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Monthly update from UNFPA in Asia and the Paci c JULY-AUGUST 2011

IN THIS ISSUE
VIDEO: Indonesian Presidents Statement for World Population Day 2011 page 3 UN Campaign Highlights Challenges and Opportunities in a World of 7 Billion page 3 Probing Causes of Violence Against Women in China page 4 Seeking Help for Private Matters page 6 Lao Ministry of Healths Maternal, Neonatal and Child Health and Nutrition Programme Receives Boost from the UN page 7 UPCOMING EVENTS page 7 Asia-Pacic Countries Seek to Broaden Reach of Sexuality Education page 8 UN-led Workshop Engages Sex Workers to Reduce HIV Transmission in China page 9 Timor-Leste Presents Results of 2010 Census page 10 VIDEO: Community Midwifery Takes Hold in Laos page 11 A Sound Investment: Skilled Care in Bangladesh page 12 New Cadre of Laotian Midwives Saving Lives page 13

Flood-affected Pakistanis Still Need Reproductive Health Services UNFPA Works to Fill the Gap
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Photo: William A. Ryan/UNFPA

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Flood-affected Pakistanis Still Need Reproductive Health Services - UNFPA Works to Fill the Gap
Given the immense needs, UNFPA in collaboration with the Government and civil society partners started to deliver urgently needed maternal health services through mobile service units as part of an outreach programme for areas that had no functional health facilities. Damaged health facilities were refurbished and female health care providers were recruited to restart basic services. The Fund, among other things, provided personal In this August 2010 photo, midwife Farzana Sarki delivered Noor Banos baby in a tent at a camp for ood victims. hygiene, newborn and clean delivery kits to tens of thousands of women. ISLAMABAD - One year after Pakistans worst Reproductive health equipment and supplies ooding in decades, UNFPA continues to deliver sufcient to cover an estimated population of 6 comprehensive reproductive health care services as million were distributed within the past year, making part of its humanitarian response. this one of UNFPAs biggest humanitarian operations globally. In August 2010, the Funds immediate response after the oods struck was to support basic reproductive Today, the emphasis is on helping ood-affected health services for the displaced. Now, during the people rebuild their lives. A vast majority of people recovery phase, the Fund is focusing on upgrading health facilities to provide comprehensive emergency have gone back but some are still here and are in need of services. Those who have gone back are obstetric care. more aware of their health needs, says Ceemab, a Community Health Worker from Khairpur. Women The oods brought to the forefront women living in who come to see us are very scared that there will be rural and underprivileged areas of Pakistan, some of another ood this year and they will again lose the whom had never been to a doctor before. Current maternal mortality gures show that one out of every little that they have managed to build back in a year, she adds. 89 Pakistani women will die of maternal causes, whereas complications of childbirth still account for The buying capacity of the ood-affected people one fth of deaths among women of childbearing who have returned to their areas has decreased age. signicantly, says Dr. Jameel Chaudhry, UNFPA Provincial Coordination Ofcer in Punjab. There is An estimated 500,000 pregnant women were a need to provide services at minimal or no cost, among the 20 million people affected by last as the returnees cannot afford out-of-pocket health years ash oods. Their vulnerability was further expenses. exacerbated by malnutrition, trauma and fatigue due to long journeys to safer areas or camps, and by The Fund is now working to provide, where possible, subsequent poor hygiene.
Photo: William A. Ryan/UNFPA

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Monthly update from UNFPA in Asia and the Paci c

JULY-AUGUST 2011

free reproductive health services in Governmentowned health facilities. The focus is to strengthen quality and improve the accessibility of services. However, sustainability of services remains the biggest challenge as it requires support and commitment from the Government at district and provincial levels. A programme aimed at protecting displaced women and girls from violence was also initiated last year. Coordination mechanisms, co-led by the Department of Social Welfare, were set up both at the federal and provincial level. Referral systems were established for the survivors to receive medical, legal, and psychosocial support. Twelve women-friendly spaces were also set up to reach women in affected communities. UNFPA will continue to provide humanitarian assistance in reproductive health and genderbased violence programmes for ood-affected communities as well as for people internally displaced as a result of conict, said Mr. Rabbi Royan, UNFPA Representative in Pakistan.

