Reproductive health and ICPD ten years on

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Reproductive health and ICPD ten years on

• TK Sundari Ravindran
• 2 September 2005

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Outline of the presentation

• ICPD what was its significance?
• Reproductive health evolution of the concept
  and how it came to be included in the ICPD
  Programme of Action
• What is happening for the promotion of
  reproductive health 11 years after ICPD?

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WHAT WAS NEW ABOUT ICPD
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1. THE WAY IT VIEWED WOMEN
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IN THE DEMOGRAPHIC APPROACH

• Women were the tools through which population
  control objectives were achieved
• Control women to control population

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IN THE ICPD APPROACH

• Women are intrinsically valuable
• Genuine concern about their health and wellbeing
• Empower them to exercise autonomy
• - on Reproductive Health and sexual health
  matter
• - within the context of social, economic and
  political situation
• Womens health not defined by access and
  availability alone but by their status in
  society- role of health seeking behaviour

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2. THE WAY IT VIEWED FAMILY PLANNING
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IN THE DEMOGRAPHIC APPROACH

• FP was the main tool for controlling population
  growth
• Effective methods received more emphasis
• Availability and access were the main concern

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IN ICPD

• FP is a not the tool for population stabilization
• Client convenience and acceptability are as
  important as effectiveness
• Quality of service is as important as availability

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3. ICPD MOVED TO REPRODUCTIVE HEALTH
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• Meeting client needs became an important
  perspective
• Acknowledged needs beyond FP
• Therefore talked of addressing reproductive
  health concerns, not just FP
• RH/FP should not be a womens only problem. Men
  should not only share the burden of
  contraception, but should also be encouraged to
  be responsible and supportive partners

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WHAT IS RH?

• Reproductive health is a state of complete
  physical, mental and social wellbeing, not merely
  the absence of disease in matters relating to
  the reproductive system
• Implies a satisfying and safe sex life
• Capability to reproduce, and the capability to
  decide if, when and how often
• to be informed and to have access to safe,
  effective, affordable and acceptable methods of
  FP
• Safe pregnancy and child birth, and a healthy
  infant
• Sexual health is not merely counselling and care
  related to reproduction and STDs, but the
  enhancement of life and personal relationships
• Life Cycle Approach

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• The Beijing Womens Conference reiterated what
  ICPD said on RH and RR

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4. THE WAY ICPD VIEWED INCENTIVES TARGETS
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ICPD said ... Governments should use the
full means at their disposal to support the
principal of voluntary choice in Family
Planning. ( 7.15 ) Governments are urged
to institute systems of monitoring with a view
to detecting, preventing and controlling abuses
by FP managers and providers to ensure
quality of services (7.17) Governments
should secure conformity to human rights and to
ethical and professional standards in the
delivery of FP and RH services aimed at
ensuring responsible, voluntary and informed
consent. (7.17)
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Government goals for FP should be defined in
terms of of unmet needs for information and
services. Demographic goals, while legitimately
the subject of government development strategies,
should not be imposed on family planning
providers in the form of targets or quotas for
the recruitment of clients (7.12) Over the
past century, many governments have experimented
with schemes of incentives and disincentives,
in order to lower or raise fertility. Most such
schemes have had only marginal impact on
fertility and in some cases have been
counterproductive. (7.12) Governments are
encouraged to focus most of their efforts for
reducing fertility through education and
voluntary measures rather than schemes involving
incentives and disincentives. (7.22)
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5. ICPD INTRODUCED THE CONCEPT OFREPRODUCTIVE
RIGHTS
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REPRODUCTIVE RIGHTS INCLUDE

• Reproductive Decision Making
• Voluntary choice in marriage and family formation
• Decide number, spacing, timing of children, and
  have the information and the means to do
• Access to safe contraception, good information,
  follow up
• Sexual and Reproductive Security
• Freedom from sexual coercion and violence
• The Right to Privacy
• Safety
• In childbirth, from infections STD, RTIs,
  HIV/AIDS

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REPRODUCTIVE RIGHTS INCLUDE (CONTD)

• Valid for couples and individuals
• Equity and Equality for men and women, exercising
  choices free from discrimination based on gender
• Create an environment where people can freely
  make reproductive choices and decisions invest
  in basic social services, education, and health
  care

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TO RECAP
ICPD was about Womens Equality about RH
instead of FP about Informed Choice against
coercion
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II. REPRODUCTIVE HEALTH EVOLUTION OF THE
CONCEPTDEVELOPMENT OF THE CONCEPT
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Reproductive rights on the feminist agenda

• 1830 Right to decision-making regarding
  childbearing raised by Owenite Socialist women
• 1908 Alexandra Kollantai in her Social bases of
  the Woman Question claimed not only womens
  right to fulfilling work but also their right to
  sexual freedom and control over their own
  fertility

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Reproductive rights on the feminist agenda (2)

• 1915 Emma Goldman and Margaret Sanger defied
  obscenity laws in the US by distributing
  pamphlets on birth control, initiating the US
  birth control movement
• 1918 National Union Womens Suffrage Societies
  in England expands its objectives to include
  legislative reforms in divorce and legitimacy,
  and pressed for public provision for birth
  control.

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Reproductive rights on the feminist agenda (3)

• 1918 onwards In England, women workers
  organisations support the development of a birth
  control movement under the leadership of womens
  suffrage groups, because of concern over high
  rates of maternal mortality and to free women
  from the bondage of unwanted pregnancies.

