UNFPA Annual Report 2016

Publication date: 2016

Annual Report 2016 Millions of lives transformed From the Executive Director Pregnancy by choice, not by chance Saving mothers’ lives Empowering the next generation Africa, East and Southern Africa, West and Central Arab States Asia and the Pacific Eastern Europe and Central Asia Latin America and the Caribbean Resources and management 02 — 03 04 — 09 10 — 33 34 — 40 UNFPA Annual Report 2016 UNFPA Delivering a world where every pregnancy is wanted every childbirth is safe and every young person’s potential is fulfilled In times of budgetary constraints, governments need to reassure constituencies that investing in UNFPA yields results. This annual report shows how funds entrusted to UNFPA have enabled us to protect and promote the health and rights of millions of women and young people and enable them to realize their full potential. The numbers in this report speak for themselves. In 2016, for example, contraceptives supplied by UNFPA reached 20.9 million people, helped avert an estimated 11.7 million unintended pregnancies and nearly 3.7 million unsafe abortions and prevent an estimated 29,000 maternal deaths. The returns on donor and developing country investments in UNFPA are quantifiable. But the more important measure of success is the survival, health and well-being of women and young people whose rights have been upheld and whose lives have been transformed as a result of our programmes in 155 countries and territories. From the Executive Director Now more than ever, we must ensure that the marginalized, the forgotten—the ones often left behind—can exercise their fundamental human right to decide, free of coercion, discrimination and violence, when or how often to have children. UNFPA, the United Nations Population Fund, is proud to have enabled millions of women of childbearing age to exercise that right and to have helped to nearly double modern contraceptive use worldwide from 36 per cent in 1970 to 64 per cent in 2016. Increasing access to voluntary planning has not only empowered more women to make decisions about the timing and spacing of pregnancies, but it has also led to better health outcomes for women and has helped reduce maternal deaths globally from 532,000 in 1990 to 303,000 in 2016. But the number of maternal deaths is still too high. We must get to zero. No woman should die giving life. We know how to reach zero maternal deaths. But in many cases, resources are still insufficient to make sure every pregnant woman has at least four antenatal care visits, every birth is attended by skilled workers and life-saving medicines are available to everyone who needs them. Without continued political and financial support from donor countries and renewed commitments from developing nations, we risk losing the momentum made towards saving mothers’ lives, increasing access to voluntary family planning and achieving universal sexual and reproductive health and rights. We also risk falling short of our shared goal to leave no one behind as we move forward with the global sustainable development agenda. D r. B ab at un de O so ti m eh in 04 This annual report shows how funds entrusted to UNFPA have enabled us to protect and promote the health and rights of millions of women and young people and enable them to realize their full potential. 06 Pr eg na nc y by c ho ic e, no t b y ch an ce One-hundred seventy-nine governments agreed in 1994 that individuals have the right and should have the means to freely decide whether or when they want to start a family. Yet, an estimated 225 million women in developing countries are unable to exercise that right because they are not using, or have no access to, contraception. Unmet demand for family planning translates into nearly 60 million unintended pregnancies annually in developing countries. UNFPA, the United Nations Population Fund, is helping respond to the unmet demand and enabling more women to exercise their right to decide whether, when or how often to become pregnant. Increased access to contraception also leads to fewer abortions and reduces risks to women’s health. Contraceptive needs vary from woman to woman. Some prefer the pill, others may prefer injectables or implants. And still others prefer condoms, which also reduce the risk of sexually transmitted infections, including HIV. UNFPA helps countries provide reliable supplies of a full range of high-quality contraceptive options. The majority of contraceptives provided by UNFPA are funded through the UNFPA Supplies programme, an initiative focused on increasing access to modern contraception in the 46 developing countries with the highest unmet demand. Donor countries and foundations together contributed $77.2 million towards the initiative in 2016. Through the UNFPA Supplies Programme and the organization's regular family planning programmes combined, UNFPA provided nearly 7 million female condoms and nearly 268 million male condoms. Th e U N FP A S up pl ie s Pr og ra m m e fu nd ed , i n 20 16 711,780 doses of emergency contraception 2,946,213 contraceptive implants 34,852,080 doses of injectable contraceptives 21,350,104 cycles of oral contraceptives 1,178,419 intrauterine devices C on tr ac ep ti ve s pr ov id ed by U N FP A in 2 0 16 * $716,000,000 savings in healthcare costs 20,900,000 11,700,000 3,680,000 29,000 people reached unintended pregnancies averted averted averted unsafe abortions maternal deaths 5,400,000 female condoms 168,600,000 male condoms *Estimates calculated using Impact 2 (v3), Marie Stopes International, 2015 Sa vi ng m ot he rs ’ l iv es Every day, 830 women die from preventable causes during pregnancy or childbirth. UNFPA makes pregnancy and delivery safer in developing countries by building the midwifery workforce, increasing access to antenatal and emergency obstetric care and providing life-saving medicines and medical equipment. In 2016, UNFPA, through its maternal health thematic fund, supported by donor governments, foundations and professional organizations, strengthened health care, particularly maternal and newborn health services, in 39 countries with high rates of maternal death. The UNFPA Supplies programme in 2016 funded maternal health medicines, such as oxytocin and magnesium sulfate, to treat postpartum haemorrhage or hypertension during pregnancy. UNFPA supports safe pregnancies and deliveries even in humanitarian settings, such as camps for refugees or internally displaced people or in the aftermath of man-made and natural disasters. At the onset of a crisis, UNFPA provides an initial basic set of services to protect the lives of mothers and newborns, prevent and manage the consequences of gender-based violence and reduce vulnerability to HIV infection. 