UN Campaign Highlights Challenges and Opportunities in a World of 7 Billion


Activities planned across Asia-Paci c region
BANGKOK - As human numbers climb towards a new milestone, UNFPA launched a global initiative to highlight the critical role population concerns will play in shaping our future. Continued population growth, declining fertility, rising mobility and a changing age structure all pose profound challenges but also opportunities. In Asia and the Pacic region, these factors point in particular to an urgent need to invest in the wellbeing of todays young people. World Population Day, 11 July, was the start of an advocacy effort that will run until 31 October 2011, when the United Nations forecasts world population will surpass 7 billion. The 7 Billion Actions (www.7billionactions.com) campaign promotes dialogue on what it means to live in a world with so many people, and encourage activism on issues that affect everyone. UNFPA ofces and their partners in Asian and Pacic countries will organize a variety of related activities over the next four months, culminating in national events marking the birth of the symbolic 7 billionth baby. The campaign addresses seven key themes; all are vital to Asia and the Pacic: poverty and inequality; the rights of women and girls; young people; reproductive health and rights; the environment; ageing; and urbanization. Globally, population has doubled since 1968 and grown by almost 40 per cent since reaching 5 billion in 1987, an event that led to the rst World Population Day. According to the UN Population Division, growth will continue at least until midcentury despite dramatic declines in the average number of children per woman.

VIDEO

Indonesian Presidents Statement for World Population Day 2011

President Susilo Bambang Yudhoyono of Indonesia talking about the challenges in a world of 7 billion people.
Video: UNFPA Indonesia Link: http://www.youtube.com/unfpaasia#p/u/0/aEfzSCwoYHY

Asia accounts for 60 per cent of the world total and is likely to grow from 4 billion to 5 billion by 2050, while its population becomes increasingly older and urban. next page

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Support for reproductive choice and gender equality remain critically important in this region. More than 100 million Asian women want to avoid or delay pregnancy but are not using contraception. Those lacking access to services are typically poor; enabling people to choose to have smaller families can help alleviate poverty and spur development. Addressing the unmet need for family planning helps to empower women, and can slow population growth in poor countries, like Afghanistan, that still have high fertility. Most of Asias growth will be population momentum - due to high fertility in the recent past, the largest-ever generation of young people are entering their reproductive years; their numbers guarantee growth for several decades even as family sizes continue to fall. We have an opportunity and responsibility to invest in adolescents and youth, states UNFPA Executive Director Babatunde Osotimehin. With the right policies, investments and social support, young people can enjoy healthier lives free of poverty and enhance prospects for peace and stability. With fewer children to support compared to people of working age, many Asian countries have a onetime opportunity to reap an economic bonus by investing in education, health care and job creation for young people. This window will close as the proportion of elderly dependents increases, a trend that is already advanced in China and a number of other East Asian countries. A human rights-based response to these and other demographic trends is imperative if development efforts are to succeed in meeting the needs of young, growing, ageing and increasingly urban populations and cope with environmental challenges in the decades ahead.

Probing Causes of Violence Against Women in China


Using technology to get the answer to sensitive questions about masculinities and gender equality
HUNAN, China - A lively workshop session on gender equality started with brainstorming of commonly used Chinese idioms describing a good man. He should have a back like a tiger and a waist like a bear. He does not shed tears until his heart is broken. He stands rm amid adversities. On the subject of a good woman, more hands shot up. She should behave in a sweet and helpless way. She should be caring and affectionate. She should be a good wife and loving mother. Of the more than 40 men and women who attended the interviewers training last spring, half were university students from all over China, and half of them were recruited locally from various professions. Most of them are in their 20s, joined by a few older retirees. The training - which included an innovative use of new technology qualied them to undertake innovative eld data collection on men, gender equality and violence against women. The eldwork is part of the research on masculinities - the qualities generally ascribed to men - and their connections to violence against women. Generating new perspectives on masculinities Equipped with knowledge of complicated issues surrounding violence and gender norms, the interviewers will seek views from both men and women in this Hunan Province city. China is one of seven countries included in a research project on gender-based violence in the Asia Pacic region. Led by Partners for Prevention, a regional programme supported by UNDP, UNFPA, UN

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Monthly update from UNFPA in Asia and the Paci c

JULY-AUGUST 2011

Interviewers familiarize themselves with iPad Touch.

