+SEX Konferencerapport

+Sex Conference
- How Sexual and Reproductive Health and Rights is a
Necessary Shortcut to Reach the Millennium Development
Goals
Conference Report
6 June 2007
The meeting room of the Danish Social Democrats, The Danish Parliament
Hosted by the Danish Parliamentary Network for Sexual and Reproductive
Health and Rights
(Folketingets Tværpolitiske Netværk for Seksuel og Reproduktiv Sundhed
og Rettigheder)
1
Background for the 2007 +Sex Conference
The conference +SEX was hosted by the Danish Parliamentary Network for
Sexual and Reproductive Health and Rights.
This was the second conference organised by the Danish Parliamentary
Network for Sexual and Reproductive Health and Rights, which was launched
in October 2006 working for the advancement of sexual and reproductive
health and rights (SRHR) nationally and internationally.
The aim of the conference was to analyse the relations between SRHR and the
Millennium Development Goals (MDGs), to identify the most important
challenges in order to reach the new objective under goal 5: “To obtain
universal access to reproductive health”. Another aim was to discuss what
Danish and European decision-makers and aid organisations can and should
do to integrate SRHR and the MDGs.
For more information about the Danish Parliamentary Network on Sexual and
Reproductive Health and Rights, please access the following link:
www.tvaerpolitisknetvaerk.dk
This report was compiled and written by Susanne Olejas for the Danish Family Planning
Association (Sex & Samfund) June 2007
2
Programme for the +SEX conference
13.30 – 14.00: Registration
Welcome
14.00 – 14.05:
Welcome by Ms. Kirsten Brosbøl, Chairperson of the Danish
Parliamentary Network for Sexual and Reproductive Health and
Rights.
14.05 – 14.15:
The background for the +SEX conference and an introduction
of the fact sheet by Bjarne B. Christensen, Secretary-general
of The Danish Family Planning Association.
14.15 – 14.30:
Opening speech by Ms. Ulla Tørnæs, Minister for Development
Cooperation.
Sexual and reproductive health and rights and the Millennium Development
Goals
14.30 -15.00:
Presentation by Stan Bernstein from UNFPA Headquarters (the
audience will be allowed to put questions for five minutes).
15.00 -15.30:
Presentation by Indu Capoor, Director of ‘Centre for Health,
Education, Training and Nutrition Awareness’ (CHETNA) an
Indian NGO, on how to integrate sexual and reproductive
health and rights in the Millennium Development Goals from a
South Asian perspective and the challenges in this regard (the
audience will be allowed to put questions for five minutes).
15.30 – 15.45:
Break - coffee and cake.
Strategies in order to secure universal access to reproductive health
15.45 – 16.15:
“The way ahead to reach universal access to reproductive
health”, by Gill Greer.
16.15 – 16.55:
Debate and suggestions for directions for action. A panel of
keynote speakers will answer questions from representatives
of the Danish Parliament as well as the remaining audience.
16.55 – 17.00:
Closing remarks by Ms. Kirsten Brosbøl, Chairperson of the
Danish Parliamentary Network for Sexual and Reproductive
Health and Rights.
3
Table of Contents
PROGRAMME FOR THE +SEX CONFERENCE ................................................................................. 3
EXECUTIVE SUMMERY OF THE +SEX CONFERENCE................................................................. 5
SUMMERY OF WELCOMING SPEECH ................................................................................................. 6
EXECUTIVE SUMMERY OF INTRODUCTORY REMARKS........................................................... 7
EXECUTIVE SUMMERY OF THE OPENING SPEECH .................................................................... 8
SUMMARY OF STAN BERNSTEIN’S PRESENTATION ................................................................ 9
SUMMARY OF INDU CAPOOR’S PRESENTATION ..................................................................... 10
SUMMERY OF GILL GREER’S PRESENTATION ........................................................................... 11
EXTRACT FROM THE PANEL DISCUSSION BETWEEN GUEST-SPEAKERS AND
PARTICIPANTS............................................................................................................................................ 13
CONCLUDING REMARKS ........................................................................................................................ 15
ANNEX 1 ....................................................................................................................................................... 16
Executive Summery in Danish (Dansk Resume) ..................................................................... 16
ANNEX 2 ....................................................................................................................................................... 18
Biographical data on the speakers ................................................................................................ 18
ANNEX 3 ....................................................................................................................................................... 20
Participants (alphabetical)................................................................................................................ 20
ANNEX 4 ....................................................................................................................................................... 22
Welcome speech................................................................................................................................... 22
ANNEX 5 ....................................................................................................................................................... 24
Opening speech .................................................................................................................................... 24
ANNEX 6 ....................................................................................................................................................... 27
The way ahead to reach universal access to reproductive health .................................... 27
ANNEX 7 ....................................................................................................................................................... 33
Stan Bernstein’s Power Point Presentation ................................................................................ 33
ANNEX 8 ....................................................................................................................................................... 37
Indu Capoor’s Power Point Presentation..................................................................................... 37
ANNEX 9 ....................................................................................................................................................... 42
Resources on Linking Sexual and Reproductive Health and Rights to the MDGs........ 42
ANNEX 10..................................................................................................................................................... 44
Media Coverage of the Conference ............................................................................................... 44
.............................................................................................................................................................................
