Network Medicus Mundi Switzerland. Sexual and Reproductive Health and Rights. A Discussion Paper

Transcription

1 IAMANEH; Solidarmed Network Medicus Mundi Switzerland Sexual and Reproductive Health and Rights A Discussion Paper 2015

2 With this discussion paper the Network Medicus Mundi Switzerland provides a common perspective on Sexual and reproductive health and rights (SRHR). It has been written by a consortium of MMS member organisations active in the field of SRHR. It defines our understanding of the current SRHR situation in the world, describes challenges ahead and sets out our view on the future. It communicates to our partners and all relevant stakeholders our continuing commitment and approach to achieving sexual and reproductive health and rights for all. 1. Our understanding of SRHR Sexual and reproductive health (SRH) is fundamental to the physical and emotional health and well-being of individuals, couples and families, and to the social and economic development of communities and countries. SRH is defined as a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence and without fear of sexually transmitted infections (STIs), including HIV/AIDS, or unwanted pregnancies. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled. 1 2 Sexual and Reproductive Health and Rights (SRHR) encompass the right of all individuals to make decisions concerning their sexuality and reproduction free from discrimination, coercion, and violence. 3 Sexual and Reproductive Rights include the right to equality, equal protection and freedom from all forms of discrimination based on sex, sexuality or gender, the right to security of the person and bodily integrity, the right to education and information and the right to choose whether or not and when to have children SRHR within the global policy framework To achieve sustainable progress in the field of SRHR for all, the international community and stakeholders in international development policy must eliminate inequities, ensure equality between men and women (gender equality and female empowerment) and improve the quality of health, in particular SRHR services, and promote and protect human rights as well as accountability. International Conference on Population and Development (ICPD). A major impetus for the consolidation of work on SRHR was the 1994 International Conference on Population and Development (ICPD) in Cairo. It marked a paradigm shift which moved family planning out of a population control context and into the broader context of SRHR by putting the rights of people, particularly women, at the centre of the agenda. It called for public health investment in this field as an essential contribution to sustainable development and the reduction of poverty. Accessible, comprehensive SRH services, alongside gender equality and the empowerment of women and girls, are the cornerstones of efforts to enable people to make informed, safe and healthy choices. Since these commitments 1 Adapted from 2 WHO (2006a). Defining sexual health: Report of a technical consultation on sexual health, January Geneva, World Health Organization. // a=1 3 International Conference on Population and Development, Summary of the Programme of Action (New York: United Nations Department of Public Information, March 1995) 1

3 had not been fully met 20 years on, the ICPD Beyond 2014 Agenda was reconfirmed. 4 Millennium Development Goals (MDG). The Cairo Plan of Action significantly contributed to the development of the Millennium Development Goals (MDG) 5 (reduction of maternal deaths) and MDG 4 (reduction of child mortality) which came to an end in In 2007, a target explicitly addressing reproductive health was added to MDG 5 - target 5b on achieving, by 2015, universal access to reproductive health. Target 5b explicitly merges the Cairo platform for action and the MDGs. Beijing Platform for Action. In 1995 the Fourth UN World Conference on Women was held in Beijing where the Beijing Platform for Action was adopted by 189 countries. This contains a series of measures in twelve critical areas where women are discriminated against. It underlines that women's SRHR are a prerequisite for their active participation in all parts of society. Sustainable Development Goals. The 2030 Agenda for Sustainable Development (Sustainable Development Goals, SDGs) was adopted in September This builds upon the MDGs. 5 SRHR is embedded under SDG 3 (health) and SDG 5 (gender): SDG 3: Ensure healthy lives and promote wellbeing for all, at all ages, with the following targets: (3.1) by 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births (3.2) by 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to a maximum of 12 per 1,000 live births and under-5 mortality to a maximum of 25 per 1,000 live births (3.3) by 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases (3.7) by 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes (3.8) achieve universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all. SDG 5: Achieve gender equality and empower all women and girls, with the following targets: (5.1) end all forms of discrimination against all women and girls everywhere (5.2) eliminate all forms of violence against all women and girls in public and private spheres, including trafficking and sexual and other types of exploitation (5.3) eliminate all harmful practices, such as child, early and forced marriage and female genital mutilations (5.6) ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the ICPD and the Beijing Platform for Action and the outcome documents from their review conferences. 4 International Conference on Population and Development, Summary of the Programme of Action (New York: United Nations Department of Public Information, March 1995) 5 2

