UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)

Guidelines on Reproductive Health


This document has been prepared by the Secretariat of the United Nations 

Inter-Agency Task Force on the Implementation of the ICPD Programme of 

Action.  For further information please contact the United Nations 

Population Fund, Task Force on ICPD Implementation, 220 East 42nd Street, 

New York, NY 10017 USA or send E-mail to: pierce@unfpa.org






1.   Definition of reproductive health 

     Reproductive health is a state of complete physical, mental

and social well-being, and not merely the absence of reproductive

disease or infirmity.  Reproductive health deals with the

reproductive processes, functions and system at all stages of life. 

     The International Conference on Population and Development 

Programme of Action states that "reproductive health ... implies

that people are able to have a satisfying and safe sex life and

that they have the capability to reproduce and the freedom to

decide if, when and how often to do so.  Implicit in this last

condition are the right of men and women to be informed and to have

access to safe, effective, affordable and acceptable methods of

family planning of their choice, as well as other methods of their

choice for regulation of fertility which are not against the law,

and the right of access to appropriate health care services that

will enable women to go safely through pregnancy and childbirth and

provide couples with the best chance of having a healthy infant.

...  Reproductive health includes sexual health, the purpose of

which is the enhancement of life and personal relations, and not

merely counselling and care related to reproduction and sexually

transmitted diseases."

2.   The importance of reproductive health

     Reproductive health is a crucial part of general health and a

central feature of human development.  It is a reflection of health

during childhood, and crucial during adolescence and adulthood,

sets the stage for health beyond the reproductive years for both

women and men, and affects the health of the next generation.  The

health of the newborn is largely a function of the mother's health

and nutrition status and of her access to health care. 

     Reproductive health is a universal concern, but is of special

importance for women particularly during the reproductive years. 

Although most reproductive health problems arise during the

reproductive years, in old age general health continues to reflect

earlier reproductive life events.  Men too have reproductive health

concerns and needs though their general health is affected by

reproductive health to a lesser extent than is the case for women. 

However, men have particular roles and responsibilities in terms of

women's reproductive health because of their decision-making powers

in reproductive health matters.

     At each stage of life individual needs differ.  However, there

is a cumulative effect across the life course  events at each

phase having important implications for future well-being.  Failure

to deal with reproductive health problems at any stage in life sets

the scene for later health and developmental problems.

     Because reproductive health is such an important component of

general health it is a prerequisite for social, economic and human

development.  The highest attainable level of health is not only a

fundamental human right for all, it is also a social and economic

imperative because human energy and creativity are the driving

forces of development.  Such energy and creativity cannot be

generated by sick, tired people, and consequently a healthy and

active population becomes a prerequisite of social and economic


3.   What is new about the concept of reproductive health

     Reproductive health does not start out from a list of diseases

or problems - sexually transmitted diseases, maternal mortality -

or from a list of programmes - maternal and child health, safe

motherhood, family planning.  Reproductive health instead must be

understood in the context of relationships: fulfilment and risk;

the opportunity to have a desired child  or alternatively, to

avoid unwanted or unsafe pregnancy. Reproductive health contributes

enormously to physical and psychosocial comfort and closeness, and

to personal and social maturation  poor reproductive health is

frequently associated with disease, abuse, exploitation, unwanted

pregnancy, and death.

     The most significant achievement of the Cairo Conference was

to place people firmly at the centre of development efforts, as

protagonists in their own reproductive health and lives rather than

as objects of external interventions.  The aim of interventions is

to enhance reproductive health and promote reproductive rights

rather than population policies and fertility control.  This

implies the empowerment of women (including through better access

to education); the involvement of women and young people in the

development and implementation of programmes and services; reaching

out to the poor, the marginalized and the excluded; and assuming

greater responsibility for reproductive health on the part of men.

4.   How this concept of reproductive health differs from existing

family planning and maternal and child health programmes

     Programmes dealing with various components of reproductive

health exist in some form almost everywhere.  But they have usually

been delivered in a separate way, unconnected to programmes dealing

with closely interdependent topics.  For example, the objectives,

design and evaluation of family planning programmes were largely

driven by a demographic imperative, without due consideration to

related health issues such as maternal health or STD prevention and

management.  Evaluation was largely in terms of quantity rather

than quality - numbers of contraceptive acceptors as opposed to the

ability and opportunity to make informed decisions about

reproductive health issues.  In general, such programmes

exclusively targeted women, taking little account of the social,

cultural and intimate realities of their reproductive lives and

decision-making powers.  They tended to serve only married people,

excluding, in particular, young people.  Services were rarely

designed to serve men even though they have reproductive health

concerns of their own, particularly with regard to sexually

transmitted diseases.  Moreover, the involvement of men in

reproductive health is important because they have an important

role to play as family decision-makers with regard to family size,

family planning and use of health services.

