1. 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

2. 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

3. 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

4. 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)

5. 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.

6. Local commitments: The Choice of Termination of Pregnancy ACT 92,1996 The SA constitution

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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.

13. 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,

14. 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.

15. 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.

16. 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.

17. 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

18. 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

19. POST PARTUM CARE Neonatal deaths contributes 40% of under-5 mortality rate Most NB intervention breastfeeding 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

20. 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

21. 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