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

REPRODUCTIVE HEALTH
AND THE MDGs:
RHETORIC AND REALITY
Dr Ernestina Coast
London School of Economics
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2.
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Historical setting
What are sexual ands reproductive
health and rights (SRHR)?
SRHR & MDGs
Themes
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Continued controversy

Politics
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Pragmatism
Historical context
Conference
Audience
Perspective/ key
issues
Rome (1954)
Technocratic
Neo-Malthusian
Belgrade
(1965)
Technocratic
Neo-Malthusian
Bucharest
(1974)
Technocrats
Country reps
Mexico City
(1984)
1. FPP
2. NeoMalthusian
Country reps 1. Neutral
(Technocrats) 2. Abortion
1994: International Conference on
Population and Development
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Massive lobbying from interest groups
• Demographic
• Women’s health
• Environmentalism

Complex and heated
• “The mess” of the Cairo process (Harcourt)
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Consensus document (PoA)
• 179 countries signed
A paradigm shift?
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Sexual and reproductive health and
rights
Consensus of 2 competing perspectives
• Population growth
• Human (esp. women’s) rights

Prevailing discourse
• Away from fertility and mortality
• Towards health and sexuality

Critiques
• Consensus = compromise?
• Demographic 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
 adolescent’s rights
 gendered responsibilities and rights
 sex education
 family planning
 gender-based violence
……amongst other things
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Geo-political context
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a dominant neo-conservative paradigm
(particularly in the US)
a weakened UN
growing religious fundamentalism
increased aid conditionalities (for example,
the “global gag rule”)
• “politically expedient silence” from otherwise
vocal detractors fearful of funding cuts
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health sector decentralization and reform in
many LEDCs
MDGs
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None refer specifically to SRHR
• 1999 – ICPD PoA reaffirmed

Where is SRHR in the MDGs?
• Everywhere
• Nowhere

Why?
• G-77 input
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Blocked change from “maternal health” to
“reproductive health”
Must be explicit
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"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”
Steven Sinding (IPPF)
Only major UN conference without MDG
Are implicit
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All require adherence to PoA
commitments
Transdisciplinary approach
“Unfortunate but not disastrous”
(Basu)
#1: Eradicate extreme poverty and
hunger
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With SRHR
• Lower fertility, slower population growth
• Smaller families higher ♀ labour force
participation
• Income distribution less skewed
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Without SRHR
• Higher pop growth, insecure livelihoods,
higher risk of food insecurity
• Teenage births and short birth intervals
• Intergenerational poverty cycle more likely
Evidence
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Reproductive illnesses and
unintended pregnancies weaken or
skill economically productive people
• SRH conditions account for approx 20%
global burden of disease
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32% of burden among women aged 15-49
• Poor RH accounts for majority of
disability-adjusted life years lost
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Loss of significant economic contributions
2005: World Summit
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RH introduced:
• ICPD PoA explicitly mentioned (MDG#6)
• Equality of access to RH (MDG#3)
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But where is the “S” in “SRH”?
• “it has become extremely difficult to
even mention the word sex in broad
intergovernmental negotiations”
(Correa, 2005)