     A reproductive health approach would differ from a narrow

family planning approach in several ways.  It would aim to build

upon what exists and at the same time to modify current narrow,

vertical programmes to ones in which every opportunity is taken to

offer women and men a full range of reproductive health services in

a linked way.  The underlying assumption is that people with a need

in one particular area - say treatment of a sexually transmitted

diseases - also have needs in other areas - family planning or

antenatal/postpartum care.  Such programmes would recognize that

dealing with one aspect of reproductive health can have synergistic

effects in dealing with others.  For example, management of

infertility is difficult and expensive but it can be largely

prevented through appropriate care during and after delivery and

prevention and management of STDs.  Promotion of breast-feeding has

an impact on reproductive health in many ways - it helps prevent

certain postpartum problems, delays the return to fertility, may

help prevent ovarian and breast cancer, and improves neonatal


     Another important difference between existing programmes and

those developed to respond to the new concept of reproductive

health is the way in which people - particularly women and young

people who are the most affected by reproductive health concerns -

are involved in programme development, implementation and

evaluation.  When women become more involved in programmes it

becomes clearer that they have health concerns beyond motherhood

and also that dealing with reproductive health involves a profound

rethinking of the behavioural, social, gender and cultural

dimensions of decision-making which affect women's reproductive



5.   What reproductive health services include

     The precise configuration of reproductive health needs and

concerns, and the programmes and policies to address them, will

vary from country to country and will depend on an assessment of

each country's situation and the availability of appropriate

interventions. Globally, however, both the epidemiological data and

the expressed wishes of diverse constituencies indicate that

reproductive health interventions are most likely to include

attention to the issues of family planning, STD prevention and

management and prevention of maternal and perinatal mortality and

morbidity.  Reproductive health should also address issues such as

harmful practices, unwanted pregnancy, unsafe abortion,

reproductive tract infections including sexually transmitted

diseases and HIV/AIDS, gender-based violence, infertility,

malnutrition and anaemia, and reproductive tract cancers. 

Appropriate services must be accessible and include information,

education, counselling,  prevention, detection and management of

health problems, care and rehabilitation.

     Reproductive health strategies should be founded first and

foremost on the health of individuals and families.  In the

operationalization of the strategies all reproductive health

services must assume their responsibility to offer accessible and

quality care, while ensuring respect for the individual, freedom of

choice, informed consent, confidentiality and privacy in all

reproductive matters.  They should focus special attention on

meeting the reproductive health needs of adolescents.

6.   Factors affecting reproductive health

     Reproductive health affects, and is affected by, the broader

context of people's lives, including their economic circumstances,

education, employment, living conditions and family environment,

social and gender relationships, and the traditional and legal

structures within which they live.  Sexual and reproductive

behaviours are governed by complex biological, cultural and

psychosocial factors.  Therefore, the attainment of reproductive

health is not limited to interventions by the health sector alone. 

Nonetheless, most reproductive health problems cannot be

significantly addressed in the absence of health services and

medical knowledge and skills.   

     The status of girls and women in society, and how they are

treated or mistreated, is a crucial determinant of their

reproductive health. Educational opportunities for girls and women

powerfully affect their status and the control they have over their

own lives and their health and fertility. The empowerment of women

is therefore an essential element for health.

7.   Who is most affected by reproductive health problems

     Women bear by far the greatest burden of reproductive health

problems. Women are at risk of complications from pregnancy and

childbirth; they also face risks in preventing unwanted pregnancy,

suffer the complications of unsafe abortion, bear most of the

burden of contraception, and are more exposed to contracting, and

suffering the complications of reproductive tract infections,

particularly sexually transmitted diseases (STDs). Among women of

reproductive age, 36% of all healthy years of life lost is due to

reproductive health problems such as unregulated fertility,

maternal mortality and morbidity and sexually transmitted diseases

including HIV/AIDS.  By contrast, the equivalent figure for men is


     Biological factors alone do not explain women's disparate

burden. Their social, economic and political disadvantages have a

detrimental impact on their reproductive health. Young people of

both sexes, are also particularly vulnerable to reproductive health

problems because of a lack of information and access to services.

8.   How countries can identify reproductive health needs and

assess priorities

     A number of countries have expressed the desire to move

forward with a new and comprehensive approach to reproductive

health.  Support to national authorities in carrying out a

systematic review of reproductive health needs at country level

should focus on the importance of adding innovative and

participatory approaches to more familiar epidemiological

methodologies in which the process tends to be directed by experts

and framed by biomedical approaches and indicators.  The

identification of reproductive health needs, the determination of

priorities and the development of programmatic responses to those

needs should be conducted through an inclusive process, soliciting

the perspectives of a range of groups concerned with reproductive

health including, for example, women's health advocates, youth

groups, health care providers at the periphery as well as at the

central level, health planners, researchers, and non-governmental


     Several instruments have already been developed for situation

analysis and needs assessment in different components of

reproductive health, for example, family planning and safe

motherhood.  However, in the context of the new approach to

reproductive health it is necessary to ensure that assessment and

prioritization reflect people's concerns as agreed at national and

local levels and not the priorities of agencies or donors.  It is

important to avoid duplication and to develop tools that are

appropriate for countries themselves.  A number of such instruments

already exist and are widely used.  However, it is important to

ensure compatibility and consistency among the various instruments

currently available.