08 11,400,000 people had access to sexual and reproductive health services and services to address gender-based violence 481 mobile maternal health clinics in 27 countries 2,488 health facilities with emergency obstetric care 485 safe spaces for girls and women 10,000 youth peer educators trained in sexual and reproductive health 741 facilities with clinical management of rape Im pa ct o f U N FP A s er vi ce s in hu m an it ar ia n se tt in gs in 2 0 16 Im pa ct o f t he m at er na l h ea lt h th em at ic fu nd 200 schools 5,200 midwives 10 countries 39 countries bolstered midwifery education and regulation of midwifery received textbooks and teaching materials trained 15,638 women underwent surgery to repair obstetric fistulas expanded comprehensive maternal health services for young mothers Em po w er in g th e ne xt g en er at io n Young people, ages 10 to 24, account for about 24 per cent of the world’s 7.4 billion people. UNFPA in 2016 helped millions of young people, especially adolescent girls, remain healthy and avoid pregnancy. UNFPA also helped protect them from harmful practices and enabled them to realize their full potential. 010 23,000,000 adolescents gain access to sexual and reproductive health services 2,906 communities declared the abandonment of female genital mutilation 730,000 girls and women received comprehensive services related to female genital mutilation In 2 0 16 , U N FP A pr og ra m m es h el pe d A s a re su lt o f U N FP A pr og ra m m es in 2 0 16 The UNFPA-UNICEF joint Global Programme to Accelerate Action to End Child Marriage aims to stop child marriage in 12 countries and protect the health and rights of girls who are already married. Between March 2015 and March 2016, the programme empowered 65,000 adolescent girls with life skills, sexual and reproductive health information and access to services. The programme also raised awareness of 285,000 community members about girls’ rights. In Uganda alone, the programme has been shown to raise the likelihood that participating girls engage in income generating activities by 72 per cent, reduce teen pregnancy by 26 per cent and early entry into marriage or cohabitation by 58 per cent. In addition, UNFPA contributed to the development of national strategies for ending child marriage in Burkina Faso, Mozambique, Uganda and Zambia. 2 407 maternal deaths per 100,000 live births 2 56% of births attended by skilled personnel 2 23% of women married or in a union with an unmet need for family planning 2 4.4 children born to average woman in childbearing years (total fertility rate) 2 32% of population between the ages of 10 and 24 A fr ic a, E as t an d So ut he rn Young people make up the largest and fastest- growing share of the region’s population. How governments in the region invest in their health, education and capabilities in the years ahead will determine whether the region will reap a demographic dividend. A demographic dividend is the potential for economic growth that can result from shifts in a population’s age structure, when the share of the working-age population expands relative to the non-working-age population. A demographic dividend is linked to a demographic transition, which begins when child and infant death rates decrease in response to increased access to vaccines, antibiotics, safe water, sanitation and better nutrition. As couples realize that they do not need to have as many children to reach their desired family size, fertility rates then begin falling. Investing in the human capital of the region’s young people entails expanding access to sexual and reproductive health services, including contraception and HIV prevention. Nearly half of all new HIV infections worldwide occur in the region, which is also home to more than half of all people living with HIV. An estimated 640 adolescent girls and young women in the region are infected with HIV every day. About one in four women in the region has given birth before age 18. There is a one- in-15 chance that a girl in the region will die from pregnancy or childbirth-related complications. Investments in the region are also needed to expand young people and women’s access to contraception. About one in four women wants to prevent a pregnancy but is not using a modern method of family planning. About one in two women in the region has experienced physical or sexual violence. In some countries, nearly nine in 10 women have been subjected to gender-based violence. 12 15,000 1,600,000 5,400,000 maternal deaths averted unsafe abortions prevented 23 5,979 women underwent surgery to repair obstetric fistulas communities declared the abandonement of female genital mutilation unintended pregnancies prevented Es ti m at ed im pa ct o f c on tr ac ep ti ve s pr ov id ed b y U N FP A in 2 0 16 Im pa ct o f U N FP A su pp or t i n 20 16 Em po w er in g th e ne xt ge ne ra ti on 811,000 adolescents who were not in school had access to comprehensive sexuality education through the Safeguard Young People programme. 17,000 teachers trained through UNFPA and UNESCO programmes to deliver comprehensive sexuality education. Sa vi ng m ot he rs ’ liv es Pr eg na nc ie s by c ho ic e, no t b y ch an ce 82,000 people affected by crises had access to family planning. 3,500 health workers received training in integrating HIV and AIDS services into sexual and reproductive health services. 2,000 health-care professionals received training in providing emergency obstetric care, gender-based violence case management and the clinical management of rape in crises. Midwifery in 10 countries was strengthened because of UNFPA training programmes. The size of the midwifery labour force grew in eight countries. 8 in 10 births attended by skilled personnel in Botswana, Comoros, Namibia, South Africa and Swaziland. 