The battle for sexual and reproductive health and rights for all

“We must be courageous in speaking out on the issues that concern us: We must not bend under the weight of spurious arguments invoking culture or traditional values. No value worth the name supports the oppression and enslavement of women. The function of culture and tradition is to provide a framework for human well-being. If they are used against us, we will reject them, and move on. We will not allow ourselves to be silenced.” UNFPA Executive Director Nafis Sadik (1987–2000)

The year 2019 marks two important milestones in the field of population and reproductive health: 50 years since the United Nations Population Fund (UNFPA) began operations, and 25 years since the landmark International Conference on Population and Development (ICPD) held in Cairo. These two events – the launch of the first United Nations (UN) agency dedicated to addressing population issues and the reproductive health needs of the world’s people, and the declaration of a global commitment to ensure universal access to sexual and reproductive health (SRH) services – have shaped the lives of women and families and the trajectories of communities and nations.

For me, being in Cairo at the ICPD was both tough and thrilling. It was tough to absorb the magnitude of the challenge and the resistance to new ideas. It was thrilling to be part of the NGO Forum with sister activists and to imagine the possibilities and the ultimate triumph for the world’s women and girls.

The outpouring of interest and participation from civil society was unprecedented. Due to publicity given to various controversies surrounding reproductive health and rights at preparatory meetings, the Cairo Conference opened with high drama. Much was at stake and 4000 journalists came to report on issues that for centuries had remained largely hidden behind closed doors. The ears of participants buzzed with words such as sexual and reproductive health and a safe and satisfying sex life; and stung with the reality of widespread violence and discrimination against women and girls, female genital mutilation, maternal death, and child marriage. The dialogue focused on expanding the roles, rights, and choices of women and girls in public life and within the family. It was historic and changed my world and the world of countless women and girls in ways measurable and immeasurable, profound and trivial, and permanent and fleeting.

At the centre of the Cairo consensus is the principle that reproductive rights and the empowerment of women and adolescent girls are central to sustainable development. The 25-year period between UNFPA’s first programmatic activities and ICPD had seen a gradual and accelerating shift: from a primary focus on population issues and fertility reduction to a more people-centred, rights-based approach – one aimed at enabling women and couples to avoid unintended pregnancy, achieve SRH, and realise their reproductive rights. This shift was driven by feminists and advocates for sexual and reproductive health and rights (SRHR), and was, in part, a response to the abuses that resulted from target-driven “population control” policies of the past. In the end, it was committed and courageous leaders in government, the UN, including past UNFPA Executive Director Nafis Sadik, and civil society that made the consensus possible.

It is now widely recognised that the right to SRH is central to women’s empowerment and gender equality and is at the very core of Agenda 2030, the 17 UN Sustainable Development Goals (SDGs), as well as Universal Health Coverage. While reproductive rights and choices have become a reality for more women than ever, vast numbers of women around the world are not empowered to make fundamental decisions about their own bodies. Marginalised groups, in particular, ethnic minorities, youth, unmarried people, lesbian, gay, bisexual and intersex people, people with disabilities, and those living in poverty, face some of the highest unmet need for SRH services. Data from 51 countries show that only 57% of women who are married or in a relationship are able to make their own choices over sexual intercourse with their partner, contraception use, and health care.¹

The role that multilateralism has played and plays in realising universal access to SRHR for all is critical and indispensable. UNFPA, WHO, Unicef, UNAIDS, UNWOMEN, and the World Bank (the H6, or six health agencies that constitute the technical assistance arm for implementation of the Secretary-General’s Global Strategy for Women, Children and Adolescent Health) must stand united with other UN agencies to push back against forces that would see us return to a time when women had little say in reproductive decisions or, for that matter, in any area of their lives. We stand to support governments, civil society, and all other stakeholders to protect the rights of all people.

We must continue to fight. One in three women experience physical or sexual violence in their lifetime. Every minute, 23 girls aged under 18 years are married, many of them being forced or coerced. Every year, three million girls are at risk of female genital mutilation, 232 million women in developing countries who want to plan their families do not use modern contraceptives, and in spite of a significant 40% decline in maternal mortality since 1990, more than 800 women die every day from complications of pregnancy and childbirth.² These extensive violations of human rights must come to an end.