     Similar considerations apply to the selection of priorities

for action in reproductive health.  Criteria for identification of

priority problems should include not only importance - prevalence,

severity, public concern, government commitment, impact on family,

community and development - but also the feasibility of addressing

them - known interventions, cost-effectiveness, availability of

financing, human resources and adequate equipment and supplies. 

9.   Human resources for reproductive health

     The operationalization of the new concept of reproductive

health will mean changes in skills, knowledge, attitudes and

management.  People will have to work together in new ways.  Health

care providers will have to collaborate with others, including

NGOs, women's health advocates, and young people.  Managerial and

administrative changes will also be needed because integrated

services can impose, at least initially, greater burdens on already

over-stretched staff and require attention to planning and

logistics in order to ensure availability and continuity of


     Training for reproductive health workers will need to focus on

improving both technical and interpersonal skills.  Additional

training, particularly in counselling skills and in ways of

reaching out to under-served groups will be essential elements of

such training.  The back-up and support of functioning referral

systems will be essential elements if the full range of

reproductive health concerns is to be adequately addressed. 

10.  Monitoring and evaluation

     Monitoring and evaluation of reproductive health takes place

at two levels - the country and the global level. Globally, the

international community has already defined a number of indicators

relevant to reproductive health, including:

     Maternal mortality

     % pregnant women who have at least one antenatal visit      

     % of pregnant women who have a trained attendant at delivery 

     % of pregnant women immunized against tetanus

       contraceptive prevalence rate

     % of infants weighing less than 2500 g at birth (a newborn   

       indicator that reflects maternal reproductive health)

     WHO is working on additional indicators for global monitoring

in reproductive health, including indicators on incidence and

prevalence of sexually transmitted diseases, quality of family

planning services, access to and quality of maternal health

services, prevalence of female genital mutilation and prevalence

and nature of obstetric and gynaecological morbidities.  

     Reproductive health indicators should cover not only

quantitative indicators such as those listed above, but also some

qualitative indicators, such as women's satisfaction with services,

perceptions of quality, maternal discomfort and dissatisfaction,

perceived reproductive morbidities, opportunities for choice, and

enabling environments.  Particular attention will be paid to

indicators that identify disparities within countries - between

population groups and/or regions, for example.  

     Data collection should be seen as a means towards an end

rather than an end in itself.  It will, therefore, be necessary to

focus increasingly on performance-based measures such as maternal

audit, surveillance and other process measures.  Such programme

indicators should be useful for policy-making and be generated

through data collection procedures that are useful for programme

management at the level at which the data are collected.  All data

collection efforts should be sustainable by the national

authorities and able to take into account new developments in terms

of strategic thinking and implementation.  In addition, all

indicators should be valid, objectively measurable and reliable. 




1.   Advocate for the concept of reproductive and sexual health

     The Resident Coordinator system can promote recognition of the

concept of reproductive health as central to general health and

human development.  This implies the integration of reproductive

health and reproductive rights into all related development

priorities and programmes.  Resident Coordinators should be aware

that reproductive health is a dynamic and continuously evolving

concept.  Therefore, information sharing and collaboration will be

needed to ensure that the approaches developed and implemented are

based on the most recent and relevant information available and on

the evolving experiences of those working in the field.  The

Country Strategy Note should be used as a vehicle to promulgate

this vision more widely.

2.   Promote multi-sectoral action

     Reproductive health is a health issue but encompasses more

than biomedical aspects and goes beyond the health sector.  The

determinants of reproductive ill-health lie in poverty, gender and

other forms of inequity, social injustice, marginalization and

development failures.  All sectors affect and are affected by

reproductive health.  The Resident Coordinator system can advocate

that all agencies and all sectors have roles and responsibilities

in promoting reproductive health.

     One of the key actions needed to improve reproductive health

is the empowerment of women especially through education.  The UN

Resident Coordinator system can mobilize increased energies and

resources for women's education both in-school and out-of-school

(youth groups, workplaces, adult literacy and income generation

groups etc.). 

3.   Stimulate adherence to essential principles

     The Resident Coordinator system can disseminate the underlying

principles which must serve as a guide to action in reproductive

health.  These are the guiding principles of human rights, equality

and gender equity, and placing people at the centre of development

efforts.  Operational principles for the implementation of

reproductive health policies and programmes include participatory

processes, involvement of multiple perspectives and multi-sectoral

action.  The Resident Coordinator system is well-placed to ensure

the involvement of different sectors and the participation of all

those concerned with reproductive health.  Where there are major

regional, ethnic, religious or cultural variations within

countries, these must be taken into account in the development of

reproductive health strategies.  Where certain groups have

difficulties in making their voices heard, the Resident Coordinator

system can play a role in providing a forum for the exchange of

ideas and experiences. 

