1,932,999

50,680

486,790

804,240

1,344,690

97,266

349,894

529,411

1,174,253

79,265

171,178

505,683

812,202

19,502

128,048

229,295

568,029

1,778

202,755

72,714

277,861

1,583

620

1,139

8,797

2,242

2,246

460,043

1,761,903

3,064,913

6,121,077

ESEAOR

SAR

WHR

Overall

(n=14)

(n=8)

(n=25)

(n=87)

520

665

3304

5286

2,169

29,453

18,423

53,184

2,689

30,118

21,727

58,470

GLOBAL INDICATORS

ESEAOR

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121

IPPF’S INCOME BY REGION

ANNEX B IPPF’s income by region

Table B.1 Total Member Association income by region, 2004 compared with 2005 Table B.2 Total income for grant-receiving Member Associations, 2001 to 2005 Sources of funding (2005 actual) Table B.3 Africa Region: Sources of funding (2005 actual) Table B.4 Arab World Region: Sources of funding (2005 actual) Table B.5 East and South East Asia and Oceania Region: Sources of funding (2005 actual) Table B.6 European Network: Sources of funding (2005 actual) Table B.7 South Asia Region: Sources of funding (2005 actual) Table B.8 Western Hemisphere Region: Sources of funding (2005 actual)

IPPF increases access to sexual and reproductive health services for under-served and marginalized groups IPPF/Chloe Hall

IPPF Annual Performance Report 2005

123

Table B.1 Total Member Association income by region, 2004 compared with 2005 Total IPPF income $000's

Increase/ (decrease) per cent

Local income $000's

Increase/ (decrease) per cent

International income $000's

Increase/ (decrease) per cent

16,987 20,789

22.4%

4,431 4,606

4.0%

10,440 11,649

11.6%

31,858 37,044

16.3%

Arab World 2004 2005

4,371 5,343

22.2%

4,236 4,051

(4.4%)

3,400 808

(76.2%)

12,007 10,202

(15.0%)

Europe 2004 2005

1,627 3,947

142.6%

364 226

(37.9%)

991 1,644

65.9%

2,982 5,817

95.1%

ESEAOR 2004 2005

6,122 6,781

10.8%

44,747 51,275

14.6%

6,193 7,864

27.0%

57,062 65,920

15.5%

South Asia 2004 2005

6,599 8,850

34.1%

5,204 4,551

(12.6%)

3,435 3,497

1.8%

15,238 16,898

10.9%

Western Hemisphere 2004 2005

9,520 10,647

11.8%

81,247 101,277

24.7%

25,914 16,559

(36.1%)

116,681 128,483

10.1%

TOTAL 2004 2005

45,226 56,357

24.6%

140,229 165,986

18.4%

50,373 42,021

(16.6%)

235,828 264,364

12.1%

Africa 2004 2005

124

IPPF Annual Performance Report 2005

Grand total $000's

Increase/ (decrease) per cent

Total IPPF income $000's

Increase/ (decrease) 2001 as base year per cent

Local income $000's

Increase/ (decrease) 2001 as base year per cent

112,837 52.3%

International income $000's

Increase/ (decrease) 2001 as base year per cent

46,872 21.7%

Grand total $000's

Increase/ (decrease) 2001 as base year per cent

2001

55,943 25.9%

215,612 100.0%

2002

44,563 21.5%

(20.3%)

120,258 57.9%

6.6%

42,774 20.6%

(8.7%)

207,595 100.0%

(3.7%)

2003

41,773 20.2%

(25.3%)

123,555 59.7%

9.5%

41,662 20.1%

(11.1%)

206,990 100.0%

(4.0%)

2004

45,226 19.2%

(19.2%)

140,229 59.5%

24.3%

50,373 21.4%

7.5%

235,828 100.0%

9.4%

2005

56,357 21.3%

0.7%

165,986 62.8%

47.1%

42,021 15.9%

(10.4%)

