| Action is especially needed in two areas: first, to
establish the broad human rights which enable sexual and reproductive rights, and create
the conditions for their exercise; and second, to put in place information and services
that meet the full range of requirements for sexual and reproductive health. Greater attention has to be paid to broader human rights
issues, especially to those that promote gender equality and the empowerment of women.
Laws and procedures must be reformed, and existing rights protections better enforced.
Procedures to document human rights violations are needed. Both government and civil
institutions must become more accountable for protecting rights. Education about human
rights should be undertaken, and alliances developed among institutions concerned with
rights. Internationally, human rights goals must be given greater priority in assistance
programmes.
Poverty is the defining factor preventing both women
and men, especially in developing countries, from exercising their sexual and reproductive
rights. The actions advocated in this report will have a powerful impact on poverty, but
specific action is needed to increase women’s access to credit and economic
resources.
Education, both general education and specific
education on sexual and reproductive health, is needed at all levels. After primary health
care, the most valuable investment a country can make is in closing the gender gap in
education for girls and women. Boys and men have specific educational needs, notably in
the area of gender relations, so that they can take their proper place as equal partners
with women in family, community and national life. Domestic and sexual violence will not
end while inequality exists between men and women.
Health services need to be restructured to meet the
reproductive and sexual health needs of clients, including currently underserved groups.
Guidelines, standards of conduct and evaluation methods need to be developed. All the
institutions of civil society— governments, non-governmental organizations and the
private sector—must be involved in designing, implementing and monitoring programmes.
Priority for sexual and reproductive health is needed when resources are allocated.
Enabling Rights
Population and development strategy. In
countries all over the world, policy frameworks for population and development programmes
are being reviewed and revised to reflect the international consensus reached at
development conferences, including the ICPD’s commitment to reproductive health and
rights. This process must continue.
Gender equality and equity. The international
conferences of this decade drew unprecedented global attention to social development, and
in particular to what it means, or should mean, for women. This awareness should grow as
countries continue to implement the conference agreements. The United Nations system is
integrating gender concerns in programmes and procedures; producing gender-differentiated
data and offering assistance for national efforts to develop culturally sensitive
education programmes.2 United Nations bodies are working for the withdrawal of
national reservations to the Convention on the Elimination of All Forms of Discrimination
Against Women, and for the adoption of its draft optional protocol adding an enforcement
mechanism.
Methods to monitor progress. Within the
United Nations system, the Inter-agency Task Force on Basic Social Services for All is
working on a set of indicators measuring gender differentials in educational attainment,
access to basic health services, access to family planning services and levels of
morbidity and mortality (including maternal mortality). Efforts have begun to reconcile
the diverse methodologies of human rights organizations, the public health community,
specialized agencies of the United Nations and national recording systems.
Multinational and bilateral assistance agencies are
cooperating to develop indicators for measuring the performance of reproductive health
programmes.3 UNFPA is developing indicators to measure national
reproductive health conditions (relating to family planning, maternal health, reproductive
tract infections and STDs, abortion and post-abortion care, infertility and harmful
traditional practices) and the impact of policies and programmes. Complementary
demographic, social and economic data will provide the context for interpreting these
indicators.
Human rights activists, UNFPA, UNICEF, WHO, the UN
Division for the Advancement of Women and the human rights treaty bodies have begun
consultations on mechanisms for monitoring reproductive and sexual rights within the
context of human rights treaty mechanisms. Relevant public health indicators could be
incorporated into national procedures for reporting to the treaty bodies.
Documenting violations. Just as civil and
political rights monitoring identifies specific violations such as arbitrary arrest or
detention, so must there be mechanisms to identify and seek redress for violations of
reproductive and sexual rights such as unauthorized medical procedures. This should extend
to gender issues such as differential inheritance and property rights.
Enforcing rights protections. Existing legal
safeguards of civil, economic and social rights must be effectively implemented and fairly
applied. Officials need to be trained to review complaints fairly and to enforce laws (for
example, laws against domestic violence, sexual harassment and rape) which protect rights
to gender equality and reproductive and sexual health. Advocacy efforts can mobilize
community concern and ensure that policy makers and civil institutions give priority to
these concerns.
Legal and procedural reforms. Rights for
sexual and reproductive health need to be reinforced by legal and institutional
frameworks. Some national constitutions (notably in Chile, Mexico and South Africa)
explicitly guarantee reproductive rights. Many other countries have reformed laws and
procedures relating to families, inheritance, credit access, schooling, domestic violence
and non-discrimination. In some countries medical codes of ethics and guidelines have been
revised to incorporate standards of care consistent with rights guarantees. The scope of
recent changes reveals an intensification of the review of national laws and procedures
following the international conferences.
Accountability. Measures to hold programmes
accountable for both performance and rights transgressions must be institutionalized.
Communities and service providers should encourage the appointment of independent
observers to receive and evaluate complaints.
