SWOP Report 2019

Unfinished Business

the pursuit of rights and choices FOR ALL

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Unfinished Business
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Fifty years ago, it was hard for women to obtain contraception and relatively easy to die giving birth. Many women were unable to decide whom and when to marry, and when or whether to have children.

A worldwide movement to give women real choices in life culminated in the 1994 International Conference on Population and Development (ICPD), where a consensus was reached about the links between women’s empowerment, sexual and reproductive health, and rights and sustainable development.

Since then, women have made enormous progress in exercising their reproductive rights. Activists, advocates, public health specialists and many others have pushed relentlessly for the transformations we see around us today.

Since 1969, when UNFPA was established, much has been accomplished. But there is still more to be done before all women and girls are able to exercise their rights.

A worldwide movement The pursuit of rights and choices for all

Can we do better for women and girls today?
If history is a guide, the answer is yes.

What are some of the obstacles still standing in the way of women reaching their full potential in life?

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Gender Inequality

The obstacle underlying all others

© T. Mukoya/Reuters
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Gender-unequal norms remain among the most significant drags on progress for women and girls to freely make fundamental decisions regarding their sexual and reproductive health and rights.

These decisions are inherently relational in that they involve interactions with others, particularly sexual or romantic partners, but also extended family members, community members, or institutions such as clinics and hospitals. The degree of agency an individual has is experienced and determined at different levels within each relationship.

Power, voice and choice shape the degree of agency an individual has within any relationship.

Three gender-dependent aspects of relationships are important in sexuality and reproductive decisions:

  • the power of the individual
  • their voice, or the degree to which individuals are able to articulate and advocate for their needs and desires
  • the extent to which individuals have real choices
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Individual Agency:

Knowledge about sexual and reproductive health and rights can enable a person to more effectively advocate for oneself and make informed choices.

Immediate Relational Agency:

Agency depends on factors such as the degree to which a partner respects the other’s bodily integrity or the degree to which there is freedom to express views about contraception.

Distant Relational Agency:

Agency depends on the responsiveness to individual needs within institutional relationships such as health systems or even the economy.

Gender-unequal norms and attitudes are often used to rationalize control over women’s sexuality and reproduction through a range of harmful practices.

Gender-based violence

Violence against women and girls is a major human rights violation and public health concern across all countries. The existence and even threat of violence creates an environment where women are subjugated by men in sexual and reproductive health matters and are at increased risk of sexually transmitted infections and unwanted pregnancies.

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1 in 3 women
worldwide will experience physical or sexual violence at some point in their lifetimes

Child marriage

Many child brides lack the autonomy to make decisions about their reproductive health — and the freedom of movement to act on their own decisions by visiting health providers. Married girls are less likely to receive adequate medical care during pregnancy, mothers and babies are at risk as many married girls are not yet physically ready to give birth.

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An estimated 800 million women alive today were married when they were children

Fertility pressure and son preference

Both men and women can face considerable pressure to prove their fertility early in marital relationships. In many societies, extreme pressure is placed on women to bear sons. They may encounter violence, abandonment, or stigma for birthing girls instead of boys.

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These practices lessen the degree of power, voice or choice for both men and women

Unfinished business

Such practices need to be entirely eliminated, starting with clear legal statutes backed by implementation. Progress has been made in working within communities to explain the harm that these practices impose and build consensus around abandonment.

Engaging men and boys in the process of transforming attitudes around gender-unequal norms is critical.

Educating and empowering girls to stay in school has had the most impact on changing these norms. Education enhances women’s understanding of their place in society, provides them with the skills and information to exercise their voice in relationships, and enables them to negotiate for their own interests.

Inaccessible Services

When availability is not enough

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The world’s population in 1969 was growing at about 2 per cent a year. At that rate, it would almost double within the next 25 years. Never before had population grown so rapidly.

Fear of over overpopulation drove many countries to adopt family planning programmes that focused more on reducing population numbers rather than on what women, depending on their specific situation, may need or want.

Many family planning programmes served to reinforce existing gender norms, as the focus was usually on women — married women in particular — and assumed the primary role of women to be wives and mothers. Little programming was directed towards men, aside from efforts to increase condom use.

Access to sexual and reproductive health care goes beyond the availability of contraception.

Sexual and reproductive health care includes:

  1. Treatment of sexually transmitted infections
  2. Treatment of infertility
  3. Safe abortion (where legal) and post-abortion care
  4. Safe delivery and postnatal care
  5. Antenatal care
  6. Education on reproductive health and responsible parenthood
Sexual and reproductive health care includes:
1 2 3 4 5 6

The barriers that still exist

The ICPD Programme of Action recognized that what the world needed was to provide women, couples and families with access to a range of sexual and reproductive health interventions, and to realize social and economic changes that would empower women, respect their rights, and help move the world towards gender equality.

Despite the progress made, some family planning services continue to remain inaccessible to many women and girls around the world.

Income inequality

 

The relationship between poverty and lack of access is complex; while financial costs of health services and supplies can be a barrier to access in some cases, income is linked to numerous social, institutional, political, geographic and economic forces that can also affect an individual’s access.

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Insufficient facilities, providers and supplies

 

A woman who seeks sexual and reproductive health information and services may find no provider in her community. If she has the means to cover the cost of transportation to a clinic in a neighbouring community, she may arrive only to find that it lacks the proper equipment or supplies for the services she needs.

