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 remains the second highest in the world, with 540 women dying for every 100,000 live births and only 37 per cent of deliveries attended by skilled health care personnel, a figure even lower than sub-Saharan Africa. Contraceptive choices are out of reach for large chunks of population, and thousands of women die every day of abortions carried out in unhygienic conditions or by quacks.
Poverty, hunger and inequality persist. One out of every three children who die in the world are in South Asia and it is home to two-thirds of the world’s malnourished children. Child labour is on the rise with millions working in hazardous industries and at risk of trafficking and sexual exploitation. The plight of little girls is especially pathetic. With low literacy and education levels, women have no part in decision making or public life. South Asia has yet to come to terms with HIV/AIDS. Though adult HIV prevalence in South Asia is below one per cent, it means 5.2 million people are living with the virus, with an estimated 5.1 million in India, making for the second largest epicentre in the world in terms of numbers after South Africa with 5.6 million.
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 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.
Every time a natural calamity strikes, and the region is prone to landslides, earthquakes, droughts and floods, normal life grinds to a halt and with it the fragile health delivery systems. The recent tsunami saw homes and facilities being washed away, livelihoods in tatters, and the collapse of regional economies.
Structural reforms mandated cuts in the social sector spending, further pushing up health care costs. 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 by cutting off aid to organisations promoting safe abortions, has hampered efforts to provide poor and marginalised women with basic reproductive health care.
It is in this scenario that SARO works through its seven member associations. 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.