264,364 100.0%

22.6%

IPPFâ&#x20AC;&#x2122;S INCOME BY REGION

Table B.2 Total income for grant-receiving Member Associations, 2001 to 2005

IPPF Annual Performance Report 2005

125

Table B.3 Africa Region: Sources of funding (2005 actual)

Local income $000’s

Membership/ international fees and other

International income $000’s

997

International/ other

10,063

105

Fundraising Local government

Foreign governments

323

Patient fees

1,871

Contraceptive sales

Organizations/ multinationals

1,310

$500

$1,000

$1,500

$2,000

IPPF total income $000’s

1,555

$2,000 $4,000 $6,000 $8,000 $10,000 $12,000

Income $000’s

12 2,731

Restricted

824

Commodities

Cash grant

17,234

$5,000

$10,000

$15,000

$20,000

Local income International income IPPF income

Key trends for the Africa Region ■ Total income for the Africa Region in 2005 amounted to US$37.0 million – an increase of 16.3 per cent from 2004. ■ Local income increased by 4.0 per cent and international income by 11.6 per cent. ■ IPPF income represented 71 per cent in 2001, reducing to 57 per cent in 2005, indicating less reliance on IPPF as the main funding mechanism. ■ IPPF income increased by 22.4 per cent representing greater funding available at IPPF level.

126

IPPF Annual Performance Report 2005

Local income $000’s

International income $000’s

Membership/ international fees and other

678

International/ other

653

265

Fundraising Local government

1,438

Patient fees

Foreign governments

IPPF’S INCOME BY REGION

Table B.4 Arab World Region: Sources of funding (2005 actual)

813

Contraceptive sales

Organizations/ multinationals

857

$300

$600

$900

$1,200

$1,500

IPPF total income $000’s

116

100 $200 300 $400 500 $600 700 $800

Income $000’s

1,630

Restricted

349

Commodities

Cash grant

% 8

3,364

$500 $1,000 1500 $2,000 2500 $3,000 3500

Local income International income IPPF income

Key trends for the Arab World Region ■ Total income for the Arab World Region in 2005 amounted to US$10.2 million – a decrease of 15 per cent from 2004.

■ The main reason for the decrease is the large reduction in funding by USAID available to the Egyptian Member Association. ■ Local income decreased by 4.4 per cent and international income fell by 76.2 per cent. ■ IPPF income represented 40 per cent in 2001, increasing to 52 per cent in 2005, indicating more reliance on IPPF as the main funding mechanism. ■ IPPF income increased by 22.2 per cent representing greater funding available at IPPF level.

IPPF Annual Performance Report 2005

127

Table B5 East and South East Asia and Oceania Region: Sources of funding (2005 actual)

Local income $000’s

Membership/ international fees and other

International income $000’s

837

International/ other

3,706

3,833

Fundraising Local government

Foreign governments

12,164

Patient fees

582

33,372

Contraceptive sales

Organizations/ multinationals

1,069

5000 $10,00015000 15000$20,00025000 25000$30,00035000 35000

IPPF total income $000’s

3,576

500 $1,0001500 1500$2,0002500 2500$3,0003500 3500$4,000

Income $000’s

10 12

1,610

Restricted

724

Commodities

78 Cash grant

4,447

Local income $0

$1,000

$2,000

$3,000

$4,000

$5,000

International income IPPF income

Key trends for the East and South East Asia and Oceania Region ■ Total income for the East and South East Asia and Oceania Region in 2005 amounted to US$65.9 million – an increase of 15.5 per cent from 2004. ■ Local income increased by 14.6 per cent and international income by 27.0 per cent. ■ IPPF income represented 11 per cent in 2001, reducing to 10 per cent in 2005, indicating an overall diversified source of funding beyond IPPF. ■ IPPF income increased by 10.8 per cent representing greater funding available at IPPF level.

