SOUTHEAST ASIAN MANIFESTO ON EMERGENCY CONTRACEPTION

We are a diverse group of non-governmental leaders, medical and health service professionals and policymakers who gathered in Bangkok from October 24 to 26, 2002 to discuss strategies to promote access to emergency contraception (EC) throughout Southeast Asia. The purpose of our meeting was to: a) enhance understanding of EC in relation to women's sexual and reproductive health and rights; b) develop critical analyses of the political and cultural climate in Southeast Asia and identify specific barriers which inhibit access to contraceptive services; c) create country-specific strategies and work plans to enhance the acceptance and accessibility of EC products, methods and services; and, d) facilitate dialogue and networking to support the development of a regional EC consortium or resource group.

While we acknowledge the diverse economic, political, social and cultural conditions across Southeast Asia, it is nevertheless our common experience that EC products and services remain unavailable or inaccessible to most women in the region. We also agree that government commitments to advancing reproductive health and rights in Southeast Asia have not been realized.

This document represents our shared vision for a concerted, multi-sector movement to improve access to EC throughout Southeast Asia and to advance the sexual and reproductive health and rights of all people in the region.

PREMISES

Through landmark international accords such as the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW, 1981), the Program of Action of the International Conference of Population and Development in Cairo (ICPD, 1994) and the Beijing Declaration and Platform of Action (1995), Southeast Asian governments have committed to take steps to ensure:

• The right to the enjoyment of the highest attainable standard of physical and mental health and access to health care services;

• 
  The right to equally enjoy the benefits of scientific progress and its applications;and

• 
  The right to sexual and reproductive health without discrimination, including the ability to have a satisfying and safe sex life, the freedom to decide if and when to have children, and access to safe, effective and affordable family planning methods.

Yet eight years after 179 nations signed on to the ICPD's Action Plan in Cairo and seven years after governments committed to the Beijing Declaration and Platform of Action, sexual and reproductive health continues to elude millions of women in our region, in large measure because reproductive health and rights have not been made a political priority. A look at the status of EC across Southeast Asia bears this out, revealing consistent barriers in the areas of government policy, social and health structures, and cultural beliefs and attitudes.

EC methods have been available since the development of the contraceptive pill more than 40 years ago. Despite this, and despite the fact that the World Health Organization (WHO) has scientifically studied and found hormonal EC pills (ECPs) to be safe and effective, restrictive government policies and vocal religious opposition have kept EC out of most women's reach in Southeast Asia. In Indonesia, POM (the national Food and Drug agency) has effectively relegated its power to approve ECP registration to the leaders of the Islamic Party. In the Philippines, the Food and Drug agency de-listed an ECP, erroneously alleging it to be an "abortifacient" on the basis of complaints from conservative religious groups. By contrast, male reproductive health products like Viagra are made available to men without delay or controversy. In Burma and Cambodia, EC is unknown to women and health service providers. Even in countries where ECPs are registered, such as Malaysia, Singapore and Vietnam, knowledge and information among women remains limited. While ECPs are readily available over the counter in urban Thailand, women receive no information about the effects or proper use of the product, and ECPs remain unavailable both in rural areas and in refugee centers. In the newly independent East Timor, where health policies and infrastructure are still nascent, healthcare professionals are not educated or trained about EC and very few include it in their services.

As a female-controlled method for preventing unwanted pregnancy, EC is critical for women's physical and mental health. This is especially true in Southeast Asia, where, according to WHO, the leading cause of death among women of reproductive age is related to pregnancy and childbirth. EC is the only means to prevent pregnancy after unprotected intercourse or rape. Clearly, there is an urgent need to address the political, structural and cultural barriers to mainstreaming EC so that women in the region can realize their sexual and reproductive health and rights.

RECOGNIZING THE ABOVE, WE THE UNDERSIGNED, gathered this 26th day of October in Bangkok, Thailand, AGREE AND DECLARE:

1) WITH RESPECT TO THE RIGHT TO EC:


To uphold and abide by internationally recognized human rights, including the right to reproductive health and women's rights;
To urge our government officials, medical associations, health service providers, educators and community leaders to adopt human rights norms into reproductive health, including the right to information about and access to EC products and services at all levels;
To hold all governments accountable to their commitments to health and human rights, as recognized in international conventions and accords;
To develop and share information and training materials on EC for widespread dissemination in our respective communities; and
To use our expertise to promote access to EC and related health services; and
To educate the public, especially in rural areas and underserved communities, about EC and the right of all people to enjoy the benefits of scientific progress with regard to reproductive health and decision-making.


2) WITH REGARD TO HEALTH POLICY:


To urge policy makers to integrate human rights and EC into the civil service training and health services;
To call upon policy makers at all levels to base health policies and laws on scientific studies and human rights instead of religious dogma;
To advocate for and facilitate the registration and distribution of EC products;
To urge government officials to support the availability and accessibility of EC services for all levels of society; and
To call upon governments to honor internationally accepted principles of human rights and reproductive health by enacting policies that promote the right to reproductive health and access to contraceptives, including EC.

