NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH - Swaziland
SIYINQABATHE KINGDOM OF SWAZILANDMinistry of HealthNATIONAL POLICY ON SEXUAL ANDREPRODUCTIVE HEALTH2013NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH1
SIYINQABATHE KINGDOM OF SWAZILANDMinistry of HealthNATIONAL POLICY ON SEXUAL ANDREPRODUCTIVE HEALTH20132NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH
FOREWORDThe country is accelerating efforts toward the realization of Millennium DevelopmentGoals (MDGs) and strengthening the access and utilization of SRH services at all levelsis one of the key initiatives that the Ministry of Health is targeting. High maternalmortality rate, high adolescent fertility rate, unmet need for family planning, andon-going problems with sexual and gender based violence (SGBV) are some of theindicators that highlight a need for a comprehensive sexuality education and evidencebased interventions. This Policy provides concrete areas of focus and is aligned tointernational and national policies and frameworks. It addresses reproductive healthand rights challenges faced by citizens of Swaziland and outlines implications for thedifferent levels in the Ministry. It also recognises the role that other sectors play inimproving the SRH of the people of the Kingdom of Swaziland.The policy takes cognizance of the existing policies, frameworks and guidelines, inparticular the National Population Policy which forms the basis for all populationrelated programmes. The development of the policy involved extensive consultationswith key informants and stakeholders in government and NGOs as well as opinionleaders at both the national, regional, Inkhundla and chiefdom levels. Young people,men and women as well as Community leaders were also consulted.This document is to be used by policymakers, program managers and service providersat all levels in both public and private sectors in SRH. It forms the basis and mandatefor all SRH activities, outlining the national strategic pillars for improving SRH. It willalso enable us forge new partnerships - between governments and communities,nongovernmental organizations, development partners and the private sector that are critical if we are to succeed in the implementation of comprehensive andintegrated SRH services.Honourable Benedict XabaMinister of HealthNATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH3
ACKNOWLEDGEMENTSThe Ministry is very grateful for the technical and financial support received fromthe EU and UNFPA for the development of this Policy. The input of the UN agenciesand SRH stakeholders into the policy was crucial and enabled finalization of thisimportant document. We also extend our appreciation to all implementing andbilateral partners of SRH who made valuable contribution in time and effort in thedevelopment of the document which will guide service provision. Many workedtirelessly in the core team that supported the whole process while others revieweddrafts and made inputs.We are so indebted to the Public Policy Coordinating Unit for technical guidanceand support in the whole process of the development of the policy, without whomthe document could not have been finalized. The leadership and guidance of theMinistry through the Deputy Director – Public health is highly appreciated.The SRH Programme is acknowledged for the continuous commitment andstewardship in the delivery of integrated Sexual Reproductive Health services.Dr Steven ShongwePrincipal SecretaryMoH4NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH
TABLE OF CONTENTSFORWARD. 6GLOSSARY OF TERMS. 5ABBREVIATIONS AND ACRONYMNS. 81.0 INTRODUCTION. 101.1 Policy development process . 111.2 Gaps and achievements. 121.3 Rationale . . 122.0 VISION, MISSION, GOAL AND OBJECTIVES. 132.1 Vision. 132.2 Mission. 132.3 Goal. 132.4 Objectives. 133.0 GUIDING PRINCIPLES AND VALUES. 143.1 Human Rights . 143.2 Universal Access to Comprehensive SRH services. 143.3 Quality of Care . . 143.4 Integration of services . 143.5 Allocation of Resources. 143.6 Community involvement and participation . 143.7 Alignment to national and international instruments. 154. POLICY FRAMEWORK. 164.1 Maternal, Neonatal, Adolescent and Family Planning. 164.2 Adolescent and Youth Sexual Reproductive Health and Rights. 174.3 Family Planning. 174.4 Abortion and post abortion care. 184.5 STIs, HIV and AIDS. 194.6 Infertility. 20NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH5
4.7 Cancers of the reproductive system. 204.8 Gender and Sexual and Reproductive Health including GBV. 214.9 Sexual Dysfunction. 224.10 Sexual and Reproductive Health and Ageing. 234.11 Community involvement and participation in SRH. 235.0 Institutional Framework for the Implementation of the Policy. 255.1 Implementation. 255.2 Financing. 255.3 Reproductive Health Commodity Security. 265.4 Human Resources. 265.5 Coordination of Partners. 265.6 Monitoring and evaluation of the policy. 265.7 Policy Revision. 266.0 CONCLUSIONS. 277. REFERENCES. 288. ANNEXES. 306NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH
