Briefing on progress made in promoting women’s

reproductive health and rights- with special focus on HIV and

AIDS

JMC on Improvement of Quality of Life and Status of Women

30 May 2008

Outline of the presentation Introduction Legislative and policy framework

( global and local) Programme status and implementation

Contraceptives and Family planning CTOP Gender based violence Male involvement Prenatal and post natal care Youth friendly services conclusion

INTRODUCTION

Defining SRH and Rights Reproductive Health and Rights include

the rights of couples and individuals to make free and informed choices about their reproductive lives.

Rights include the rights of all individuals to make free and informed decisions on all matters relating to their sexuality

Legislative and policy framework

Global treaties and commitments: SA ratified and is signatory to Elimination of All

Forms of Discrimination Against Women (CEDAW) 1995,

The Beijing Platform for Action 1996 The Millennium Development Goals 2000, four (3,

4, 5 and 6 ), Recommitted, to the implementation of the

International Conference on Population and Developmental (ICPD) (Cairo 1994)

Global treaties and commitments:continued

Adopting the Sexual and Reproductive Health Policy Framework at the 2nd Ordinary Session of the Conference of African Ministers of Health (CAMH 2) in Gaborone, Botswana 2005.

This programme of action led to a Special Ministerial Conference on Sexual and Reproductive Health in September 2006 in Maputo.

Local commitments:

The Choice of Termination of Pregnancy ACT 92,1996

The SA constitution

Local policies and commitments

Medical Termination of Pregnancy Guidelines Policy on Conscientious Objection to CTOP Draft Policy document on Fertility Options

including HIV infected -2007 Policy on Sexual Assault Care Updated Sexual Assault Care Training Manual –

pilot phase completed- 2007 Cervical Cancer Screening Policy Family Planning Training Manual and Policy A comprehensive Sexual and Reproductive

Health

Local policies commitments:

National Strategic Plan (NSP), 2007 -2008

Comprehensive Care, Management, Treatment and Support (CCMT &S) 2003

New PMTCT Guidelines and Implementation Plan, 2008

Programme status and implementation

Contraception and Family Planning Services

Objective 2.5 of the NSP is to integrate sexual and reproductive health services and HIV prevention

In-cooperated VCT into family planning 65% contraceptive coverage in SA. 13,357 women and 4.623 men had

undergone hysterectomy and vasectomy respectively in 2003. 9

Choice on the Termination of Pregnancy

currently provided at 70% of hospitals and 27% of Primary Health Care facilities

Caters for all women including those that are HIV infected

Plans are afoot for the introduction of Medical Termination of Pregnancy (using drugs to induce labour).

Concern –There appears to be a decline in contraception use and an increase in a demand for termination.

Gender Based Violence (GBV)

awareness campaign for 365 days a year for preventing GBV

There are presently 10 Thuthuzela centers

Concern- still a preponderance of violence against women

MALE INVOLVEMENT IN SRHR

No specific coverage figure Quite a number of male activists throughout the

country Three - day workshop with men groups Good response, 250 men participated Objectives of male involvement:

To develop an understanding of Men’s SRH experience,

To identify ways in which men can support their partners participation in MCH, SRH especially HIV and AIDS.

To increase men’s skills, knowledge and motivation related SRH services.

Peri-natal and post natal care

Antenatal Entry points for HIV-infected women CCMT and Support programmes

including counseling on feeding choices Testing is an integral part of PMTCT as

well as family planning. opportunity for women of unknown

status to under go Voluntary Counseling,

top five causes of maternal deaths were:

Non – pregnancy related infections (predominantly AIDS) 37%

Complications of hypertension 19.1% Obstetric haemorrhage 13.4% Pregnancy related sepsis 8.3% Pre-existing maternal conditions 5.6%Concern- these maternal deaths are

attributable to avoidable factors, missed opportunities and substandard care.

Concern

Though there is high coverage of ANC at 92% (DHS) 2003 and that 84% of women deliver in a facility with skilled birth attendants, these seam to be missed opportunities for improved maternal care.

Strategies to address maternal deaths.

Department is implementing the recommendations of the National Committee on Confidential Enquiry into Maternal Deaths made recommendations to try and reduce maternal deaths

Basic Antenatal Care (BANC) strategy. Banc is a focused antenatal care quality assurance tool meant to improve pregnancy outcomes.

PMTCT

Primary Prevention of HIV Prevention of unintended

pregnancies and family planning Prevention of mother to child

transmission Provision of comprehensive care

management and treatment for the affected woman and her family

INTRA-PARTUM CARE

Extra care for HIV infected mothers Avoidance of unnecessary vaginal

examinations Avoidance of early rupture of

membranes (ROM) Episiotomy Forceps delivery Vacuum extraction Excessive suctioning of the newborn Resuscitation of the new born

POST PARTUM CARE

Neonatal deaths contributes 40% of under-5 mortality rate

Most NB interventionbreastfeeding within the 1st hour of birth

as it promotes bonding and provides warmth to the baby ( for mothers who have chosen to breastfeed)

Kangaroo Mother Care (KMC) empowers mothers of LBW babies to actively participate in the care of their newborn

YOUTH FRIENDLY SERVICES

Provide Young People with life-skills education including negotiation skills thereby uplifting their right to informed decision making

BENEFITS OF THE YOUTH FRIENDLY SERVICES Understanding the value of health seeking behaviour Encourage peers to use health services appropriately

(peer-peer education) Respect the rights and responsibilities of young people Facilitate interaction between adults and young people Encourage youth participation in their SRHR

CONCLUSION The constitution of South Africa lays a

foundation for a right based approach in programming. This is ensured in all programmes.

In addition the principles guiding HIV testing, care and support include imperatives of the constitution, batho pele and those guiding the implementation of the Strategic Plan 2007 – 2011