128

IPPF Annual Performance Report 2005

Local income $000’s

International income $000’s

Membership/ international fees and other

129

Fundraising

International/ other

1,196

Local government

Foreign governments

Patient fees

122

IPPF’S INCOME BY REGION

Table B.6 European Network: Sources of funding (2005 actual)

Contraceptive sales

Organizations/ multinationals

$30

$60

$90

$120

$150

IPPF total income $000’s

326

$200

$400

$600

$800 $1,000 $1,200

Income $000’s 4

2,701

Restricted

Commodities * -3

Cash grant

1,249

500

$1,000 1500 $2,000 2500 $3,000

Local income International income

*This figure represents grants accrued from the earlier year which were settled in 2005 at a lower sum than expected, and hence the 2004 income had been overstated.

IPPF income

Key trends for the European Network ■ Total income for the European Network in 2005 amounted to US$5.8 million - an increase of 95.1 per cent from 2004.

■ Local income decreased by 37.9 per cent whilst international income increased by 65.9 per cent. ■ IPPF income represented 48 per cent in 2001, increasing to 68 per cent in 2005, indicating more reliance on IPPF as a source of funding as finding other donors willing to support countries within this region becomes more difficult. ■ IPPF income increased by 142.6 per cent representing greater funding available at IPPF level and a revision to the Resource Allocation System which recognizes the needs within the eastern European countries.

IPPF Annual Performance Report 2005

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Table B.7 South Asia Region: Sources of funding (2005 actual)

Local income $000’s

Membership/ international fees and other

International income $000’s

206

International/ other

Fundraising

993

Local government

Foreign governments

1,325

Patient fees

665

452

Contraceptive sales

Organizations/ multinationals

1,575

$500

$1,000

$1,500

$2,000

IPPF total income $000’s

864

$500

$1,000

$1,500

Income $000’s

2,282

Restricted

Commodities

1,968

168

% 21

Cash grant

6,400

$0 $1,0002000 2000$3,0004000 4000$5,0006000 6000$7,0008000 8000

Local income International income IPPF income

Key trends for the South Asia Region ■ Total income for the South Asia Region in 2005 amounted to US$16.9 million - an increase of 10.9 per cent from 2004. ■ Local income decreased by 12.6 per cent whilst international income increased by 1.8 per cent. ■ IPPF income represented 54 per cent in 2001, reducing to 52 per cent in 2005, indicating some progress in developing diversified sources of funding beyond IPPF. ■ IPPF income increased by 34.1 per cent representing greater funding available at IPPF level.

130

IPPF Annual Performance Report 2005

$2,000

IPPF’S INCOME BY REGION

Table B.8 Western Hemisphere Region: Sources of funding (2005 actual)

Local income $000’s

Membership/ international fees and other

International income $000’s

10,716

Fundraising

International/ other

3,883

9,201

Local government

Foreign governments

4,142

Patient fees

2,043

55,891

Contraceptive sales

Organizations/ multinationals

21,327

10000 $20,000 30000 $40,000 50000 $60,000

IPPF total income $000’s

10,633

2000 $4,000 6000 $8,000 10000 $12,000

Income $000’s

Commodities

2,255

Restricted

1,046

79 Cash grant

7,345

$0 1000$2,0003000 1000 3000$4,0005000 5000$6,0007000 7000$8,000

Local income International income IPPF income

Key trends for the Western Hemisphere Region ■ Total income for the Western Hemisphere Region in 2005 amounted to US$128.5 million - an increase of 10.1 per cent from 2004.

■ Local income increased by 24.7 per cent whilst international income fell by 36.1 per cent. ■ IPPF income represented 10 per cent in 2001, reducing to 8 per cent in 2005, indicating an overall diversified source of funding beyond IPPF. ■ IPPF income increased by 11.8 per cent representing greater funding available at IPPF level.

