The population of Iraq increased from 8 million in 1965 to an estimated 37 million in 2015. This rapid growth is fuelled by a high total fertility rate, currently estimated at 4.2, a low contraceptive prevalence rate (modern methods) at 33.6 per cent and a relatively high life expectancy at birth 67.6 years for males and 70.9 for females. The majority of the population of Iraq (69.9 percent) lives in urban areas.

Since 2014, the sudden escalation of the conflict in Iraq has caused several successive massive waves of displacement, with a total of 3.2 million internally displaced persons. More than 90 percent of internally displaced persons live within host communities, particularly within the Kurdistan Region, which has seen a population increase of 30 per cent over the last two years. In addition, 250,000 Syrian refugees are still hosted within Iraq. The population influx, the lack of adequate health professionals and structural damage to facilities have contributed to the decreased capacity to deliver timely and high quality services, and has put significant strain on existing social services, including reproductive health services.

Between 1990 and 2013, the maternal mortality ratio declined from 117 deaths per 100,000 live births to 35.7 per 100,000 live births. Over 90 per cent of deliveries were with a skilled birth attendant and over 75 percent were in a health facility. Despite these positive trends, the Millennium Development Goal (MDG) target was not achieved; recent conflict-related access issues are expected to reverse or stall this progress. An assessment carried out by Ministry of Health in 2014, revealed that currently only 25 facilities have the capacity to deliver emergency obstetric and neonatal care (EmONC).

Iraq is at a demographic turning point, with 60 percent of the population under the age of 25, it has one of the most ‘youthful’ populations in the world. Young people’s access to formal education and health services, including sexual and reproductive health services, is negatively affected by the years of conflict and displacement. One in three young persons in the age group 15-29 is illiterate, with a marked gender difference between young women and young men (36.2 percent and 22.4 percent, respectively).

The low level of political and civic participation by young people hinders them from contributing to the development in Iraq. Young people are not adequately represented in national planning processes and not afforded space for dialogue and engagement with the Government. However, the Government has clearly indicated its interest in engaging with young people and involving them in the development processes within Iraq.

The 2014 Human Development Report ranks Iraq 120 out of 187 countries, with a gender inequality index estimated at 0.54. Iraqi women and girls are subject to domestic violence, ‘honour’ killings, early and forced marriages and human trafficking. Domestic violence is common, with 46 percent of currently married women exposed to at least one form of spousal violence. Although the legal age of marriage is 18 years for both men and women, 21 percent of young women aged 15-19 years and 5.5 percent under the age of 15 are married. In the Kurdistan Region, 43 percent of women aged 15-49 years have experienced some form of female genital mutilation, despite the fact that the practice is criminalized.

Conflict and displacement have acutely increased the vulnerability of women and put them at higher risk of violence, including sexual exploitation. The 2015 Iraq Humanitarian Response Plan estimates that approximately 630,000 women are in need of protection assistance. Female-headed households are particularly vulnerable due to their precarious economic and social situation. A disturbing negative coping mechanism emerging from the conflict situation is the increased incidence of child-marriages. The existing service structure has been overwhelmed and the standardized protocols for gender-based violence services, including reporting and case management, are largely absent.

Iraq’s institutions have suffered from the attrition effects of conflict, challenging their ability to formulate policies, design programmes and deliver services, including in the areas of population, gender and reproductive health. While the capacity of statistical institutions has recently improved, Iraq has limited capacity to provide up-to-date and disaggregated data for evidence-based policymaking. With the demographic changes in Iraq over the past two years, there is a need to revisit national and sectoral strategies that were designed based on the 2012 population-based survey.

UNFPA in Iraq

The first UNFPA country programme for Iraq (2011-2014), which was extended to 2015, made contributions to improving sexual and reproductive health; integrating life skills and civic engagement for young people in national programmes; establishing structures for gender equality and empowerment of women; and availing disaggregated population data for decision-making.

The programme supported the Ministry of Health to formulate the reproductive health strategy for 2013-2017, family planning guidelines, youth-friendly health services guidelines and revision of curricula for midwifery training. The programme improved the policy environment and technical capacity for gender equality and empowerment of women through formulation of national and regional violence against women strategies and action plans.

