BUENOS AIRES - Three years after it got under way, Argentina's sexual and reproductive health programme has spread from 124,000 beneficiaries to 2.3 million. But monitoring by non-governmental organisations has brought to light some problems in its implementation.

The National Consortium for Monitoring Reproductive and Sexual Rights (CONDERS), an umbrella group of 570 organisations and individuals dedicated to reviewing the plan's operation, said that the most frequent failing is the lack of awareness about the programme on the part of the population at large.

Monitoring was carried out in 14 of the country's 23 provinces. In some, provincial authorities have added to the input materials provided by the central government, but in others this has not happened.
In general, the plan is working better in the provincial capitals than in the hospitals and health centres in outlying areas of the provinces.

Among the problems found, there were allegations of the sale of intrauterine devices (IUDs), which the national State distributes to be fitted free, as well as the rationing of free contraceptive pills and condoms, which means beneficiaries have to make more frequent visits to the health centres.

In addition, there were problems involving inadequate training of health centre staff, who were blocking people's access to benefits by insisting on unnecessary requirements, and failures to provide counselling on reproductive health, as required by law. The group also found discontinuity in supplies of some birth control methods, and an almost total lack of emergency contraceptives (the "morning-after pill"), which are guaranteed by law.

CONDERS considered it a shortcoming that 95 percent of all beneficiaries were women, and that only 21 percent of the total were under 20 years old. These figures suggest that the service has no effective strategy for reaching men, and particularly teenagers of both sexes, who should be the primary targets of the programme, the experts said.

"We are concerned that more teenagers are not encouraged to use the service," Dr. Mabel Bianco told IPS. She is the head of the Foundation for Studies and Research on Women (FEIM), one of the organisations on the CONDERS coordinating committee.

In Argentina, one out of every six births are to mothers aged 15 to 19, according to the United Nations Population Fund's Report for 2005. Experts interpret this statistic as a sign of a lack of sex education and of access to contraceptive methods.

One of the goals of the National Programme of Sexual and Reproductive Health, which began to be implemented in 2003, is to lower the teen pregnancy rate. But CONDERS found that in some provinces, teenagers inquiring about contraception were required to be accompanied by an adult, a condition that is not part of the project.

According to the report, in some provinces young women only approach the sexual and reproductive health service after they have become mothers. "Teen-friendly services are needed, where they don't have to wait too long, or have to wait alongside pregnant women," Bianco argued.

She also said that a basic step towards attracting men to use the plan was removing sexual and reproductive services from the maternal and child health care area, and relocating them as part of primary health care. This change has been carried out at the level of national agencies, but has not yet been adopted in provincial health centres.

Men are unlikely to visit obstetrics and gynaecology services, Bianco said. That is why, in her opinion, the change of service area is essential. "It's important to involve men, because contraception is their responsibility too, and the programme also includes prevention of sexually transmitted diseases, as well as uterine and breast cancer and prostate cancer," she pointed out.

The CONDERS report has the support of the centre-left administration of President Néstor Kirchner.

"The monitoring study was excellent," Valeria Islas, coordinator of the National Programme of Sexual and Reproductive Health at the ministry of Health, told IPS. "There are some problems with the implementation of the plan, and we are trying to improve it through better training and better distribution of birth control methods," she said.

According to the official, rather than publicity campaigns, what is needed is specific social work to empower potential beneficiaries to "stand up for their rights" in matters of sexual and reproductive health. This approach, through community organisations, "will broaden the strategies" for attracting participants to the plan, Islas said.

After years of fierce resistance by conservative sectors linked to the Catholic Church, the programme was put into effect in 2003, after the law of Sexual Health and Responsible Procreation was passed.

The law recognises sexual and reproductive rights and guarantees freedom of choice when it comes to birth control methods.

The law maintains that it is the State's obligation to inform people about reproductive health, provide contraceptive methods and offer this service to teenagers without requiring them to be accompanied by an adult.

Since then the number of participants in the programme has grown 18-fold, and the number of health promoters dedicated to this service has been multiplied by 14. The ministry said that between 2003 and 2005, the total number of women who had an IUD fitted at public institutions rose from 12,200 to nearly 112,000.

Women taking oral contraceptives were up from 63,000 to 1.3 million, and those using contraceptive injections also grew in number from 2,400 to nearly 223,000. And in 2003 the programme distributed 31,150 condoms, a number that climbed to 601,000 in 2005.

However, CONDERS found that there was resistance among health personnel to requests for contraceptives, and that they were reluctant to recommend IUDs or emergency contraception. Patients were not always treated with the respect they deserved, waiting times for appointments were overly long, and attention was focused on methods of avoiding pregnancy and not on other sexual health issues.

In many cases, the services were "centred on women of child-bearing age," and attention for teenagers, older women, men, and sexual and ethnic minorities was "poor or insufficient," the study added.