4
Executive Summery of the +Sex Conference
About 75 people, including Danish Members of Parliament, Youth politicians, NGO staff,
staff from Danish research institutions and universities, staff from the Ministry of Foreign
Affairs and other people working with sexual and reproductive health and rights (SRHR),
gathered at the +Sex-Conference to
- analyse the relations between SRHR and the MDGs,
- identify the most important challenges in order to reach the new objective
under goal 5: “To obtain universal access to reproductive health” and
- discuss what Danish and European decision-makers and aid organisations can
and should do to integrate SRHR and the MDGs.
Three prominent speakers from UNFPA, IPPF and CHETNA accepted to come and speak
about these key issues from their perspective.
The Danish Minister for Development Cooperation, Ulla Tørnæs, affirmed her personal
and professional dedication to promote SRHR and stressed it as an important tool to
achieve the MDGs. She was happy to note that Denmark early understood the
importance of linking SRHRs to the MDGs.
She underlined the importance of having indicators to support the implementation of the
new target of universal access to reproductive health by 2015 under Goal 5 (Improve
Maternal Health) and underlined that collaboration between civil society, UN, donors and
governments is a must for the attainment of the MDGs.
Stan Bernstein, Senior Policy Advisor, UNFPA, stressed the need to scale up efforts by
ensuring a systematic and comprehensive approach to integrating SRHR into the MDGs.
He stressed that better service delivery and the full integration of SRHR into health
systems is required and recommended that the new indicators were used to coordinate,
monitor and evaluate efforts towards achieving the MDGs.
Indu Capoor, Director of CHETNA, India, requested that donors did not focus solely on
institutional care and health services as the solution to sexual and reproductive health
(SRH) problems. She stressed the need to break the cultural silence about women’s
sexuality and to empower young women to speak out to express their sexual and
reproductive health needs. She pleaded for a people-centred and holistic approach and a
stronger civil society.
Gill Greer, Director General, IPPF, reminded us that SRHR is often blocked by political
leaders, fear of controversy and the lack of recognition of women’s human rights. She
underlined that universal access to SRH is only realizable with patience and with
determination to change judgmental attitudes. She also stressed the need to scale up
information and education for people world wide.
In summary, the conference clarified some of the important links between SRHR and the
MDGs and underlined the need to integrate SRHR into development aid in order to
secure the attainment of the MDGs. Furthermore, the speakers stressed the important
role of politicians in legislating and securing funds for the integration of SRHR in the
MDGs and the need for a strong civil society to put pressure on governments.
5
Summery of Welcoming Speech
By Kirsten Brosbøl, MP for the Danish Social Democrats and Chairperson for the Danish
Parliamentary Network for Sexual and Reproductive Health and Rights.
Kirsten Brosbøl welcomed everybody and expressed her gratitude and satisfaction with
the big interest shown at the +Sex Conference.
The conference is the second conference held by the Danish Parliamentary Network for
Sexual and Reproductive Health and Rights open to the public and the first international
conference about reproductive health issues in the network. Kirsten Brosbøl was
therefore particularly proud to present the renowned guest-speakers.
The aim of the conference was to discuss the linkages between SRHR and the MDGs as
well as challenges and progress half way towards 2015 and the attainment of the MDGs.
Kirsten Brosbøl emphasized the importance to maintain Denmark’s leading position in
emphasising the link between SRHR and the attainment of the MDGs.
Kirsten Brosbøl thanked Bjarne B. Christensen, Executive Director at the Danish Family
Planning Association (Foreningen Sex & Samfund), Jacqueline Bryld, International
Advocacy Officer and Henny Hansen, Head of International Department also at The
Danish Family Planning Association (Sex & Samfund) for their great help in organizing
the conference.
6
Executive Summery of Introductory Remarks
By Bjarne B. Christensen, Secretary General, The Danish Family Planning Association
(Sex & Samfund).
Bjarne B. Christensen presented the three goals of the conference being:
-
-
-
To explain how sexual and reproductive health and rights (SRHR) is a shortcut
to reach the Millennium Development Goals.
