Draft first regional report on the implementation of the Montevideo Consensus on Population and Development

<strong>Draft</strong> <strong>first</strong> <strong>regional</strong> <strong>report</strong> on the implementation of the Montevideo Consensus on Population and Development
Summary
Currently, data for most of the countries are only available on some 30% of the 22 agreed monitoring
indicators for this chapter. Some of these data are still approximate, and the great bulk cannot be disaggregated
by population groups. This does not mean that the current situation cannot be appropriately mapped in all the
fields mentioned, however, albeit incompletely.
Since the Montevideo Consensus on Population and Development was approved in 2013, substantial progress
has been made on priority measures relating to sexual and reproductive health and rights. As pointed out at
the beginning of the <strong>report</strong>, the five years of implementation have not been a favourable period economically
and politically for some countries, and this has created an even greater challenge for the rights agenda, chiefly
when it comes to the progress needed to achieve universal access to sexual and reproductive health services.
With regard to sexual health, prevention and treatment of infections of the reproductive system, chiefly HIV/
AIDS, have progressed more slowly than hoped. There has been progress towards the 90-90-90 goal as agreed by
the countries. The main achievement has been a high level of viral suppression in people undergoing treatment,
but there are groups in which adherence to treatment is very low, such as female sex workers, drug users and
gay men and other men who have sex with men. Nor has progress been as great as hoped when it comes to
detection levels, especially in the Caribbean countries. The good news is the almost complete elimination of
mother-to-child transmission. However, a great challenge lies ahead: integrating prevention and treatment of
reproductive system infections, including HIV/AIDS, with other sexual and reproductive health services.
Access to family planning has improved, mainly thanks to increased use of modern contraceptive methods
and a wider range of available methods, allowing more demand to be met. However, family planning is an
ongoing activity that cannot be allowed to flag whatever the economic, political or social circumstances, since
failure in contraception is a breach of rights that has serious consequences for individuals and society. Also part
of family planning are conception services for people in need of assisted reproduction technology, which is at
a very early stage in almost all the countries. There remains, then, the great challenge of improving access to
and the quality of family planning services in order to reduce the number of unwanted pregnancies through
more appropriate use of contraceptive methods and to make wanted pregnancies possible by using appropriate
conception methods. Methods must meet the specific needs of each population segment in an effective
and timely way, and generational differences, diversity and interculturality must all be taken into account. In
particular, it is vital for there to be action to expand services and information in a way that recognizes the needs
of adolescent and young people in all countries, given the high rates of early fertility discussed in chapter B.
The provision of resources so that people can implement their reproductive preferences, from prevention
of unwanted pregnancies to skilled attendance in antenatal care and at births, is essential to reduce maternal
morbidity and mortality, which is still very high in the region. The indicators show a continuing improvement
in access to prenatal check-ups and skilled care during childbirth, but these high levels of access do not
square with the high maternal mortality seen in most of the region’s countries. This mortality is due partly
to the quality of the services provided in the prenatal period and during childbirth, partly to care standards
when pregnancies are voluntarily terminated. There thus remains the great challenge of expanding access to
harm reduction services in the event of complications from unsafe abortions and of extending coverage of
high-quality care and information services in the prenatal period and during childbirth to the whole population,
especially those living in poverty and in hard-to-reach areas and those suffering any form of discrimination.
Both access to appropriate and timely information and discrimination-free service provision must involve
comprehensive sex education in people’s early years and, in general, over the whole life cycle. There has been
little progress in the five years for which the Montevideo Consensus on Population and Development has been
implemented, as section B shows, so this remains one of the greatest challenges facing the region. It is a
policy that if properly implemented affects all the areas dealt with in this chapter, from sexual and reproductive
rights to access to sexual and reproductive health services. A great deal of progress still needs to be made on
this in the region, and some countries have fallen back in certain ways. There are recent initiatives to change
education for health and family life that do not address issues of sexuality comprehensively, for example by
dealing with negative gender stereotyping in schools. The countries need to pursue greater integration between
the spheres of education and health when planning and implementing comprehensive sex education so that
sexuality can be covered in all its aspects.
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