There may not be enough health service providers, if any, working that day. The providers may not have the right training to offer appropriate information or services, or perhaps not be able to offer privacy or other measures that would enable her to feel safe and respected.

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Legal barriers

 

In some places, laws require third-party authorization for women or adolescents to access health services. There may be laws in place that criminalize same-sex relationships, sex work or drug use, forcing people into hiding and preventing them from seeking or receiving the information and services they need. Laws regarding access to abortion fall along a continuum, from total prohibition to no restrictions. The more restrictive the legal setting, the higher the proportion of unsafe abortions.

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Norms, attitudes and practices

 

Marginalization and fear of stigma in one’s community can prevent individuals from seeking services they need and are entitled to, increasing their risk of sexual violence, unplanned pregnancy and sexually transmitted infections.

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Insufficient education about sexuality

 

Misperceptions or a lack of understanding about sexuality, the human body and development, and rights and gender can leave a young person ill-equipped to make decisions regarding their reproductive health.

Curriculum-based sexuality education programmes aim to equip children and young people with knowledge, skills, attitudes and values that will empower them to understand and ensure the protection of their rights throughout their lives.

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Unfinished business

Everyone, everywhere should have access to high-quality information and services for the full range of their sexual and reproductive health needs over the course of their lives. While remarkable progress towards this objective is evident, its full realization remains elusive for many, due to lack of awareness, scant resources, insufficient political will, or underlying gender inequality.

Services not only need to physically reach these groups, but they must also be tailored to their needs, confidential, and free of judgement or coercion.

Many countries can do much more to uphold rights and choices for all by removing barriers to services and information for people with diverse sexual and gender orientations.

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The world today faces unprecedented levels of humanitarian need. 136 million people were in need of humanitarian aid worldwide in 2018.

Every humanitarian crisis—whether due to conflict or natural disaster—causes systems to break down, increasing multiple needs for protection and services.

Systems breakdown

  • Icon breakdown in
    security
  • Icon loss of shelter
  • Icon disruption of water, food, sanitation and health services

Crises can increase the vulnerability of women and girls and threaten their lives. In the initial rush to provide food and shelter, responders may overlook the additional need for protection and availability of services.

Due to a lack of services or legal restrictions:

  • access to contraceptives is extremely limited
  • the risks of unintended pregnancy and sexually transmitted infection are extremely high
  • safe abortion services are often minimal or nonexistent in crisis settings
© B. Sokol/Panos Pictures
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© B. Sokol/Panos Pictures
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Every day, more than 500 women and girls in countries with emergency settings die during pregnancy and childbirth, due to the absence of skilled birth attendants or emergency obstetric procedures and to unsafe abortions.

Pregnant women and mothers of small children are particularly at risk.

Trauma and malnutrition are dangerous during pregnancy, and during emergencies many women miscarry or deliver prematurely. The lack of even basic conditions for a clean delivery increases the risk of a fatal infection for both mother and child.

© Ali Arkady/VII/Redux
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© Ali Arkady/VII/Redux
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At least 1 in 5 refugees or displaced women in complex humanitarian settings have experienced sexual violence, though it is often unreported.

Fear of sexual assault or exploitation and abuse restrict the mobility of many refugee and displaced women. Some families in dire circumstances resort to child marriage, hoping that marrying their daughters off will protect the girls from violence.

© Filippo Monteforte/Getty Images
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© Filippo Monteforte/Getty Images
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Unfinished business

Governments, aid organizations and international institutions are increasingly delivering services to women and adolescent girls whose choices have been constrained by conflicts and natural disasters.

Being prepared means putting plans in place where supplies are pre-positioned to respond to disasters. Supplies should include contraceptives, safe delivery kits and other essentials for reproductive health. Boosting investments in psychosocial services and mental health is critical.

More programmes that provide people with the chance to learn about sexual and reproductive health, challenge gender norms or offer refuge from gender-based violence are essential. Amid the disruption, women and girls should be able to explore new roles, such as through job training.

Four women, Four Journeys

A woman who was 10 years old in 1969, when UNFPA was established, came of age in a time when her sexual and reproductive rights were much more constrained than those of a woman who was 10 years old in 1994, when the ICPD took place.

Their different experiences tell a story of the changes we have seen over the last 50 years. But it is also clear that not everyone, everywhere, is fully able to exercise their reproductive rights, even today.

“I was married at 13.” - Dahab, 60

“Work is my freedom.” - Fanie, 35

“I didn’t know family planning existed.” - Alma, 60

“Access to information is everything.” - Tsitsina, 35

 

Realizing rights and choices for all

Many remarkable advances in expanding sexual and reproductive rights and choices have been championed by governments, civil society and international organizations over the last 50 years. The ICPD offered a visionary global commitment to these rights and choices, and an unprecedented consensus on the essential ties between women’s empowerment and development. Twenty-five years later, the ICPD vision remains a high point of human aspiration, reflected now across the 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs).

Looking forward, however, some old problems remain. And new ones have emerged.

As a measure of the task ahead, UNFPA and its many partners have issued a clarion call for three zeros by 2030: there should be no unmet need for contraception, no preventable maternal deaths, and no violence or harmful practices against women and girls.

© Andrea Bruce/NOOR Photo

We all deserve a world where everyone enjoys all of their rights and can live the lives they choose.

If not now, when?

© Cristina García Rodero/Magnum Photos
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