Stan Bernstein, Senior Advisor from UNFPA has worked specifically with this
inter-connection. Stan Bernstein published the Millennium Development
Report “Public Choices, Private Decisions: Sexual and Reproductive Health
and the Millennium Development Goals” in 2006.
To focus on some of the challenges in linking SRHR and the MDGs at civil
society level.
This will be exemplified by Indu Capoor from CHETNA, India, who will explain
how a civil society organization works with SRHR and the MDGs. Gill Greer,
Director General, IPPF will present how to focus and work with the link at a
global organizational level experienced from the world largest NGO working
with SRHR.
To facilitate a political understanding on how to integrate SRHR and the MDGs
in the future. Strong political focus was stressed as particularly important to
ensure universal access to SRHR.
Bjarne B. Christensen was very happy to see the great number of people, especially the
politicians, and thanked the Minister for putting her heart into fighting poverty and
promoting sexual and reproductive health and rights. He thanked her for her willingness
to share her perspectives on how Denmark can continue to be a leader in this field.
Bjarne B. Christensen launched the newly developed fact sheets, ‘Sex, Health and
Development II – the road to sexual and reproductive health and rights for all’. The
publication by the Danish Family Planning Association (Sex & Samfund) contains nine
fact sheets explaining that without access to SRHR for all, the MDGs can not be attained
(The fact sheets can be downloaded from www.tvaerpolitisknetvaerk.dk). The aim is that
the fact sheets will be beneficial in the future work to link SRHR to the MDGs.
Bjarne B. Christensen reminded everyone that last years ‘No Sex’ conference resulted in
a strong commitment from parliamentarians to continuously support SRHR. The Danish
Parliamentary Network on Sexual and Reproductive Health and Rights was launched as a
consequence of the ‘No Sex’ conference, and Bjarne B. Christensen was excited to see
what would come out of this year’s +Sex conference.
A summery of last year’s conference on sexual and reproductive health, the ‘No Sex
Conference” that focused on raising awareness among decision-makers as a consequence of the American ‘abstinence-only’ policy, can be downloaded from the
following link: http://www.sexogsamfund.dk/Default.aspx?ID=2637&Purge=True
7
Executive Summery of the Opening Speech
By Ulla Tørnæs, the Danish Minister for Development Cooperation.
The Minister welcomed the initiative taken by the Danish Parliamentary Network for
Sexual and Reproductive Health and Rights to have a conference on the integration of
sexual and reproductive health and rights (SRHR) in the Millennium Development Goals
(MDGs). SRHR is a topic which is very important to the Minister. She was therefore
proud to have developed the Danish Strategy on Sexual and Reproductive Health and
Rights, which was launched in May 2006.
The Minister explained that it had been difficult to integrate SRHR in the MDGs because
of strong international political opposition trying to limit women’s right to decide over
their own bodies. This opposition, of which some consider abstinence a solution to
unwanted pregnancies, unsafe abortions and protection against HIV/AIDS, has been
proved not to be sustainable. Cultural norms and practices impede women’s rights and
participation in society and in development. The Minister stressed the importance of
involving men in the promotion of SRHR– an approach that is also reflected in the
Danish Strategy on Sexual and Reproductive Health and Rights.
The Minister supported that the recommendations from the 2005 UN Summit were
translated into action. She underlined that Denmark will work to ensure the full the
integration of SRHR into national strategies on poverty alleviation. Denmark will also
assist donor countries in integrating SRHR into health sector reforms thereby improving
their health services.
The Minister named the EU an important leader in the promotion of SRHR and poverty
eradication. Other organizations like the WHO, UNAIDS and the World Bank were also
mentioned as vital in assisting countries improving their technical capacities and
strengthening their health systems. Denmark should work for a better coordination of
efforts and ensure the inclusion of civil society. Denmark should also hold the UN,
Governments and other donors responsible, aligned and accountable of their promises in
integrating SRHR in the MDGs, she said.
In conclusion, the Minister noted that the new target on universal access to reproductive
health for all by 2015, may be the best that we can achieve on a global scale. However,
Denmark and the international community should continue to strive for more resources
and higher goals. She re-affirmed Denmark’s commitment to continue the fight for SRHR
as a prerequisite for the achievement of the MDGs.
8
Summary of Stan Bernstein’s Presentation
“A ‘Simple’ Guide for Travellers in the ICPD and the MDG Galaxy”
Stan Bernstein praised Denmark for its progress on integrating sexual and reproductive
health and rights (SRHR) in its development aid. He summarized the development of the
Millennium Development Goals (MDGs) and explained how the goal of universal access
to reproductive health by 2015 disappeared from the MDGs after the World Summit for
Social Development Conference in Geneva in 2000.