4.   Foster national ownership

     A global reproductive health strategy must be translated into

approaches that are country-driven.  Implementation of reproductive

health programmes is the sovereign right of each country, in a way

that is consistent with national laws and development priorities,

with full respect for religious, cultural and ethical values and in

harmony with universally recognized human rights.  The Resident

Coordinator system can ensure that the development of strategies,

policies and programmes is a nationally owned process and that

decisions taken reflect national priorities and are not dictated by

external agencies.  

5.   Ensure consistency and complementarity

     Translating the concept of reproductive health into actions

means ensuring a shared understanding of the concept and

consistency and complementarity in the application of approaches. 

It is critically important to avoid conflicting messages from UN

agencies to national counterparts.  The Resident Coordinator system

can help to ensure consistency and bring together different parties

in order to avoid duplication and make best use of resources.  One

practical way of doing this would be the creation in countries of

a database of information from all in-country agencies on project

design, implementation, monitoring, evaluation, lessons learned and

future programme plans.  This could be drawn upon by all agencies

and would help avoid duplication while ensuring greater

information-sharing and networking among agencies.

6.   Coordinate agency, regional, bilateral and NGO activities

     Each agency has specific mandates and comparative advantages

which need to be incorporated into the concept of reproductive

health.  Some agencies, including WHO, UNAIDS, UNFPA, UNICEF, and

UNHCR are likely to have a deeper involvement than others in

reproductive health issues.  While subscribing to the overall broad

concept of reproductive health, agencies select priorities in a

focused way on the basis on capacities and resources.  Resident

Coordinators should be well aware of agency mandates, capacities

and resources and be able to assess where there are gaps and

duplications and recommend strategies to overcome them.  

     Resident Coordinators can promote harmony between the

activities of international agencies, bilateral donors and NGOs

working to support government and regional strategies in

reproductive health. The Resident Coordinator system should gather

and disseminate information about the resources available at

country, regional and global levels, in terms of funding, knowledge

and expertise.

7.   Assist in the identification of reproductive health needs

     The Resident Coordinator system can help countries in the

identification of national reproductive health needs and the

selection of priorities, in the evaluation of current programmatic

responses to the needs identified and in assessing potential for

improvement and avoidance of overlap.  The Resident Coordinators

should promote the need for appropriate guidance and training for

all agency, regional and national representatives in the

reproductive health approach.

8.   Support national planning

     The resident coordinator system should support national

planning through making the most effective use of specific agency

plans and programmes, making the best use of the comparative

advantages of each agency, and through seeking to achieve an

appropriate balance in the response of country and agency

activities and promoting an incremental improvement in programmes

bearing the overall reproductive health vision in mind.  Of

particular importance in the national planning process is the

development of decision-making tools and the improvement of

managerial capacities.  The overall objective is to increase

national capacity for planning and implementation of reproductive

health policies and programmes within national constraints,

objectives and approaches.

9.   Promote integrated approaches

     The Resident Coordinator system can ensure integration of all

aspects of reproductive health, especially those delivered in the

past through vertical programmes such as family planning.  The

Resident Coordinator can encourage the incorporation into

reproductive health programmes of such concerns as the eradication

of harmful practices affecting women's health, as well as various

forms of violence.

     The Resident Coordinator system can integrate follow-up to the

various international conferences on related issues such as

population, reproductive health and development, including the

World Summit for Children, the United Nations Conference on

Environment and Development, the World Social Summit, the United

Nations Conference on Human Rights and the forthcoming Fourth World

Conference on Women.

10.  Support monitoring and evaluation

     The Resident Coordinator system has an important role to play

in monitoring and evaluation.  Global monitoring should be limited

and not impose additional burdens on national reporting systems. 

The Resident Coordinator should support national capacity-building

for monitoring progress in country programmes in a way which is

helpful to programme management and useful at the point of delivery

of the intervention.


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Berer M. Population and family planning policies: women-centred

perspectives. Reproductive Health Matters, 1993, 1:4-12.

Cook R. International law and women's health. In: Gomez E. ed.

Gender, Women and Health in the Americas. Washington DC, PAHO,


Dixon-Mueller R. Population Policy and Women's Rights: Transforming

Reproductive Choice. Westport, CN, Praeger, 1993.

Dixon-Mueller R. The sexuality connection in reproductive health.

Studies in Family Planning. 1993, 24:269-82.

Faundes A, Hardy E, Pinotti JA. Commentary on women's reproductive

health: means or end? International Journal of Gynecology and

Obstetrics. 1989, (supp)3:115-8.

Freedman LP, Isaacs SL. Human rights and reproductive choice.

Studies in Family Planning, 1993, 24:18-30.

Germain, A. and Kyte, R.  The Cairo Consensus, International

Women's Health Coalition, New York, 1995

Graham WJ, Reproductive health in developing countries:

measurement, determinants, and consequences: overview. In:

International Population Conference. Liege, Belgium: IUSSP. 1993,


Graham WJ, Campbell OM. Maternal health and the measurement trap.

Social Science and Medicine, 1992, 35(8):967-77.

IWHC and WHO. Creating common ground. Geneva, WHO, 1991.

Jacobson, J. The silent emergency: Women's reproductive health,

Worldwatch Institute, 1991.

