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An emergency

Dirk Jena
Tuesday, December 11, 2012

Last weekend, The New York Times published a feature on Haiti's silenced victims, a heart-wrenching article on a young woman's ordeal after she was raped, with the stigma attached to this insidious crime still very much perpetuated by the institutions that were supposed to be helping the survivor: health services staff and the police.

It is sad that women are still treated like this in the majority of our communities. The article also makes reference to the "morning-after" pill. First the doctor told the rape survivor that the pill was of no use after 12 hours (a blatant lie) after the woman's male colleague had spent the good part of the day looking for it.

With respect to the young woman whose case was discussed to bring to the fore this societal scourge, the article drives home the importance of emergency contraceptives. It is not an abortion pill, it merely inhibits ovulation. Once fertilisation and implantation have occurred, it is too late to prevent a pregnancy.

This pill offers a 75 per cent chance of preventing pregnancy when a woman has been forced to have sexual intercourse or when a couple for some reason, may have defaulted on the family planning method they're using.

In some countries, it is part of a treatment rape survivors receive when they finally reach a health care facility for a medical examination, as would have been required from the police station.

The atrocious treatment of women in our communities sometimes also means that rape survivors "just try to forget it" as the Haiti woman did; but such a pill would at least prevent an unintended pregnancy. Some emergency pills must be taken within 72 hours of intercourse while some allow a period of as many as 120 hours.

A report in March this year prepared for the United Nations Commission on Life-Saving Commodities for Women and Children entitled Contraceptive Commodities for Women's Health said for communities to really experience the benefits of such contraceptives though, access to them and the ability of women to choose a method were essential conditions.

The report identified emergency contraceptives as one of the three contraceptives used by woman (the other two being implants and female condoms) that had the "greatest promise for improving reproductive health outcomes".

Emergency contraceptives are safe and do not need prescription; it is available over the counter in more than 50 countries. The UNFPA (United Nations Population Fund) continues to seek donor assistance in ensuring that it becomes more available at public sector level.

The report said of the pill: "This method is of particular importance for all those who have a limited access to contraceptives, adolescents in particular." If and when other methods — including abstinence — fail, imagine the number of teenage pregnancies which could be avoided with this pill, and allow young women to pursue their studies and professional choices.

Emergency contraceptive is a unique family planning method and women-controlled but it can never and should not replace other planning methods. If however and when couples particularly women need it, the latter should be able to make the decision to take it, be able to access it and afford it.

The Haiti article took me back to a meal I shared recently with colleagues when accompanying Dr Babatunde Osotimehin, the UNFPA Executive Director and UN Under Secretary-General, in Canberra (Australia) where discussions with civil society organisations working in sexual and reproductive health and rights shifted to one of the woman's previous professional experiences as a manager of a major vehicle assembly line in Belgium.

With companies reliant on parts arriving from all over of the world, maintaining a supply chain for parts to arrive at the plant "just in time" is a most stressful management affair. I couldn't help thinking of how this was very similar to the concept of emergency contraceptives for in most cases than not, they really are "just in time", if taken within the prescribed period.

Recently, UNFPA has been in the process of implementing new ways of doing business if you will, after an assessment of our performance as an entity. There are many changes that we hope will translate to better management in support of our mandate.

Essentially, we are focussed on ensuring the best outputs from our supply chains and commodity management; ensuring the human resources in the health sector are empowered and supported to be the best health care professionals; and that health financing is secured to ensure that no one is left behind in our quest to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled.

The Haiti article also reminded me of how crucial a role we play at UNFPA to get commodities such as contraceptives — whether for family planning purposes or in emergency cases to avoid unplanned pregnancies — to as many people as possible.

In 2007, UNFPA launched the Global Programme to Enhance Reproductive Health Commodity Security which works closely with 46 countries to ensure access to a reliable supply of contraceptives among other things. The program provides financial and technical support for countries to procure and manage supplies of reproductive health commodities and strengthen their health system.

This year, Fiji, Samoa, Tuvalu and other regional nations have benefitted from a collaboration between the UNFPA Pacific Sub-Regional Office and a couple of universities to develop an internationally-recognised qualification for pharmacist assistants; the study format was specifically designed with our island realities in mind.

Fiji, we also note, has allocated $140,000 to adolescent reproductive health in this new financial year's budget; we hope to see similar commitments across the region by progressive decision-makers.

For the UNFPA, ensuring commodities are available to couples, especially women, can mean a drop in the current global trends of 800 women dying from pregnancy complications and childbirths; of 222 million women in developing countries who want contraceptives but cannot access it to prevent 54 million unintended pregnancies, seven million miscarriages; of 1.1 million infant deaths and 79,000 maternal deaths.

This is not just about a contraceptive. It is about empowering couples or women to realise their reproductive rights. That women cannot decide how many children they want or space them according to how their bodies cope with childbirth is a violation of their (several) basic human rights.

Empowering women will only empower our communities to plan our childbearing and childrearing and thus plan for a healthier and better educated family, village and nation as a whole.

p Dirk Jena is the United Nations Population Fund Pacific sub-regional office director and representative. The views expressed are his and not of this newspaper.

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