This is the plenary presentation of Sai Jyothirmai Racherla of ARROW, which took place as part of Seventh session of 10th Asia Pacific Conference on Reproductive and Sexual Health and Rights (APCRSHR10) Virtual, on 14th September 2020, on the theme of "Population ageing and sexual and reproductive health and rights (SRHR) in Asia and the Pacific". CHAIR: Sono Aibe PLENARY SPEAKERS * Caitlin Littleton, Regional Programme Adviser, HelpAge International, Asia Pacific | "Sexual health of older people: an overview" * Sai Jyothirmai Racherla, Deputy Executive Director, ARROW | "Reclaiming and Redefining Rights -Older Women's Health and Well-Being in Asia and the Pacific Region at ICPD+25" * Krishna Gautam, founder and Chair of Ageing Nepal | "Not Leaving Older Adults Behind in the process of achieving SDG-2030" A B S T R A C T P R E S E N T A T I O N S * Dr Tey Nai Peng | Understanding the Sexual Behaviour of Older Men and Women in Malaysia * Prof Xiaoming Sun | Unmet Needs on Sexual and Reproductive Health among Women Aged 50-64 in Rural China For more information on this session go to www.bit.ly/apcrshr10virtual7 #SRHR #sexualhealth #reproductiverights #familyplanning #womenshealth #LGBT #genderequality #SDGs #ageing #elderly #olderpeople #IDOP2020 #InternationalDayOfOlderPersons

2. SAI JYOTHIRMAI RACHERLA
ASIAN PACIFIC RESOURCE AND RESEARCH CENTRE FOR WOMEN (ARROW)

3. Statistical Profile of Older Persons
• In 2019, an estimated that 60.1 per cent of the world’s older
population reside in the Asia-Pacific region.
• The number of older persons is expected to increase from an
estimate of 548 million in 2019 - nearly 1.3 billion by 2050.
• The number of older women is growing even more rapidly.
52.9 per cent of the older population in Asia and the Pacific are
women in 2019.
Source https://www.unescap.org/our-work/social-development/ageing/about

4. Implications
• These demographic shifts have implications related to health ,
health care systems, health workforce, health care
technologies , social protection, employment quality of life and
long term care of individuals including humanitarian and
disaster response.

5. International Commitments in Relation to Older persons – a chronology
Year Framework
1982 First World Assembly on Ageing
Vienna International Plan of Action on Ageing
1991 10th anniversary of Vienna International Plan of Action on Ageing and adopted UN Principles
for Older Persons…
1992 International Conference on Ageing and adopted the “ “Proclamation on Ageing”.
2002 Adopted Political Declaration and the Madrid International Plan of Action on Ageing
Member States in the Plan of Action, committed to promote and protect gender equality,
human rights and fundamental freedoms of older persons, and eliminate all forsm of
discrimination including age-based discrimination and dignity enhancement, and eliminate
all forms of neglect , abuse and violence.

6. Other Human Rights Frameworks with Reference to Older Persons
Issues of ageing have also been prioritised in the treaty bodies, and the Human Rights Council
work.
• International obligations to older persons are implicit in most core human rights treaties, such as covenants, on
Economic, Social and Cultural Rights and on Civil and Political Rights, the Convention on the Elimination of All
Forms of Discrimination against Women and the Convention on the Rights of Persons with Disabilities.
• In 2010, at the 47th Session of the Committee on the Elimination of Discrimination Against
Women (CEDAW) adopted a General Recommendation no 27 on Older Women and the
Protection of their Rights. The Recommendation includes policy recommendations to
mainstream the concerns of older women into national strategies and development
initiatives. The Recommendation also recognizes the importance of maintaining
disaggregated statistics and will require States to report on the situation of older women
in their countries. It is an important step toward ensuring that older women can
participate fully in the political, social, cultural, civil and other fields in their societies.

7. International Conference on Population and Development
Programme of Action (ICPD-PoA)
International commitments such as,
• International Conference on Population and Development (ICPD)
Programme of Action (PoA);
• Beijing Platform for Action (BPfA);
• the General Assembly Resolution 70/1 – Transforming our World:
the 2030 Agenda for Sustainable Development;
• the Addis Ababa Action Agenda of the Third International
Conference on Financing for Development;
have all discussed ageing in the outcome documents.