14 1,500,000 adolescents and youth had access to sexual and reproductive health services 445,000 survivors of gender-based violence received services in humanitarian settings 913,616 women and girls in humanitarian settings had access to reproductive health services to prevent and treat the effects of gender-based violence 14,000,000 youth received sexual and reproductive health messages through social media 80,000,000 condoms were made available to young people Angola 1,992 Botswana 1,079 Burundi 5,448 Comoros 782 Democratic Republic of the Congo 21,357 Eritrea 1,605 Ethiopia 14,757 Kenya 14,115 Lesotho 1,522 Madagascar 5,864 Malawi 8,214 Mauritius 79 Mozambique 11,440 Namibia 1,299 Rwanda 4,169 South Africa 2,179 South Sudan 17,474 Swaziland 1,462 Uganda 15,122 United Republic of Tanzania 13,163 Zambia 7,629 Zimbabwe 13,259 Country/territory programmes 164,010 Regional projects 16,924 Total programme expenses 180,934 Includes core and non-core resources Integrated sexual and reproductive health Non-Core Core Total 87.4 36.3 123.7 18.4 7.0 25.4 9.0 5.2 14.2 4.0 11.6 15.6 1.0 1.0 2.0 68.4 % 14.0 % 7.8 % 8.6 % 1.2 % Data for development Organizational efficiency and effectiveness Adolescents Gender equality and rights Resources Pr og ra m m e ex pe ns es b y pu rp os e Pr og ra m m e ex pe ns es in m ili on s of U S$ in th ou sa nd s of U S$ 2 676 maternal deaths per 100,000 live births 2 48% of births attended by skilled personnel 2 24% of women married or in a union with an unmet need for family planning 2 5.2 children born to average woman during childbearing years (total fertility rate) 2 32% of population between the ages of 10 and 24 A fr ic a, W es t an d C en tr al A woman in West and Central Africa is 120 times more likely to die from pregnancy- related complications than a woman in a developed country. In the region, one woman in six uses modern contraception, contributing to an average fertility rate of more than five children per woman. High fertility rates are buoyed in part by high rates of child marriage and adolescent pregnancy, which in turn increase the economic and social vulnerability of girls and undermine investments in their education and prevent them from realizing their full potential. The region has the world’s highest child marriage rates, with an average of two of five girls married before age 18. About 6 per cent of girls give birth before age 15. Educational attainment for girls is lower in West and Central Africa than any other region in the world. For every 100 boys, there are only 89 girls enrolled in primary school. At the secondary level, for every 100 boys enrolled, there are only 83 girls. Low rates of educational attainment affects future job prospects. Jobs for young people are scarce, and the World Bank estimates that over the next 10 years, only one in four young people in the region will secure paid employment. Key challenges in 2016 2 Reducing maternal mortality 2 Increasing use of modern methods of contraception 2 Accelerating the demographic transition to pave the way for a demographic dividend 2 Stopping harmful practices such as early marriage and female genital mutilation 2 Keeping girls in school 2 Matching training to decent jobs 2 Participation of young people in decision-making 16 1,000,000 unsafe abortions prevented 2,900,000 unintended pregnancies prevented Es ti m at ed im pa ct o f c on tr ac ep ti ve s pr ov id ed b y U N FP A in 2 0 16 8,195 1,768 women underwent surgery to repair obstetric fistulas communities declared the abandonment of female genital mutilation Im pa ct o f U N FP A su pp or t i n 20 16 maternal deaths averted 12,000 Sa vi ng m ot he rs ’ liv es 3,000 women underwent surgery to repair obstetric fistula. 800 midwives received training in emergency obstetric and newborn care. 600 midwifery students attended pre-service training. 44 institutions for midwifery training were strengthened. Pr eg na nc ie s by c ho ic e, no t b y ch an ce $33,000,000 invested in contraceptives, especially for disadvantaged women in rural areas. 6 countries strengthened management of reproductive health supplies. Em po w er in g th e ne xt ge ne ra ti on 2,400 adolescents in Sierra Leone gained access to life-skills training through girls clubs. 16% 56% Safe spaces where married adolescents in Niger learned about health and gender also led to an increase in contraceptive use from 16 per cent to 56 per cent in eight months. 18 5,200,000 additional women gained access to family planning information and services 2,262,303 women and girls in humanitarian settings had access to reproductive health services or services to prevent and treat the effects of gender-based violence 2,300,000 women had access to sexual and reproductive health services 1,600,000 adolescents had access to sexual and reproductive health services 10,000 service providers trained in sexual and reproductive health Benin 4,382 Burkina Faso 6,739 Cameroon 6,826 Cape Verde 629 Central African Republic 4,458 Chad 6,303 Congo 2,181 Côte d'Ivoire 8,086 Equatorial Guinea 1,927 Gabon 672 Gambia 1,509 Ghana 3,632 Guinea 7,028 Guinea-Bissau 2,146 Liberia 6,377 Mali 5,722 Mauritania 2,635 Niger 10,064 Nigeria 26,634 São Tomé and Príncipe 1,048 Senegal 6,222 Sierra Leone 12,800 Togo 3,015 Country/territory programmes 131,035 Regional projects 8,907 Total programme expenses 139,942 Includes core and non-core resources Integrated sexual and reproductive health Non-Core Core Total 68.4 27.1 95.5 8.2 6.2 14.4 9.4 3.9 13.3 4.7 11.0 15.7 0.2 0.8 1.0 68.3 % 10.3 % 9.5 % 11.2 % 0.7 % Data for development Organizational efficiency and effectiveness Adolescents Gender equality and rights Resources Pr og ra m m e ex pe ns es b y pu rp os e Pr og ra m m e ex pe ns es in m ili on s of U S$ in th ou sa nd s of U S$ 2 162 maternal deaths per 100,000 live births 2 73% of births attended by skilled personnel 2 16% of women married or in a union with an unmet need for family planning 2 3.3 children born to average woman during childbearing years (total fertility rate) 2 28% of population between the ages of 10 and 24 A ra b St at es Much of the Arab States region continued to be affected by conflict and natural disasters in 2016, endangering the health and lives of hundreds of thousands of pregnant women. In Syria and neighbouring countries alone, 5.3 million women were of childbearing age that year, and an estimated 440,000 were pregnant. Women and adolescent girls bear extraordinary burdens as wars and disasters leave a trail of turmoil and destruction. Without the usual protection of family and community, women and adolescent girls frequently become victims of sexual violence, unwanted pregnancies and sexually transmitted infections. Basic needs for family planning, reproductive health care and safe childbirth are rarely met when women and adolescents become untethered from the lifeline of health systems. In Yemen, displacement and instability have heightened the vulnerability of 2.6 million women and girls to gender-based violence, which has increased by 63 per cent over the past two years. In addition, child marriages are on the rise. In Iraq, fighting in and around Mosul has resulted in large-scale displacement and has blocked women’s access to maternity care. Elsewhere in the region, a number of governments faced economic and political challenges to expanding access to sexual and reproductive health services, including family planning. 