INTRODUCTION:
Rights, Empowerment and Development

Reproductive and sexual health is a right for both men and women. Today, gaps and failures in reproductive health care, combined with women's long-established inequality and the pressures of society and family, keep people all over the world from exercising their sexual and reproductive rights.1 This massive denial of human rights causes the deaths of millions of people every year: many more are permanently injured or infected. Most of these people are women, and most are in developing countries.

Reproductive rights include voluntary choice in marriage, sexual relations and childbearing.

At the International Conference on Population and Development (ICPD) in 1994, 180 nations accepted universal access to reproductive health information and services as a goal to be reached by 2015. UNFPA's third State of World Population report since the ICPD presents the evidence on progress and problems in attaining and protecting sexual and reproductive rights.

What Are Sexual And Reproductive Rights?

International understandings about sexual and reproductive rights have broadened considerably over the past three decades. The key components are the rights to:

• reproductive and sexual health as a component of overall health, throughout the life cycle;
  
  
• reproductive decision-making, including voluntary choice in marriage, family formation and determination of the number, timing and spacing of one's children; and the right to have access to the information and means needed to exercise voluntary choice;
  
  
• equality and equity for men and women to enable individuals to make free and informed choices in all spheres of life, free from discrimination based on gender;
  
  
• sexual and reproductive security, including freedom from sexual violence and coercion, and the right to privacy. These rights are related to other social, economic and cultural rights through an intricate web of international, national and local understandings about the mutual obligations of individuals, families, communities and the state.
  

The Effect Of Denying Sexual And Reproductive Rights

The following statistics are estimates. All are drawn from reliable sources, but the data are incomplete—itself an indicator of the low priority given in the past to sexual and reproductive health.

• 585,000 women—one every minute—die each year from causes related to pregnancy. Nearly all are in developing countries. Many times that number suffer temporary or permanent disability as the result of childbirth. Most of these lives and much suffering could be spared by relatively low-cost improvements in reproductive health care such as better monitoring and care during pregnancy, and by emergency referral and transport systems and care after delivery.
  
  
• About 200,000 maternal deaths each year result from the lack or failure of contraceptive services
  
  
• 120–150 million women who want to limit or space their pregnancies are still without the means to do so effectively. Altogether 350 million couples lack information about contraception and access to a range of contraceptive services.
  
  
• At least 75 million pregnancies each year (out of a total of about 175 million) are unwanted; they result in 45 million abortions and over 30 million live births.
  
  
• 70,000 women die each year as a result of unsafe abortion: an unknown number suffer infection and other health consequences. Many of the estimated 20 million unsafe abortions would be avoided if safe and effective means of contraception were freely available. (Page 23.)
  
  
• 1 million people die each year as a result of reproductive tract infections, including sexually transmitted diseases (STDs) other than HIV/AIDS. For women aged between 15 and 44 in developing countries, the second highest burden of disease (after maternal mortality and morbidity) comes from STDs, and they account for nearly 15 per cent of all health lost in this age range. There are an estimated 333 million new cases of STDs per year.
  
  
• Six out of ten women in many countries have a sexually transmitted disease. About half of all infected women may experience no symptoms; more do not understand their symptoms; but all face a higher risk of infertility, cervical cancer and other serious health problems. STDs also increase susceptibility to HIV/AIDS and can place users of intra-uterine contraceptive devices at risk of pelvic inflammatory disease and other reproductive tract disorders. Female genital mutilation increases susceptibility to STDs.
  
  
• 3.1 million people in 1996, six every minute, were infected by the human immunodeficiency virus (HIV) which leads to AIDS. An estimated 50-60 per cent of all new STD cases, including HIV infections, are among young people under 20.
  
  
• 120 million women have undergone female genital mutilation; another 2 million are at risk each year. It is in its various forms an invasive, painful, sometimes life-threatening and completely unnecessary type of surgery, usually carried out under conditions that easily transfer infection. The reproductive health consequences are severe and life-long. The international community and individual governments have condemned the practice, yet it remains widespread in about 28 countries.
  