A strategic priority for UNFPA in this campaign, that also reflects the SDGs, is Universal Health Coverage (UHC). It would allow everyone to obtain the health services they need, when and where they need them, without facing financial hardship. To fully achieve UHC will require reaching all vulnerable populations with a full range of quality services, according to their needs. These services, in line with existing WHO guidelines, include contraceptive services; maternal and newborn care; prevention and control of sexually transmitted infections including HIV; comprehensive sexuality education; safe abortion care, including post-abortion care; prevention, detection, and counselling for gender-based violence; prevention and treatment of infertility and cervical cancer; and counselling and care for sexual health and well-being.³

Alongside UHC, the success of our aim to fulfil the promise of the ICPD Programme of Action (PoA) will depend on our joint commitments to address SRHR in its entirety. Young people today want more than what was agreed by member states in 1994 at ICPD; they want recognition of the centrality of rights and choice to people’s lives, to governments’ obligations, and to an equitable, sustainable agenda for social and economic development. They want to be able to make decisions about their own sexual and reproductive lives and exercise their sexual and reproductive rights. It will require governments to enable this by removing any barriers that hinder such decisions, at policy, system, community, and societal levels.²

The world has changed since 1994. The population is becoming larger, older, more mobile, and more spatially concentrated than ever before, and at the same time, in some regions, the challenges of huge young populations and high fertility rates remain.⁴ Unprecedented technological and scientific advances converge with the existential threats to populations of climate change and increasing humanitarian crises, including natural disasters and protracted conflicts, and rising displacement with more migrants and refugees. Of the 143 million people in need of humanitarian assistance, more than a quarter are women and girls of reproductive age who require lifesaving SRHR services and action to prevent and respond to gender-based violence. Today more than half of all maternal deaths take place in countries affected by crises and fragility, and gender-based violence risks increase in these settings. Women, girls, and young people are a force for change and it is time to fully tap their potential and their leadership to drive solutions. This “new normal” challenges us as individuals and a global community to foster human solidarity and to promote the fundamental principles of human rights upon which the UN was founded.

The PoA also called for the collection, processing, analysis and timely dissemination, and utilisation of population and related development data, and for that data to be disaggregated, particularly by sex, age, and income. While the quality and availability of population data have significantly improved since 1994, many gaps persist especially for populations, age groups, and constituencies that are the furthest behind.

What the future holds in terms of population trends and dynamics and SRHR will determine and be determined by the ability of women and girls to achieve their full potential as members of society. And this will be determined, in no small part, by how the world takes forward the promise of Cairo.

The governments of Kenya and Denmark, and UNFPA are co-convening the Nairobi Summit (12–14 November 2019) on ICPD25, a high-level meeting to mobilise the political will and financial commitments we urgently need to finally and fully implement the ICPD PoA. The summit aims to bring together heads of state, ministers, parliamentarians, thought-leaders, technical experts, civil society organisations, grassroots organisations, young people, business and community leaders, faith-based organisations, indigenous peoples, international financial institutions, people with disabilities, and academics, to ensure that all are heard and no one is left behind. Creating momentum for increased financing of a comprehensive approach to SRHR is crucial and will be a game changer. To this end, UNFPA has embarked on an exercise to identify costs and financing means to improve the quality and relevance of SRHR for all and for preventing sexual and gender-based violence.

The way forward is the full realisation of SRHR for every individual and couple, no matter who they are or where they live, seizing the opportunity the demographic dividend provides and putting adolescents at the very centre of our efforts. This includes dismantling all the barriers – whether economic, social, or institutional – that inhibit free and informed choices and people’s enjoyment of their rights and full equality.

My commitment and the commitment of UNFPA is to ensure SRHR for all, to make sure that preventable maternal deaths, unmet need for contraception, and gender-based violence and harmful practices become history within our lifetime.