20 498 169 950,995 272,000 823,000 women and girls in humanitarian settings had access to reproductive health services or services to prevent and treat the effects of gender-based violence maternal deaths averted unsafe abortions prevented communities declared the abandonment of female genital mutilation unintended pregnancies prevented Es ti m at ed im pa ct o f c on tr ac ep ti ve s pr ov id ed b y U N FP A in 2 0 16 Im pa ct o f U N FP A su pp or t i n 20 16 Sa vi ng m ot he rs ’ liv es 402,651 women and adolescents in Iraq had access to antenatal and post-natal care and contraceptives, had safe deliveries and received treatment for sexually transmitted infections. Five hundred fifty-five medical personnel in Mosul were trained in emergency obstetric care. 100,000 women in North and Central Darfur states in Sudan received life-saving reproductive health medicines and supplies. 2,500 safe deliveries supported by UNFPA in Iraq. 2,015 safe deliveries in Za'atari refugee camp in Jordan. 1,219 health-care providers in Syria were trained in reproductive health, including emergency obstetric care. 563 operations to repair obstetric fistulas. 52 mobile teams provided services, including safe deliveries, in conflict-affected parts of the Yemen. Pr eg na nc ie s by c ho ic e, no t b y ch an ce Em po w er in g th e ne xt ge ne ra ti on 39,056 young people in two governorates in Egypt and in Cairo gained access to health services. 722 youth peer counsellors now trained and deployed in Syria. 64,000 unintended pregnancies were averted in Sudan. 16,500 women and adolescents in refugee camps or in host communities gained access to, and could choose from, four modern methods of contraception in Jordan. 22 650,000 people in 10 governorates gained access to family planning in Syria 2,000,000 Syrian women and girls had access to life-saving reproductive health services through 1,331 facilities, mobile clinics and outreach teams in Syria, Egypt, Iraq, Jordan and Turkey 740,000 people gained access to family planning in Yemen 1,000,000 people in Yemen gained access to reproductive health services or services to support survivors of gender-based violence Algeria 431 Djibouti 1,066 Egypt 3,999 Iraq 22,101 Jordan 13,847 Lebanon 3,013 Libya 1,640 Morocco 1,015 Oman 1,174 Palestine 2,573 Somalia 13,393 Sudan 13,761 Syrian Arab Republic 10,506 Tunisia 816 Yemen 14,281 Country/territory programmes 103,616 Regional projects 9,227 Total programme expenses 112,843 Includes core and non-core resources Integrated sexual and reproductive health Non-Core Core Total 44.7 14.8 59.5 3.8 1.7 5.5 35.0 3.4 38.4 3.6 3.6 7.2 1.4 0.8 2.2 52.8 % 4.9 % 34.0% 6.4 % 1.9 % Data for development Organizational efficiency and effectiveness Adolescents Gender equality and rights Resources Pr og ra m m e ex pe ns es b y pu rp os e Pr og ra m m e ex pe ns es in m ili on s of U S$ in th ou sa nd s of U S$ 211,000 unintended pregnancies averted through family planning in Somalia 2 127 maternal deaths per 100,000 live births 2 70% of births attended by skilled personnel 2 10% of women married or in a union with an unmet need for family planning 2 2.1 children born to average woman during childbearing years (total fertility rate) 2 24% of population between the ages of 10 and 24 A si a an d th e Pa ci fic Dramatic socioeconomic gains in Asia and the Pacific, home to almost 60 per cent of the world’s population, have benefited hundreds of millions of people. Despite these gains, hundreds of millions of others still face formidable development challenges. This imbalance must be addressed urgently if countries—and the region as a whole—are to achieve the Sustainable Development Goals and the vision for progress that leaves no one behind. While many countries have improved access to sexual and reproductive health services for their citizens, millions of women still lack access to family planning, leading to unintended pregnancies and unsafe abortions. Of the estimated 114 million pregnancies in the region in 2016, about 45 million were unintended. An estimated 83,700 women and adolescent girls, mainly in South Asia, continue to die each year from complications related to pregnancy and childbirth where there is little or no access to quality health facilities and trained personnel, especially midwives. The majority of young people in and out of school receive no basic information about their bodies and reproduction, let alone comprehensive sexuality education that would empower them to make responsible choices and decisions as they mature into adulthood. Child marriage remains widespread, although efforts by governments and civil society in some countries to counter harmful practices and violence against women are gathering momentum. All of these challenges are exacerbated in several countries by pressures to limit the work of civil society organizations, including some that advocate for access to sexual and reproductive health services. Asia and the Pacific is the world’s most disaster-prone region, resulting in additional vulnerabilities for women and adolescent girls in their childbearing years. Long-running conflicts in several countries have also taken a toll on girls and pregnant women, especially those who have been displaced or who have fled to neighboring countries. 24 927 901 244,473 299,000 1,100,000 maternal deaths averted unsafe abortions prevented women underwent surgery to repair obstetric fistulas unintended pregnancies prevented women and girls in humanitarian settings had access to reproductive health services or services to prevent and treat the effects of gender-based violence Es ti m at ed im pa ct o f c on tr ac ep ti ve s pr ov id ed b y U N FP A in 2 0 16 Im pa ct o f U N FP A su pp or t i n 20 16 Em po w er in g th e ne xt ge ne ra ti on 600 teachers trained in providing comprehensive sexuality education in the Lao People's Democratic Republic, reaching 12,000 students. Sa vi ng m ot he rs ’ liv es Pr eg na nc ie s by c ho ic e, no t b y ch an ce 6,000 clean delivery kits distributed in conflict-affected zones of Myanmar. 