Annual Report | 2014

Reem is one of some 619,000 Syrian refugees who have been forced to cross the border into Jordan. Her family has struggled to adjust. “Our lives changed in one day, when we had to flee to Jordan from the horror and violence in Syria,” she said.

The terror stayed with them. Her husband was overwhelmed with fear for the family’s safety. He even restricted Reem’s movements.

“My husband was so obsessed after we arrived here that he didn’t want us to cross the house door,” she said.

“I learned about this centre from my neighbours. I visited them and explained our problem. In turn, the staff sat with me and my husband several times, individually and together. They gave us a great help.”

The IFH Deir Alla centre is one of many supported by UNFPA in Jordan. These centres offer a range of services to women, including antenatal care and family planning counselling. They also provide psychosocial assistance, legal counselling and support for survivors of gender-based violence.

Since the outbreak of the Syrian crisis, these centres have been an important resource for Syrian refugee women and girls.

In 2014, there were an estimated 150,000 Syrian refugee women and girls of reproductive age in Jordan. An estimated 11,000 of them were pregnant.

In August and September alone, UNFPA and its partners helped nearly 18,000 women and girls gain access to reproductive health services and about 2,900 survivors of gender-based violence access care.

The Deir Alla centre has also begun offering skills-building programmes, such as knitting and beadwork classes, which could potentially help women earn an income.

Photo credit: UNPFA/Aral Kalk

In a country where a woman dies every two hours from pregnancy-related complications, midwives play a key role in promoting safe motherhood and delivering healthy babies. They embody the difference between life and death.

“My grandmother left this world delivering my father,” says Fatima, one of the midwifery students at the school. “I think this is the reason my family encouraged me to help my community by joining this programme, so no one has to live without a mother or a father.”

Fatima’s story is not unique in Afghanistan, where around 40 percent of the population lacks access to health services within 10 kilometres—a three-hour walk—and women are often left to deliver alone.

“I still remember a woman in my community who died because she couldn’t get to the hospital on time,” Masooma, another student, recalls.

“My uncle’s wife died during childbirth,” says classmate Aqela. “Her two children survived, but they died months later because the adopting families didn’t have enough resources to take care of them.”

Fatima, Masooma and Aqela joined the Community Midwifery Programme eight months ago, following a tough selection process that involved their families, their communities and a written examination. The ones with the best marks enrolled in the programme, an initiative supported by UNFPA in collaboration with the Ministry of Public Health and support from the governments of Canada and Italy.

Thirty-six candidates passed the exam and joined the school in Kabul. These midwives represent a country that is changing and moving towards a future where every birth is safe.

The students and their families sign a commitment so the future midwife will return to the village once she finalizes her studies. They all realize how important their role will be when they move back to their communities after completing the two-year midwifery degree.

“We are really proud that we passed the exam. I was very nervous, but now I am very happy that I will be able to help the people living in my community,” says Aqela.

Photo credit: UNFPA/Maria Blanco

Cabo Delgado also has the highest maternal mortality ratio in the country, at 822 deaths per 100,000 live births. It is significant that the majority of these deaths are among girls and women, 15 to 24. This trend is closely associated with a low contraceptive prevalence rate of 2.9 percent in the province.

In response to the high rates of adolescent pregnancy and maternal death, UNFPA supports community-based distribution of contraceptives and family planning services and information to people in remote communities, through Associação Moçambicana para o Desenvolvimento da Família, AMODEFA, an affiliate of the International Planned Parenthood Federation. Diamond works for AMODEFA.

Diamond talked to Faustina about what it would mean to become a mother so early in life and about the pressures she may be experiencing from her family and community. Diamond also told her about family planning.

Since being taken under Faustina’s wing, Josefina has continued her education and managed to avoid motherhood in childhood. Convinced that this is the right path for all girls her age, she has begun helping
her peers learn about the benefits of family planning and the importance of staying in school. Josefina is now helping people like Ameha, a 14-year-old girl participating in one of the brigade’s events. Ameha dreams about becoming a nurse: “For someone at my age to become a mother is not right—we are still children,” she says.

