State of World Population 2012 - UNFPA Haiti

pregnancy, their inability to negotiate contraceptiveuse with their (usually older) husbands, orto access services contribute to high levels ofchildbearing in adolescence.Few family planning programmes includestrategies for reaching child brides who are oftenisolated, without well-developed social networks,and vulnerable to many adverse maternal healthoutcomes associated with early pregnancy andchildbirth. This is another important area forinvestment. (Malhotra et al., 2011; Bruce andClark, 2003; UNFPA, 2009; Lloyd, 2009;Countries with the highestrates of child marriageCountryPer cent girlsmarried beforeage 18Niger 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, 2012World Health Organization, 2008; Lam,Marteleto and Ranchhod, 2009; Levine et al,2008; Mensch, Bruce and Greene, 1999.)Poor quality as an obstacle to familyplanning useWhen services are unreliable or delivered byuntrained personnel, or when a full range ofcontraceptives and information is unavailable,people with unmet need may choose not to takeadvantage of family planning and are thereforeunable to exercise their right to it.Health systems in many countries struggle tomeet the challenge of managing their humanresources effectively, making sure that infrastructureis adequate to the task of providing servicesand ensuring the supply of adequate materialsand equipment of all kinds. People living inrural areas are especially vulnerable to weaknessesin the health system that can leave them beyondthe reach of services available to people in townsand cities.One consequence of poor guidance on a rightsbasedapproach to health and weak managementof staff can be the biased and discriminatoryattitudes of health workers. Some providers internalizesocial biases towards minority populations.Health workers’ attitudes can affect the quality ofinformation given to specific clients, resulting ina lack of informed choice and options.A lack of privacy and inability to communicateare barriers to service delivery for somegroups. A recent multi-country study found thathealth programmes in refugee camps did notensure the right to privacy, confidentiality, andnon-discrimination to all, particularly for adolescentsand unmarried persons (United NationsHigh Commissioner for Refugees, 2011). Insome settings, internally displaced persons orrefugees are often unable to access quality servicesdue to limited commitment to helping66 CHAPTER 3: CHALLENGES IN EXTENDING ACCESS TO EVERYONE