600 midwifery graduates received their licences in Bangladesh. 70 women per day received sexual and reproductive health services as they returned to Afghanistan from Pakistan. 5,200 women in poor, remote areas of Nepal gained access to long- acting modern contraceptives, such as intrauterine devices and implants, through visiting providers and satellite clinics. Free contraceptive implants made available to poor women in remote areas of Myanmar. 26 20,000 contraceptive implants supplied in the Lao People’s Democratic Republic 49,000 young people received life-skills training through 16 UNFPA-supported youth-development centres 385,000 young people in Indonesia received information through social media about sexual and reproductive health 4,000 women received life-saving reproductive health services, including antenatal care, family planning and safe deliveries after Cyclone Winston struck Fiji Afghanistan 26,461 Bangladesh 10,722 Bhutan 735 Cambodia 2,627 China 1,940 Democratic People's Republic of Korea 2,092 India 8,154 Indonesia 3,439 Islamic Republic of Iran 1,231 Lao People's Democratic Republic 2,989 Malaysia 680 Maldives 391 Mongolia 3,685 Myanmar 9,981 Nepal 5,598 Pacific Multi Islands* 4,914 Pakistan 8,302 Papua New Guinea 6,312 Philippines 6,253 Sri Lanka 950 Thailand 990 Timor-Leste 1,900 Viet Nam 3,805 Country/territory programmes 114,151 Regional projects 7,733 Total programme expenses 121,884 Includes core and non-core resources Pr og ra m m e ex pe ns es b y pu rp os e Pr og ra m m e ex pe ns es in m ili on s of U S$ in th ou sa nd s of U S$ Integrated sexual and reproductive health Non-Core Core Total 19.6 30.0 49.6 4.3 8.6 12.9 10.5 8.6 19.1 21.7 16.0 37.7 0.2 2.4 2.6 40.7 % 10.6 % 15.7 % 30.9 % 2.1 % Data for development Organizational efficiency and effectiveness Adolescents Gender equality and rights Resources *Figures for Pacific multi-islands comprise several islands which, for reporting purposes, are classified under one heading, including the Cook Islands, Fiji, Kiribati, the Marshall Islands, the Federated States of Micronesia, Nauru, Niue, Palau, Samoa, the Solomon Islands, Tokelau, Tonga, Tuvalu and Vanuatu. 2 25 maternal deaths per 100,000 live births 2 98% of births attended by skilled personnel 2 11% of women married or in a union with an unmet need for family planning 2 2 children born to average woman during childbearing years (total fertility rate) 2 22% of population between the ages of 10 and 24 Ea st er n Eu ro pe an d C en tr al A si a The Eastern Europe and Central Asia region consists of middle-income countries with significant resources at their disposal and corresponding levels of public services and infrastructure. Antenatal care, for example, is nearly universal, and maternal mortality rates have fallen by more than half since the early 1990s, from 66 to 25 deaths per 100,000 births. But economic inequalities and lack of job opportunities remain commonplace and have contributed to migration, both within countries and within the region, the inability of many couples to have as many children as they desire, and wide disparities in access to services, including sexual and reproductive health services. Masked by national data, marginalized and disadvantaged groups, such as national minorities, refugees and migrants, young people and the poor, face particular challenges in realizing their reproductive rights and accessing information and services. Some 17 million women have an unmet demand for modern contraception in the region, with two thirds of them relying on traditional methods, putting them at higher risk of unintended pregnancy and sexually transmitted infections. In most countries of South-Eastern Europe and the South Caucasus, rates of modern contraceptive use are lower than the average in the world’s least developed countries. For every 1,000 live births in the region (including Russia), there are 257 abortions, and every year, 443,000 teenagers give birth, a rate three times that of Western Europe. HIV is still on the rise in the region, with an estimated 190,000 new infections every year, and sexual transmission rapidly becoming the predominant factor. The region has a high incidence of “secondary infertility”: 12.6 million women between the ages of 22 and 44 are unable to have another baby. Gender inequality still permeates societies in the region and manifests itself in discrimination of women, gender-based violence and harmful practices such as gender-biased sex selection in parts of Southeastern Europe and the South Caucasus. 28 45 849,535 maternal deaths averted 67,000 unsafe abortions prevented 231,000 unintended pregnancies prevented women and girls in humanitarian settings had access to reproductive health services or services to prevent and treat the effects of gender-based violence Es ti m at ed im pa ct o f c on tr ac ep ti ve s pr ov id ed b y U N FP A in 2 0 16 Im pa ct o f U N FP A su pp or t i n 20 16 Pr eg na nc ie s by c ho ic e, no t b y ch an ce Em po w er in g th e ne xt ge ne ra ti on Eradicating child marriage In a move to eradicate child marriage, Kyrgyzstan enacted a law banning religious marriage ceremonies for underage girls and boys. Child marriage is illegal in Kyrgyzstan, but before the new law came into force, this prohibition was often circumvented by holding informal ceremonies. Sa vi ng m ot he rs ’ liv es 500 midwives based in hospitals in Uzbekistan were trained in 2015 and 2016 in preventing post-partum haemorrhaging, a leading cause of maternal death in the country. + 10% increase in the number of women screened for cervical cancer in Moldova. 8,700 more women in Armenia gained access to a contraceptive method of their choice as a result of improvements to the country's logistics management information system for family planning supplies. 150 family doctors were trained in Bosnia and Herzegovina in counselling women and men in family planning options. 