Jain A, Bruce J. Implications of reproductive health for objectives

and efficacy of family planning programs. New York, The Population

Council. (Programs Division Working Papers No. 8). 1993

Koblinsky M, Timyan J, Gay J. eds. The Health of Women: a Global

Perspective. Boulder, Westview Press, 1993:33-62.

Lane, S.  From population policy to a reproductive health agenda.

Social Science and Medicine 39 (9), 1994

Mazur LA, ed. Beyond the Numbers: A reader on Population,

Consumption, and the Environment. Washington DC, Island Press.


Rockefeller Foundation. Improving the quality and reach of

reproductive health service delivery: a strategy paper. New York,

The Rockefeller Foundation, 1994.

Sen G, Germain A, Chen L, eds. Population Policies Reconsidered:

Health, Development, and Human Rights. Cambridge, Harvard

University Press, 1994:1-17

Tinker A et al. Women's health and nutrition: Making a difference.

Washington, DC, World Bank (Discussion Paper No. 256), 1994.

UNFPA.  Reproductive Health and Family Planning: Directions for

UNFPA Assistance. Report on Expert Consultation.  New York, 1995.

World Bank. World Development Report 1993. New York, Oxford

University Press, 1993.

World Bank. Population in Developing Countries: Implications for

the World Bank. Washington DC, World Bank, 1994.

World Bank. Improving Reproductive Health: The Role of the World

Bank. Washington DC, World Bank, 1995

World Health Organization. Care of mother and Baby at the health

centre: a practical guide. WHO/FHE/MSM/94.2. Geneva, WHO, 1994.

World Health Organization. Health, Population and Development,

WHO/FHE/94.1. Geneva, WHO, 1994.

World Health Organization. Mother-Baby Package: Implementing Safe

Motherhood in Countries. WHO/FHE/MSM/94.11. Geneva, WHO, 1994.

World Health Organization. Achieving Reproductive Health For All.

The Role of WHO. WHO/FHE/95.6. Geneva, WHO, 1995.

World Health Organization. Women's Health: Improve our health -

improve the world. WHO/FHE/95.8. Geneva, WHO, 1995.


                        AGENCY PROFILES

World Health Organization (WHO)

     WHO was an active contributor throughout the ICPD process and

fully subscribes and is committed to the implementation of the

Programme of Action, and to reinforcing the central role of health

and human development in the global agenda for sustainable

development.  In following up ICPD WHO is committed to further

build upon the existing collaboration within the UN system to

support countries in their efforts to take on the challenges of

Cairo.  WHO will foster its relationship with UNICEF, UNFPA, UNDP

and the World Bank in particular, at both global and country


     WHO will continue to affirm that to bring about the necessary

changes and improve health and quality of life, health policies

must reach beyond the health sector while remaining rooted in the

health-for-all principles of primary health care.  A primary health

care approach includes promotive and preventive aspects as well as

care and rehabilitation and comprises actions at the community

level supported by referral to a higher level of care when needed.

     WHO stimulates and supports research in reproductive health,

particularly in the area of fertility regulation, safe motherhood,

and reproductive tract infections including STDs and HIV/AIDS

prevention.  WHO's research is aimed at identifying gaps in

addressing reproductive health needs, at adapting technologies and

applying existing knowledge, and at developing new approaches and

interventions for better reproductive health. WHO works with a

worldwide network of collaborating centres to build national

research capabilities, develop innovative methodologies and

disseminate the results of research to policy-makers, planners,

health care providers, women's health advocates, non-governmental

organizations and scientists.

     As part of its normative function WHO develops policies,

strategic approaches, norms and standards.  WHO has developed a

range of guidelines dealing with technical, managerial and clinical

aspects of reproductive health, including family planning

guidelines, maternal health care, management of obstetric

complications, prevention and management of abortion complications,

prevention and treatment of STDs including HIV/AIDS, and detection

and management of cervical cancers.  The objective is to

disseminate appropriate and relevant up-to-date information to

those working in the field and to promote adherence to the highest

attainable standards of quality health care.

     WHO's normative work includes guidance on the elimination of

harmful practices such as female genital mutilation and the

development of standard definitions and guiding protocols on data

collection and analysis.  

     WHO provides support to the development of training materials,

and works with national and international professional and

educational bodies on different aspects of health curriculum

development.  Such training materials must now be adapted to

incorporate the concept of reproductive health and to assist the

many categories of health care providers in responding to

reproductive and sexual health needs in a more integrated way.  

     Within the broader reproductive health framework WHO is

currently paying increased attention to ethical issues in

reproductive health; appropriate technologies; gender equity,

women's perspectives and the roles and responsibilities of men; the

particular needs of women and young people; the interrelationships

between reproductive health and other public health issues such as

nutrition and the environment; indicators for assessing progress

and monitoring and evaluation of reproductive health programmes.

     In its technical support to Member States WHO's underlying

philosophy is that policies, strategies and programmes must be

country-owned, build national capacity and self-reliance, and be

sustainable. WHO promotes and supports programme development that

is based on a consultative process which brings together all

concerned constituencies in reproductive health, particularly those

whose voices have hitherto remained unheard -women, young people,

the poor, the marginalized, refugees and the displaced. 