IPPF Annual Performance Report 2005

131

References FOREWORD 1

PRB (2005) ‘Women of Our World 2005’. Washington: PRB. Pages 3, 7. Available at: <http://www.prb.org/pdf05/WomenOfOurWorld200 5.pdf> [Accessed 24 November 2006]. UNFPA ‘Making Motherhood Safer: Reducing Risks by Offering Contraceptive Services’ [Internet]. Available at: <http://www.unfpa.org/mothers/contraceptive.htm> [Accessed 06 November 2006]. World Health Organization (2005) ‘World Health Report 2005: Make Every Mother and Child Count’. Geneva: World Health Organization. Page 51. Available at: <http://www.who.int/whr/2005/whr2005_en.pdf> [Accessed 24 November 2006]. UNFPA ‘Supporting adolescents and youth: Fast facts’ [Internet]. Available at: <http://www.unfpa.org/adolescents/facts.htm> [Accessed 24 November 2006].

5 6 7

8 9 10

11 12

CHAPTER 1 ADOLESCENTS 1

3 4 5

UNFPA (2005) ‘State of the World Population 2005’. New York: UNFPA. Page 45. Available at: <http://www.unfpa.org/swp/2005> [Accessed 24 November 2006]. UNFPA ‘Supporting adolescents and youth: Fast facts’ [Internet]. Available at: <http://www.unfpa.org/adolescents/facts.htm> [Accessed 24 November 2006]. Ibid. Ibid. IPPF (2004) ‘Setting Standards for Youth Participation: Self-Assessment Guide for Governance and Programmes’. London: IPPF.

CHAPTER 3 ABORTION 1

CHAPTER 2 HIV AND AIDS 1

2 3

UNAIDS (2006) ‘Report on the global AIDS epidemic 2006’. Geneva: UNAIDS. Page 8. Available at: <http://www.unaids.org/en/HIV_data/2006GlobalRe port> [Accessed 24 November 2006]. Ibid. UNFPA ‘Young People: The Greatest Hope for Turning the Tide’ [Internet]. Available at: <http://www.unfpa.org/hiv/people.htm> [Accessed 24 November 2006].

UNAIDS and World Health Organization (2005) ‘AIDS epidemic update, December 2005’. Geneva: UNAIDS. Page 3. Available at: <http://www.unaids.org/epi/2005> [Accessed 24 November 2006]. Ibid. Ibid. UNAIDS (2006). Pages 33-34. Eberstadt, N. (2002) ‘The future of AIDS’. Foreign Affairs November/December 2002. Available at: <http://www.foreignaffairs.org/2002/6.html> [Accessed 24 November 2006]. Ibid. UNAIDS (2006). Page 42. Ibid. Eberstadt. UNAIDS ‘Women’ [Internet]. Available at: <http://www.unaids.org/en/GetStarted/Women.asp> [Accessed 24 November 2006]. Ibid. UNAIDS and World Health Organization (2005). Pages 1-3. UNAIDS ‘UNAIDS Policy Position: Condoms’ [Internet]. Available at: <www.unaids.org/en/policies/condoms/default.asp> [Accessed 24 November 2006]. World Health Organization (2004) ‘The Glion Call to Action on Family Planning and HIV/AIDS in Women and Children’. Geneva: World Health Organization. Available at: <www.who.int/reproductivehealth/stis/docs/glion_cal_to_action.pdf> [Accessed 24 November 2006]. UNFPA (2004) ‘The New York Call to Commitment: Linking HIV/AIDS and Sexual and Reproductive Health’. New York: UNFPA. Available at: <www.unfpa.org/icpd/10/docs/hiv_aids_rh_call_com mitment.doc> [Accessed 24 November 2006].

2 3

IPPF (2004) ‘IPPF Glossary on Sexual and Reproductive Health’. London: IPPF. IPPF (1995) ‘Policy 4.18, as adopted in 1995 by Central Council 11-1995’. London: IPPF. World Health Organization (2005) ‘World Health Report 2005: Make Every Mother and Child Count’. Geneva: World Health Organization. Page xxi. Available at: <http://www.who.int/whr/2005/whr2005_en.pdf> [Accessed 24 November 2006]. Ibid. Page 51.

