Working in the South Asia presents great challenges. While the region has made spectacular technological and medical advances, large sections of its population have little or no access to basic health facilities and medical care. Maternal mortality in South Asia remains the second highest in the world. Iran and Sri Lanka have the lowest maternal mortality rate (28 and 30) in the Region, with countries such as Afghanistan reporting an MMR as high as 1,575. An analysis of the decline in MMR since 1990 shows that while many other countries have achieved some reduction in deaths related to maternity, in Afghanistan there has been an increase in MMR (see table below).

Maternal mortality ratio (MMR) in South Asia Region

In South Asia, contraceptive choices are still out of reach for large proportions of the population, and thousands of women die every day of abortions carried out in unsafe conditions or by unqualified health services providers.

Poverty, hunger and inequality persist. One out of every three children who die in the world is in South Asia, which is also home to two-thirds of the world’s malnourished children. Child labour is on the rise with millions of children working in hazardous industries and at risk of trafficking and sexual exploitation. The plight of little girls is especially pathetic. Due to their low literacy levels and lack of empowerment , women have a small role in decision-making or in public life. South Asia is yet to address the problem of HIV/AIDS adequately. Though adult HIV-prevalence in South Asia is below one per cent, in terms or absolute numbers it translates into 5.2 million people living with the virus, with an estimated 5.1 million in India alone, making for the second largest epicentre in the world in terms of numbers after South Africa which has 5.6 million people infected with the virus.

HIV / AIDS prevention and treatment programmes are frequently isolated from other health services, defeating the very purpose for which they are designed. If these programmes were to be linked and integrated with basic reproductive health care, awareness would spread faster. This is all the more necessary in South Asia where HIV is largely spreading through heterosexual contact with husbands, as women have little ability to refuse unsafe sex. The spread of the virus is deeply entrenched in gender inequalities.

HIV / AIDS disproportionately affects the young, with more than a third of all people living with AIDS being under 25, and young women the most vulnerable. ICPD had recognised the link between the fight against HIV/ AIDS and the promotion of sexual and reproductive health and rights. Ten years later, reaching out to the young is one of the big challenges facing planners and service providers.

South Asia is also home to the largest number of adolescents and teenage mothers in the world. They have little access to reproductive and sexual health knowledge, and the region counts high numbers of Sexually Transmitted Diseases and Reproductive Tract Infections. There is an urgent need to provide them with knowledge and health facilities that they can access. However, making the task difficult are cultural taboos and the reluctance to talk about issues relating to sexual and reproductive health , domestic violence and abuse within the family. Regional conflicts, militarisation and the hardening of fundamentalist postures have hindered, and often led to a complete breakdown of health and education services and increase in violence against women.

The South Asian region is prone to landslides, earthquakes, droughts and floods. Once hit by a calamity, life comes to a halt. The tsunami in 2004, the earthquake in 2005 and the floods in Pakistan in 2010 are reminders of the grave vulnerability of this region. The destruction due to these disasters has been enormous, affecting millions of people, and leading to the collapse of regional economies.

Structural reforms mandated cuts in the social sector spending, further pushing up health care costs in the region. With growing and poorly regulated privatisation of the health sector and soaring prices of drugs and treatment, health care expenditure in many countries is driving households into poverty.

And with all this, come cuts in health sector fund allocation by international donors and national governments. The United States Government’s Gag Rule which cut off aid to organisations promoting safe abortions has been lifted and has helped intensify efforts in providing poor and marginalised women with basic reproductive health care.

In this scenario, IPPF SARO works through its eight member associations in Afghanistan ( www.afga.org.af ), Bangladesh ( www.fpab.org ), Bhutan ( www.renewbhutan.org ), Iran ( www.fpairi.org ), Maldives ( www.she.org.mv ), Nepal ( www.fpan.org ), Pakistan ( www.fpapak.org ) and Sri Lanka ( www.fpasrilanka.org ). It reaches out to the young, the poor, the marginalised and the most vulnerable, saving women from repeated pregnancies, providing contraceptives, safe abortions, counselling, treatment, care and working in the broader framework of women’s empowerment and rights.

The Millennium Development Goals (MDGs), by not making a specific reference to reproductive and sexual health, have directly affected IPPF’s work. Governments and donor agencies have cut down on funds, no longer seeing sexual and reproductive health as an essential component in the march towards a poverty-free world. For the South Asian Region, home to the world’s largest number of adolescents and teenage mothers, rising number of abortions, lack of contraceptive choices, soaring cases of STDs, HIV positive people and a pervasive culture of silence surrounding reproductive and sexual health topics, the omission has had serious repercussions, derailing the ICPD spirit, that had spurred governments’ to action.

We remain committed to overcoming the challenges that lie before us in accomplishing our mission which is to improve the quality of lives of individuals, by campaigning for sexual health and reproductive rights through advocacy and services, especially for poor and vulnerable people.