     WHO's governing bodies have given increased attention to

reproductive and women's health, and have requested a greater role

for the Organization. WHO has started a series of specific

activities as follow-up to the Programme of Action of ICPD. The

goals and objectives of the Programme of Action of Cairo are being

integrated into WHO's 9th General Programme of Work which runs from

1996 to 2001. 

     WHO has identified reproductive health a priority for the

Organization. This will be reflected in the 1996-97 programme

Budget and the area of reproductive health will receive increased

resources effected by a 5% shift of Regular Budget funds.  The

World Health Assembly has requested the Director-General to develop

a coherent programmatic approach for research and action in

reproductive health and reproductive health care within WHO.

United Nations Population Fund (UNFPA)

    ln its support for reproductive health, UNFPA will continue to

underscore a number of basic programming concepts including, in

particular, efforts to:  

     o    involve women, women's organizations, and other groups

          working for women's needs in the planning, implementation

          and monitoring of reproductive health services and



     o    promote men's participation in reproductive health

          programmes and responsibility for their sexual and

          reproductive behaviour;


     o    assure the highest level of quality of care in providing

          information and services;  

     o    promote an approach that provides a constellation of

          linked or integrated services to meet the needs of



     o    make available as wide a range as possible of safe and

          effective modern methods of family planning technically

          approved by the World Health Organization (WHO); 

     o    create a better understanding of the social, cultural and

          behavioural context within which reproductive ill-health

          occurs; and


     o    promote the coordination of national reproductive health

          programmes among Governments, multinational and bilateral

          agencies, NGOs and the private sector.

    UNFPA supports the concept of sexual and reproductive health as

a human right. Women and men must therefore be provided with the

necessary information and services to exercise this right. UNFPA

support for reproductive health will be based on a public-health,

pragmatic and participatory approach.  Such an approach: (a)

responds to the reproductive health needs of individuals and

involves them in the programming process; (b) promotes

sustainability: and (c) identifies interventions that have the

greatest impact for the most people at an affordable price. It also

encourages partnerships between Governments, NGOs, and the private

sector to maximize both coverage and quality of services and to

stimulate innovative ideas. This will best be achieved, in

practice, through an incremental approach that builds on the system

that is currently in place, identifies gaps and inadequacies in

that system and strengthens links between programmes in order to

respond better to the reproductive health needs of individuals.

    The rationale for using such an incremental approach is that it

makes the most efficient and cost-effective use of existing staff

and health-care facilities. In fact, it is often the same primary

care worker, working out of the same facility, who provides family

planning care and many of the other components of reproductive

health.  UNFPA will thus work to integrate reproductive health care

information and services into the various other services provided

at the service-delivery level and to assure that the health-care

personnel working in such facilities receive training in integrated

reproductive health care.

    Activities supported by UNFPA in reproductive health include: 

     o    the full spectrum of family planning information and

          services, including counselling and follow-up services,

          aimed at all couples and individuals;  

     o    prenatal, delivery (including assisted delivery) and

          postnatal care of mothers at the primary health care

          level with appropriate referral for the management of

          obstetric complications; 

     o    prevention of abortion, management of the consequences of

          abortion, and post-abortion counselling and family



     o    prevention of reproductive tract infections (RTIs)

          including STDs and HIV/AIDS through preventive

          counselling, condom distribution and treatment of

          symptomatic infections, as part of primary health care,

          with appropriate referral for follow-up;  

     o    prevention of infertility and sub-fecundity, as part of

          primary health care, with appropriate referral for



     o    routine screening for other women's reproductive health

          conditions such as urinary tract infections, cervical

          infections, and cervical and breast cancer, where primary 

          level treatment is available or referral for follow-up


     o    active discouragement of harmful practices such as female

          genital mutilation.

    The fund strongly encourages the further strengthening of

collaborative and coordination arrangements with WHO, UNICEF, other

UN systems partners, bilateral agencies and non-governmental

organisations, in order to assist countries in the development of

reproductive health programmes in the most effective and effective


The World Bank

Reproductive health activities constitute a significant portion of

all World Bank lending for population, health and nutrition


     o    In the Bank's 1994 fiscal year, over 40 percent of all

          lending for population, health and nutrition supported

          reproductive health activities.

     o    Over the past 25 years, the Bank has lent more than $2.5

          million to support reproductive health components of more

          than 130 projects in almost 70 countries. Although the

          number of new commitments have varied from year to year,

          the trend has been steadily upward.

     o    In recent years, Bank lending has Integrated reproductive

          health projects with its population programmes, financing

          an average of nearly $400 million in such programmes each

          year since 1992.