Women and UN Volunteers, the research will generate new analysis on masculinities and violence in the region and is expected to improve measures to prevent and respond to violence against women. The research is the most strict one in terms of the ethics standard, and the most comprehensive one with lots of hard-to-ask questions, said Professor Wang Xiangxian, one of the key Chinese researchers dedicated to this project. For both men and women, the questionnaire includes probing some of the most private aspects of their lives, including sexual relations, violence, intimate relationships and drug use. The greatest challenge the research team faces is how to ask these questions in the most appropriate way and to get honest answers without betraying the privacy of the interviewees. Using technology to make hard-to-ask questions easier The Apple portable iPad Touch provides an innovative solution. All the questions are programmed in a special application that can be installed in an iPad Touch that will serve as a

personal digital assistant for the interviewer. Instead of holding printed questionnaires in hand and going through each question face-to-face with the interviewee, the interviewer will guide the subject to answer the questions directly on the iPad Touch. The questions are even recorded so that those who cant read will hear the questions with headsets and key in their answers. The use of the PDAs aims to avoid embarrassment, to allow self-reporting of violent acts such as physical abuse and rape, and to ensure maximum protection of privacy. The eld work will last for over a month in the UNFPA-supported pilot site. Already the project has made some important breakthroughs, ranging from village level awareness-raising to the issuing of city-level legislation on violence against women. The ndings from the research will bring valuable insights to all stakeholders involved to formulate effective actions to prevent and respond to violence against women by taking into account of both men and women. The results will also be shared with Chinese experts involved in the process of drafting the AntiDomestic Violence Law of China.

Photo: Guo Tieliu/UNFPA China

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Seeking Help for Private Matters
LIU YANG CITY, China - I feel happy with my life now. I believe it is going to be better, says 32-year-old Xiao Hui, who no longer fears the shadow of domestic violence. Xiao Hui and her husband were schoolmates. After leaving high school, they both went to work in Guangdong Province as migrant workers for a few years, and they fell in love. They returned to Duzheng Village to get married. With the arrival of their daughter seven years ago, Xiao Hui stayed at home while her husband worked with construction companies nearby. With one more person to feed, the couple began to quarrel about money. One day, her husband returned Xiao Huis complaints by forcefully shoving her to the bedside. He treated me with no respect. He hurt me as much as if he had beaten me, said Xiao Hui. Xiao Hui did not just worry and cry after the incident. She remembered seeing the anti-domestic violence posters and performances near the village and she mustered up the courage to ask Ms. Zu of the Womens Committee whether her private matter would qualify for some sort of formal intervention. To her surprise, Ms. Zu organized a mediation session with the couple and their parents. My husband was told if he did not stop, he would have to face the consequences, Xiao Hui recalled. Xiao Hui thought the mediation really worked. My husband would have started beating me if he did not get the formal warning, Xiao Hui believes. Duzheng Village is one of the seven local villages in Liuyang that have organized intensive community activities to encourage villagers to speak out and seek support whether violence occurs in or out of their houses. It is part of a UNFPA-supported pilot initiative aiming at setting up a multi-sectoral model on violence against women. Our volunteers spread messages on violence when entertaining big crowds of people, even at weddings and funerals, said Ms. Zu. Every household got a letter on domestic violence and there were displays in the village on where to get support when violence happens. According to the Violence against Women: Facts and Figure 2010 compiled by UNFPA China and a Chinese NGO Andi-Domestic Violence Network, one of the greatest challenges to addressing this is that women usually seek help from informal networks such as family, and neighbours, or never tell anyone of the violence. In China, where the culture of washing your dirty linen at home is extremely strong, the village campaign on violence makes it possible for many women like Xiao Hui to speak up and seek help for what is usually seen as private matters. - Gao Cuiling