SRHR was re-addressed at the World Summit 2005, where a new target was linked to
Development Goal 5 (Improve Maternal Health) in the recognition of the importance of
women’s reproductive health in the attainment of the MDGs. New indicators are still
being developed and are expected to be useful instruments for integrating SRHR in the
work to achieve the MDGs in documents and in national strategies.
Stan Bernstein explained that world leaders could no longer refuse the link between
SRHR and in order to reach the MDGs. Countries world wide now develop MDG-oriented
strategies and goals. The African Union finalized and adopted their own comprehensive
framework recognizing the link between SHRH and the MDGs in Maputo in September
2006. However, as Stan Bernstein pointed out there is still great discrepancy between
the rich and poor countries. Universal access to health services, training and emergency
care is still only a possibility for the rich part of the world.
Stan Bernstein urged countries to scale up efforts and ensure systematic and
comprehensive approaches to integrate SRHR in the MDGs. This must be done by
providing better health services and integrating SRHR fully in the health systems.
Current shortfalls, like the lack of anti-retroviral medicines (ARVs), lack of universal
access and prevention, must be addressed. UN agencies must assist countries in
ensuring a comprehensive approach to integrating SRHR into their national health
strategies, as well as coordinate efforts, ensure supplies and develop better surveillance
systems. Also, civil society must be strengthened to ensure involvement of young people
and men in sexual and reproductive health.
Stan Bernstein made a series of recommendations for Denmark’s work on integrating
SRHR in the MDGs:
- Denmark must continuously support the International Conference on
Population and Development and the MDGs by monitoring national and
bilateral collaboration.
- Denmark should continue to raise awareness and form donor coalitions and
call for 10% of ODA going to SRHR.
- Denmark must preserve and expand the European consensus and vigorously
implement the African strategy with a fully integrated approach to SHRH.
- Denmark should continue to promote and support civil society involvement.
9
Summary of Indu Capoor’s Presentation
“Need for Integrating Sexual and Reproductive Health and Rights in the MDGs
– a Plea from South Asia”
Indu Capoor stressed that none of the Millennium Development Goals (MDGs) could be
achieved without being linked with sexual and reproductive health and rights (SRHR)
and without collaboration with and support from the international community.
Indu Capoor provided examples of how SRHR affect people in Asia. She explained how
women were disproportionately discriminated against and that there was a great need
for empowerment of women, if the MDGs were to be achieved. The health system of
India does not reflect the realities of girls growing up, and many people do not have
access to health services. Indian women’s health is negatively influenced by social,
cultural and nutritional problems. The Indian health system focuses more on profit and
on public-private partnerships, than on addressing the special needs of women. There is
a big gap between policies and practice in India. Therefore, Indu Capoor urged the
global community to address SRHR in other ways that solely focusing on health systems
and institutional care.
Indu Capoor explained that one of the main obstacles for integrating SRHR in the MDGs
was a strong local religious opposition in India. This has made it difficult to inform and
educate women and has hindered girls in expressing their sexual and reproductive
health wishes. The result is widespread cultural silence about SRHR has seriously
affected young women. Indu Capoor therefore stressed the need to build partnerships at
all levels and to focus more on ‘people-centered’ advocacy. She stressed that civil
society has a big role to play in filling the gaps in governmental policies and breaking the
cultural silence by educating and training people.
Indu Capoor gave the following recommendations on Denmark’s future work:
- Involve organisations working at community level.
- Build capacity at both grass root level and political level.
- Ensure that promises at global level are kept.
- Ensure the involvement of young people of both sexes.
- Continue to focus on controversial issues.
- Exert pressure on governments and ensure the inclusion of women’s
organisations.
- Ensure that funding agencies examine the gaps of country budgets.
- Create dialogue with civil society organisations, public health and political
leaders as local realities are complex and unpredictable.
10
Summery of Gill Greer’s Presentation
“The Way Ahead to Reach Universal Access to Reproductive Health”
Gill Greer’s speech stressed that much is still to be done before universal access to
sexual and reproductive health and rights (SRHR) can be achieved. She praised
Denmark for setting a good example on implementing a pragmatic approach to SRHR.
Gill Greer explained that it will only be possible to prevent unwanted pregnancies and
halt the feminized HIV/AIDS epidemic, if governments realize the importance of linking
SRHR to the MDGs. Political leadership, however, is often blocked because of fear of
controversy and caution to changes. Although it requires only a minimum of financial
investments to improve the reproductive health of both women and men, political
leaders often debate the moral implications of language, instead of saving the lives of
millions of people dying from AIDS every year. Here, advocacy from the civil society and
parliamentary groups, like the Danish Parliamentary Network for Sexual and
Reproductive Health and Rights, plays a pivotal role in pressurising governments.