     Research sponsored by the Bank also often provides the

analytical basis for reproductive health policy and action:

     o    Bank operations research, situation analyses, and field-

          based pilot projects aid program managers in assessing

          needs, instituting or modifying services, and in

          determining the effects of interventions on health

          systems and health status.

     o    The Bank's Special Grants programs represent another

          mechanism for support of large-scale, long-term efforts

          that are too costly for most developing countries to

          undertake independently.  For example, the Bank already

          has contributed $18 million to the Special Programme of

          Research, Development and Research Training in Human

          Reproduction (HRP) which is being co-sponsored by UNFPA

          and WHO.

     o    The Bank is also involved in sector work, in which Bank

          staff analyse data that enable more informed policy

          decisions and program development Sector analyses in

          Brazil, India and Uganda have helped identify the

          dimensions of women's health problems, as well as

          constraints on their use of health services.

     o    In addition to support provided for reproductive health

          activities through project lending, the Bank's Economic

          Development Institute organizes training activities that

          strengthen national capacities to design and implement

          policies and programs in the field.  These activities

          serve to foster the exchange of ideas and experiences

          that support the improvement of reproductive health

          information and services.

     Importantly, the World Bank actively seeks and supports

collaboration among donor agencies and local non-governmental

organizations (NGOs) to spread awareness of reproductive health

issues and improve the effectiveness of projects with reproductive

health components:

     o    Special Grants Programs for Population NGOs and Safe

          Motherhood, for example, provide a coordinating mechanism

          for safe motherhood programs.

     o    Bank projects in Bangladesh, Indonesia, and Zimbabwe have

          strengthened collaboration among multilateral, bilateral,

          and NGOs, thereby improving the delivery of maternal

          health and family planning services. 

International Labour Organisation (ILO)

     Relevant ILO policies and programmes are based on the premise

that success in protecting and promoting reproductive health is

linked to social and economic factors including education,

training, employment, working conditions and gender equality in

labour markets. It is accordingly affected by the adequacy of

measures designed to protect workers; the levels of success

achieved by attempts to promote and ensure equality of opportunity

and treatment and the effectiveness of policies to promote

employment opportunities. Each of these policies, measures and

programmes in various ways promotes the empowerment of women -

through legal protection (standard setting and application); all

improved access to resources and opportunities, including

education, information, employment and incomes. At the same time

the ILO recognizes that reproductive health and related outcomes

(in terms of timing of births and levels of morbidity and

mortality) are important factors affecting gender equality; the

levels of living of workers and their families; family

responsibilities and workers' ability to cope with them; employment

opportunities and career development; and the viability and

profitability of enterprises. 

     ILO promotes and provides technical support to its

constituents to enable them to design, develop and implement

comprehensive policies and programmes which link population and

reproductive health concerns to social and economic goals and

achievements. Accordingly governments are assisted to analyse,

identify and address the relevant aspects of population,

development and employment policies and to ratify and apply

existing International Labour Standards relevant to maternity

protection, safety and health at work, and promotion of equality

and employment opportunities. Employers are helped to adopt

appropriate workplace rules and mechanisms, both to eliminate

reproductive health hazards in places of work and to promote family

welfare and planning through education and access to supports and

services. Workers' organizations are strengthened to promote and

implement workers' education on population, reproductive health and

gender issues. 

United Nations Children's Fund (UNICEF) 


     UNICEF has been active in developing appropriate strategies

and programming interventions in the area of reproductive health,

specifically safe motherhood, family planning and in the prevention

of HIV/AIDS and other STDs. UNICEF support to women's health

activities emphasises working with women's organisations at the

community level. The focus is on promoting linkages with the health

sector, assisting women's organisations in implementing

information, education, communication efforts and in developing

financing mechanisms for purchasing health care. UNICEF programmes

of assistance will also include support to national-level

mobilization on safe delivery. National commissions or task forces

on safe delivery will serve to monitor progress toward reducing

maternal mortality, rationalise medical practices, and mobilize

political and community commitment to women's health. In close

collaboration with WHO, UNICEF support is provided to strengthen

essential obstetric care services and referral of women with

complications in pregnancy and delivery, including the life-

threatening complications of unsafe abortion. Increasing emphasis

will be placed on the role of nurses and midwives, specifically

training in life-saving skills, maternal and newborn care, pre- and

post-natal counselling diagnosis and treatment of reproductive

tract infections, and family planning.

     UNICEF efforts in the area of adolescent health seek to build

stronger dialogue and partnership among young people, parents,

educators, health providers and community leaders on health,

including reproductive health. They also seek to help assure that

adolescents have access to the information, skills and services

they need to protect and promote their own health and eventually

the health of their children. UNICEF supports school health

programmes which emphasise skills-based health education, including

reproductive health education, health and nutrition services, water

and sanitation on school premises, and extra-curricular activities

which promote the health of school-age children. Working closely

with parents and community organisations, increasing emphasis will

be placed on expanding adolescents' access to and utilisation of

quality health care and counselling services. UNICEF will work with

governments and NGOs to support increased outreach to vulnerable

adolescents, training of health workers on adolescent health, and

strengthening linkages between the health sector and NGOs. The

health needs of girls and young women, specifically preventing

early and unwanted pregnancy, eliminating harmful traditional

practices, like female genital mutilation and nutrition are

becoming an increasingly important part of UNICEF efforts. IEC

efforts with boys and young men will emphasise healthy practices,

including responsible sexual behaviour.  

