Kate Gilmore, UNFPA Deputy Executive Director (Programme) addressed our High Level Side Event “Sexual and Reproductive Health and Rights: The key to gender equality and the empowerment of women and girls” at the 59th Commission on the Status of Women.
Upholding human rights for sexual and reproductive health is key to ensuring that all people can be equal and free to make decisions in all spheres of their lives, without discrimination, without violence or coercion, and with the assurance of their dignity upheld. Together the outcomes of the Vienna human rights conference (1993) affirming indivisibility and universality of human rights, the Cairo population and development conference (1994) putting the person at the centre of development and the Beijing women’s conference (1995) affirming that women’s rights are indeed human rights, set a complimentary agenda – defined by the international community and reaffirmed globally time and time again. This is the agenda by which rights in respect of sexual and reproductive health are made normative and the means by which these rights are to be protected universally. It is on this foundation that women and girls, in particular, are reliant if they are to enjoy a life of choices, empowerment and equality, and this invokes the right to health throughout the life course inclusive of the right to make choices freely in marriage, family formation and determination of the number, timing and spacing of children. For such rights to be exercised and enjoyed, people – and women and young people in particular - must be supported with quality access to information, to services and to the means by which to exercise their voluntary choices.
SRHR are rights in principle, upheld by international and universal norms and supported indivisibly, by all other human rights norms. However, they are also rights that, in practice, save lives and reduce ill-health: If all pregnant women and their newborns were to receive care at WHO recommended standards, if all women who want to avoid a an unplanned pregnancy had access to modern contraceptives, the life-saving benefits would be substantial. Maternal deaths would drop by 67%. Newborn deaths would drop by 77%. Unintended pregnancies would drop by 70%. Women’s and newborns’ burden of disability related to pregnancy and childbirth would drop by 66%. Transmission of HIV from mothers to newborns would be nearly eliminated—a 93% reduction.
The correct thing to do in principle, upholding SRHR is just smart in practice. At its simplest, universal access to sexual and reproductive health is cost effective. With far fewer unintended pregnancies, the costs of improving pregnancy-, birth- and newborn-care, and of preventing mother-to-child transmission of HIV, are lowered. For each dollar spent on contraceptive services, the cost of pregnancy-related care reduces by $1.47. Expanding access to modern methods of contraception, and associated services, so that current rates of unmet need are met, would result in 163,000 fewer infants infected with HIV by 2015, while reducing total HIV treatment costs by $200 million. The UNFPA and the Guttmacher Institute report Adding It Up calculates that to provide essential sexual and reproductive health services to all women and girls aged 15-49 in developing countries would cost a mere $25 per woman per year, which, incidentally, is the cost of a movie ticket with popcorn in New York city.
When human rights in sexual and reproductive health are upheld total claims on a country’s health budget are reduced while economic productivity and growth are stimulated; promoting a demographic transition that boosts both economic growth and individual wellbeing. When the number of dependent children in a country decreases, the ratio of productive workers to dependents increases, driving faster economic growth and reducing burdens on families. This window of opportunity is known as a ‘demographic dividend’ and with more young people than ever before this promises both a “youth” and a “gender” dividend, generating broader, long-term benefits for women, young people, their children, partners and families, economies and societies.
Preventing maternal deaths and disability also helps protect individuals and families from catastrophic health expenses and loss of income while preventing unintended pregnancy reduces poverty by increasing women’s and girls’ ability to both access education and employment opportunities and participate more fully in social, political and economic life. A study conducted in 2013 in Kenya shows that families experiencing a maternal death spend more on medical care and funeral expenses than all other yearly expenses combined, including food, shelter, and education. The impact of complications of unsafe abortion and the expense of treating these are also substantial for households.