Photo: Guo Tieliu/UNFPA China

Monthly update from UNFPA in Asia and the Paci c

JULY-AUGUST 2011

Lao Ministry of Healths Maternal, Neonatal and Child Health and Nutrition Programme Receives Boost from the UN
VIENTIANE - The health and nutrition of mothers, babies and young children in the remote areas of Lao PDR will receive a major boost - thanks to the launch of a joint UN-Ministry of Health programme on maternal, neonatal and child health, and nutrition in the provinces of Savannakhet, Phongsaly, Luangnamtha and Oudomxay. In a meeting to launch the programme on 27 May, senior representatives from the Ministry of Health were joined by senior representatives from UNICEF, WFP, WHO and UNFPA. A similar launch was earlier held in Savannakhet on 23 May. Through good cooperation with our health colleagues and international partners, we believe this programme will help improve mother and child health and nutrition, and thus, also alleviate poverty in our target areas, said Deputy Minister of Health Dr. Bounkong Sihavong. This is one of the Ministry of Healths topmost priorities to help our country achieve the Millennium Development Goals. Despite major socio-economic improvements in the past decade, Lao PDR continues to hold some of the highest rates of maternal and child deaths, illnesses and disabilities in the region. This is compounded equally by high malnutrition rates. The programme is aimed at signicantly reducing mortality and malnutrition rates among mothers, newborns and young children, and improving nutritional outcomes through increased leadership, enhanced services and community empowerment, said Dr. Yunguo Liu on behalf of the UN agencies. The ve-year programmatic support aims to integrate a full package of maternal, newborn and child health, and nutrition interventions by working with health managers to upgrade the services and build demand for services. In this joint effort, the four UN agencies will use their comparative advantages to support a range of essential activities that have direct impact on the health and nutrition status of mothers and children.

UPCOMING EVENTS

International Youth Day


Date of event: 12 August Location: Global Themed Change Our World, this years celebration marks the culmination of the International Year of Youth and the 25th Anniversary of the rst International Year of Youth.

World Humanitarian Day


Date of event: 19 August Location: Global The Day honours those, who have lost their lives in humanitarian service and those, who continue to bring assistance and relief to millions. It also seeks to draw attention to humanitarian needs worldwide and to explain what humanitarian aid work entails.

International Congress on AIDS in Asia and the Pacic (ICAAP)


Date of event: 26-30 August Location: Busan, Republic of Korea ICAAP, the regions largest HIV/ AIDS forum, is a biennial gathering for the release and discussion of scientic, programmatic and policy developments in the global response to the issues of HIV/AIDS. It promotes opportunities for greater regional collaboration, sharing of ideas among people infected and affected by the HIV/ AIDS epidemics, and provides organizations and governments with space to enhance their mutual contributions in the response to HIV/AIDS.

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Asia-Pacic Countries Seek to Broaden Reach of Sexuality Education
These have been the most substantive regional talks on these issues to date, and it is heartening that key ofcials from across the Asia Pacic are leaving Bangkok with concrete ideas on how they can strengthen their own national programmes, Sheehan said. They will be important advocates in raising awareness on the vital role sexuality education has in the healthy development of adolescents, and young girls in particular.
Photo: Jo Sauvarin/UNFPA

Justine Sass, UNESCOs Asia-Pacic HIV and AIDS Advisor, said shared learning across countries has been an important outcome of these consultations. Effective sexuality education programmes will help reduce the risk of STIs, including HIV, by encouraging lower risk behaviour, such as delaying sexual debut, avoiding sex with multiple partners, and consistently and correctly using condoms, Sass said. Quality sexuality education will not only achieve important health outcomes, but also produce healthier, mutually-supportive relationships free from violence. Dr. Jo Sauvarin, Asia Pacic Technical Adviser for UNFPA, said much more advocacy work was required in the Asia Pacic to show that sexuality education was too important to ignore. Investing properly in the participatory teaching methodology required to effectively deliver sexuality education will achieve benets across the education sector. It will also help reduce early marriage, early pregnancy and the high rates of maternal and infant mortality associated with that, and reduce the social and economic losses arising when young women have children too early. Professor Saroj Yadav, coordinator of Indias national Adolescence Education Program, said that, while countries would continue to adopt culturallyappropriate approaches, the UN International Technical Guidance on Sexuality Education, published by UNESCO in 2009, represented an invaluable guide for education and health-sector professionals. While for many in the region, the topic of sexuality education remains taboo, lessons being shared this week have proven that barriers to sexuality education can be overcome and the long-term health and other benets, particularly for adolescent girls, are too critical to ignore.

Participants doing a role-play

BANGKOK (UNESCO/UNFPA news release) Nearly 100 delegates from 18 Asia-Pacic countries met in the Thai capital to discuss how to provide more and better sexuality education for the regions millions of adolescent girls and boys. The 18-21 July Regional Consultations on Sexuality Education and Gender, convened by UNFPA, UNESCO and UNICEF, brought together governments, civil society, and development partners, and researchers from Afghanistan, Bangladesh, Bhutan, Cambodia, China, Fiji, India, Indonesia, Malaysia, Mongolia, Nepal, Pakistan, Papua New Guinea, the Philippines, Sri Lanka, Thailand, and Timor-Leste. They were joined by representatives from Guatemala, Ethiopia and Malawi, where a global UN initiative to support adolescent girls has been piloted. The focus of the meeting was nding better ways to reach both in and out of school adolescents with vital health and sexuality education, and to nd ways to overcome barriers to its implementation. Drawing on these exchanges, participants looked at how they could improve national sexuality education programmes, and promote the rights of adolescent girls in the Asia Pacic region as part of the UN Adolescent Girls Task Force Initiative. Margaret Sheehan, UNICEFs Asia-Pacic Youth and Adolescence Development Specialist, said the networking and exchanges of ideas among regional ofcials and experts would help build momentum for much-needed gains in sexuality education.