A woman and her child access health services from a mobile clinic for the internally displaced run by IPPF’s Member Association in Colombia IPPF/Jon Spaull

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5 6

Ibid. Center for Reproductive Rights (2005) ‘The World’s Abortion Laws’ [Internet]. Available at: <http://www.crlp.org/pub_fac_abortion_laws.html> [Accessed 24 November 2006].

CHAPTER 4 ACCESS 1

United Nations ‘Resolution adopted by the General Assembly, 60/1. 2005 World Summit Outcome, Agenda items 46 and 120, 24 October 2005’ [Internet]. Available at: <http://unpan1.un.org/intradoc/groups/public/docu ments/UN/UNPAN021752.pdf> [Accessed 24 November 2006]. UNFPA (2005) ‘State of the World Population 2005’. New York: UNFPA. Page 87. Available at: <http://www.unfpa.org/swp/2005> [Accessed 24 November 2006]. Population Action International, Family Care International, IPPF ‘ICPD at Ten: Where are we now?’ [Internet]. Page 5-6. Available at: <http://www.populationaction.org/news/press/news _083104_ReportCard.pdf> [Accessed 24 November 2006]. United Nations Development Programme (2005) ‘Human Development Report 2005: International cooperation at a crossroads: Aid, trade and security in an unequal world’. New York: United Nations Development Programme. Pages 219-222. Available at: <http://hdr.undp.org/reports/global/2005/pdf/HDR05 _complete.pdf> [Accessed 24 November 2006]. World Health Organization (2006) ‘World Health Report 2006: Working together for health’. Geneva: World Health Organization. Page 12. Available at: <http://www.who.int/whr/2006/en/index.html> [Accessed 24 November 2006]. World Health Organization, UNICEF, UNFPA (2004) ‘Maternal Mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA’. Geneva: World Health Organization. Page 18. Available at: <www.who.int/reproductive_health/publications/mat ernal_mortality_2000?mme.pdf> [Accessed 24 November 2006]. IPPF (2004) ‘IPPF Standards and Responsibilities of Membership, as adopted by the IPPF Governing Council in November 2004.’ London: IPPF.

CHAPTER 5 ADVOCACY 1

IPPF ‘ICPD to MDGs: SARO Explores’ [Internet]. Available at: <http://content.ippf.org/output/sar/files/14003.pdf> [Accessed 24 November 2006].

CHAPTER 6 MANAGEMENT 1

134

UNFPA (2006) ‘UNFPA Global Population Policy Update’. Issue 64. New York: UNFPA. Available at: <http://daccessdds.un.org/doc/UNDOC/GEN/N06/21 6/41/PDF/N0621641.pdf?OpenElement> [Accessed 27 November 2006].

