Africa: Universal Health Coverage Will Remain Elusive for Women and Adolescents Unless It Includes Sexual and Reproductive Health and Rights

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The ICPD25 conference in Nairobi is being attended by about 7 000 participants.
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This is not only good public health; it makes economic sense as well

This week, Nairobi plays host to global leaders, policymakers and influencers to mark the 25th anniversary of the ground breaking International Conference on Population and Development (ICPD) in 1994 which established an ambitious programme of action to achieve comprehensive sexual and reproductive health and reproductive rights for all.

The Nairobi Summit takes place at a time of critical importance for sexual and reproductive health and rights. Ideologically driven forces are seeking to roll back hard-won gains, to slash funding for essential services, and to remove references to these services and rights from international agreements.

Such efforts to reverse 25 years of progress cannot be allowed to succeed!

The Nairobi Summit must emphatically restate that sexual and reproductive health are matters of fundamental human rights - and they are critical for women's, children's and adolescents' health. At a time when there is growing political momentum in countries to provide affordable, quality health for all - universal health coverage - we must ensure that the full panoply of sexual and reproductive health interventions are included in national health plans, with the financial resources to back them up. We also must direct urgent attention to the ways in which discrimination and stigma prevent the most marginalized groups, including adolescents, migrants, people with disabilities, lesbian, gay, bisexual and transgender persons, minorities and indigenous peoples, amongst others, from accessing sexual and reproductive health services.

It is fitting that ICPD+25 is being held in the region of the world most vulnerable to the negative effects of cuts to sexual and reproductive health and rights. Annually, sub-Saharan Africa accounts for two-thirds of all maternal deaths (196 000), and the rate of stillbirths - often seen as an indicator of the quality of care around the time of birth - is more than eight-times that of high-income regions. Undermining sexual and reproductive health services will place more women, more infants, more children and more adolescents at risk. Rather than cutting back on sexual and reproductive health services and rights, we need to accelerate global efforts to bring them to everyone.

By enshrining sexual and reproductive health and rights into their national health plans, governments can accelerate progress towards universal health coverage, establish accountability mechanisms for such progress and improve the health and lives of women, children and adolescents.

This is not only good public health; it makes economic sense as well. Countless studies have shown, for example, that investing in family planning is one of the most cost-effective development interventions with both immediate savings and long-term benefits, including from reduced infant and maternal mortality and stronger economic growth.

Furthermore, providing a comprehensive package of sexual and reproductive health interventions is affordable and attainable. In low- and middle-income countries, the Guttmacher-Lancet Commission (2018) estimated that the cost of meeting all women's needs for contraceptive, maternal and newborn care (not including HIV treatment and care) amounted to US$13.0 per capita annually. This is surely something that the world can - and must - afford.

As young women in our respective countries, we three fought against entrenched gender norms in order to live independent and fulfilling lives, with decision-making power over our own bodies and the ability to make personal and professional life choices. This generation should not still have to be fighting these battles.

Sadly, decades on, millions of the world's women are still denied autonomy over their own bodies, including access to sexual and reproductive health services to enable them to control whether or when to have children. They lose out on education, their health suffers and they are denied opportunities to earn and control their own income. This is not only holding them back; it is holding us all back.

In the 25 years since ICPD, more and more women (although still too few) have earned their places at the top decision-making tables - in governments, legislatures, civil society, academia, the media and other institutions with power and influence. That they have achieved this is due, at least in part, to being able to pursue the highest educational and professional attainment in tandem with exercising their reproductive choices.

On the eve of the Nairobi Summit, as current and past leaders of the Partnership for Maternal, Newborn & Child Health, we call on other leaders, in all their diversity, to unite their voices behind fully financed health plans to ensure universal access to sexual and reproductive health and rights.

The bright future of girls and women in every corner of the globe depends upon our collective action.

Helen Clark, The Partnership for Maternal, Newborn & Child Health (PMNCH) Board Chair and former Prime Minister of New Zealand

Michelle Bachelet, United Nations High Commissioner for Human Rights, PMNCH former Board Chair and former President of Chile

Graça Machel, PMNCH former Board Chair and Founder of the Graça Machel Trust

Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

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