GLOSSARY OF TERMSAbortion: Abortion is the expulsion of the products of conception before 28 weeks(viability stage) of gestation (MOH 2011).Adolescent: A young person aged between 10 and 19 years (WHO)Community: A group of people who share an interest, a neighbourhood, or acommon set of circumstances. They may or may not acknowledge membership of aparticular community (WHO, 2002).Competent: Refers to capable, knowledgeable, skilled and proficient serviceproviders who are providing services according to national guidelinesComprehensive: refers to health care that comprise of many elements of care suchas promotive, preventive, curative and rehabilitative services. Comprehensive SRHservices bring together all the elements of SRH to prevent, manage conditions.Infertility: Failure by a couple to achieve a conception after twelve months of normalregular and unprotected sexual intercourse.Integration: Combination of different sexual and reproductive health care servicesor programmes to ensure expected outcomes. This may involve referral of a clientfrom one service to another or provision of all requisite services at the same timeand place.Maternal mortality ratio: Number of maternal deaths per 100,000 live birthsReproductive health: A state of complete physical, mental and social well-beingand not merely the absence of disease or infirmity, in all matters relating to thereproductive system, its functions, and processes. (ICPD 1994)Service delivery level: refers to the different levels of service delivery in Swazilandwhich include clinics, Health centre, regional hospitals and national referral hospitalsSexual health: A state of physical, emotional, mental and social well-being in relationto sexuality and not merely the absence of disease, dysfunction or infirmity, requiresa positive and respectful approach to sexuality and sexual relationships, and anappreciation of the importance of having pleasurable and safe sexual experiencesSexuality: A significant aspect of a person’s life, from birth to death, consisting ofNATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH7
many interrelated factors, including anatomy, growth and development, gender,relationships, behaviors, attitudes, values, self-esteem, sexual health, reproduction.Sexuality education: refers to age appropriate, medically accurate, culturallysensitive education provided to individuals, couples and groups aimed at promotingunderstanding sexual reproductive health and related rights and responsibilities.Social justice: refers to the idea of creating a society or institution that is based onthe principles of equality and solidarity, that understands and values human rights,and that recognizes the dignity of every human being.Youth: young men and women aged from 15 to 35 years (MOSCYA, 2009)8NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH
ABBREVIATIONS AND d Immunodeficiency SyndromeAnte Natal CareAnti-Retroviral TreatmentAnti-RetroviralAdolescent Sexual and Reproductive Health & RightsAfrican UnionBasic Essential Obstetric careConvection on the elimination of all forms of discrimination againstwomenConfidential Enquiry into Maternal DeathsComprehensive Essential Obstetric CareClinton Health Access InitiativesContinuous Medical EducationCentral Medical StoreContraceptive Prevalence RateCentral Statistics OfficeDeputy Prime Minister’s OfficeEssential CareErectile dysfunctionEmergency Obstetric and Neonatal CareEssential Health Care PackageFaith Based OrganisationFamily PlanningFourth World Conference on WomenGender based ViolenceGross Domestic ProductHealth Information and Management SystemHuman Immunodeficiency VirusHuman Resource for HealthHealth Sector Strategic PlanInternational Conference on Population and DevelopmentInjection drug userInfant Mortality RateIntegrated Sexual and Reproductive Health Strategic PlanLesbian, gays, bisexual, transsexuals and queerMost at risk populationsMaternal Child HealthMillennium Development GoalMonitoring and evaluationNATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH9