Monthly update from UNFPA in Asia and the Paci c

JULY-AUGUST 2011

UN-led Workshop Engages Sex Workers to Reduce HIV Transmission in China


and discrimination faced by sex workers and the impact this has on their willingness and ability to access lifesaving prevention and treatment services. Data presented showed that between 2007 and 2009 only 37 per cent of sex workers tested for HIV in the previous 12 months knew their results.
Photo: Chen Jianzhong/UNFPA China

Ye Haiyan speaking at the workshop

BEIJING (UNFPA/UNAIDS/WHO news release)Sex workers grassroots organizations met with UN agencies and government representatives to discuss how to further efforts to reduce HIV infections among sex workers and clients of sex workers in China at the Second International Workshop on HIV Prevention in Sex Work held on 22-23 June. The workshop, with over 100 participants from China and other countries in the Asia and the Pacic region, was organized by the China ofce of UNFPA, with support from UNAIDS, WHO and the Government of Luxemburg. After the rst International Workshop, which was held in April 2007, the objectives of this second workshop were to discuss the current situation of sex work and HIV in China and border areas and reach a common understanding on the recommended strategies for the duration of Chinas next Five-Year AIDS Action Plan (2011-2015). Only we who really understand sex workers know what services are most effective, said Ye Haiyan, a representative from a grassroots sex workers network. While sex workers are becoming more actively involved through forming their own communities and networks, their voices have not been strong enough to reach policy makers and donors. There was considerable discussion around the stigma

Research by the China Sex Workers Organizations Network Forum also showed that police-led crackdowns in 2010, have had an adverse impact on HIV-prevention efforts. Almost 40 per cent of respondents (170 out of 437) reported that they continued to engage in sex work during crackdowns, but were forced to do so in more obscure locations or to frequently change locations. These ndings demonstrate that crackdown style approaches signicantly increase the difculty of reaching sex workers with effective HIV-prevention services and information. Success in achieving the 25 per cent reduction in new HIV infections by 2015 as set in Chinas National Five-Year Action Plan requires focused efforts to prevent new infections among sex workers, noted Mark Stirling, UNAIDS Country Coordinator in China. At the recent 2011 High-Level Meeting on AIDS at the United Nations in New York, national governments including China made specic commitments to redouble efforts to achieve MDG 6, to halt and reverse the spread of HIV by 2015. Mr. Stirling urged the participants to discuss explicit targets for reducing new HIV infections and AIDS deaths among sex workers in China in light of the Political Declaration on HIV/AIDS adopted at the high-level meeting. HIV has been the most challenging MDG for many developed and developing countries, including China, said Urmila Singh, ofcer-in-charge of UNFPA China. Sexual transmission continues to be the primary mode of HIV transmission; more efforts should be committed to targeting the most-at-risk and hardestto-reach sex workers. They include low-income, lesseducated, street-based sex workers, and those who use substances including new drugs, as well as sex next page

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workers from ethnic minorities in poor and remote areas. The workshop explored strategies to improve HIVprevention efforts among sex workers and clients, including approaches to addressing violence against sex workers and responding to the challenges arising from the high levels of mobility of many sex workers and clients due to both internal and cross-border migration. The consultation generated a set of priority actions. First and foremost, it was agreed that sex workers need to be effectively involved in policy formulation, planning and the design and delivery of programmes intended to reach sex workers. Representatives of the Ministry of Health expressed their commitment to strengthening the involvement of sex workers community-based organizations in the HIV response. Second, it is essential that efforts are made to build supportive environments which ensure that HIV-prevention efforts among sex workers and their clients are successful. This requires shared understanding and closer collaboration between different departments including public health and public securities in particular. Third, a comprehensive package of services should be dened and promoted. The package should include peer-based information and education, sexual and reproductive health services including diagnosis and treatment of sexually transmitted diseases, condoms, voluntary HIV testing and counselling, and effective referral to HIV treatment, care and support as needed. Scaling-up of effective prevention among low-income street-based sex workers should be prioritized. Fourth, monitoring and evaluation of interventions for sex workers must be strengthened to measure the results of programmes. Finally, opinion leaders and the media have an important role to play in challenging social norms that perpetuate stigma and discrimination against sex workers. The UN system in China will continue to support such platforms to facilitate direct dialogues with sex workers organizations and closer collaboration of stakeholders to strengthen responses among sex workers in China.
UNFPA Representative Pornchai Suchitta (left) presenting the report