In order to make information, services and supplies available, Gill Greer emphasized,
that we all need to assume individual responsibility. Everybody has a role to play in
changing the negative perception of women and their sexuality. Gill Greer stressed that
universal access should be affordable, accessible and acceptable, and that services and
treatment should be based on principles of equity.
Gill Greer stressed the importance of involving young people in identifying problems and
implementing solutions. Today’s generation of young people is the largest ever. It is
therefore vital that they receive comprehensive sexuality education, and that
governments provide the services needed, as Gill Greer praised Denmark for having
done. Regarding role models, Gill Greer explained that parents, teachers, health
practitioners and the media play a critical role in assisting young people making healthy
life choices and informing them of their right to universal access to reproductive health.
Gill Greer specified that poor sexual and reproductive health, including the transmission
of HIV, was strongly linked to gender inequalities, discrimination, sexual violence and
poverty. Women in many parts of the world are denied their human rights because of
their gender. This is why it is essential to address women’s place in society when
wanting to improve universal access to reproductive health.
Weak and fragmented health systems in Africa are often the symptoms of deep-rooted
poverty and inequalities in societies. More resources are needed if poor countries are to
attain the MDGs. Denmark has a clear role in building capacity and providing the funds
needed, through bi- and multilateral contributions. Gill Greer very clearly communicated
that poor sexual and reproductive health is both a contribution to poverty and the result
of poverty – a vicious circle.
Gill Greer provided the following recommendations for the Danish government:
- It is essential that the Danish government and the EU stay committed to the
new target of universal access to reproductive health.
- Denmark needs to support country level NGOs and their partners in policy
negotiations and advocacy on implementing SRHR in the national strategies.
- Continue funding international organisations, like the IPPF, who in turn
support local NGOs.
11
-
Parliamentarians have the power to advocate for people’s rights and needs
and turn words in to action regarding SRHR.
Denmark should lead the call for real investment in sexual and reproductive
health, internationally and in the EU.
Involve NGOs across the world and monitor the progress being made in terms
of linking SRHR and MDGs
12
Extract from the Panel Discussion between Guest-Speakers and
Participants
Participants in the panel: Stan Bernstein (UNFPA), Indu Capoor (CHETNA), Gill Greer
(IPPF), Anne Marie Tyndeskov Voetmann (Ministry of Foreign Affairs).
Kirsten Brosbøl (MP and Chairperson of the Danish Parliamentary Network for Sexual
and Reproductive Health and Rights) facilitated the debate.
Vibeke Rasch, Associate professor from the Institute of Public Health Department for
International Health, Copenhagen University wanted the panel’s comments on why
sexually transmitted infections (STI) were not included in the new MDG target.
Stan Bernstein replied that STIs were perceived as very closely related to HIV/AIDS and
that UNFPA and WHO jointly had developed a new set of indicators to include STIs under
goal 6 (HIV/AIDS and other communicable diseases). Stan Bernstein also called
attention to the development and launch of a new Human Papilloma Virus vaccine, by
the World Health Organisation.
Maria Glinvad, Co-chair, Women and Development (Kulu) asked Stan Bernstein how he
proposed the dialog should be on abortion between different countries like China and
USA.
Stan Bernstein responded that abortion is always a delicate matter to be treated
respectfully. He recommended that safe abortion regulations were incorporated into
national strategies and laws and specified that most countries now have laws that
legalise abortion when the mother’s life is in danger. Stan Bernstein further stated that
is could be interesting to investigate the costs difference between providing services in
time and treating complications to abortions and estimated the difference to be as high
as 9 times. He underlined that national countries need to include HIV/AIDS and SRHR in
the efforts to achieve maternal health, as they are inter-dependant.
A question about gender barriers was raised and Gill Greer stressed the importance to
involve men. Indu Capoor recommended that sensitivity training and open dialogue
should start when boys are still young as their ideas, norms and values change, as they
become older. Education also plays a paramount role in the shaping of their norms and
values. Indu Capoor gave the example of a review performed by CHETNA that cleaned
out all gender insensitive messages and pictures from material relating to sexuality and
reproductive health.
Gill Greer remarked that IPPF had made small plays to inform men, because men
actually do care about women’s problems but do not always know facts. Gill Greer
confirmed the importance to start young and to have good role models.
Stan Bernstein reminding us that norms, values and perceptions are often generated in
poor settings. Poverty and socio-economic changes make it difficult to position oneself
as a man in a new society. Stan Bernstein stressed that occasionally men changed – if
only given the opportunity.
13
Birgitte Bruun, PhD-student, asked Stan Bernstein if the delay of the new indicators
derived from problems related to bureaucracy, technical issues or if they derived from
resistance.
Stan Bernstein answered that part of the delay had to do with resistance, part of the
delay had to do with a lack of understanding and lack of consensus on how to work with
the indicators. The indicators were now to be finalized at the next committee meeting.
