REPRODUCTIVE HEALTH AND THE MDGs: RHETORIC AND REALITY Dr Ernestina Coast London School of Economics

1. Historical setting 2. What are sexual ands reproductive health and rights (SRHR)? 3. SRHR & MDGs

Themes Continued controversy Continued controversy Politics Politics Pragmatism Pragmatism

Historical context ConferenceAudience Perspective/ key issues Rome (1954) TechnocraticNeo-Malthusian Belgrade (1965) TechnocraticNeo-Malthusian Bucharest (1974) Technocrats Country reps 1. FPP 2. Neo- Malthusian Mexico City (1984) Country reps (Technocrats) 1. Neutral 2. Abortion

1994: International Conference on Population and Development Massive lobbying from interest groups Massive lobbying from interest groups DemographicDemographic Women’s healthWomen’s health EnvironmentalismEnvironmentalism Complex and heated Complex and heated “The mess” of the Cairo process (Harcourt)“The mess” of the Cairo process (Harcourt) Consensus document (PoA) Consensus document (PoA) 179 countries signed179 countries signed

A paradigm shift? Sexual and reproductive health and rights Sexual and reproductive health and rights Consensus of 2 competing perspectives Consensus of 2 competing perspectives Population growthPopulation growth Human (esp. women’s) rightsHuman (esp. women’s) rights Prevailing discourse Prevailing discourse Away from fertility and mortalityAway from fertility and mortality Towards health and sexualityTowards health and sexuality Critiques Critiques Consensus = compromise?Consensus = compromise? Demographic target-settingDemographic target-setting

“complete physical, mental, and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes”. Men and women should be able to enjoy a satisfying and safe sex life, have the capability to reproduce and the freedom to decide if, when and how often to do so. This requires informed choice and access to safe, effective, affordable and acceptable health-care services.”

“We are not preparing to give reproductive health services. We are not changing our work after the Cairo conference. There are some lectures on reproductive health and we are now using the term, but we are not preparing these services in our clinics….There is no difference in the offering o services before and after ICPD. There are the same services now as then” Ministry of Health and Health Care Official, Jordan “The scope of reproductive health is not too large. We have already been doing certain things” INGO rep. Bangladesh “Functionally, we don’t think of or refer to the Cairo conference. The government does, and they will talk about it in meetings and when writing reports. But our organisation’s culture does not. Our chief executive doesn’t believe in these big conferences…Within our organisation there is hardly a reference to Cairo or changing anything because of the conference” INGO rep. Malawi

SRHR = a hot button issue public health systems public health systems adolescent’s rights adolescent’s rights gendered responsibilities and rights gendered responsibilities and rights sex education sex education family planning family planning gender-based violence gender-based violence ……amongst other things

Geo-political context a dominant neo-conservative paradigm (particularly in the US) a dominant neo-conservative paradigm (particularly in the US) a weakened UN a weakened UN growing religious fundamentalism growing religious fundamentalism increased aid conditionalities (for example, the “global gag rule”) increased aid conditionalities (for example, the “global gag rule”) “politically expedient silence” from otherwise vocal detractors fearful of funding cuts“politically expedient silence” from otherwise vocal detractors fearful of funding cuts health sector decentralization and reform in many LEDCs health sector decentralization and reform in many LEDCs

MDGs None refer specifically to SRHR None refer specifically to SRHR 1999 – ICPD PoA reaffirmed1999 – ICPD PoA reaffirmed Where is SRHR in the MDGs? Where is SRHR in the MDGs? EverywhereEverywhere NowhereNowhere Why? Why? G-77 inputG-77 input Blocked change from “maternal health” to “reproductive health” Blocked change from “maternal health” to “reproductive health”

Must be explicit "If you're not an MDG you're not on the agenda. If you're not a line item you're out of the game" "If you're not an MDG you're not on the agenda. If you're not a line item you're out of the game" “To be excluded from the MDGs is to be relegated to a lower status of development priorities by developing countries, donor countries and international institutions” “To be excluded from the MDGs is to be relegated to a lower status of development priorities by developing countries, donor countries and international institutions” Steven Sinding (IPPF) Only major UN conference without MDG Only major UN conference without MDG

Are implicit All require adherence to PoA commitments All require adherence to PoA commitments Transdisciplinary approach Transdisciplinary approach “Unfortunate but not disastrous” (Basu) “Unfortunate but not disastrous” (Basu)

#1: Eradicate extreme poverty and hunger With SRHR With SRHR Lower fertility, slower population growthLower fertility, slower population growth Smaller families higher ♀ labour force participationSmaller families higher ♀ labour force participation Income distribution less skewedIncome distribution less skewed Without SRHR Without SRHR Higher pop growth, insecure livelihoods, higher risk of food insecurityHigher pop growth, insecure livelihoods, higher risk of food insecurity Teenage births and short birth intervalsTeenage births and short birth intervals Intergenerational poverty cycle more likelyIntergenerational poverty cycle more likely

Evidence Reproductive illnesses and unintended pregnancies weaken or skill economically productive people Reproductive illnesses and unintended pregnancies weaken or skill economically productive people SRH conditions account for approx 20% global burden of diseaseSRH conditions account for approx 20% global burden of disease 32% of burden among women aged % of burden among women aged Poor RH accounts for majority of disability-adjusted life years lostPoor RH accounts for majority of disability-adjusted life years lost Loss of significant economic contributions Loss of significant economic contributions

2005: World Summit RH introduced: RH introduced: ICPD PoA explicitly mentioned (MDG#6)ICPD PoA explicitly mentioned (MDG#6) Equality of access to RH (MDG#3)Equality of access to RH (MDG#3) But where is the “S” in “SRH”? But where is the “S” in “SRH”? “it has become extremely difficult to even mention the word sex in broad intergovernmental negotiations”“it has become extremely difficult to even mention the word sex in broad intergovernmental negotiations” (Correa, 2005)