ASIA

In much of Asia, in contrast to Latin America and Africa, "reproductive health" has been approached through demographically focused population policies, and services have been narrowly centered on contraception. Civil society -- women's groups in particular -- have had little scope to influence these programs and few have even been interested in them. As a result, since its inception in 1980, IWHC's Asia program has focused on developing means to improve the quality of national family planning services.

IWHC has supported work initiated by non-governmental organization (NGO) colleagues in Bangladesh, Indonesia, and the Philippines to demonstrate how family planning services can be improved -- in technical quality, and in client-provider relations -- and expanded to encompass other reproductive health concerns. This support has been gradually phased down though collegial contacts have been retained. We are currently undertaking a review of the Asia Program with a view to expanding our work in the region.

BANGLADESH

Bangladesh has long been cited as one of the world's major demographic challenges -- a large population with high fertility in a very small land area. After years of sluggish progress, Bangladesh has recently been termed a family planning success story, but contraceptive method choice is narrow, quality of services are very poor and abortion rates appear to be high. Because of a history of large amounts of donor funding to both the Bangladesh government and NGOs for development programs, a relatively strong NGO infrastructure exists in Bangladesh. This includes women's rights groups as well as health and family planning service delivery NGOs. In particular, women's groups are strongly linked to the international women's movement and have knowledge of and expertise in international agency politics as well as documents relevant to national and international policy makers (e.g. CEDAW, Cairo and Beijing Conference agreements).

• IWHC has supported programs in Bangladesh since 1980 --- including technical support for the national Menstrual Regulation (M.R.) Training and Services Program which provides reproductive health services and trains government workers. The Government of Bangladesh has provided menstrual regulation in its national health program since 1974 as a women's health measure.

• In the past year, IWHC facilitated involvement of the Centers for Disease Control and Prevention in Atlanta in the first survey since 1978 to estimate the extent of induced abortion, and the role of unsafe abortion in maternal mortality in Bangladesh. The data promise to illuminate not only the extent to which access to M.R. may be contributing to safer abortion, but also the role of induced abortion in the dramatic fertility decline in Bangladesh since the early 1980s.

Vietnam

In 1996, IWHC began modest work in Vietnam, where women's reproductive health is very poor. A national family planning program, driven by demographic objectives, relies primarily on IUDs even though reproductive tract infections are very common in women and are a contraindication to IUD use. Abortion is legal, available and frequently used, but of generally poor quality; other maternal health services are relatively neglected.

• In February 1996, IWHC's Vice President and Ms. Ninuk Widyantoro, a senior IWHC colleague from Indonesia who has worked in Vietnam periodically since 1991, made an initial assessment of whether IWHC could contribute to the national population policy and family planning program. Ms. Widyantoro has been requested to work on issues of sexuality, HIV prevention, and on counseling in government family planning and reproductive health services. IWHC will supplement Ms. Widyantoro's work with materials.