Kirsten Brosbøl promised that the Danish Parliamentary Network for Sexual and
Reproductive Health and Rights would advocate for these new indicators, and will follow
up to see, how they are being implemented in the political work towards achieving the
MDGs so as to hold the politicians responsible.
Catrine Christiansen, PhD-Student wanted to know if the panel could advise on how to
work with religious movements and organizations.
Stan Bernstein stated that UNFPA had a long tradition of and positive experience with
working with religious organizations. He stressed the importance of collaborating with
religious people and suggested that the next focus in relation to SRHR and the MDGs
could be cultural influences.
14
Concluding Remarks
By Kirsten Brosbøl
The Minister of Development Cooperation re-affirmed that Denmark will continue to be
at the forefront in promoting SRHR and will continue to prevent international
commitments being weakened and important results from being undermined. SRHR are
human rights, and they are the prerequisite for eradicating poverty, promoting
development and achieving the MDGs.
Stan Bernstein stressed the need to be specific when dealing with SRHR messages. It is
important to have clear indicators, when improving universal access to reproductive
health. Furthermore, it is vital that governments can be held accountable and that they
donate a minimum of 10% of the official development aid (ODA). Stan Bernstein
concluded by stressing that there is an obvious link between SRHR and the MDGs that
no one can deny.
Indu Capoor reminded us that SRHR have a huge impact on people’s lives. However,
since many women do not have access to health services and are not aware of their
right to service, a holistic life cycle approach is needed.
Sexuality is a taboo and we need to be conscious of that.
Partnerships with civil society and NGOs must be strengthened for the implementation of
SRHR strategies and for the attainment of the MDGs.
Gill Greer confirmed that we have to break the culture of silence and start talking about
sex. In Denmark, this is easier than in other countries. That means that Denmark has a
responsibility when advocating for sexual and reproductive health and rights.
Gill Greer confirmed that women’s place in society impedes their sexuality and their
reproductive health – we have a responsibility to change these wrong perceptions.
Finally, Gill Greer stressed the responsibilities of politicians and policy makers and their
influence on the SRHR agenda and their role in the attainment of the MDGs.
15
ANNEX 1
Executive Summery in Danish (Dansk Resume)
Cirka 75 deltagere, heriblandt folketingspolitikere, ungdomspolitikere, NGO personale,
personale fra de danske undervisnings- og forskningsinstitutioner, repræsentanter fra
Danida, samt andre, indenfor feltet seksuel og reproduktiv sundhed og rettigheder
(SRSR), deltog i +Sex konferencen på Christiansborg d. 6. juni 2007.
Konferencens mål var at:
- analysere forholdet mellem SRSR og 2015-målene.
- identificere de største udfordringer i forbindelse med opnåelse af det nye
delmål under mål 5: ” Universal adgang til reproduktiv sundhed”.
- diskutere
hvad
danske
og
europæiske
beslutningstagere,
samt
hjælpeorganisationer kan og bør gøre for at integrere SRSR i 2015-målene.
Tre prominente oplægsholdere fra UNFPA, IPPF og CHETNA havde indvilliget il at komme
og tale om disse punkter fra hver deres perspektiv.
Den danske udviklingsminister, Ulla Tørnæs, bekræftede sit personlige og professionelle
engagement i forhold til at promovere SRSR og understregede, at det var et vigtigt
redskab for at opnå 2015 Målene. Hun var glad for at konstatere, at Danmark tidligt
havde forstået vigtigheden af at forbinde SRSR til 2015 Målene. Ministeren
understregede vigtigheden af, at have indikatorer, der støttede implementeringen af det
nye delmål om universal adgang til reproduktiv sundhed inden 2015 under mål 5
(Forbedring af mødres sundhed) og gjorde samtidigt opmærksom på samarbejdet
mellem civilsamfundet, FN, donorer og regeringer er helt centralt, hvis 2015 Målene skal
opnås.
Stan Bernstein, seniorrådgiver i UNFPA, understregede nødvendigheden af at øge
indsatserne for at sikre en systematisk og gennemgribende tilgang til at integrere SRSR
i 2015 Målene. Bedre udbud af serviceydelser og fuld integrering af SRSR i
sundhedssektoren er nødvendigt. Han anbefalede, at de nye indikatorer blev brugt til at
koordinere, monitorere og evaluere indsatser for at opnå 2015 Målene.
Indu Capoor, direktør for CHETNA, opfordrede donorer til ikke udelukkende at fokusere
på udbygning af sundhedstilbud og institutionelle tiltag i forhold til SRSR problemer,
eftersom langt størstedelen af indiske kvinder ikke har adgang til sundhedssektoren.
