State of World Population 2012 - Country Page List - UNFPA

pregnancy, their inability to negotiate contraceptive
use with their (usually older) husbands, or
to access services contribute to high levels of
childbearing in adolescence.
Few family planning programmes include
strategies for reaching child brides who are often
isolated, without well-developed social networks,
and vulnerable to many adverse maternal health
outcomes associated with early pregnancy and
childbirth. This is another important area for
investment. (Malhotra et al., 2011; Bruce and
Clark, 2003; UNFPA, 2009; Lloyd, 2009;
Countries with the highest
rates of child marriage
Country
Per cent girls
married before
age 18
Niger 75%
Chad 72%
Bangladesh 66%
Guinea 63%
Central African Republic 61%
Mali 55%
Mozambique 52%
Malawi 50%
Madagascar 48%
Sierra Leone 48%
Burkina Faso 48%
India 47%
Eritrea 47%
Uganda 46%
Somalia 45%
Nicaragua 43%
Zambia 42%
Ethiopia 41%
Nepal 41%
Dominican Republic 40%
Source: UNFPA, 2012
World Health Organization, 2008; Lam,
Marteleto and Ranchhod, 2009; Levine et al,
2008; Mensch, Bruce and Greene, 1999.)
Poor quality as an obstacle to family
planning use
When services are unreliable or delivered by
untrained personnel, or when a full range of
contraceptives and information is unavailable,
people with unmet need may choose not to take
advantage of family planning and are therefore
unable to exercise their right to it.
Health systems in many countries struggle to
meet the challenge of managing their human
resources effectively, making sure that infrastructure
is adequate to the task of providing services
and ensuring the supply of adequate materials
and equipment of all kinds. People living in
rural areas are especially vulnerable to weaknesses
in the health system that can leave them beyond
the reach of services available to people in towns
and cities.
One consequence of poor guidance on a rightsbased
approach to health and weak management
of staff can be the biased and discriminatory
attitudes of health workers. Some providers internalize
social biases towards minority populations.
Health workers’ attitudes can affect the quality of
information given to specific clients, resulting in
a lack of informed choice and options.
A lack of privacy and inability to communicate
are barriers to service delivery for some
groups. A recent multi-country study found that
health programmes in refugee camps did not
ensure the right to privacy, confidentiality, and
non-discrimination to all, particularly for adolescents
and unmarried persons (United Nations
High Commissioner for Refugees, 2011). In
some settings, internally displaced persons or
refugees are often unable to access quality services
due to limited commitment to helping
66 CHAPTER 3: CHALLENGES IN EXTENDING ACCESS TO EVERYONE