2015+: Achieving Universal Access Requires More Than Health Services

By: Serra Sippel, President of the Center for Health and Gender Equity

2015+.JPGThe International Conference on Population and Development (ICPD) and Millennium Development Goals (MDGs) deadlines are coming up in 2014 and 2015 respectively, and will quickly pass. What will come next? Deadline extensions? A single health MDG? A combined solution of a new mechanism with new deadline? When it comes to maternal health—to women’s health—does this matter? 

Consider the ICPD goal of universal access to reproductive health through the primary health system by 2015. The goal was adopted in 2007 as a target for reaching MDG 5 on maternal health. Universal access to reproductive health through primary care is not merely access to contraceptive supplies, or safe delivery in pregnancy. According to the ICPD, reproductive health:

...implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the rights of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. [R]eproductive health … also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted diseases.

So when we talk about universal access to reproductive health, we are not limited to talking about access through primary care to prenatal and perinatal care, safe delivery, prevention of unintended pregnancy, or the prevention and management of sexually transmitted infections like HIV. It includes rights, human relations, satisfying and safe sex—the things in life that require societies that value and respect women as demonstrated by laws and policies.

Around the world we have laws that oppress, discriminate and stigmatize: laws that do not protect women from rape in marriage and impunity for all rape, laws that prevent women from access to safe abortion, laws that discriminate against those living with HIV, and laws that stigmatize lesbian, gay, and transgender persons. In some countries, such laws are exacerbated by harmful traditional practices such as early child marriage, female genital mutilation and cutting, and abduction.

We have health care workers who denigrate, dismiss, and demean women in labor, women living with HIV, women engaged in sex work. We have families who ostracize women, kicking them out of their homes because of an HIV diagnosis or pregnancy as a result of rape. How can we achieve universal access to reproductive health—or any other health service—as long as women and girls, and those who face stigma and discrimination based on sexual orientation, marital status, or HIV status, continue to have their rights violated?

The United Nations made its stance clear in August, when the Special Rapporteur reported that any criminal law or legal restriction that bars access to sexual and reproductive education and information, contraception, or abortion violates the right to health, and thus must be removed by the state. A community can have the best, most comprehensive, reproductive health service (which is rare enough on its own), but if a woman is unable to say no to sex, if she is told by her priest she cannot use modern methods of contraception, if her husband refuses to agree to use a condom to protect her from HIV, if she refuses medical care in childbirth because she is treated poorly, or if she is forced to marry, the mere existence of these services means nothing to her. 

With 2014 and 2015 deadlines upon us, the question is not what deadline or mechanism is needed to deliver for women. The question is when will the world—heads of state, ministers of health, parliamentarians, health care providers, advocates—demand that national laws reflect the human rights women are guaranteed under international law so that women have the power to seek and demand of their primary care givers access to reproductive health. What will it take?


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