Indu Capoor påpegede behovet for, at bryde den kulturelle tavshed om seksualitet og
hjælpe med at styrke kvinder, så de selv kan tale ud om deres seksuelle og reproduktive
sundhedsbehov. Hun plæderede for en mere menneske-centreret og holistisk tilgang til
SRSR arbejdet, samt for en stærkere involvering af civilsamfundet.
Gill Greer, generaldirektør fra IPPF, mindede os om at SRSR ofte blokeres af politiske
ledere, frygten for kontroversielle emner og en manglende anerkendelse af kvinders
menneskerettigheder. Hun gjorde opmærksom på, at universel adgang til SRS kun kan
gennemføres med en vis portion tålmodighed og hvis man sætter sig for at bekæmpe
fordømmende holdninger. Gill Greer understregede også behovet for at øge mængden af
information og uddannelse for unge verden over. Hun fremhævede at kun stærke
budskaber og partnerskaber mellem civilsamfundet, FN og EU kan opbygge kapacitet.
Det er nødvendigt at regeringer udvikler de nødvendige rammer for at 2015-målene kan
opnås.
16
Konferencen klargjorde nogle vigtige forbindelser mellem SRSR og 2015 Målene og
understregede behovet for at integrere SRSR i udviklingsbistand for at sikre at 2015
Målene bliver opnået. Derudover, understregede alle talerne, politikernes vigtige rolle i
forhold til at lovgive og sikre midler til integreringen af SRSR i 2015 Målene samt
behovet for et stærkt civilsamfund, der kan presse regeringerne til at udbyde
reproduktiv sundhed til alle.
17
ANNEX 2
Biographical data on the speakers
Ms. Kirsten Brosbøl – MP
Kirsten Brosbøl is a Member of Parliament for the Social
Democratic Party. She is the chairperson of the Danish
Parliamentary Network for Sexual and Reproductive Health
and Rights. Kirsten Brosbøl is the spokeswoman on food and
rural affairs for the Social Democratic Party and is a
substitute member of the sub-committee for Foreign Policy.
Mr. Stan Bernstein – Senior Policy Advisor for UNFPA
Stan Bernstein is the primary author of the report Public
Choices, Private Decisions, currently a Senior Policy Advisor
with the United Nations Population Fund with responsibilities of
advising on the follow-up to the 2005 World Summit Outcome,
including recommendations on the monitoring framework for
following up on the consensus international development
goals, including the Millennium Development Goals (the
MDGs). He participates in the Interagency and Expert Group
on MDG Indicators which reviews technical inputs to the
monitoring of progress on the international consensus
development goals. He spent the past two years as Policy
Advisor on Reproductive Health to the UN Millennium Project,
directed by Jeffrey Sachs in his role as Special Adviser to the
UN Secretary General and to the Administrator of UNDP.
Ms. Indu Capoor – Founder of CHETNA
Founder and Director of CHETNA (Center for Health,
Education, Traning, and Nutrition Awareness). Since 1980
Indu Capoor has been instrumental in getting CHETNA's
work recognized at the national, South Asian region and
international level.
She is an active board/advisory member of several
national and international organizations that advocate for
recognizing
field
realities
of
disadvantaged
and
marginalized sections of society in policies and
programmes. Indu Capoor is committed to contribute to
improving the health and well being of disadvantaged and
marginalized women, children and adolescents.
18
Dr. Gill Greer – Director-General of the IPPF
Since 2006 Dr. Greer has been Director General of IPPF
(The International Planned Parenthood Federation). From
1998- 2006 she was the Executive Director of the New
Zealand Family Planning Association. She also chairs the
Asia Pacific Alliance (a network of 30 NGOs in seven
countries), and the New Zealand NGO Ministry of Health
Forum (a network of more than 100 NGOs). Dr Greer has
been a member of the New Zealand government
delegations to the United Nations General Assembly
Session on HIV/AIDS (2006), the United Nations World
Summit (2005), the Commission on the Status of Women
(2005) and the Commission on Population and
Development (2004).
Mrs. Ulla Tørnæs – Danish Minister for Development
Cooperation
Since February 2005, Ulla Tørnes has held the position as
Minister for Development Cooperation. She has been a
Member of Parliament for the Liberal Party since 1994.
From 1998 to 2001 she was the political spokeswoman for
the Liberal Party. From 2001 to 2005 she was Minister of
Education.