Human rights associated with sexual and reproductive health matter for women’s economic, educational, and political empowerment and thus for their countries’ advance too. The autonomy to decide whether, when and with whom to have children, and the opportunity to access quality health services whenever and wherever she needs, is essential to the realization of her other life opportunities and fulfilment. These realities underscore why the promotion and protection of rights pertaining to sexual and reproductive health are instrumental to the achievement of all human rights including the right to education, the right to decent work, the right to food and the right to participation.
While sexual and reproductive health are human rights in principle, they are also right the thing to do strategically and thus right in practice. Yet, still many women and girls around the world are denied exercise of their rights. Therefore tackling harmful gender norms is a must, given they are at the core of why so many women and girls are deprived of their rights to sexual and reproductive health. Female genital mutilation, child marriage, rape in marriage, wife inheritance and maltreatment of widows and son preference are all forms of gender based violence and each constitutes a grave impediment to the realization of human rights intrinsic to sexual and reproductive health. At the same time, unless the grave discrimination and inequalities faced by specific population groups are addressed (i.e. those faced by adolescent girls, persons with disabilities, indigenous women and girls, persons living with HIV, displaced persons, the elderly, LGBT, sex workers and others) we will continue to leave millions of people far behind the sustainable development agenda.
Nowhere is this clearer than in regards to adolescents and young person. Today’s youth are 1.8 billion strong, forming a quarter of the world’s population. They are shaping social and economic development, challenging social norms and values, and setting the terms of the world’s future. While notable progress has been made under the Millennium Development Goals, many young people – especially adolescent girls – are still denied the investments and opportunities that they require to realize their full potential. Instead, for millions of girl children around the world, puberty – the biological onset of adolescence – brings not only often incomprehensible changes to their bodies but – thanks to perverse gender norms – also new vulnerabilities to human rights abuses, particularly in the arenas of sexuality, marriage and child bearing.
The Beijing+20 review has highlighted that in the past 20 years much has been achieved. Increasingly countries are removing discrimination from their laws and adopting laws to promote gender equality and address violence against women and girls. There have been significant gains in girls’ enrolment in primary and – to some extent – in secondary education too. In some regions, women’s participation in the labour force has increased while some regions have made remarkable progress in increasing women’s access to contraception. There have been important gains in women’s representation in national parliaments and significant normative advances have been won in the global agenda on women, peace and security.
However, 20 years on from Beijing, we can see what for women amounts to a life-threatening disconnect between agreed normative frameworks and the reality on the ground. Implementation, accountability and engaged must be strengthened. Without strong accountability mechanisms to enable women to hold decision makers answerable for their actions, substantial progress for human rights in sexual and reproductive health is unlikely. To turn this around, commensurate financial resources and political support for key institutions and mechanisms that promote gender equality, and the human rights of women and girls more broadly is essential, including for such as national gender equality mechanisms and national human rights institutions. Ensuring there are mechanisms for tracking and reporting on commitments made to human rights in sexual and reproductive health is also an essential part of building and fortifying accountability.
UNFPA is undertaking bold and innovative measures to turn advance human rights. We are supporting countries to address gender and sexual based violence, for example, by working with sister UN agencies to support governments provide access to essential services for survivors and victims of gender based violence. We are enabling South-South cooperation and learning between countries through ground-breaking initiatives like the VIRAVIDA programme in Brazil, which brings together the private sector, government and community organizations to empower, educate and employ marginalized young people who have been sexually violated. By committing resources and action to support women and girls around the world to exercise autonomy over their bodies and fertility, including by enabling access to safe, voluntary family planning, we are ensuring realization of rights pertaining to their education and their labour force participation. Promoting the engagement of men as supportive partners in gender equality, we have established “husbands’ schools” that aim to promote better health for women and children. Implementing our Adolescent Girls Initiative, we are reaching the most marginalized adolescent girls, protecting their rights, particularly by delaying age at marriage and childbearing, by empowering them and by elevating their social status in their communities.
Right in principle, smart in practice and plain strategic for sustainable development: the most pressing question cannot be “why should governments invest in human rights for sexual and reproductive health?” but rather “why haven’t they?”