Non-governmental alliances. Organizations
focused on human rights, women’s empowerment, health and reproductive rights have
been forging alliances to promote their shared concerns. The historic consensus on
reproductive and sexual rights reached at the ICPD and extended at Beijing was achieved
with the active participation of hundreds of international, national and local
organizations, facilitated by governments’ increasing acceptance of NGO inputs.
Networks have formed to influence conference outcomes and to take part in and monitor
national follow-up efforts. International and local human rights organizations are
documenting and publicizing women’s rights issues including reproductive rights in a
wide variety of countries.4 International and national news media help to raise
awareness of gender-related issues such as sexual violence, discrimination and
reproductive freedom. International meetings have helped ensure prominent attention to
these concerns.5
Mobilization of communities is the best
guarantee of reproductive and sexual rights. The women and men seeking to exercise these
rights know the social, legal and institutional obstacles they face. Women, especially,
are aware of gender inequality with regard to participating in and benefiting from social
and economic development; they know when decisions and actions are being forced on them.
Mobilizing the public to monitor human rights issues will require better education about
these issues and the procedures required to obtain redress. Materials for this purpose
have been developed for use in school curricula at various levels.6
International assistance programmes, both
multilateral and bilateral, need to ensure that programmes they support work to advance
human rights. The United Nations system, in collaboration with governments and NGOs,
should work to strengthen programme monitoring in order to prevent rights violations.
UNFPA is committed to reproductive rights, gender equality and male responsibility, and to
the autonomy and empowerment of women everywhere; it recognizes that safeguarding and
promoting these rights, and promoting the well-being of children, especially girls, are
development goals in themselves. The Fund gives the highest priority to programmes
supporting the advancement of reproductive and sexual rights, and includes such
considerations in its evaluation of programme and project design and implementation.
Towards Better Sexual and
Reproductive Health
The ICPD Programme of Action calls for eliminating
programme-related barriers to information and services for reproductive health, including
family planning and sexual health, by 20057 and attaining
universal access to services by 2015. The function of service delivery programmes should
assist men and women in meeting their reproductive goals.
Capacity building. Provision of high-quality
services requires improved staff training and supervision, supported by regular and
thorough monitoring of performance including provider-client interactions. To work with
their staff and clients in reviewing and improving services, managers need to understand
evaluation methodologies and to allocate the relatively small resources needed to apply
them.8 Self-assessment tools can help managers identify clinic
problems including staff and supply shortages, inadequate equipment, gaps in keeping and
retrieving records, and deficiencies in counselling and outreach.
Improving the quality of care and reorienting
services to address the full range of reproductive health concerns may require additional
investments in both infrastructure (including equipment as well as water and electrical
supplies) and personnel (including training of managers and service staff). Facilities and
personnel need to be used more efficiently. Managers need feedback to identify and correct
shortcomings including uneven quality, efficiency and effectiveness in serving different
delivery sites and different client groups.
Serving underserved groups. National-level
indicators of progress in addressing reproductive health concerns should include
information on specific groups (e.g., the poor, women, rural dwellers, adolescents,
indigenous people, the disabled, migrants and refugees) that are often underserved by
programmes and left out of information systems and research. The perspectives of
underserved groups need to be reflected in the design, implementation and monitoring of
programmes.
Geography, language and cultural barriers all limit
indigenous people’s access to health services. At public health facilities service
providers sometimes fail to respond to indigenous women’s complaints. Language
differences may limit indigenous clients’ understanding of the examination process.
Indigenous groups have criticized the use in their communities of sterilization and
provider-controlled contraceptive methods (especially injectables and implants). Some NGOs
have reported cases of medical experimentation without informed consent, and use of
unapproved or inappropriate drugs. In Ecuador, with UNFPA’s support, the Indigenous
Federation of Imbabura provides indigenous communities with integrated health services,
including vaccination, family planning, emergency referrals and nutrition education,
provided by indigenous physicians and traditional healers. Close attention is paid to
service quality and follow-up.
Partnership with civil society. The ICPD and
other conferences have stressed the importance of involving civil
society—non-governmental and community organizations as well as individual women and
men—in designing, implementing and monitoring reproductive health programmes so they
respond to the felt and stated needs of those they serve. This is true both in public
enterprises serving those too poor to afford private services and in programmes with
substantial private sector involvement. Programmes can also benefit from qualitative
research (such as focus groups, group interviews and rapid assessment procedures9) on the dynamics of social change supporting the expansion
of sexual and reproductive rights.
Partnerships between government programmes and NGOs
have been developed in many countries, recognizing the comparative advantages of the
different actors. Non-governmental organizations have helped test new methods of service
delivery, including outreach to the poor and to adolescents, and collaborated in training
government service providers and in advocacy for national programme expansion.
Guidelines and standards of conduct for
health systems need to incorporate a reproductive rights perspective. WHO (in
collaboration with UNFPA, UNICEF, the World Bank, UNAIDS and other experts) is developing
standards that stress informed consent, attention to the quality of care and
client-centred participatory approaches in reproductive health care, including family
planning, sexuality, safe motherhood and STD/HIV/AIDS prevention and management. Staff
members need training in the protection of clients’ rights, along with information
materials on procedural safeguards for use with clients. |