Timor-Leste Presents Results of 2010 Census


Increased literacy rates, more jobs needed and a fast-growing capital

DILI - The National Statistics Directorate, together with Prime Minister Xanana Gusmao, Finance Minister Emilia Pires and UNFPA Representative Pornchai Suchitta, launched the main results of the 2010 Population and Housing Census. Some tendencies stand out in the vast statistical material: the large increase of the total population, the rapid migration to Dili continues, literacy rates are improving and a large number of new job opportunities will be needed to reverse the trend of declining labour force participation and employment rates. The ndings also suggest that the number of Timorese households with access to social amenities like mobile phones, TV and electricity has increased rather dramatically. At the same time, nine out of ten Timorese households still use rewood for cooking, thus posing an environmental threat to the country. I am very pleased with the way the whole 2010 Census operation has been carried out by the literally thousands of staff members who have participated in some stage of this great national effort. We should rejoice and be really proud of ourselves for pulling it off, but I also want to point out that the most important part of our work as a nation starts now, and that is to use this immense knowledge base as much and as effectively as possible, says Pires. next page

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Photo: Ministry of Finance, Timor-Leste

Monthly update from UNFPA in Asia and the Paci c

JULY-AUGUST 2011

The main census report contains a wealth of information. Apart from data on access to household amenities and rates of literacy and employment, interested readers will nd information about crop production, livestock, school enrollment, housing materials, sanitation facilities and people with different kinds of disabilities, to name but a few of the indicators included in the report. For most indicators it is also possible to verify the difference between rural and urban areas, men and women and between different age groups. We fully understand that the statistical material produced by the census team at the National Statistics Directorate can be rather overwhelming, but at the same time we cannot afford not to make the most of this information. For this reason, we will make sure that policymakers and other stakeholders receive the necessary training to be able to use the data. Census staff will be visiting every district to hold workshops on how to interpret the results and how to maximize the use of the census report, and I urge everyone to participate and pay close attention, says Pires. A preliminary census report was launched in October 2010. Towards the end of the year, ve out of a total of eleven planned thematic census reports will be published.

Australia Supports Lao PDR in Social Indicator Survey


VIENTIANE - The Australian Agency for International Development (AusAID) signed an agreement with UNFPA to provide AUD 300,000 support for the Lao Social Indicator Survey (LSIS). LSIS is a signicant nationwide householdbased survey on social development. Australias contribution is earmarked for eld data collection, which is planned this September 2011 in 20,000 households in 1,000 villages. The funds will be channelled through UNFPA to support the government to carry out the survey. The survey is coordinated and led by the Ministry of Health, with technical support from the Department of Statistics of the Ministry of Planning and Investment, and is being supported by development partners, namely UNFPA, UNICEF, USAID, the Government of Luxembourg, UNDP, WHO and JICA. It is a big operation with an estimated total cost of USD 1.3 million. Australias contribution is timely and will contribute to the governments successful implementation of LSIS. LSIS combines two surveys that were previously conducted separately: the Multi Indicator Cluster Survey (1996, 2000 and 2006) and the Lao Reproductive Health Survey (1995, 2000 and 2005). It also draws upon the Demographic and Health Survey, which is conducted globally. The survey focuses on health, including reproductive health, maternal health, contraception, sexual behaviour, HIV/AIDS, child health and nutrition. It also collects data about education, child protection, child development, and water and sanitation.

VIDEO

Community Midwifery Takes Hold in Laos

Maternal and infant mortality in Laos are high because too many women give birth without skilled assistance. To address this gap, the country recently began to train and deploy a new cadre of licensed community midwives.
Video: UNFPA APRO and UNFPA Lao PDR Link: http://www.youtube.com/unfpaasia#p/u/1/CySJNLcdRdk

The data obtained from LSIS will be analysed and disaggregated to national and provincial levels. Eventually, it will contribute to a baseline for the 7th National Socio-Economic Development Plan for 2011-2015 and support the countrys monitoring of progress towards achieving the Millennium Development Goals.