4 Universal Health Coverage (UHC). Calls for UHC 6 have recently gained momentum. Universal access to SRHR requires a system to be in place that meets the needs of the beneficiaries within their specific local context. A minimum package of SRH services at health facilities, embedded within a functioning health system, should cover the areas of contraception; antenatal care; maternity and post-natal care; safe abortion (where legal); post-abortion care; and the prevention, diagnosis and treatment of STIs, including HIV. A unified approach should include comprehensive sexual education through community-based interventions that foster local participation and recognise human rights from the inception of relevant programmes to their implementation and evaluation. Achieving universal access to SRHR means taking measures to eradicate inequalities by eliminating barriers to access, whether they be economic, structural or cultural. Twenty years after the ICPD, universal access to SRHR is an unfinished agenda. Despite the great resistance to equal rights for women around the world, successes in the improvement of SRHR of women and girls can be found and can partially be attributed to interventions supported by the international community. 1.2 Remaining challenges While progress is being made in universal access to SRHR, challenges remain. The following challenges require continuous international attention and action in order to further improve SRHR outcomes: Lack of focus on young people's SRHR. Over 1.5 billion people in the world are aged between 10 and 25. An estimated 16 million young women aged between 15 and 19 (11 percent of all births) experienced a pregnancy in Around 12 percent of young women in low-income countries are married under the age of 15; this rises to 30 percent by the age of 18. This increases the likelihood of risky teenage pregnancies. Pregnancy-related complications are the most common cause of death for girls aged between 15 and 19 in developing and emerging countries. 7 Of the 22 million abortions per year worldwide, an estimated 19 to 20 million unsafe abortions occur and nearly all of them are in developing countries (97 percent). 8 In many parts of the world, sexual activity by young people before marriage is not accepted. As a consequence, it is difficult for many young people to access information, contraception, counselling and healthcare. Education on SRH and rights is essential to help young people understand themselves better and make informed choices when it comes to sexuality and relationships, and also to counteract myths and misconceptions about sexuality and reproduction. Young people (both girls and boys) must be given the opportunity to participate in shaping their own lives and be strengthened in their capacity to make decisions affecting their SRH in a positive way. Unmet family planning needs. A woman s ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy. An estimated 222 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. 6 Savedoff W et al. (2012) Political and economic aspects of the transition to universal health coverage. Lancet 380:9845, Paper.pdf 7 Adolescent pregnancy 8 Lancet Series Unsafe abortion: the preventable pandemic. 3

5 Contraceptive use has increased in many parts of the world, especially in Asia and Latin America, but continues to be low in sub- Saharan Africa. Globally, use of modern contraception has risen slightly, from 54 percent in 1990 to 57 percent in Despite growing recognition that men need to be involved in SRH matters, both as partners and for their own benefit, progress has been slow. Slow and uneven progress in halting maternal mortality and adverse events during and after giving birth. Global maternal mortality was reduced between 1990 and 2010 by almost 50 percent. 10 However, advancements in maternal health have been slow compared to those in other areas. According to official figures, 289,000 women still died during pregnancy or childbirth in In southern Africa, the number is around one hundred times higher than in countries with a high income. 99 percent of maternal deaths are concentrated in developing countries. 11 The worldwide neonatal mortality rate fell by 40 percent between 1990 and from 33 to 20 deaths per 1,000 live births. Over the same period, the number of newborn babies who died within the first 28 days of life declined from 4.7 million to 2.8 million. Recent estimates show that the number of deaths in under-fives worldwide has declined by half since 1990, from 12.7 million to 6.3 million today. Yet, 17,000 children under the age of five still died every day in Around 2.6 million stillbirths occur each year. 13 Worldwide, an estimated 2 million women suffer from obstetric fistula. Every year an additional 50,000 to 100,000 women are affected by this complaint. Obstetric fistula is one of the most serious and tragic injuries that can occur during childbirth. Fistula prevention, fistula surgery and social reintegration need to be part of national maternal health programmes. Unsafe abortion is a significant cause of maternal mortality and morbidity in the world. Most unsafe abortions occur where abortion is illegal, or in developing countries where affordable, well-trained medical practitioners are not readily available, or where modern contraceptives are unavailable. Every year an estimated 19 to 20 million unsafe abortions occur, nearly all of them in developing countries (97 percent). 14 Morbidity and mortality due to STIs and HIV/AIDS. Each year, an estimated 500 million people acquire a curable STI (chlamydia, gonorrhoea, syphilis and trichomoniasis). In addition, probably 536 million people live with the incurable herpes simplex virus type 2 (HSV-2) infection. Approximately 291 million women experience a human papillomavirus (HPV) infection once in their lifetime, and it is likely that the number of HPV-infected men is similar. An estimated 35 million people live with HIV globally, of which 19 million are not aware of their HIV status. By ending the epidemic by 2030, 18 million new HIV infections and 11.2 million AIDS-related deaths would be averted worldwide. 15 Today, about 4 million young people between the ages of 15 and 24 are infected with HIV, 29 percent of whom are young people between 15 and 19 years of age World Health Statistics 2014, p Women and Children s Health in the post-2015 Development Agenda, PMNCH, January 2013, p orecode/child_mortality_report_2014_195.pdf 13 Lancet Series (2015): 14 Lancet Series Unsafe abortion: the preventable pandemic. 15 UNAIDS Gap Report 2014t 16 The Gap Report. UNAIDS,