  
• Rape and other forms of sexual violence are increasing, though many rapes are unreported because of the stigma and trauma associated with them and the lack of sympathetic treatment from legal systems. Estimates of the proportion of rapes reported vary: less than 3 per cent in South Africa and about 16 per cent in the United States.
  
  
• At least 60 million girls who would otherwise be expected to be alive are "missing" from various populations as a result of sex-selective abortions or relative neglect.
  
  
• 2 million girls between the ages of 5 and 15 are introduced into the commercial sex market each year.
  
  
• Studies of domestic violence suggest that it is widespread in most societies; it is a frequent cause of suicide among women, and of murder.
  
  
• Nearly 600 million women are illiterate, compared with about 320 million men.
  
  
• 25 million people are refugees, a disproportionate number of them women; reproductive health care is only now becoming a standard part of the health care package offered to refugees.
  
  
• Contraceptive protection for women in refugee camps could be provided for between $1 and $5 per woman. Safe delivery of a child in a refugee camp can be guaranteed for between $5 and $10.
  
  
• The total worldwide yearly cost of better reproductive health care is approaching $17 billion —less than one week of world expenditure on armaments.
  
  
• The total worldwide yearly cost of better reproductive health care is approaching $17 billion— less than one week of world expenditure on armaments.
  

This report advocates sexual and reproductive rights to empower people, especially women, and to promote gender equality. People in authority, those in public positions and the media should do all they can to strengthen these rights. Abuses must be exposed and vigorously condemned.


Human Rights, Global Needs

Achieving sexual and reproductive rights is an end in itself. It will also have an impact on the economic and social life of the community, and on national and global futures.

Global and national needs coincide in this case with personal rights and interests. Given the choice, most women in developing countries would have fewer children than their parents' generation. Ensuring that women and their partners have the right to choose has stimulated the trend towards smaller families, and has helped countries to find a balance between their populations and their resources; better prospects for development will in turn bring sexual and reproductive heath and rights to more people.

The most practical and effective population and development policy is to create an environment in which people can freely make reproductive choices and decisions. This implies a priority for investment in basic social services such as education and health care. Especially, it means investing in women and redressing the gender imbalance, so that women can make choices on an equal basis with men.

This was the basis for agreement at the International Conference on Population and Development and forms part of the Programme of Action2 accepted by the 180 nations attending the Cairo conference. It is a key part of the social development agenda of the 1990s series of world conferences. Governments, non-governmental organizations and communities are now working on turning the understanding into practical reality.



Summary

The first chapter of this report sets out the legal framework for reproductive rights, discusses specific rights for sexual and reproductive health, and advocates legal and policy reforms to promote reproductive rights.

Chapter 2 examines the burden of poor health related to reproduction and sexuality, and addresses a number of the major causes and some of the solutions, including reproductive health services.

Chapter 3 addresses the sexual and reproductive health needs of adolescents, rights in marriage and childbearing, violence against women—in the home, in the streets and in war or natural disasters—and trafficking in girls and women.

Chapter 4 deals with sustainable development, defined by, among other things, a better quality of life for all people, regardless of gender. This implies a development agenda that focuses directly on meeting the needs and hopes of individual men, women and children. Empowering people to escape from poverty and accelerate overall development will require the recognition and exercise of their basic rights.

The most practical and effective population and development policy is to create an environment in which people can freely make reproductive choices and decisions.

Chapter 5 points out that action is especially needed in two areas: first, to put in place information and services that meet the full range of requirements for sexual and reproductive health; and second, to establish the broad human rights which enable sexual and reproductive rights. This will require public advocacy and leadership; efforts to ensure that the full range of high-quality reproductive health information and services are available to all women and men, whatever their personal situation; action towards better health and education for all, but especially to close the "gender gap" in education; and action against poverty.

Also needed are: national and international legal reform; the recognition in national human rights documents of the definitions of reproductive rights accepted by the ICPD and the Fourth World Conference on Women (FWCW) in Beijing in 1995; better data and better monitoring of sexual and reproductive health and rights; and strengthening NGOs working for reproductive health and rights, including international human rights and reproductive rights organizations.

Key to achievement of sexual and reproductive rights and specifically the goals of ICPD will be honouring the commitments made at Cairo. A special section on progress made in implementing ICPD concludes the report.