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A Sound Investment: Skilled Care in Bangladesh
trained by Kumudini Hospital, with the support of the initiative under the Private CSBA Initiative. She advised him to bring Shanu to the community clinic. Shanu was brought to the clinic at 5:00pm on May 4. She delivered a healthy baby at 10:00pm. Both Shanu and her husband were overjoyed to have this baby, delivered safely and at no cost. On 20 June, the rst-ever State of the Worlds Midwifery 2011: Delivering Health, Saving Lives was launched in Durban, South Africa, at the 29th Triennial Congress of the International Confederation of Midwives. The report, whose publication was coordinated by UNFPA, reveals that unless an additional 112,000 midwives are trained, deployed and retained, 38 of the 58 countries surveyed might not meet their target to achieve 95 per cent coverage of births by skilled attendants by 2015, as required by MDG 5 on maternal health. Globally, 350,000 midwives are still lacking. Despite signicant progress in improving maternal mortality and reproductive health services in Bangladesh, there remain serious shortfalls in maternal health outcomes and access to services, particularly for poor women and for people in hard- to-reach and remote areas. The good news is that the maternal mortality ratio has signicantly declined in the last nine years, from 320 per 100,000 live births in 2001 to 194 in 2010, according to the recent Bangladesh Maternal Mortality Survey 2010. But still, more than 7,000 women are dying every year while giving birth. More than 75 per cent of all deliveries take place at home and skilled health personnel attend only 26.5 per cent of all deliveries, with vast inequalities between the rich (53 per cent of whom have been attended by a skilled provider) and the poor (only 7.5 per cent had access to skilled care). There is a growing international consensus on the critical role that midwives play in reducing maternal and neonatal mortality and morbidity and sustaining the same. Investing in midwives is one of the soundest investments Bangladesh can make. Fully certied midwives, trained in accordance with international standards, are an essential workforce in an effective healthcare system and the best way forward to reduce maternal and neonatal mortality, as well as morbidity. A health system that can deliver for women and newborns is a health system that can deliver for all. next page

Photo: UNFPA Bangladesh

Skilled birth attendants help ensure the safe delivery of babies in Thakurgaons district hospital

When Shanu, 25, gave birth to a healthy child on May 4 in a local community clinic, she was crying with joy. She never thought she would have a child after what happened six years earlier Shanu got married at the age of 17 and became pregnant after a couple of months. Living in a remote village of Thakurgaon district, where road conditions are poor and no health facility nearby, Shanus family members decided that her baby be delivered at home with the help of a local traditional birth attendant (dai). After more than 16 hours struggle, Shanu gave birth to her rst child, but the baby had respiratory complications. A local village doctor was called in to try to manage the situation at home, but the newborn died later that night. Shanu was unable to conceive for the next six years, but became pregnant again in mid-2010. This time, Shanu was registered as a pregnant mother, and she attended several mothers group meetings, where she received information about the danger signs of pregnancy, the importance of antenatal and postnatal checkups, birth planning practices, exclusive breastfeeding, and postpartum family planning. This was made possible with the support of the Maternal and Newborn Health Initiative, a joint initiative of the government of Bangladesh and three UN agencies (UNFPA, UNICEF ad WHO) to reduce maternal and neonatal morbidity and mortality in Bangladesh, funded by the European Union, UKAid and CIDA. When labour started, Shanus husband contacted Merina, a community-based skilled birth attendant,

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Monthly update from UNFPA in Asia and the Paci c