30 27,000 young people learned about sexual and reproductive health and rights through a pilot programme in Moldova 10,000 survivors of gender-based violence in conflict- affected areas of Ukraine received psychological support from UNFPA mobile teams 45,000 refugees and migrants who survived gender-based violence had access to services provided through 24 safe houses in Turkey 100,000 refugees and migrants in Turkey received sexual and reproductive health services Albania 1,026 Armenia 776 Azerbaijan 498 Belarus 655 Bosnia and Herzegovina 690 Georgia 1,033 Kazakhstan 567 Kyrgyzstan 960 Republic of Moldova 705 Serbia* 929 Tajikistan 1,632 The former Yugoslav Republic of Macedonia 408 Turkey 10,340 Turkmenistan 463 Ukraine 2,524 Uzbekistan 728 Country/territory programmes 23,934 Regional projects 6,565 Total programme expenses 30,499 Includes core and non-core resources Integrated sexual and reproductive health Non-Core Core Total 10.6 5.4 16.0 0.3 1.5 1.8 5.0 2.3 7.3 0.9 3.0 3.9 — 1.5 1.5 52.4 % 5.9 % 23.9 % 12.8 % 5 % Data for development Organizational efficiency and effectiveness Adolescents Gender equality and rights Resources Pr og ra m m e ex pe ns es b y pu rp os e Pr og ra m m e ex pe ns es in m ili on s of U S$ in th ou sa nd s of U S$ *Includes Kosovo 2 68 maternal deaths per 100,000 live births 2 93% of births attended by skilled personnel 2 11% of women married or in a union with an unmet need for family planning 2 2 children born to average woman during childbearing years (total fertility rate) 2 26% of population between the ages of 10 and 24 La ti n A m er ic a an d th e C ar ib be an Latin America and the Caribbean is a region of contrasts and diverse challenges. While the region has the largest number of young people in its history, it also includes countries with a rapidly increasing share of the population that is older. While there is enormous wealth, there is also extreme poverty, disproportionately affecting indigenous groups, Afrodescendants and millions living in precarious settlements vulnerable to the effects of climate change. Meanwhile, the region’s overall gross domestic product contracted by 1.1 per cent in 2016, resulting in a 2.2 per cent decline in per capita gross domestic product, continuing an economic slowdown that began in 2011, resulting in large numbers of people trapped in, or falling into, poverty. And while quality sexual and reproductive health services, including family planning, are increasingly available to affluent, educated and urban individuals, access to services in some countries is limited in poorer and rural communities, and among young people, including adolescents. On average, one in every 10 women in the region has an unmet need for family planning. About 36 per cent of the region’s adolescents also have an unmet need for modern contraception. The region now has the world’s largest share of pregnancies that are unintended: 56 per cent. 32 497 3 1,617 392,000 1,000,000 maternal deaths averted unsafe abortions prevented communities declared the abandonment of female genital mutilation unintended pregnancies prevented women and girls in humanitarian settings had access to reproductive health services or services to prevent and treat the effects of gender-based violence Es ti m at ed im pa ct o f c on tr ac ep ti ve s pr ov id ed b y U N FP A in 2 0 16 Im pa ct o f U N FP A su pp or t i n 20 16 Sa vi ng m ot he rs ’ liv es Pr eg na nc ie s by c ho ic e, no t b y ch an ce Em po w er in g th e ne xt ge ne ra ti on 20 teachers and 18 midwives in Chile received training in adolescent sexual and reproductive health services, including contraception. 18 countries identified legal barriers to young people's access to sexual and reproductive health services, with UNFPA support. 15 maternity wards rehabilitated after Hurricane Matthew struck Haiti. Mobile clinics dispatched to provide services to survivors of gender-based violence. Midwifery training strengthened in 20 countries of the region. 14 public health facilities made contraceptive implants available through a pilot project in Uruguay. 8 countries' health- care institutions received training in rights-based approaches to family planning. 34 130 young people trained to advocate for health and rights of the region's adolescents and youth 500,000 condoms distributed and information about HIV and Zika prevention provided in Brazil during the Olympics 1,500 adolescent peer educators in Honduras received training in comprehensive sexuality education and gender equality Argentina 214 Plurinational State of Bolivia 2,618 Brazil 1,383 Caribbean, English and Dutch speaking* 1,703 Chile 175 Colombia 2,736 Costa Rica 602 Cuba 622 Dominican Republic 607 Ecuador 1,007 El Salvador 1,772 Guatemala 6,167 Haiti 3,524 Honduras 3,489 Mexico 1,239 Nicaragua 1,013 Panama 743 Paraguay 886 Peru 813 Uruguay 1,233 Bolivarian Republic of Venezuela 638 Country/territory programmes 33,184 Regional projects 7,266 Total programme expenses 40,450 Includes core and non-core resources Integrated sexual and reproductive health Non-Core Core Total 10.1 9.5 19.6 2.7 4.2 6.9 4.3 2.1 6.4 1.4 4.7 6.1 0.2 1.3 1.5 48.4 % 17.0 % 15.8 % 15.1 % 3.7 % Data for development Organizational efficiency and effectiveness Adolescents Gender equality and rights Resources *Figures for Caribbean, English- and Dutch-speaking, comprise several countries and islands which, for reporting purposes, have been classified under one heading, including Anguilla, Antigua and Barbuda, the Bahamas, Barbados, Belize, Bermuda, the British Virgin Islands, the Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Montserrat, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, the Netherlands Antilles (Aruba, Curacao, and St. Maarten), Suriname, Trinidad and Tobago and the Turks and Caicos Islands. Pr og ra m m e ex pe ns es b y pu rp os e Pr og ra m m e ex pe ns es in m ili on s of U S$ in th ou sa nd s of U S$ Re so ur ce s an d m an ag em en t Gross Contributions to UNFPA totaled $848 million in 2016. The amount includes $353 million towards the organization’s “core resources” and $495 million earmarked for specific programmes or initiatives. Core resources are the bedrock of UNFPA programmes that serve women and young people around the world. Core resources enable long-term planning as well as rapid response to emerging priorities. Core resources also enable UNFPA to have a universal presence, even in fragile contexts, such as in conflict zones or in refugee situations. In 2016, contributions to core resources were $45 million lower than in 2015, because of decreases of contributions from some of UNFPA’s major donors and the unfavourable exchange rates between major donor contribution