A SIMPLE GUIDE FOR TRAVELLERS IN THE ICPD AND MDG GALAXY!

Reproductive Health A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters realting to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. ICPD Pragraph 7.2 Key definitions from the ICPD Programme of Action

Reproductive Rights The basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents. ICPD Paragraph 7.3

In concrete terms, what services are necessary to reach that stage? World Health Assembly May 2004 Prenatal, obstetric neonatal care including promotion of breast feeding and male involvement Contraception Eliminate unsafe abortion Control STI including HIV/AIDS and reproductive system cancers Promoting reproductive health

However, services are not enough. Reproductive health is different from other health fields. It is of pivotal importance in the identity and survival of cultures. Therefore it has been a central concern of statesmen, religious leaders, teachers, parents for thousands of years – medical personnel have diminished role. Especially ill suited to vertical campaigns It is an issue for both men and women, but a much bigger one for women (approx 30% of women’s disease burden) It implicates several people – not only the woman, but often the man and sometimes the child – adding to the complexity It is of particular concern to people in key reproductive ages ( for women) where they are otherwise most healthy

The MDGs 6-8 Sept 2000, 189 States, 147 Heads of State signed Declaration. Afterwards, 8 MDGs, 15 targets and 52 indicators established as monitoring tool for Declaration That monitoring tool was developed quickly, and has some weak points: vertical goals without cross linkages, little human rights language, and in some cases even less integrative concepts related to RH and HIV and Aids

What does the evidence say about Reproductive health and the MDGs?

MDG 5: Improve Maternal Health Contraception STIs Infertility Burden of disease Disparity in access, in actual use and outcomes Women’s Health and domestic violence Target 6: Reduce by 75%, , the maternal mortality ratio. Indicators : - Maternal mortality ratio - Proportion of births attended by skilled health personnel

Other Direct Causes include: ectopic pregnancy, embolism, anaesthesia-related Indirect Causes include: Anaemia, malaria, heart disease Source: WHO 1997

UNFPA is the only UN agency completely devoted to MDG 5!

MDG 6: Combat HIV/AIDS, malaria, other diseases Target 7: Have halted by 2015 and begun to reverse the spread of HIV/AIDS. Target 8: Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases. What is different about HIV/AIDS? Transmission STIs Feminization of the disease Condom prevalence

MDG 4: Reduce child mortality Target 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. Neonatal Deaths Maternal Mortality Birth Spacing Family Size

MDG 3: Promote gender equality and empower women Target 4: Eliminate gender disparity in primary and secondary education, preferably by 2005, and in all levels of education no later than Education Reproductive Health Legal Rights vs. Customary and Traditional Rights Political Empowerment

MDG 1: Eradicate extreme poverty and hunger Target 1: Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day. Target 2: Halve, between 1990 and 2015, the proportion of peole who suffer from hunger.  Population structure has profound implications for economic growth, although it is not easy to draw simple conclusions. Population ageing  30% of economic growth in East Asian miracle is attributed to declining birth rates – lower dependency rates, higher female labour participation  Amongst developed countries, those where women have higher status, and are able to combine work and child bearing, have higher fertility

International statements « The Millennium Development Goals, particularly the eradication of extreme poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And that means stronger efforts to promote women’s rights, and greater investment in education and health, including reproductive health and family planning. » Kofi A. Annan United Nations Secretary General, Bangkok, December 2002

Some relevant commitments at the 2005 Summit Eliminating gender inequality in schools, guaranteeing the right of women to own property equal access to work Universal access to reproductive health by 2015 eliminating discrimination in women’s participation in decision making bodies

The case for reproductive health and rights as a development priority are only words unless bold and decisive action is taken to make them a reality. Need for Action

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