Meanwhile, Faustina continues traveling through difficult rural terrain to reach people in remote communities with information about family planning. Several times a month, she joins her fellow activists at family planning “brigades,” which use theatre, community dialogue and individual consultations, to help inform people about the benefits of spacing or delaying pregnancies. “People are starting to value our work and appreciate the difference family planning can make in their lives,” she says.

Photo credit: UNFPA/Helene Christensen.

Following her close call, Aygul began receiving free contraceptives, which will enable her to prevent another pregnancy until she has fully recovered and received treatment for her condition.

Like many other countries in Eastern Europe and Central Asia, Turkmenistan is stepping up efforts in helping at-risk women access modern contraceptives, acknowledging that when women are empowered to choose the number, spacing and timing of their children, they face fewer complications during pregnancy and childbirth, and their children are healthier.

Turkmenistan announced in 2014 that it would begin covering the cost of modern contraceptives and other reproductive health medicines and supplies through the state budget by 2017. The initiative is part of a larger effort to ensure all people, particularly at-risk women, have access to voluntary family planning and will help doctors identify the most-at-risk women and then direct them to local reproductive health centres like the one that saved Aygul’s life.

“Risk factors of most-at-risk women contribute to a significant percentage of the maternal mortality rate,” says Bahar Agayeva, head of the Medical Statistics Department at Turkmenistan's Ministry of Health and Medical Industry. “Addressing the family planning needs of these women will help us significantly decrease maternal mortality and improve maternal and child health.”

“Photo credit: UNFPA

Jessica Torres, an advocate for the Nicaraguan Communal Movement’s pregnancy-prevention campaign, says she provides vital information to fellow young people in her community and is there “to give them the support they need.” Byron Martinez, a community health promoter, says he’s already seeing positive changes in young people’s attitudes and noted that before he could change people’s minds, he had to change his own views about sexual and reproductive health. “The hardest thing was recognizing that the change had to start with me. I needed to change in order to be an example for all the kids in my community. In the beginning, I was embarrassed about discussing the use of condoms. Now I’m more open, and they are too,” he said.

Jony Cuan, one of the 200 adolescents reached through the initiative, says it helped him gain access to modern contraceptive information and services. “As a young person, I have the right to plan my life; we shouldn’t be exposed to any kind of risks.” The initiative is giving young people not only the information they need to empower themselves to exercise their own reproductive rights, but also the tools to inform their peers about how to access sexual and reproductive health services, including modern methods of contraception.

Photo credit: UNFPA/Daniel Bravo

“I dreamed of becoming a teacher. Unfortunately, I stopped my education because of my pregnancy,” she said.

Laetitia is not an isolated case. A survey by the Ministry of Education revealed that more than 5,000 primary- or secondary-school students become pregnant in 2013, quadruple the number reported seven years earlier.

Faced with these increasing numbers of adolescent pregnancies, the Government designed a national plan on accelerated pregnancy reduction in schools, with technical and financial support from UNFPA.

The plan aims for a 50 percent reduction in the number of adolescent pregnancies by expanding access to sexual and reproductive health information and services. As a result, 88 percent of public schools’ clinics are now providing family planning services, including contraceptives. Comprehensive sexuality education is also being introduced into the curriculum. One academic year after the plan was launched, the number of pregnancies in the school has been reduced by 21 percent, the Ministry of Education reported.

In early 2014, Côte d’Ivoire introduced a national campaign, Zero Pregnancy in School, to raise students’ awareness about sexual and reproductive health. Meanwhile, laws have been introduced to increase penalties for sexual abuse of minors, including sanctions against teachers who abuse their students.

More than one in 10 adolescents becomes pregnant in Côte d’Ivoire. Factors contributing to high adolescent fertility rates include limited access to comprehensive sexuality education in schools, poor communication between parents and children about sexual health and reproduction, child marriage and limited access to reproductive health services for adolescents and youth.

Photo credit: UNFPA/Ollivier Girard