currencies and the US dollar. Earmarked contributions in 2016 included $80 million for the UNFPA Supplies Programme, which expands access to contraceptives and reproductive health services, and for the UNFPA Maternal Health Thematic Fund, which supports midwifery programmes, the Campaign to End Fistula and other actions to protect the health and lives of mothers. Earmarked contributions also included $155 million to protect the health and lives of more than 11 million women and adolescents in crises in Afghanistan, Haiti, the riparian countries of the Lake Chad Basin, Syria and neighboring countries, Myanmar, South Sudan, Ukraine, Yemen and about 40 other countries and territories. While maintaining relationships with traditional donors in 2016, UNFPA also established or strengthened partnerships with non-traditional donor governments and multilateral institutions to ensure sufficient resources are mobilized to meet the reproductive health needs of millions of women and adolescents. UNFPA continued to partner with other United Nations entities to scale up humanitarian and development programmes. Earmarked contributions in 2016 included a total of $109 million through inter-organization transfers. This consists of agency-to-agency transfers and funds received as a participant in pooled inter-agency funding mechanisms. Core Contributions 2 Sweden 59,044,049 Norway 46,845,794 Netherlands 39,106,145 United States of America 30,700,000 Denmark 28,113,350 United Kingdom of Great Britain and Northern Ireland 25,000,000 Germany 24,369,027 Finland 20,000,000 Japan 19,023,833 Switzerland 16,145,308 Canada 11,685,393 Belgium 7,891,770 Australia 7,037,319 New Zealand 4,008,016 Ireland 3,171,008 Luxembourg 2,899,344 Italy 2,040,816 China 1,200,000 France 835,897 Pakistan 551,839 Non-Core Contributions 3 United Kingdom of Great Britain 116,288,544.61 United Nations and Interorganizational transfers 108,796,815.04 Canada 42,229,874.21 United States of America 32,562,030.51 European Commission 23,819,835.57 Sweden 17,705,623.50 Japan 17,282,097.17 Switzerland 15,666,793.56 Australia 10,778,457.38 Belgium 10,706,967.90 Republic of Korea 9,299,222.00 Luxembourg 8,387,646.02 El Salvador 7,993,676.32 Norway 6,252,925.85 Denmark 5,778,114.50 Finland 5,462,648.39 Bill and Melinda Gates 4,000,365.00 France 3,311,258.28 Liberia 3,300,000.00 Saudi Arabia 3,000,000.00 To p 20 d on or s 1 co nt rib ut io ns in U S$ 36 1. All figures are provisional as of 21 April 2017. 2. These amounts represent the contribution revenue recorded for 2016 core resources. 3. The amounts represent contribution revenue for trust funds. They includes multi-year co-financing agreements which were recognized in 2016, in accordance with UNFPA accounting policies. Programme implementation continues to be linked to actual receipt of resources. 4. All figures are provisional as of 6 April 2017, as published in the United Nations Population Fund Statistical and Financial Review, 2016, subject to external audit and, as a result of rounding, may not add up to the totals. 5. This amount represents reimbursement of income taxes to the nationals of one Member State. It is included in the 'Other revenue' amount. Core resources Contributions to core resources - gross 352.8 Less: transfers to other revenue for reimbursement of tax charges 5 (5.8) Other revenue 52.1 Total core resources revenue 399.1 Non-core resources Contributions to non-core resources - gross 494.9 Less: refunds to donors (4.4) Less: indirect costs (34.7) Other revenue 4.6 Total non-core resources revenue 460.4 Total revenue 859.5 Core resources Country programmes, Global and Regional Interventions (GRI) and other programme activities 258.3 Institutional budget 136.8 Corporate 12.6 Total core resources expenses 407.7 Non-core resources Country programmes, Global and Regional Interventions (GRI) and other programme activities 505.2 Corporate 9.6 Total non-core resources expenses 514.8 Total expenses 922.5 Ex pe ns es 4 Re ve nu e 4 In m ill io ns o f U S$ In m ill io ns o f U S$ 37 U N FP A p ro gr am m e an d in st itu tio na l b ud ge t e xp en se s 1 Integrated sexual 343.5 127.6 — 471.1 52.3 % and reproductive health Adolescents 38.6 30.4 — 69.0 7.7 % Gender equality and rights 80.3 28.6 — 108.9 12.1 % Data for development 36.6 53.4 — 90.0 10.0 % Organizational 6.2 18.3 136.8 161.3 17.9 % efficiency and effectiveness Total 505.2 258.3 136.8 900.3 East and Southern Africa 119.8 61.1 17.2 198.1 21.9 % West and Central Africa 90.9 49.0 17.3 157.2 17.5 % Arab States 88.5 24.3 10.8 123.6 13.7 % Asia and the Pacific 56.3 65.6 17.3 139.2 15.5 % Latin America 18.7 21.8 11.4 51.9 5.8 % and the Carribean Eastern Europe 16.8 13.7 6.0 36.5 4.1 % and Central Asia Office in Addis Ababa — 1.0 — 1.0 0. 1 % Global activities 114.2 21.8 56.8 192.8 21.4 % Total 505.2 258.3 136.8 900.3 2016 programme and institutional budget by purpose 2016 programme and institutional budget by region Non-core Core Institutional Total resources resources budget Non-core Core Institutional Total resources resources budget In m ill io ns o f U S$ 38 1. All figures are provisional as of 6 April 2017, as published in the United Nations Population Fund Statistical and Financial Review, 2016, subject to external audit and, as a result of rounding, may not add up to the totals. U N FP A p ro gr am m e an d in st itu tio na l b ud ge t e xp en se s 1 Governments 76.3 33.7 110.0 14.5 % Non-governmental 112.6 25.0 137.6 18.0 % organizations United Nations agencies 1.0 0.9 1.9 0.2 % UNFPA 315.3 198.7 514.0 67.3 % Total 505.2 258.3 763.5 Primary objective of the 90.6 27.2 117.8 15.5 % activity is contribution to gender equality and/or women’s empowerment (gender stand-alone) Significant contribution 267.9 102.4 370.3 48.5 % to gender equality (gender mainstreaming) Some contribution 115.4 105.5 220.9 28.9 % to gender equality and/or women’s empowerment No contribution to gender 31.3 23.2 54.5 7.1 % equality and/or women’s empowerment Total 505.2 258.3 763.5 2016 programme expenses by implementing agency 2016 expenses by gender marker Non-core Core Total resources resources Non-core Core Total resources resources In m ill io ns o f U S$ 39 1. All figures are provisional as of 6 April 2017, as published in the United Nations Population Fund Statistical and Financial Review, 2016, subject to external audit and, as a result of rounding, may not add up to the totals. D on or c om m itm en ts 2 0 16 C