CT10Maternal Mortality RatioMaternal, Newborn and Child HealthMinistry of Economic Planning and DevelopmentMinistry of Education and TrainingMinistry of HealthMinistry of Justice and constitutional affairsMinistry of Sports Culture & Youth AffairsMemorandum of UnderstandingMother - to - Child TransmissionNon communicable diseasesNational Clinical Laboratory ServicesNational Development StrategyNew Partnership for Africas DevelopmentNon-Governmental OrganisationNational Health PolicyNational Health Sector Strategic PlanNeonatal Mortality RatePost Abortion CarePost-exposure prophylaxisPrimary health carePeople Living With HIV/AIDSPrevention of Mother to Child TransmissionPlan of actionPoverty Reduction Strategy and Action ProgrammeSouthern Africa Development CommunitySwaziland Demographic and Health SurveySexual Gender Based ViolenceSexual and Reproductive HealthSexual and Reproductive Health & RightsSexual and Reproductive HealthcareSexual and Reproductive Health Commodity SecuritySexual and Reproductive Health ProgrammeSmart Programme for Empowerment and Economic DevelopmentSub-Saharan AfricaSexually Transmitted InfectionsTotal Fertility RateUnited Nations Population FundUnited Nations General Assembly Special SessionVoluntary Counselling and TestingNATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH
1.0 INTRODUCTIONThe Kingdom of Swaziland is a landlocked country in Southern Africa with anestimated land area of 17,364 km2. It shares its border with Mozambique to the East,the Republic of South Africa to the North, West and South. Swaziland is classified as alower-middle income country with a per capita income of US 2.280.According to the Swaziland PopulationCensus the total population was 1,018,449in 2007. Females make up 52.6% of thetotal population and the correspondingproportion for males is 47.44%. Thetotal population of reproductive age(15-49years) was projected at 53.5% in2011. The population of Swaziland isgenerally young, with 47% of the totalbeing aged less than 18 years (CSO 2007).The Total Fertility Rate (TFR) was 3.95 in2007, a drop from 4.5 in 1997 and intercensal population growth rate between1997 and 2007 was 0.9% annually downfrom 2.9% a decade earlier. This declineis partly attributed to the increase incontraceptive prevalence rate (CPR) from17% in 1990 to 50.6% in 2007 and anunexpected increase in mortality. The MMR has remained high at 370 in 1995 to589/100,000 live births in 2007(SDHS 200607). The IMR and NMR have also increasedThe country’s HIV situation:as a result of the HIV/AIDS epidemic. Despite 19% prevalence among the 2the drop in TFR and increase in the CPR fromyears and older (CSO 2007)the unmet need for FP is high. Early sexual 26% among sexually activedebut among youth is still high and 25% of alladults (31% for women and19% for men) (CSO 2007)institutional deliveries are by adolescent girls. 41.1% among antenatalThere is poor or no integration of servicescare clients (2010 HIV ANCsuch as FP, HIV/AIDS, STIs, and MNCH.Serosurveillance)Gender based violence and sexualdysfunctions are common social and medicalconditions. The complex interactions among all the stated issues contribute to highmorbidity and mortality.NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH11
1.1 POLICY DEVELOPMENT PROCESSThe policy was developed through consultations with key stakeholders in a processthat was led by the Ministry of Health through the SRHP. The SRH policy is meant toensure proper coordination, integration and harmonious delivery of comprehensiveSRH services in order to better the health and the well-being of the population aswell as to contribute to its socio-economic development as set out in the PRSAP andother national documents.The steps indicated in the box below were taken in the development of this policy.Key Steps in the Development of the SRH Policy: A situation analysis to inform the Policy development, Desk review of relevant national strategy documents Gap Analysis to inform areas of intervention focus Review of the draft with national relevant stakeholders12NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH
1.2 GAPS AND ACHIEVEMENTSThere are many achievements that the country has reached in the provision of SRHservices; however some gaps still exist as shown in the following table.AchievementsGaps Existence of a functional SRHprogramme Integration of SRH and HIV servicesin PHC services A dedicated RH commoditiesbudget line Development of the IntegratedSexual and Reproductive StrategicPlan ( 2008-2015) Introduction of Confidential Enquiryinto Maternal Deaths ( CEMD) Inclusion of sexual health educationin schools in the Education Policy (2010) Existence of a Gender policy ( 2010)which calls for redressing supportfor gender based violence forsurvivors SRH service delivery guidelines inplace (Family planning, PMTCT,cervical cancer and obstetricguidelines) 94% women accessed ANC servicesand 74.1% delivered in healthfacility (CSO 2007) SRH Policy in draft form Inadequate skill and competenceamong health professionals todeliver SRH Health services Health disparities in the distributionof health resources in the rural andurban health facilities Weak coordination of SHR services No FP services in ART centres Inadequate data on abortion. Inadequate skills in