6 Lack of investment in effective cancer prevention and treatment programmes. Cancer of the reproductive system, such as cervical and breast cancer, are a burden. Cancer is among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer-related deaths in More than 60 percent of the total new annual cases worldwide occur in Africa, Asia and Central and South America 17. Gender based violence on the increase. Violence against girls and women is a leading cause of injury and disability, as well as a risk factor for other physical, mental, sexual and reproductive health problems with long-term consequences. 18 It is estimated that one in three women of reproductive age have experienced either physical and/or sexual violence by an intimate partner or someone else. About 30 percent of all women aged between 15 and 49 have experienced some form of physical and/or sexual violence by an intimate partner. 19 A particular aspect of this gender-based violence is female genital cutting, the consequences from which approximately 130 million girls and women worldwide suffer. 20 The reduction of gender discrimination is both a target and a prerequisite of development. Discrimination against sexual minorities. Lesbian, gay, bisexual, transgender and intersex (LGBTI) people around the world risk persecution and serious violations of their human rights, such as imprisonment, torture, beatings and murder, solely because of their sexual orientation and/or gender identity. The consequences of this are very serious and require national and international attention to combat the stigma of and discrimination against LGBTI people. Exclusion of people with disabilities. The World Report on Disabilities shows that over 1 billion people globally experience disability and face inequalities including no or reduced access to health care, education and employment. 21 Among them, 80 percent live in developing countries. 22 Such people become more vulnerable when a humanitarian crisis occurs. People with disabilities have the same SRH needs as other people and many of them are marginalized, deprived of freedom and have their human rights violated. They are more likely to experience physical, emotional and sexual abuse and other forms of genderbased violence. They are more likely to become infected with HIV and other sexually transmitted infections (STIs). In crisis situations these risks are multiplied Obstacles to progress Progress is being made in universal access to SRHR. Nevertheless, a considerable number of people have no or limited access due to their socio-demographic status, gender, ethnicity, disability, residency status, situations of conflict or other forms of marginalization. The reasons vary from the low status given to women and girls, to weakening political commitment and inadequate resources. An overall issue is weak, overburdened and understaffed health systems. Accessing those hardest to reach with much needed information and services has likewise proven to be a challenge. As a result, progress tends to be concentrated among those who are better off economically, have more education and live in urban areas ng.pdf ICPD Beyond 2014, ua=1 23 ICPD Beyond

7 Unequal gender norms in and around schools continue to pose barriers to the sustained participation of girls, especially at the secondary school level and beyond. Schools remain important vehicles for promoting health, the best example being the reduction of teen pregnancies. Comprehensive sexual education enables young people to make informed decisions about their sexuality and health. These programmes develop life skills and increase responsible behaviour, and because they are based on human rights principles, they help advance human rights, gender equality and the empowerment of young people. recognise that SRHR are an important component in the strengthening of health systems and a factor in Universal Health Coverage address social, cultural and economic barriers, using a rights-based approach, and tackling issues outside of the health sector support research, monitoring and evaluation and apply knowledge and lessons learnt in policy and planning promote the involvement of rights' holders in programme development and implementation. 2. Our contribution We recognise the need for SRHR for all to reduce poverty, advance development and promote equality and human rights. The Network Medicus Mundi Switzerland and its member organisations: remain engaged in promoting and lobbying for SRHR advocate internationally and nationally for policies and resources that address people s rights to SRH continue to provide, improve and expand SRHR services and access for all improve access to comprehensive SRH services that are responsive to the rights and needs of poor people and all vulnerable groups promote SRHR for both men and women at all stages of their lives advocate for the implementation of the Cairo Agenda in those countries which signed the agenda but where SRHR have not yet been put into practice 3. What we expect from actors in the Swiss health cooperation SRH and maternal and child health are part of Swiss Health's foreign policy. Furthermore, SRHR and Maternal, Newborn and Child Health (MNCH) are one of the three priority areas identified in the Swiss Development Cooperation's (SDC) health policy. 24 We recognise the engagement of the SDC in the contribution towards improving SRHR for all. Accelerating progress on SRHR for all requires urgent and sustained action by actors in the Swiss health cooperation and the global community and we request that they: I. make continuous efforts in and strengthening of SRHR activities II. ensure SRHR mainstreaming in programmes and projects III. regularly and critically revisit their commitment to the Cairo Agenda and work on existing shortfalls

8 IV. allocate adequate funding and demonstrate continuous political commitment to SRHR V. along with all stakeholders involved in SRHR, base their work on a human rights-based approach that promotes equality and fairness for all VII. utilise more effective monitoring, evaluation and evidence-based research, using disaggregated SRHR data for sex, age and disability VIII. provide additional funding for effective monitoring and evaluation, and implementation research. VI. consider laws and policies and their implementation which will prohibit and sanction harmful practices, genderbased violence and discrimination in accessing healthcare and exercising related rights - END - 7