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Reproductive rights on the feminist agenda (4)

• 1960s and 1970s The rise of the new wave
  feminist movement in the West. Right to abortion,
  violence against women, medicalisation of womens
  bodies are major issues of concern.
• Major actions setting up womens health centres,
  campaigning for the legal abortions, demystifying
  medicalisation through womens health resource
  centres .. Major types of actions in womens
  health.

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Reproductive rights on the feminist agenda (5)

• 1977 The first International Women and Health
  Meeting (IWHM) held in Rome, drawing mainly
  European feminist groups
• 1980s Womens health movement becomes truly
  international, drawing feminist groups from
  developing countries, chiefly Latin America and
  Asia. No to population control, women decide!
  becomes important campaign message alongside
  right to abortion and contraception.

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Reproductive rights on the feminist agenda (6)

• 1984 The fourth IWHM held in Amsterdam, and
  Womens Global Network for Reproductive Rights
  formed from the International Abortion Rights
  Campaign to reflect the changing agenda and
  priorities of the movement.
• 1987 - 1993 A dynamic womens movement supported
  by a favourable political climate succeeds in
  putting in place womens health policies, in
  Brazil, Columbia and Australia

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Reproductive rights on the feminist agenda (7)

• 1990s There is more dialogue between technical
  institutions such as the WHO and some feminists
  in the womens health movement on issues such as
  contraceptive research and maternal mortality.
  Several meetings held in WHO specifically for
  womens health advocates to meet with scientists.

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Reproductive rights on the feminist agenda (8)

• 1990s The International Womens Health Coalition
  (IWHC) emerges as a major player among those
  willing to engage in dialogue with the
  establishment. They lobby international donor
  organisations, technical and professional
  organisations to expand the MCH/FP agenda.
• 1993 A pre-ICPD meeting sponsored by IWHC brings
  together more than 500 women and forges a
  consensus position among the diverse voices of
  feminists.
• Womens Declaration on Population Policies
  which emerged from this process was signed by
  hundreds of womens organisations across the
  globe.

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Reproductive rights on the feminist agenda (9)

• 1992-1994 Active participation by some feminist
  groups and NGOs in the Cairo process. Women find
  their way into official delegations and also plan
  for active participation in the ICPD.
• 1994 ICPD adopts the language of reproductive
  rights and reproductive health, due to a very
  specific configuration and alignment of political
  forces and Vaticans extremist position.

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REPRODUCTIVE HEALTH AND ICPD PoA 10 YEARS DOWN
THE LINE
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Comprehensive reproductive health care still a
distant dream?

• However, a comprehensive reproductive health (RH)
  programme on the ground is a long way off in the
  vast majority of countries. What exists in many
  countries are a few add-on-services such as
  screening and treatment of reproductive tract
  infections and sexually transmitted infections
  superimposed on maternal and child health care
  (MCH) and /or family planning services. In many
  of the countries, HIV/AIDS services are provided
  through a parallel vertical structure.

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Improvement in population coverage modest

• Improvement in population coverage also appears
  to have been limited. Only 48 countries (about
  one-third of the total) report having increased
  service delivery points for reproductive health
  services, and the number of countries reporting
  the provision of facilities for post-abortion
  services is even lower at just 15.

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Affordability worsening

• Information related to affordability and to
  services for low-income and socially
  disadvantaged groups suggests that very limited
  progress has been made in this regard. Free
  reproductive health services are available in
  public health facilities in less than 10 per cent
  of the countries, and are reported to be
  affordable in another 10 per cent.
  Contraceptives are supplied free of cost or at
  subsidised rates in only 27 countries. Specific
  measures have been taken to provide maternal
  health services to vulnerable groups and/or
  remote areas in only 19 countries and only 12
  countries have taken steps to address the issue
  of transportation for emergency obstetric care.

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Resources a major challenge

• Resources are crucial for even significantly
  expanding the
• coverage of maternal and child health (MCH) and
  family planning (FP) services, without seeking to
  improve quality or increase new services.
• (e.g.) In the late 1990s 40 of Moroccos
  provinces lacked medical facilities to handle
  obstetric emergencies. At around the same period,
  a third of the population of Burkina Faso lived
  in districts without access to surgical
  facilities including emergency obstetric care.

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Hostile political environment

• The concept of Reproductive health is under
  serious attack by fundamentalist forces
  everywhere.
• However, the opposition of the Bush
  administration has perhaps caused the most damage
  to the progress of reproductive health.
• Major funding cuts to reproductive health and
  family planning programmes in international
  organisations
• The global gag rule causing major damage

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The evaporation of RH policies

• Political muscle flexing has succeeded in keeping
  reproductive health out of Millennium Development
  Goals

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The struggle for reproductive health and rights
is ongoing

• Efforts to keep RH on the agenda continue.
• This includes the development of an RH strategy
  by WHO which emphasises the centrality of RH for
  achieving MDGsPolitical muscle flexing has
  succeeded in keeping reproductive health out of
  Millennium Development Goals
• There have been efforts to introduce indicators
  on RH in at least two MDG Task Force reports.
• UNFPA is actively involved in keeping the RH
  agenda alive.
• Many NGOs and most importantly, feminist groups,
  continue with their advocacy efforts

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Reproductive Health - more than a medical or a
health issue

• Reproductive health is not now, and never has
  been, simply a matter of preventing disease. This
  is because womens ability to bear children is
  linked to the continuity of families, clans and
  social groups the control of property the
  interaction between human beings and their
  environment the relationship between men and
  women and the expression of sexuality. It is
  therefore valuable currency in every society and
  the object of regulation by families, religious
  institutions and governmental authorities.
  (Maine D, Freedman L, Shaheed F et al, 1995)