demandcreation for SRH services Limited decentralization of SRHservices to community level e.g.outreach services Inadequate youth friendly services Integration of SRH information andservices into wellness programmes Discrepancy in provision,distribution and utilization of SRHequipment Inadequate data on access tocomprehensive SRH services1.3 RationaleAn overarching Policy on SRH will ensure proper coordination, integration andharmonious delivery of comprehensive SRH information and services in order toimprove the health and well-being of the population as well as contribute to itssocio-economic development as set out in the Poverty Reduction Strategy and ActionPlan (PRSAP) and other national documents.NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH13
2.0 VISION, MISSION, GOAL AND OBJECTIVESThis policy is developed as an integral part of the Government’s efforts to addressthe social and economic development of its peoples by improving their sexual andreproductive health and well-being and upholding their rights.2.1 Vision:A healthy and well-informed population with universal access to quality SRH services,that are sustainable and provided through an efficient, effective and rights basedsupport system.2.2 Mission:To provide, facilitate and support an integrated and well-coordinated sexual andreproductive health services and information upholding the rights of women, men,youth, adolescents and children in Swaziland.2.3 Goal:To guide establishment of an evidence-based framework for the implementationof a well-coordinated and integrated sexual and reproductive health and rightsprogrammes in order to attain the highest level of health and well-being for allpeople of Swaziland.2.4 Objectives:i) To inform and guide actions of policy makers and programmersii) To inform and guide the development of an integrated SRH strategic frameworkiii) To facilitate mobilization and appropriate
NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH 1 THE KINGDOM OF SWAZILAND Ministry of Health NATIONAL POLICY ON SEXUAL AND REPRODUCTIVE HEALTH S I Y I N Q A B A P r i n t p a k: o 2 4 0 4 1 0 8 1 s o c ati n e A o f S w fi L a y z l i l m a n F d T e . SDHS Swaziland Demographic and Health Survey SGBV Sexual Gender Based Violence SRH .
2.4 The School’s Sexual Harassment and Sexual Violence Policy is intended to cover instances of harassment and/or violence of a sexual nature. In the event of a conflict between this discrimination, harassment and bullying policy and the Sexual Harassment and Sexual Violence Policy, the terms of the latter policy will prevail.
The University of Michigan5 defines sexual harassment as unwelcome sexual advances, requests for sexual favors, and other . talking about one's sexual activity in front of others and displaying or distributing sexually explicit drawings, pictures and/or written material. Unwanted sexual statements can be made in person, in writing .
Ministerial Task Team Report on Sexual Harassment, Sexual Exploitation, Sexual Abuse and Sexual Offences within the Department of Defence A Defence Force that Cares
3. Demonstrate ability to recognize potential cases of elder sexual abuse a. List four signs or symptoms of sexual abuse. b. Provide three situations under which cases of sexual abuse may come to the attention of APS workers. 4. Demonstrate ability to effectively screen for sexual abuse and interview clients regarding possible sexual abuse a.
coerced sexual acts—sexual activity that involved touching or penetrating of sexual body parts 0.5% of youth who reported being forced or coerced into other sexual activity with another youth that did not meet the description of forced or coerced sexual acts, such as kissing on the mouth, looking at private
Sexual Conduct" (Cont.) 1. (Cont.) The type of verbal conduct (if all other elements are met) may include: o Unwelcome sexual advances (including explicit or implicit proposition(s) of sexual contact or activity); o Requests for sexual favors (including overt or subtle pressure); o Gratuitous comments about an individual's sexual
Sexual exploitation is a form of abuse covered by the multi-agency safeguarding adult’s policy and procedure. 2. Definition There is currently not a statutory definition of sexual exploitation for Adults. However, one that applies to both children and adults is: Child sexual exploitation is a form of child sexual abuse. It occurs where an
discover how we can better express our love for God in how we love one another, and enable each other to love. Many courageous steps have already been taken. It has not been easy. We do not all agree. Sadly, we have sometimes hurt one another and have been tempted to part company over these issues of love. For the questions at the heart of this pilgrimage are fundamentally about how we can .