8. WHAT DOES THE INTERNATIONAL CONFERENCE ON POPULATION AND
DEVELOPMENT (ICPD) PROGRAMME OF ACTION (POA) SAY ?
The ICPD Programme of Action, calls upon governments to :
• Enhance through appropriate mechanisms the self-reliance of elderly persons and create
conditions that improve the quality of life… (6.17.a);
• Develop systems of health care, economic and social security paying special attention to
the needs of women… (6.17.b);
• Enable elderly people to lead self-determined, healthy and productive lives (6.19);
• Eliminate all forms of violence and discrimination against elderly people paying special
attention to the needs of elderly women (6.19).

9. 6th Asia Pacific Population Conference Ministerial Declaration
• Closer to home the 6th Asia Pacific Population Conference ministerial
declaration, stressed the need to adapt health and social systems in
response to the rising demand for elder care and support, with particular
attention to the specific needs of older women. …Implement and monitor
laws and regulations on the basis of gender equity and equality to
strengthen the protection of the rights of older persons with a view to
eliminating all forms of discrimination, abuse and violence against older
persons, including ageism in employment, health care and other
settings(161) , and Strengthen health and social protection systems to
prepare for and respond to the needs of older persons by adopting a life
course approach and by providing an integrated continuum of care,
including preventive care, acute care, chronic disease management, long-
term care and end-of-life care, and palliative care.

10. Key Trends in which the Ageing Phenomenon is occurring in the Region
a) an increase in the proportion of older persons: In 2016, in the
ICPD+25 countries under review the percentage of persons above
60 years with more than 10% have been noted in Viet Nam
(19.1%), China (15.7%), Bangladesh (13.9%), Thailand (13.5%),
Samoa (12.6%), and Maldives (11.7%). Regional average is 12.4%
b) an increase in the pace of ageing- The pace of ageing in the Asia
Pacific region is also rapid. While countries such as China, Thailand
and Vietnam will take 25 years, 22 years and 19 years only for
moving from ageing to aged societies, countries such as France
have taken 115 years.

11. Key Trends in which the Ageing Phenomenon is occurring in the Region
c) Even in countries with low proportion of older persons, the
absolute numbers of older persons can be quite significant,- While
the proportion of persons aged 60 years, in the region shows South
and South-West Asia sub region having the lowest proportion of
persons aged 60 years, in absolute terms the number of older
persons in the same sub-regions is 168 million (2016), which is 33% of
all persons over 60 years of age living the Asia Pacific (ESCAP) region.
These demographic shifts have huge implications, especially in the
provision of SRHR information and services without stigma ,
discrimination and violence

12. Monitoring Progress at ICPD+25: Where are we
• Gender dimension of ageing
• Social protection for elderly
• Elder abuse
• Health of elderly

13. Gender Dimensions of Ageing
• An important dimension to note is that of gender, with the proportion of
women in the population increases with age. Currently, there are 90.8 men
for every 100 women above the sixty years, and 69.5 men for every 100
women over the age of eighty.
• Women’s poverty is directly related to the absence of economic
opportunities and autonomy, lack of access to economic resources,
including credit, land ownership and inheritance, lack of access to
education and support services and their minimal participation in the
decision-making process.
• Poverty can also force women into situations in which they are vulnerable
to violence and discrimination including sexual exploitation.

14. Gender Dimensions of Ageing
• In the Asian and Pacific region, women outlive men by at least four years on average.
• This difference is as high as 13.2 years in Republic of Korea and 12.7 years in the Russian Federation.
Women’s longer life expectancies and the consequent larger proportion of older women living alone
throws challenges on a number of issues, as older women have lesser income security, and are often
discriminated against due to limited access to resources and opportunities including health care,
adequate housing, social protection and legal justice.
• These challenges are further aggravated for women in cases of widowhood and divorce. With the
death and disability causes changing from infectious to non-communicable diseases, these are other
health challenges that need focus.
• Older women face greater risk of physical and psychological abuse due to discriminatory societal
attitudes and the non-realisation of the human rights of women. Some harmful traditional and
customary practices result in abuse and violence directed at older women, often exacerbated by
poverty and lack of access to legal protection

15. Social Protection for Older Persons
• All countries in the region will face major challenges to ensure that their
health and social systems are ready to make the most of this demographic
shift in ageing, and enable an environment of opportunities for older
persons in the region, however the reality in the region is different.
Some best practices in the region include:
• Japan has integrated long -term care insurance to protect people from the
costs of care;
• Thailand is strengthening the integration of health and social care as close
as possible to where people live;
• The Ministry of Health in Vietnam will build on its comprehensive health
care system and the large number of elderly health care clubs to better
meet the needs of older people in their communities.

