Download Policymaker Workshop Presentation.

Policymakers
Workshop
To support the National
SRH/ HIV/AIDS Behaviour
Change Strategy
What is Reproductive Health?
“A state of complete physical, mental and
social well-being and not merely the absence
of disease and infirmity in all matters related
to the reproductive system and its functions
and processes.” ICPD ‘94
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RH Components
Harmful Cultural
Practices
Safe
Motherhood
STIs,
including
HIV
Unsafe
Abortions
RH
Cancers
Family
Planning
Gender Inequalities
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What is the
situation we are
facing now in
Malawi related
to Sexual and
Reproductive
Health?
High Maternal Mortality Rates
High maternal
mortality ratio:
1120 deaths per
100,000 live births
Picture copied with permission from the Friends of Malawi web page.
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High Infant Mortality Rate
High infant
mortality rate:
104 deaths per
1,000 live births
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High HIV/AIDS Prevalence
 15% of adults 15-49 years old HIV
positive
 845,000 people infected with HIV
Photograph by David Jones
 410,000 children under the age of
15 years have lost their mothers
due to AIDS
 11 of 12 Malawians not infected
with HIV
 1 of 4 infected in major urban areas
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MTCT Has Become A New Priority
 Mother-to-child transmission is by
far the largest source of HIV
infection in children below the age
of one year
 25% to 35% of babies born to an
infected mother will be infected in
the absence of preventive measures
 HIV may be transmitted during
pregnancy, through child birth, or
through breast feeding
Picture copied with permission from the Friends of Malawi web page.
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High STI Prevalence
 National syphilis prevalence rate: 3.9%
 11% of women and 8% of men had an STI during
last 12 months
 STIs on their own pose a significant burden of
disease with serious complications
 STIs facilitate HIV transmission and progression
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High Total Fertility Rate
High total
fertility rate:
6.3
Picture copied with permission from the Friends of Malawi web page.
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While contraceptive prevalence is rising, there
is still high unmet demand for family planning
methods
Unmet need for
FP: 29.7%
Met need for FP:
30.6%
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Adolescents Are At Greatest Risk for
SRH problems.
 Average age of sexual debut is 16-17
years old
 High occurrence of pregnancy and
childbirth among adolescent girls: 1/3 of
15-19 year olds; 2/3’s by age 19
 Unwanted pregnancies
 High exposure to STIs and HIV
 Limited access to services
 Issues with provider attitudes
Picture copied with permission from the Friends of Malawi web page.
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Harmful Cultural Practices Put Men and
Women At All Ages at Risk
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Initiation practices
Wife inheritance
Fisi (hiring of the man for sex and conception)
Dry sex
Violence
Death ritual (hiring of a man to drive out spirits)
Use of traditional herbs to induce labour
Traditional treatment of vulval/vaginal warts and
hemorrhoids (e.g., by cutting)
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Specific Risks For Women’s
Reproductive Health
 Rape
 Battery
 Domestic violence
 Incest
 Psychological abuse
 Sexual harassment
Photograph by David Jones
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Violence Against Women
All these types of violence directed against women
are linked to the same familiar courses of:
 the low status of women,
 the notion that women are the “property” of
men, and
 that it is acceptable for men to exercise control
over them - by physical force if necessary.
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What is the RH Programme’s Response
to these Needs?
Purpose: To promote
through informed choice,
safer reproductive health
practices by men, women
and young people,
including increased use of
high quality, accessible
reproductive health
services
Key Areas to Address:
 Adolescent Reproductive Health
 Management and Prevention of STIs, including
HIV/AIDS
 Management of unsafe abortions
 Family Planning
 Safe Motherhood (including PMTCT)
 Elimination of Harmful Cultural Practices
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C
H
A
L
L
E
N
G
E
S
Consistent and adequate supplies
Adequate number of well trained,
deployed and supplied providers
Adequate physical assets
Strong management, resource allocation,
coordination and monitoring systems
Clients seeking, adopting and maintaining
safer sexual and RH practices
Translating knowledge into positive
behaviour change
Why was a Behaviour Change Strategy
Needed?
 High knowledge about SRH has not translated into
adoption of safer behaviours.
 Past IEC materials and activities have not been
systematically planned.
 Lack of coordination of IEC activities has led to
duplication of efforts at all levels.
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Why Was A Joint Strategy Needed?
 Both agencies wanted to develop a coordinated
response to the common behavioural issues that
are critical address
 There is a need to promote integration of HIV within
reproductive health service delivery
 Within communities, it is likely that the best way of
achieving impact on HIV prevalence is by meeting
men and women and young people’s wider sexual
and reproductive health needs
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What We Must Do?
Promote choice for all Malawians to achieve
our reproductive health goals:
 Support an integrated, multisectoral approach to
promote reproductive health for all
 Provide adequate, ongoing financial resources for
reproductive health services
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What We Must Do?
 Use all channels to educate, and develop
confidence, skills and support within communities
 Provide our youth with necessary RH information
and accessible, friendly RH services
 Communicate openly and honestly with each other
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Policy makers have a critical role to play
 Actively support the establishment of quality
services through the development and enforcement
of supportive SRH policies
 Allocate sufficient budget to support delivery of
SRH-related education and services.
 Speak out against unsafe sexual norms and
practices in communities
 Actively promote greater equality between men and
women (eg. Silence, stigma, gender inequalities,
harmful traditional practices)
 Set programs within their own workplaces and…BE
A ROLE MODEL for others!
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Two National Behavioural Objectives
 Promote safer sexual and reproductive health
practices of men and women of all ages
 Promote consistent health-seeking behaviour of
men and women of all ages.
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National Behaviour Change Priorities
 YOUTH
 MEN AND WOMEN ENGAGING IN HIGH RISK
BEHAVIOURS
 WOMEN OF CHILD-BEARING AGE
 SUPPORTIVE ENVIRONMENT (Opinion leaders,
policy makers, service providers)
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Program Activities
 Programming to increase effectiveness of SRH/HIV
related to BCIs.
 Reduce adolescent risk for pregnancy and HIV/STI
transmission
 Increase informed contraceptive choice among
men, women, and young people
 Promote safe pregnancy and motherhood for
mother and child (including PMTCT)
 Promote STI/HIV prevention and access to early STI
treatment within high risk areas
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Program Activities Cont.
 Promote better client provider relationship
 Promote community responsibility for creating a
positive, open and caring environment in relation to
SRH/HIV/AIDS risks (Stigma, stigmatisation, open
dialogue)
 Advocate for policies that protect youth from early
sexual intercourse and sexual abuse, increase
women’s access to skilled attendance, PMTCT
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Key BC Indicators Tracked by SRHP
 Condom use with cohabitating partners increased from
5.9% in men and 2.5% in women to 8% for men and 5%
in women by 2006
 Condom use with noncohabitating partners increased
from 38% in men and 28.7% in women to 50% for men
and 40% in women by 2006.
 Number of women who receive EOC increased from 35%
to 60%
 Number of men and women of all ages who are
counselled and tested for HIV at available centres
increased from 8.5% for women and 15.2% in men to
30% for both men and women
 Unmet demand for FP methods reduced from 29.7% to
15%.
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Roles and Responsibilities of the HEU
 Develop and maintain an inventory of
organizations producing communication materials
and BCI training nation wide
 Coordinate materials production processes with
the districts, the KSG lead organizations and the
NAC/BCI Unit
 Establish mechanisms/guidelines to monitor the
quality of communication materials
 Monitor the distribution and utilization at
community levels, working in close collaboration
with Department of Population Services
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