State of World Population 2012 - UNFPA Haiti

with a public health challenge (World HealthOrganization, 2003).International human rights instrumentsexplicitly recognize that human rights, includingthe right to health and family planning,apply to all persons including migrants, refugeesand other non-nationals (World HealthOrganization, 2003). The denial of theserights for socially excluded migrants and displacedpersons makes them unable to fullybenefit from health services, including familyplanning. Women (and men, as evidence isstarting to show) are also vulnerable to sexualviolence from soldiers, guards, recipient communitymembers and other refugees andare therefore at risk of unwanted pregnancy(United Nation's High Commissioner forRefugees and Women’s Refugee Commission,2011).According to migrants and displaced personsin developed and developing countries,a lack of information about their rightsand available services is among the key reasonsgiven for not accessing health services(Braunschweig and Carballo, 2001). Forexample, a national review of several WesternEuropean countries noted that the rates ofmaternal mortality and morbidity are higheramong immigrant women—outcomes areassociated with lower levels of access to contraceptives(Kamphausen, 2000).A study by the United Nations HighCommissioner for Refugees and the Women’sRefugee Commission in Djibouti, Jordan,Kenya, Malaysia and Uganda in 2011 foundthat people who live in refugee settingsreport lower contraceptive use and greaterdifficulty accessing information and services,especially adolescent girls and boys (UnitedNations High Commissioner for Refugees andWomen’s Refugee Commission, 2011).Family planning and a satisfying sex lifeAccording to paragraph 7.2 of the Programme of Action of the InternationalConference on Population and Development, reproductive health implies“that people are able to have a satisfying and safe sex life… It also includessexual health, the purpose of which is the enhancement of life and personalrelations, and not merely counseling and care related to reproduction andsexually transmitted diseases.” This comprehensive notion of reproductivehealth—one that includes a satisfying and safe sex life—has been taken intoaccount in a number of family planning programmes.CASE STUDYFamily planning classes in IranThe Islamic Republic of Iran has required that all couples intending to marryattend a pre-marital counselling course and undergo medical examinations.In order for couples to obtain the results of these exams and register theirmarriages, couples must attend a two-hour class that covers issues of familyplanning, disease prevention and most importantly, the emotional and socialrelationships involved in marriage. The Islamic Republic of Iran has prioritizeddiscussion of “sexual and emotional issues,” in part as a consequence ofhaving observed high divorce rates. Since its inception, the family planningprogramme in the Islamic Republic of Iran has been one of the most successfulin the world, achieving a contraceptive prevalence rate of about 81.6 per cent.CASE STUDYFear of unintended pregnancy in MexicoAccording to a 2008 study of one traditional community in Mexico (Hirsch2008: 101), women’s religious beliefs prevented them from using familyplanning (sterilization was the main method available to them) for most oftheir reproductive lives. These women were therefore often worried aboutunintended pregnancies. Only late in life, after their reproductive years, didthe women have the “possibility of enjoying sexual intimacy free from theworry of an unintended or unwanted pregnancy.”CASE STUDYHIV, sex and condom useSome men's resistance to using condoms has been recognized as an obstacleto use of this method of contraception and HIV prevention (UNAIDS2000). But the approach to encouraging women to use the method hasshifted considerably since the beginning of the HIV/AIDS epidemic (Higginsand Hirsch 2007). Many programmes emphasize building women’s negotiationskills, in recognition of men’s resistance. But we know little aboutwomen’s sexual resistance to male condoms. Research in the United States,however, found that more women than men disliked the feeling of male condoms(Higgins and Hirsch 2008).THE STATE OF WORLD POPULATION 201263