The second country programme of Iraq (2016 – 2019), is guided by analytical studies and assessments and benefited from multisectoral consultations with the Government, civil society and other United Nations agencies. It is aligned with the National Development Plan (2013-2017), the United Nations Development Assistance Framework (UNDAF) (2015-2019), the UNFPA Strategic Plan (2014–2017), and the 2015 Iraq Humanitarian Response Plan.

Iraq was declared a United Nations system-wide level three emergency in 2014. Therefore, due to the humanitarian situation, UNFPA modes of engagement during its second country programme includes service delivery in addition to targeted capacity development and knowledge management. The new programme situates itself in the current humanitarian context to provide targeted support to internally displaced persons, host communities and refugees, while deliberately seeking to build linkages between the short and medium-term humanitarian context and the development context through resilience and preparedness strategies.

The programme will be delivering the majority of its interventions at a subnational governorate level, both in the Kurdistan Region (Duhok, Suliemania, Erbil) and in the Central South Region (Diyala, Baghdad, Najaf, Ninewa). However, depending upon the flow of internally displaced persons and Syrian Refugees, security and access, this scope may change.

UNFPA Second Country Programme

Outcome 1: Sexual and reproductive health

Output 1: Increased capacity of Ministry of Health, and civil society organizations to deliver integrated quality reproductive health services that meet the needs of vulnerable populations, especially those in humanitarian settings. This will be achieved through advocacy and policy dialogue, capacity development, knowledge management and service delivery as a part of humanitarian response. Strategies will include

  1. Increasing the coverage and referral system of basic and comprehensive emergency obstetric and neonatal care services.
  2. Increasing coverage of family planning services for populations affected by emergencies.
  3. Developing protocols, guidelines and policies on sexual and reproductive health.
  4. Awareness-raising on sexual and reproductive health.
  5. Improving the logistics management information system for a better reproductive health commodity security.
  6. Strengthening youth-friendly services tailored to the needs of young people affected by emergencies.

Outcome 2: Adolescents and youth

Output 2: Enhanced capacity of national government and civil society organizations to design and implement programmes on reproductive health, social cohesion and civic engagement for vulnerable young people, with special focus on marginalized adolescent girls in humanitarian settings. This will be achieved through advocacy and policy dialogue, capacity development and knowledge management. Strategies will include;

  1. Support to development of a national youth strategy.
  2. Roll-out of life skills and civic engagement education, with particular focus on adolescents and youth in humanitarian settings.
  3. Support for youth-led networks and organizations to participate in planning and implementation of programmes that address their needs.
  4. Scale-up of outreach of capacity building interventions for displaced and out-of-school young people.
  5. Increased public awareness and support to the sexual and reproductive health needs of young people.

Outcome 3: Gender equality and women’s empowerment

Output 3: Strengthened capacity of government and civil society institutions to mitigate and respond to gender-based violence and harmful practices, with a special focus on vulnerable women in humanitarian settings. To achieve this, UNFPA will provide support to;

  1. Strengthen a multisectoral response, including referral pathways to gender-based violence (health, including clinical management of rape, psychosocial and legal response)
  2. Review policies, legislation and institutional frameworks on practices that are harmful to women, including female genital mutilation.
  3. Develop a national gender-based violence strategy.
  4. Support women civil society organisations to advocate for gender equality and empowerment of women.
  5. Increase public awareness of the detrimental impact of gender-based violence on families and communities, including female genital mutilation, child and forced marriage, domestic violence, honour killings and human trafficking.
  6. Strengthen the role of the gender-based violence sub-cluster to provide technical leadership and facilitate cooperation and coordination among organizations active in gender-based violence prevention and response.
  7. Establish a gender-based violence information management system to collect, store, and analyse incidents reported by survivors using standardized tools and definitions to allow for information sharing in an ethical, secure and anonymous manner.

Outcome 4: Population Dynamics

Output 4: Increased national capacity for the production and dissemination of high-quality disaggregated data to inform policies and programmes and to promote the integration of population dimensions in development planning. This will be achieved through advocacy and policy dialogue and knowledge management. Strategies include;

  1. Supporting central statistical organizations to conduct large scale population-based surveys.
  2. Upgrading national expertise to respond to population data needs and in-depth analysis in humanitarian settings.
  3. Improving user-friendly data dissemination.
  4. Providing technical assistance in support of monitoring the sustainable development goals.
  5. Supporting the development of tools and mechanisms aimed at promoting integration and monitoring of population dynamics in development.