16. Abuse of Older Persons
• The WHO defines “elder abuse” as “harm to an older person through a single or repeated act or lack of
appropriate action, occurring within any relationship where there is an expectation of trust, which causes
harm or distress to an older person” (WHO, 2016d). Abuse may be physical, psychological, sexual, emotional
or financial, including neglect and abandonment.
• Estimates note one in six older persons experience some form of abuse worldwide. This
is a gross human rights abuse. Understanding the prevalence and a situational analysis
is the first step towards developing a public health, and community approach. One of
the other gaps is the lack of consensus in defining and measuring elder abuse and its
major subtypes (psychological, physical, sexual, and financial abuse and neglect), as a
result there are variations in prevalence reporting. There are dearth of studies on elder
abuse. Dong did a small-scale systematic review of prevalence studies and grouped
estimates by continents, including Asia with a range from 14% in India 23 to 36·2% in
China.

17. Abuse of Older Persons
• It is widely known that older women are at lesser risk for sexual violence than
younger women, but current inattention to older women in the gender-based
violence (GBV) field has minimized the experiences of older women survivors at
great detriment to their health and rights. For example, health providers seldom
ask older women about their sexual activity and relationships, a neglect that
leads to older women being excluded from necessary HIV testing and care as
well as support services for abuse.
• This oversight is increasingly worrisome given the rise in new HIV infections
among adults age 50 and older in recent years, with the majority of
transmissions stemming from individuals unaware of their HIV-positive status.
Approaches are required in public health interventions for GBV and HIV that
acknowledges older women – their sexuality, sexual agency, and activity – so that
health providers and advocates acknowledge and serve older survivors

18. Health
• Despite their demographic significance and the lifetime impact of gender disparities on their
health and rights, women considered older than reproductive age are excluded from most
investments in global public health.
• While development policies linking human rights with access to sexual and reproductive
healthcare have yielded progress towards improving the status of women and girls, older
women have not benefited from these initiatives. Yet as women grow older, they experience
a range of health conditions rooted in their reproductive biology – from ageing with fistula,
to cervical and breast cancers.
• Reclaiming the framework suggested by the International Conference on Population and
Development and the Beijing Platform for Action, it is important to relook at the global
health policies to incorporate a life course approach to women’s health as a matter of
human rights.

19. Recommendations
• A concerted research effort is needed to provide a basis for developing policy guidance and for
pinpointing essential indicators and establishing necessary data systems to enable a routine
tracking of progress and strengthen the capacity to mainstream gender, age and age-related
disability analysis
• Strengthen the development and implementation of comprehensive and integrated policy
frameworks that address and mainstream population ageing into national development strategies
and plans, heath and gender equality plans in line with the Madrid International Plan of Action on
Ageing;
• Ensure that no older persons are left behind, including, in particular, older persons living in rural
and urban areas, indigenous and ethnic minority older persons, older migrants and older women
and vulnerable older persons in general;
• Ensure equal enjoyment of all human rights by all older persons and to address gender and age
discrimination, including in access to health-care services, affirmative action measures or other
appropriate measures;
• Ensure the inclusion of older persons, and their specific requirements, vulnerabilities and capacities,
in policymaking processes, including in humanitarian contexts and in particular in disaster risk
reduction policies, strategies and practices and in emergency response;

20. Recommendations
• Align disease prevention and health systems and to advance universal health coverage, as
appropriate, as a platform for bringing together various health and development efforts, so that all
older persons have access to quality health services locally without suffering the financial hardship
associated with paying for care;
• Develop health and social long-term care systems, including palliative care, that can deliver high-
quality integrated care, while recognizing and enhancing the capacity of formal and informal
caregivers and volunteers;
• Health services for older persons need to ensure mental as well as physical health, address violence,
neglect and abuse of older persons, promote positive images of ageing, prevent ageism and age-
related discrimination at the workplace.
• Currently data for persons beyond the reproductive years is not available, and data on population
ageing and age-disaggregated statistics as key elements in formulating evidence-based policies and
of supporting monitoring and evaluation of programme delivery to assure their efficiency and
effectiveness
• Human rights and gender equality are central to address the issue of ageing in Asia Pacific, and
policies to take into account a lifecycle approach