Office of the United Nations High Commissioner for Refugees (UNHCR)

     The mission of the United Nations High Commissioner for

Refugees (UNHCR) is to assist and protect refugees worldwide. 

Based in Geneva, Switzerland,  UNHCR was created by the UN General

Assembly and began work in 1951, aiding millions of European

refugees in the aftermath of World War II.  Since then, the agency

was twice awarded the Nobel Prize - has aided tens of millions of

desperate and needy people who have been forced to flee their

countries because of persecution, war, or massive human rights

abuse.  The total number of people who come under UNHCR's concern

has risen from 17 million in 1991 to more than 27 million at

January 1, 1995:  one out of every 205 people on this planet.

     Roughly three-quarters of those destitute displaced people are

women and their dependent children.  Their role within their family

and their community is pivotal.  But, in areas of the world often

deeply scarred by suffering, exploitation and ill-health these

refugee women and children - deprived, by definition of the

protection of their state are hard-hit by the violence and

uncertainty of displacement.  Many have already survived situations

of extreme pain.  They are among society's most vulnerable members.

     For them, food, water, shelter, sanitation and preventive

health care are a priority.  So is protection:  refugees need to be

protected from being returned against their will to a country where

their lives and fundamental rights are under threat.  However,

reproductive health care is also among the crucial elements that

can give refugees the basic human welfare and dignity that they

deserve.  The key issues are safe and adequate maternity care;

access to family planning and child spacing, treatment and

prevention of sexually transmitted diseases (including HIV/AIDS);

prevention of - and response to - sexual violence; gynaecological

care; and prevention and treatment of complications arising from

the genital mutilation of girls and unsafe abortion.

     The range of reproductive health services required by refugees

are similar to those needed by any other population.  The

differences:  refugees' needs are likely to be more influenced by

trauma, in part because, amid the chaos of displacement and exile,

refugees are more vulnerable to abuse.  Compared to those of other

populations, the reproductive health care needs of refugees are

therefore likely to be both more urgent and more acute.

     UNHCR is committed to improving the reproductive health

situation of refugees, particularly of women and adolescents. 

Recently, UNHCR and UNFPA jointly sponsored an inter-agency

symposium specifically to address the reproductive health of

refugees.  It has also issued guidelines on the prevention and

follow-up of rape and has taken a series of steps to better empower

and assist refugee women.  Together with the non-governmental

organizations that operate as UNHCR partners in many refugee

situations.  UNHCR field staff in areas as far-flung as Tanzania

and Nepal have set up medical services specifically intended to

begin work on improving reproductive health.

     Staff are also working to develop a field manual, grounded in

the practical experience of hundreds of refugee aid-workers.  The

manual will define the how, where and what of future reproductive

health services to refugees.  This basic guide should be an

invaluable practical tool for UNHCR's more than 3000 field workers. 

It will be completed before the end of 1995.

United Nations Educational, Scientific and Cultural Organization


     UNESCO continues to work in close co-operation and

collaboration with UN agencies and its partners including NGOs to

enhance the quality of life of human populations through effective

educational, scientific and cultural development policies and


     UNESCO supports the educational, scientific and cultural

dimensions of reproductive health.  The interdisciplinary project

on environment, population and development (EPD) has drawn

expertise from all the relevant sectors of UNESCO to enrich and

enhance the EPD programmes.  It is believed that EPD will develop

its programme further to include the present and emerging issues

related to reproductive health in its various population

environment, and other educational programmes through effective

training and communication strategies to meet the needs of

developing and developed countries.  Much success has been achieved

in human sexuality education, adolescent/youth participation in

development programmes.

     EPD has focussed through its various programmes and projects

on the development of relevant education, training and information

activities that deal with the complex and interlinked issues of

population, environment and development.  There has been growing

emphasis on integrated activities and on national capacity building

UNESCO supports and also actively participates to better understand

the multicultural aspect of social development that includes

reproductive health, because it is crucial to the improvement of

quality of life and human resources development programmes. 

Reproductive health issues involve active  participation of

individuals, communities and societies and this can be successfully

achieved through UNESCO continued support through its education,

information, communication training and research policies and

programmes at the global, regional and country level.

     In the current biennium (1994-1995) and in the forthcoming

biennium (1996-1997), EPD proposes enhanced activities in relevant

reproductive health issues, through it inter-agency, inter-

disciplinary and inter-sectoral projects/programmes in all regions. 

This task is being and will continue to be achieved in closely

collaboration with the UNFPA TSS/CST programme.  New programmes are

under preparation that will focus on the follow-up on the

reproductive health aspects as stated in ICPD and efforts are being

made to focus on those areas where best results can be expected

through collaborative expertise and activities of UNESCO and its

partners in the UN system, NGOs and others.  

For further information, please contact: popin@undp.org
POPIN Gopher site: gopher://gopher.undp.org/11/ungophers/popin
POPIN WWW site:http://www.undp.org/popin