63 per cent to 93 per cent <strong>of</strong> young men reportingusing contraception in parts <strong>of</strong> NorthAmerica, Europe, and Latin America and theCaribbean (United Nations, 2007). These figuresstand in stark contrast with most sub-SaharanAfrican countries, where less than 50 per cent<strong>of</strong> young, sexually active men used a condom atlast sex. Globally, female sterilization remains themost commonly used method, chosen by 20 percent <strong>of</strong> married women (United Nations, 2011).The figure is much higher in some countriesdepending on fertility patterns and the range<strong>of</strong> reversible methods available to women.Countries, with the support <strong>of</strong> the international community,should protect and promote the rights <strong>of</strong> adolescents toreproductive health education, information and care andgreatly reduce the number <strong>of</strong> adolescent pregnancies …Governments, in collaboration with non-governmentalorganizations, are urged to meet the special needs <strong>of</strong>adolescents and to establish appropriate programmes torespond to those needs. Such programmes should includesupport mechanisms for the education and counseling <strong>of</strong>adolescents in the areas <strong>of</strong> gender relations and equality,violence against adolescents, responsible sexual behaviour,responsible family-planning practice, family life, reproductivehealth, sexually transmitted diseases, HIV infection andAIDS prevention.— ICPD Programme <strong>of</strong> Action, paragraphs 7.46 and 7.47.The international community has morethoroughly cultivated men’s engagement in thecontext <strong>of</strong> HIV prevention, and communitybasedprevention efforts have contributed toincreased uptake <strong>of</strong> male condoms. Yet the<strong>World</strong> Health Organization reports that lessthan a third (31 per cent) <strong>of</strong> young men indeveloping countries have a “thorough andaccurate” understanding <strong>of</strong> HIV, suggesting thatmore support for men’s sexual and reproductivehealth, including sexuality education and contraceptives,is needed (United Nations, 2009b).Men are increasingly expressing a desire tobe more engaged in planning their families,including reducing the number <strong>of</strong> unplannedpregnancies (Barker and Pawlak, 2011). Up to50 per cent <strong>of</strong> men in some countries—Brazil,Germany, Mexico, Spain, and the United<strong>State</strong>s—would consider hormone-based contraceptionif such male methods became available(Glasier, 2010). Involving men <strong>of</strong> reproductiveage in family planning programmes from anearly age can promote more constructive communicationbetween couples about the timingand spacing <strong>of</strong> children.4 Other marginalized groupsIndigenous people and ethnic minorities.Indigenous peoples and ethnic minorities <strong>of</strong>tenlack access to family planning. Results fromqualitative interviews find that providers themselvesexpress difficulties assisting ethnic andindigenous women, <strong>of</strong>ten because <strong>of</strong> an inabilityto adequately communicate or understandtheir cultural practices (Silva and Batista, 2010;Cooper, 2005). Prejudice against these groupscan lead to lower levels <strong>of</strong> investment in theirsexual and reproductive health (United NationsEconomic and Social Council, 2009).The harmful consequences <strong>of</strong> governmentunder-investment are reflected in large disparitiesbetween indigenous and non-indigenous womenon key reproductive and maternal health indicators.These include maternal mortality rates,total fertility rates and unmet need for familyplanning (Silva and Batista, 2010).Significant health-related inequalities existbetween indigenous and non-indigenousgroups in several countries around the world.In Guatemala, for example, where indigenous56 CHAPTER 3: CHALLENGES IN EXTENDING ACCESS TO EVERYONE
groups (Maya, Xinka, and Garifuna) account fornearly 40 per cent <strong>of</strong> the total population and75 per cent <strong>of</strong> its poor, 39 per cent <strong>of</strong> marriedindigenous women ages 15–49 have an unmetneed for family planning and are thereforeunable to exercise their right to family planning(Guatemala Ministry <strong>of</strong> Public Health andSocial Assistance, 2003). In contrast, 22 per cent<strong>of</strong> non-indigenous women have an unmet needfor family planning. These disparities in accessto services contribute to the high fertility rate(6.1) among indigenous women who are also atgreater risk <strong>of</strong> maternal death compared to nonindigenouswomen.CASE STUDY<strong>UNFPA</strong> and indigenous groups inLatin AmericaIn order to address the high maternal and infantmortality among indigenous women, youth andadolescent girls, <strong>UNFPA</strong> has been working toincrease their access to quality, safe and culturallyacceptable maternal, newborn and reproductivehealth services, including family planning(<strong>UNFPA</strong>, <strong>2012</strong>d). In so doing, <strong>UNFPA</strong> hasbeen promoting intercultural dialogue amongtraditional health systems with national, predominantlyWestern allopathic health systems,Need for family planning reflected in multi-year gap between men’s age atfirst intercourse and age at marriageMean age at first intercourseMean age at marriageSub-Saharan Africa18.923.7Latin Americaand the Caribbean1723.8South andSoutheast Asia22.323.50 10 20 30Age• In sub-Saharan Africa, young men have sex approximately five years before they marry• In Latin America and the Caribbean, young men on average have sex before their 18th birthday, and then wait nearlyseven years before marrying• In South and Southeast Asia, the gap (1.1 years) between men’s self-reported age at first intercourse and their age atmarriage is significantly less compared to other regions.Source: Select countries with latest available demographic and health survey data, data: IFC Macro DHS StatcompilerTHE STATE OF WORLD POPULATION <strong>2012</strong>57
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OverviewOne hundred seventy-nine go
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The report is structured to answer
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viiiCHAPTER 1: THE RIGHT TO FAMILY
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“All human beings are born free a
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Treaties, conventions and agreement
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Monitoring Monitoring ICPD ICPD Goa
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Monitoring Monitoring ICPD ICPD Goa
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Monitoring Monitoring ICPD ICPD Goa
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Monitoring ICPD Goals Demographic -
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Monitoring ICPD Goals - Selected In
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BibliographyAbbasi-Shavazi, Mohamma
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Delivering a world where every preg