Policymakers Workshop Policymakers Workshop To support the National SRH/ HIV/AIDS Behaviour Change Strategy

2 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

3 STIs, including HIV RH Components Safe Motherhood RH Cancers Unsafe Abortions Family Planning Harmful Cultural Practices Gender Inequalities

What is the situation we are facing now in Malawi related to Sexual and Reproductive Health?

5 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.

6 High Infant Mortality Rate High infant mortality rate: 104 deaths per 1,000 live births

7 High HIV/AIDS Prevalence  15% of adults years old HIV positive  845,000 people infected with HIV  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 Photograph by David Jones

8 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.

9 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

10 High Total Fertility Rate High total fertility rate: 6.3 Picture copied with permission from the Friends of Malawi web page.

11 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%

12 Adolescents Are At Greatest Risk for SRH problems.  Average age of sexual debut is years old  High occurrence of pregnancy and childbirth among adolescent girls: 1/3 of 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.

13 Harmful Cultural Practices Put Men and Women At All Ages at Risk  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)

14 Specific Risks For Women’s Reproductive Health  Rape  Battery  Domestic violence  Incest  Psychological abuse  Sexual harassment Photograph by David Jones

15 Violence Against Women  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. All these types of violence directed against women are linked to the same familiar courses of:

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

17 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

Consistent and adequate supplies Adequate number of well trained, deployed and supplied providers Adequate physical assets Clients seeking, adopting and maintaining safer sexual and RH practices Translating knowledge into positive behaviour change CHALLENGESCHALLENGESCHALLENGESCHALLENGES CHALLENGESCHALLENGESCHALLENGESCHALLENGES Strong management, resource allocation, coordination and monitoring systems

19 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.

20 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

21 What We Must Do?  Support an integrated, multisectoral approach to promote reproductive health for all  Provide adequate, ongoing financial resources for reproductive health services Promote choice for all Malawians to achieve our reproductive health goals:

22 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

23 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!

24 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.

25 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)

26 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

27 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

28 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  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%.

29 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