State of World Population 2012 - UNFPA Haiti

“… culture influences the status of women’s reproductive healththrough determination of the age and modalities of sexuality,marriage patterns, the spacing and number of children,puberty rites, decision-making mechanisms and their ability tocontrol resources, among others. Societal and cultural genderstereotypes and roles also explain why so many adolescent boysand men remain on the fringes of sexual and reproductive healthpolicies and programmes, despite their key role in this realm andtheir own needs for information and services.”— UNFPA Family Planning Strategy, 2012also exist within rural communities, andnational income quintile assessments can maskthe relative disparities within rural and urbancommunities. For example, research from LatinAmerica and sub-Saharan Africa finds thatwhen adjusted quintiles for rural communitiesare used to examine family planning indicators,women from the wealthiest quintiles withintheir rural communities are more able to accessfamily planning services (Foreit, 2012).In other settings, the rapid expansion ofurban areas has also outpaced governments’abilities to develop the infrastructure to providethe urban poor with quality family planning.More than half of the world’s populationStrengthening integration of HIVand sexual and reproductive healthin ZimbabweWomen and girls of reproductive age have been hardest hit by the HIVepidemic in Zimbabwe: prevalence among pregnant women is high, andHIV and AIDS are responsible for about one in four maternal deaths. In2010, an assessment of sexual and reproductive health and HIV/AIDSpolicies and programmes found that inadequate integration of sexual andreproductive health and HIV programmes diminished health providers’capacities to respond to women’s and girls’ unmet need for familyplanning. In collaboration with UNFPA, the World Health Organizationand UNICEF, the Ministry of Health and Child Welfare is closing the gapby developing new integrated service-delivery guidelines and trainingservice providers.now lives in urban areas, and in the comingdecades, almost all global population growthwill occur in towns and cities, with most urbangrowth concentrated in Africa and Asia (UnitedNations Population Fund, 2007). Two-thirds ofAfrica’s urban population lives in informal settlements,where a lack of infrastructure and thethreat of violence impede women’s use of transportationand health services (UN Habitat,2003; Taylor, 2011). Many urban pregnanciesin developing countries are unintended; thereis a 30 per cent to 40 per cent difference incontraceptive prevalence between women in therichest and poorest urban households (Ezeh,Kodzi and Emina, 2010).Stock-outs, disruptions in supply chains,and costs contribute to unmet need in hardto-reach,underserved communities in bothurban and rural settings. Additionally, a lackof targeted information relating to the needsof people who live in isolated rural areas anddensely populated urban communities areamong key factors contributing to lower levelsof contraceptive use and higher unmet need(Ezeh, Kodzi and Emina, 2010).Migrants, refugees and displaced people.Migration and displacement, the movement ofpersons from one area to another has becomeincreasingly commonplace. The total numberof international migrants has increased overthe last eight years from an estimated 150 millionin 2000 to 214 million persons in 2008(UN Department of Economic and SocialAffairs, 2008a). The reasons for migration anddisplacement within and across borders vary,but whether forced or voluntary, for political,economic, social or environmental reasons, theWorld Health Organization notes that the largenumbers of people whose place of residence hasshifted present the international community62 CHAPTER 3: CHALLENGES IN EXTENDING ACCESS TO EVERYONE