A Call for Engagement by the Sexual and Reproductive Health and Rights Community
By: Alicia Ely Yamin is Director of the Program on the Health Rights of Women and Children at the Francois-Xavier Bagnoud Center for Health and Human Rights at Harvard University. She served on the 2011 PMNCH Commitments Report advisory Panel.
It is understandable that the sexual and reproductive health and rights (SRHR) communities have generally maintained a critical distance from the Millennium Development Goals (MDGs) process, as MDG 5 represented a dramatic departure from the hard-won, holistic vision of reproductive health set out in the 1994 Programme of Action of the International Conference on Population and Development (ICPD) and reaffirmed in the subsequent Beijing Declaration.
The reasons that the MDGs reduced reproductive health to the relatively depoliticized realm of maternal health have been well-trod in the literature, including a reconfiguration of political forces in the world, and in the US in particular; a change of leadership at UNFPA; and the role of message entrepreneurs and technocrats, together with a failure to operationalize the concepts laid out in the ICPD.
Similarly, human rights critiques of the MDGs have been repeatedly articulated: their reductionism obscured complex power relations in achieving rights; they ignored international legal frameworks and selectively excluded certain rights; they adopted a one-size-fits-all approach that ignored states’ capacities; they were devised and applied in a top-down manner that precluded participation by affected groups; and they largely overlooked important equity concerns. All of these critiques, as well as others, apply with particular force to MDG 5. Nonetheless, the MDGs garnered unprecedented global support-- as well as funding.
By the time the 2010 MDG summit was approaching, it was clear that there had been lagging and uneven progress with respect to both MDG 5 and MDG 4, relating to child health. At least 70% of countries were not on track to meet these two goals. As a result, the UN Secretary General launched a Global Strategy for Women’s and Children’s Health, which involved unprecedented political advocacy around women’s and children’s health and resulted in the commitment of approximately $USD 40 billion in new funding, as well as other significant policy and service delivery commitments by both donor states and national governments, along with the private sector, heath professional associations, foundations and NGOs.
As a result of the Global Strategy, a number of initiatives have occurred at the international level: the Every Woman, Every Child Campaign was launched; the G8 and the African Union both made further commitments in early 2011; a UN Innovation Working Group was formed; the Partnership for Maternal, Newborn and Child Heath (PMNCH) undertook a follow-up study of commitments made at the MDG summit, which was just released in September; and a WHO Information and Accountability Commission was established, which recommended, among other things, the creation of both national level accountability mechanisms and a global independent Expert Review Group (iERG).
The intense attention to implementation of the Global Strategy comes at the same time as a post-2015 agenda is being debated in the halls of the UN as well as among governments, multilaterals and civil society organizations. It is now being decided whether the future development agenda will reflect minor tinkering with the MDGs or an entirely different approach that embraces an understanding of health, including reproductive health, in terms of global public goods. And these discussions are occurring against the backdrop of an unstable global economy, impending food and climate crises, and fundamentalisms of various stripes—all of which potentially will have a disproportionate effect on women and girls. These are conversations that require the SRHR community to have a seat at the proverbial table.
The SRHR and human rights communities have been extremely effective over the last ten years in anchoring SRHR in binding law; landmark decisions in national and international fora have found state obligations to make reproductive health services (from abortion to maternal care) available, affordable and accessible on a non-discriminatory basis. Similarly, ground-breaking advocacy has been done at the Human Rights Council, as well as at regional and national levels, around maternal mortality as a human rights issue.
It is imperative that we now bring similar energy to engagement with the MDGs process and post-MDGs planning at this pivotal juncture. For example, the way in which both the iERG and the national-level oversight mechanisms function will not only determine accountability for advancing SRHR in the next few years, but also likely will foreshadow the nature and degree of accountability we might expect in a post-2015 world.
It is critical that both the iERG and national mechanisms take a broad and non-technocratic approach to reproductive health, going beyond the eleven indicators listed in the WHO Accountability Commission report. They should also allow for meaningful citizen participation; provide full transparency; evaluate non-discrimination and equity in achieving progress; consider laws, policies, budgets, and enabling institutional environments; and promote effective redress procedures. The iERG in particular has a role to play in fostering donor accountability. Ensuring that these mechanisms function optimally will only be possible with robust advocacy from the human rights and SRHR communities.
Now is the time for all of us in the SRHR community to make our voices heard with respect to implementation of the Global Strategy, as well as our vision for a post-MDGs development agenda.