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Ethelston, S. and Leahy, E. (2006) ‘Reproductive health: How much? Who pays?’. Research Commentary. Volume 1, Issue 6. Washington D.C.:Population Action International. Available at: <http://www.populationaction.org/resources/researc hCommentaries/ResearchComm_v1i6_June06.pdf> [Accessed 27 November 2006]. 3 EUROPA ‘Translating the Monterrey Consensus into practice’ [Internet]. Available at: <http://europa.eu/scadplus/leg/en/lvb/r12527.htm> [Accessed 27 November 2006]. 4 Reuser, M. Willekens, F. and Eckhardt-Gerritsen, J. (2004) ‘Real time estimates for donor assistance for population and AIDS activities (2003 and preliminary 2004 data)’. The Hague: Netherlands Interdisciplinary Demographic Institute (NIDI). Page 13. Available at: <http://www.resourceflows.org/index.php?module= upload&func=download&fileld=76> [Accessed 27 November 2006]. Data for 1995 figures previously obtained from NIDI. 5 Organisation for Economic Co-operation and Development ‘Aid flows top USD 100 billion in 2005’. [Internet]. Available at: <http://www.oecd.org/document/40/0,2340,en_264 9_33721_36418344_1_1_1_1,00.html> [Accessed 27 November 2006]. 6 Funders Network on Population, Reproductive Health & Rights (2006) ‘Funding analysis 2004. Highlights from the grants database’. Rockville, MD: Funders Network. Page 9. Available at: <http://www.fundersnet.org/news/docs/funding_ana lysis_2004___final_6_29_06.pdf> [Accessed 27 November 2006]. 7 World Bank (2005) ‘Paris Declaration on Aid Effectiveness. Ownership, Harmonisation, Alignment, Results, and Mutual Accountability’. Paris: World Bank. Available at: <http://www1.worldbank.org/harmonization/Paris/FI NALPARISDECLARATION.pdf> [Accessed 27 November 2006]. 8 Ibid. Funders Network on Population, Reproductive Health & Rights. 9 European Network on Debt and Development (EURODAD) (2006) ‘EU aid: Genuine leadership or misleading figures? An independent analysis of European aid figures’. Joint European NGO Report. Available at: <http://www.concordeurope.org/download.cfm?me dia=pdfUK&id=1418> [Accessed 27 November 2006]. 10 Ibid. Organisation for Economic Co-operation and Developemnt.

Key abbreviations ICPD

International Conference on Population and Development

IEC

Information, education, and communication

IEPFPD

Inter European Parliamentary Forum on Population and Development

ICW

International Community of Women Living with HIV/AIDS

IPPF

International Planned Parenthood Federation

IUD

Intrauterine device

JFSP

Jovens Feministas de São Paulo

MAP-UK

Medical Aid for Palestinians

MCH

Maternal and child health

MDG

Millennium Development Goals

MYSU

Mujer y Salud en Uruguay

NEPAD

New Partnership for Africa’s Development

NPOKI

Non-Profit Organization Knowledge Initiative

NYKS

Nehru Yuvak Kendra Sangathan

ODA

Official development assistance

Grupo de Información en Reproducción Elegida

RHAN

Reproductive Health Advocacy Network

RTE

Radio Telefís Éireann

GNP+

Global Network of People Living with HIV/AIDS

RTI

Reproductive tract infection

GTPOS

Grupo de Trabalho e Pesquisa em Orientaçao Sexual

SAR

South Asia Regional Office, IPPF

STI

Sexually transmitted infection

GLBT

Gay, lesbian, bisexual, and transgender

United Nations

GLBTQ

Gay, lesbian, bisexual, transgender, and questioning

UNAIDS

Joint United Nations Programme on HIV and AIDS

HIV

Human immunodeficiency virus

UNFPA

United Nations Population Fund

IAPG

Inter-American Parliamentary Group on Population and Development

UNIFEM

United Nations Development Fund for Women

ICAAP

International Congress on AIDS in Asia and the Pacific

YOSEP

‘Youth out-of-school empowerment project’

ICASA

International Conference on AIDS and Sexually Transmitted Infections in Africa

VCT

Voluntary counselling and testing

WHR

Western Hemisphere Regional Office, IPPF

AIDS

Acquired immune deficiency syndrome

Africa Regional Office, IPPF

ARV

Anti-retroviral

AWR

Arab World Regional Office, IPPF

CDD

Católicas por el Derecho a Decidir

CFFC

Catholics For Free Choice

CIPA

Centro de Atención Integral a la Pareja

CPA

Crisis Pregnancy Agency

CYP

Couple years of protection

DFID

Department for International Development

ECOS

Estudos e Comunicaçao em Sexualidade e Reproduçao Humana

eIMS

electronic Integrated Management System

European Network, IPPF

ESEAOR

East and South East Asia and Oceania Regional Office, IPPF

European Union

Family planning

GIPA

Greater involvement of people living with and affected by HIV and AIDS

GIRE

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From choice, a world of possibilities