3) WITH REGARD TO PARTNERSHIPS:

To continue to share knowledge and information about reproductive health, rights and EC;
To expand our network of allies and supporters;
To foster collegial attitudes that promote interdisciplinary, multi-disciplinary and trans-disciplinary approaches and to ensure meaningful exchanges with other professions to promote access to EC;
To help raise and leverage funds for reproductive health and women's access to EC; and
To collectively form a regional consortium or network that will support our local and national efforts to promote and improve access to EC and realize sexual and reproductive rights.

WE THEREFORE RESOLVE:

To actively advocate for social and reproductive health policies founded on human dignity, equality and scientific studies;
To systematically eradicate all impediments which restrict access to EC across Southeast Asia; and
To support local, regional and international efforts - including country work plans and strategies - that enable women to fully realize their right to health as well as their right to control their fertility and prevent unwanted pregnancy.

Signed:

Carolina S. Ruiz-Austria, Attorney
Executive Director (for) Women's Legal Education, Advocacy
& Defense Foundation, Inc. (Womenlead)
Quezon City, Philippines

Hara Srimuangboon
Program Manager, Cambodia
PATH Mekong Region
Phnom Penh, Cambodia

Ms. Lola Wagner
Founder & Executive Director
Yayasan Mitra Kesehatan dan Kemanusiaan (YMKK)
Batam, Indonesia

Jean Ahlborg
Regional Medical Advisor
Engender Health
Bangkok, Thailand

Benjamin De Leon
Chairperson, Board of Trustees
Philippine NGO Council on Population,
Health & Welfare (PNGOC)
Metro-Manila, Philippines

Tahera Ahmed
Assistant Representative
UNFPA Bangladesh
Dhaka, Bangladesh

Suneeta Mittal, M.D.
Officer-In-Charge
WHO Collaborative Centre for Research
in Human Reproduction
Dept. of Obstretrics and Gynaecology
All India Institute of Medical Sciences
New Delhi, India

Nyo Nyo Minn, M.D.
Director
Population Services International (PSI)
Yangon, Myanmar

Van Phoung Nguyen Thi
Senior Project Officer
Pathfinder International
Hanoi, Vietnam

Carla Jesuina Do Carmo Quintao, M.D.
Alola Foundation
Dili, East Timor

Risman Musa
Director
Advocacy and IEC
BKKBN
Jakarta, Indonesia

Angeles Cabria
Senior Program Officer for Latin America
Coordinator, Latin American Consortium for
Emergency Contraception (LACEC)
Pacific Institute for Women's Health
Los Angeles, California U.S.A.

Harti Saad
Managing Director
Altacare/HRA Pharma
Paris, France

Eden Divinagracia, Ph.D.
Executive Director
Philippine NGO Council on Population,
Health & Welfare Inc. (PNGOC)
Pasay City, Philippines

M. Therese Factora
Consultant Los Angeles Women's Foundation
Los Angeles, California
U.S.A.

Rina Jimenez-David
Columnist
Philippine Daily Inquirer
Metro-Manila, Philippines

M.E. Khan
Senior Program Associate and Regional Advisor
Population Council
Dhaka, Bangladesh

Stacey Freeman
Senior Development Officer
Pacific Institute for Women's Health
Los Angeles, California
U.S.A.

Elizabeth Barr
Communications Officer
Pacific Institute for Women's Health
Los Angeles, California
U.S.A.

Surasak Taneepanichskul, M.D.
Associate Professor, Dept. of Obstetrics & Gynecology
Faculty of Medicine, Chulalongkorn University
Bangkok, Thailand

Malee Sunsiri
Field Officer
Population and Community
Development Association
Bangkok, Thailand

Jade Alburo
Operations Assistant
Pacific Institute for Women's Health
Los Angeles, California
U.S.A.

Cynthia Maung, M.D.
Director
Mae Tao Clinic
Tak Province, Thailand

Sophia
Program Manager
Reproductive Health In-patient Department
Mae Tao Clinic
Tak Province, Thailand

Alycia Nicholas
Education Officer
Women's Studies Center
Chiangmai University
Chiangmai, Thailand

Emelina Quintillan, Attorney
Senior Program Officer for Asia
Pacific Institute for Women's Health
Los Angeles, California
U.S.A.

Neang Ren
Executive Director
Cambodian Midwives Association (CMA) &
Coordinator of Mekong Sub-regional Network
Phnom Penh, Cambodia

Rionda Zynia
Senior Advisor, Programs
Catalyst Consortium
Washington, DC
U.S.A.

Vathiny Ouk Vong, MD
Executive Director
Reproductive Health Association
Of Cambodia (RHAC)
Phnom Penh, Cambodia

Josephine Sauvarin
Program Associate
Population Council
Bangkok, Thailand

Isabelita Solamo-Antonio
Executive Director
PILIPINA Legal Resources Center, Inc. (PLRC)
Davao City, Philippines

Dr. Florence Tadiar, M.D.
President
Women's Health Care Foundation
Quezon City, Philippines

Anh Vinh Tran
Vice Director
Center for Reproductive & Family Health (RaFH)
Hanoi, Vietnam

Yanti Triswan
Associate Representative
PATH
Jakarta, Indonesia

Ronnel Villas
Program Coordinator
Institute for Democratic Participation in Governance
Leyte, Philippines

Jennifer Winkler
Program Officer
PATH
Seattle, Washington U.S.A.