on tr ib ut io ns to w ar ds c or e re so ur ce s in U S$ Algeria 10,000 Andorra 11,089 Angola 20,000 Argentina 5,000 Armenia 3,000 Australia 7,037,319 Bahamas 1,000 Bangladesh 25,000 Belgium 7,891,770 Belize 2,500 Bhutan 5,950 Bolivia (Plurinational State of) 6,022 Botswana 5,072 Burkina Faso 13,259 Burundi 577 Cameroon 16,678 Canada 11,685,393 Chad 25,000 Chile 5,000 China 1,200,000 Comoros 500 Costa Rica 5,314 Côte d'Ivoire 28,618 Czech Republic 19,223 Democratic People's Republic of Korea 6,766 Denmark 28,113,350 Djibouti 1,000 Dominican Republic 14,646 Equatorial Guinea 10,000 Eritrea 5,000 Estonia 63,492 Ethiopia 2,834 Fiji 2,488 Finland 20,000,000 France 835,897 Gabon 17,233 Georgia 20,000 Germany 24,369,027 Ghana 18,000 Guatemala 2,041 Guinea Bissau 1,000 Guyana 500 India 487,911 Indonesia 27,882 Iran (Islamic Republic of) 29,790 Ireland 3,171,008 Israel 55,000 Italy 2,040,816 Japan 19,023,833 Jordan 49,995 Kazakhstan 50,000 Kenya 10,000 Kiribati 15,279 Kuwait 10,000 Lao People's Democratic Republic 3,000 Lesotho 2,216 Liechtenstein 25,907 Luxembourg 2,899,344 Malawi 5,411 Malaysia 15,000 Mali 7,529 Mauritania 3,025 Mauritius 2,786 Mexico 70,000 Micronesia (Federated States of) 3,000 Monaco 5,587 Mongolia 4,000 Morocco 11,958 Myanmar 154 Nepal 4,706 Netherlands 39,106,145 New Zealand 4,008,016 Nicaragua 5,000 Norway 46,845,794 Oman 10,000 Pakistan 551,839 Panama 10,000 Papua New Guinea 3,486 Philippines 31,867 Poland 10,070 Qatar 59,950 Republic of Korea 99,000 Russian Federation 300,000 Samoa 3,000 Saudi Arabia 500,000 Sierra Leone 30,000 Singapore 5,000 Slovakia 5,571 South Africa 35,584 Sri Lanka 18,000 Swaziland 10,000 Sweden 59,044,049 Switzerland 16,145,308 Tajikistan 889 Thailand 150,006 Togo 5,003 Trinidad and Tobago 5,000 Tunisia 13,047 Turkey 150,000 Uganda 15,000 United Kingdom of Great Britain and Northern Ireland 25,000,000 United Arab Emirates 10,000 United States of America 30,700,000 Uruguay 30,000 Vanuatu 864 Viet Nam 20,000 Zimbabwe 30,000 Private Contributions 16,379 Subtotal 352,525,563 Government contribution to local office cost 282,234 Total 352,807,797 40 Partnerships with the private sector—corporations, foundations, academic institutions, individuals and other stakeholders—are critical to achieving the Sustainable Development Goals. Through partnerships in 2016, UNFPA mobilized funding and in-kind contributions valued at $12.8 million, a 24 per cent increase over 2015. During the year, 72 agreements were signed with 50 partners. Some of the partnerships have helped fund UNFPA programmes around the world, while others have involved technical assistance or expertise to enable UNFPA to deliver programmes more effectively or advocate for the rights and health of women and adolescents. New partnerships with global companies, foundations and individuals have amplified UNFPA's ability to support life- saving initiatives through the Safe Birth Even Here Campaign, which raises awareness about urgent unmet needs and vulnerabilities of pregnant women in conflicts and in the aftermath of natural disasters. Through other partnerships in 2016, academic institutions helped UNFPA advance the sustainable development agenda, and UNFPA engaged with the private sector in corporate social responsibility programmes and cause-related marketing initiatives and with information technology firms to develop data monitoring and collection systems that boost the effectiveness of UNFPA offices. In Kenya, UNFPA, other United Nations agencies and the private sector established the Private Sector Health Partnership in 2016 to improve health care for women and children. In Liberia and Niger, an international foundation has supported UNFPA programmes for adolescent girls. In Copenhagen, Geneva and elsewhere in 2016, UNFPA also engaged with parliamentarians to sustain or increase political support and funding for efforts to protect the sexual and reproductive health and rights of women and adolescents. To p 10 p ri va te s ec to r p ar tn er s, 2 0 16 St ra te gi c pa rt ne rs hi ps C on tr ib ut io ns in U S$ Co-financing In-kind contribution In-kind contribution Total goods services Bill & Melinda Gates Foundation 4,000,365 1,250,000 5,250,365 Zonta International Foundation 2,000,000 2,000,000 Children’s Investment Fund Foundation 1,150,000 1,150,000 (through Crown Agents Limited) UN Foundation (through United Nations Fund 884,631 884,631 for International Partnerships) 1 Terre de hommes Mission in Albania 788,954 788,954 MacArthur Foundation 432,000 432,000 Merck Sharp & Dohme B.V. 389,074 389,074 Global Medical Aid 311,715 311,715 Relief International 2 286,902 286,902 Ford Foundation 225,000 225,000 41 1. With co-financing from: Bill & Melinda Gates Foundation, Bloomberg Philanthropies, Government of Canada, National Philanthropic Trust, Novo Foundation. 2. Acted as a conduit for funds from the Iraq Humanitarian Pooled Fund. In 2016, private sector partnerships were leveraged globally and in 26 countries to support women and adolescents Pr iv at e se ct or pa rt ne rs hi ps Viet Nam Albania Belarus Ukraine Turkey Tajikistan Algeria South Africa Argentina El Salvador Ethiopia Guatemala Haiti India Uzbekistan Iraq Kenya Tanzania Liberia Mexico Myanmar Thailand Nigeria Nepal Niger Republic of Congo The designations employed and the presentation of material on the map do not imply the expression of any opinion whatsoever on the part of UNFPA concerning the legal status of any country, territory, city or area or its authorities, or concerning the delimitation of its former frontiers or boundaries. The dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties. Sources for Indicators United Nations Population Fund (UNFPA) United Nations Maternal Mortality Estimation Inter-agency Group (MMEIG) United Nations Population Division Regional statistics are based on UNFPA programme countries. Designed by LS - lsgraphicdesign.it UNFPA programmes reached women and young people in 155 countries, territories and other areas in 2016 through a network of 123 country offices, six regional and three subregional offices and liaison offices in Addis Ababa, Brussels, Copenhagen, Geneva, London, Tokyo and Washington, D.C. These offices combined had a total of 2,638 regular staff in 2016. United Nations Population Fund 605 Third Avenue New York, NY 10158 Tel. +1 212 297 5000  unfpa.org  unfpa ISBN 978-0-89714-035-5 © UNFPA 2017

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