JULY-AUGUST 2011

The Bangladesh prime minister, Sheikh Hasina, committed during the MDG Summit in September 2010 in New York to doubling the percentage of births attended by a skilled health worker by 2015 through training an additional 3,000 midwives, stafng all 427 sub-district health centres to provide round-the-clock midwifery services, and upgrading all 59 district hospitals and 70 Mother and Child Welfare Centres as centres of excellence for emergency obstetric care services. This commitment is highly laudable and will tremendously help in achieving further reductions in maternal mortality and morbidity to achieve the Millennium Development Goal 5 by 2015. To operationalize this strategic direction of the prime minister, the government of Bangladesh, with the support from the United Nations Population Fund and the World Health Organization, initiated a midwifery education programme in alignment with international and national standards to produce midwives with the required competencies. To date, a six-month post-basic advance training curriculum has been developed, six training institutes have been strengthened with training aids, 20 faculties/teachers have been trained and 60 midwives have already been certied on May 5. These sixty midwives are under process of deployment in 15 upazila health complexes. The six-month post basic midwifery training is been scaled up to train another 50 faculties and 140 midwives by 2011. Simultaneously, the development of a three-year diploma direct entry midwifery programme curricula is under nalization and the course is planned to start in 2012. This programme will slowly replace the 6-month training for a more sustainable and longterm solution for the country. In the Mujabonni Community Clinic in Thakurgaon, Merina provides essential midwifery services to the women, children and families in her community. We need more community-based skilled birth attendants, like Merina, and midwives in Bangladesh, so that in the near future no woman dies when giving birth and no child starts her/his life without skilled care. The good news is Bangladesh is on the right track. - Arthur Erken

New Cadre of Laotian Midwives Saving Lives

Community midwife Bounchan Phimmasan (left) giving Ta Sivilay an antenatal exam.

XIENG KHOUANG, Lao Peoples Democratic Republic - Pregnant again after suffering a stillbirth and a miscarriage at home, Ta Sivilay is comforted to know help is now available nearby. I lost two babies. It was very sad. You carry the baby a long time and then you expect to see his or her face. It took me a long time to recover, she says. I dont want to lose another one. Anytime I feel anything strange, I immediately go to see the midwife. Her midwife, Bounchan Phimmasan, graduated in December 2010 from the countrys rst midwifery education programme in more than two decades. From her rural health centre base, she serves women in a dozen surrounding villages. In Lao PDR, only one in ve births is attended by a trained health professional. Maternal mortality has decreased by 51 percent since 1990 but remains very high - more than 300 mothers die for every 100,000 live births. Just seven countries outside sub-Saharan Africa have such a high maternal mortality ratio. Deaths of newborns are similarly frequent. Providing lifesaving care during all births is an urgent priority if the country is to achieve Millennium Development Goals 4 and 5, which call for sharp reductions in infant and maternal mortality by 2015. next page

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Photo: William A. Ryan/UNFPA

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accreditation exam were also established for the rst time. In the capital city of Vientiane, international experts taught 40 teachers how to conduct competency-based midwifery training. The teachers then returned to eight provincial public health schools where they are training midwives through participatory teaching methods, which include group exercises and peer feedback. Ninety-seven per cent of the rst class passed the exam, and at the end of 2010, 135 newly accredited community midwives returned to their local health centres. Each wears a distinctive new uniform, readily recognized in her or his community, and carries a midwifery bag with a new logo. Bounchan has seen a steady increase in clients since she came back from school, and feels more condent delivering babies. Now I can recognize the danger signs of complications and know the next steps to follow to save lives, she says. For example, she learned how to remove a retained placenta, which causes haemorrhage. I didnt know how to do that before. If I have a case I dont know how to handle, I call the doctor at the provincial hospital. I can also call the teachers from the public health school, she adds. Caring for mothers and infants in remote areas remains a challenge. Bounchan recounts one instance when the husband of a woman in labour took her 25 kilometres by motorbike to a mountain village not reachable by car. The woman was nearly ready to deliver by the time I arrived, she recalls. It didnt take long. - William A. Ryan

Photo: William A. Ryan/UNFPA

A teacher showing midwifery students how to examine a pregnant client

An assessment of Lao health workers in 2008 found that few were competent to adequately manage childbirth complications. To close this gap, the Ministry of Health decided to establish a new professional category of community midwives. It started the training the following year, with support from international donors and UNFPA. Most of the rst students, like Bounchan, were community health workers who had delivered babies but lacked comprehensive knowledge about the procedures to follow, particularly in dangerous situations. Whether a skilled birth attendant is a midwife, a nurse, a physician or other person, we must ensure that they have essential knowledge, skills and decision-making ability - so-called competencies - to safely meet the common needs of mothers, infants and children and also handle emergencies as they arise, notes Kathleen Fritsch, Regional Adviser in Nursing for the World Health Organization. UNFPA helped the Ministry create a new midwifery curriculum based on standards, techniques and materials developed by WHO and the International Confederation of Midwives, translated into the Lao language. Certication standards and a national

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