19
ANNEX 3
Participants (alphabetical)
Navn
Organisation
Anette Tønnes
Anne Marie Frøkjær
Anne Marie Tyndeskov
Voetmann
Anne Sofie Pinstrup
Jørgensen
Asger Ryhl
Birgitte Bruun
Birgitte Hagelund
Bjarne B. Christensen
Carsten Borup
Catrine Christiansen
Christian Graugaard
Claus Rasmussen
David Ceesay
Ditte Marie Klitbo
Elsebeth Gravgaard
Emil Dyrvad
Fiona Watson
Gill Greer
Gitte Lillelund Bech
Gry Nielsen
Helle Blom
Helle Sjelle
Henriette Svarre
Nielsen
Henny Hansen
Indu Capoor
Inger Olesen
Illa Westrup
Ilse Kristensen
Jacqueline Bryld
Jo Dietrich
Joan Erlandsen
Karin Henrichsen
Katrine Paysen
Katrine Pii
Maternity Worldwide
Master student
Ministry of Foreign Affairs
Kira Fortune Jensen
Kirsten Brosbøl
Kirsten Jensen
Kirstine Berner
Lene Hansen
Student
UNFPA
Phd Student
Programme manager, Global Funding Unit, Dan Church Aid
Sekretary- General, Sex & Samfund
Head of Lysthuset - Århus Kommune
Phd stipendiat
Chairman, Sex og Samfund
Stud. Sexology
Stud. Sexology
Stud. Med.
Senior policy officer, Dan Church Aid
Youth Politician Radikal Ungdom
IPPF
Director General, IPPF
MP, Venstre
UNFPA
Head nurse, National Defence health service
MP, C
Chair person, Maternity Worldwide
Head of International Department, Sex & Samfund
Director, CHETNA
Programme coordinator, ADRA
Press responsible, Maternity Worldwide
International Advocacy officer, Sex & Samfund
Cross-Over
MP, Venstre
Student
Youth politician SF Ungdom, medlem af ligestillingsudvalget
Århus University
Research coordinator for the international health network
Copenhagen University
MP, A, Chairperson for the Danish Parliamentary Network for
Sexual and Reproductive Health and Rights
Head of Project, AIDS Fondet
Ministry of Foreign affairs FNU
Mp, A
20
Linda Luckow
Lise Rosendal
Østergaard
Lise von Seelen
Magnus Boesen
Maria Glinvad
Maria Molde
Marisha B.N. Heldvig
Knudsen
Marion Pedersen
Mark Ceesay
Martha Topperzer
Martin Bojsen
Martin Rosenkilde
Mette Grøndahl
Hansen
Mette Olsen
Mette Stentoft
Mette Strandlod
Mia Lund Sørensen
Michael G. Madsen
Niels Sandø
Pernille Warberg
Pernille Vigsø Bagge
Peter Strauss
Jørgensen
Robert Holm Jensen
Ruben Kirkegaard
Rune Lund
Signe Yde-Andersen
Simon F. Kristensen
Stan Bernstein
Stine Kromann
Sule Lindskrog
Susanne Olejas
Toyah Hunting
Vibeke Rasch
Ulla Tørnæs
Sexologist
AIDSNET
Mp, A
Educator, Sex & Samfund
Co- chair person, KULU
Project assistant Sex og Samfund
Stud. Sexology
MP, Venstre
Stud. Sexology
International Advocacy Assistant, Sex & Samfund
Sex og Samfund
International advisor, Dan Church Aid
Master student
National student assistant, Sex & Samfund
Danish Red Cross
UNFPA
Student assistant, Sex & Samfund
Information officer, Sex & Samfund
Academic assistant, The National Board of Health
Advisor, AIDS linjen
MP, F
Political assistant, DSU
National project assistant, Sex & Samfund
MP, KDU
MP, Ø
Coordinator in the gender network, Dan Church Aid
Student assistant, Sex & Samfund
Senior Policy Advisor
Master student
Advisor, Cross Over
Student assistant, Sex & Samfund
CSR
Associate professor for the Department for International Health
– institute of Public Health
Minister for Development Cooperation, Venstre
21
ANNEX 4
Welcome speech
By Bjarne B. Christensen, Secretary General Danish Family Planning
Association (Sex & Samfund)
Dear Participants,
First of all I would like to express my sincere thanks to the all-party network for sexual
and reproductive health and rights for having taken this initiative to focus on the
linkages between sexual and reproductive health and rights and the Millennium
Development Goals – as a necessary short-cut to reach the MDGs
Political focus and prioritization is of absolute importance in order to reach the MDGs,
which were agreed upon in 2000. This political focus is particularly important in order to
ensure universal access to reproductive health as a right for all! This is where Danish
members of parliament have a specific role to play.
For this reason, we are extremely happy to have this opportunity to assist the network
in organizing this conference. We have three specific goals for our conference today:
1) To explain how SRHR is a necessary short cut to reach the MDGs. To assist us in
very interesting exercise we have an incredible competent and knowledgeable
person: Stan Bernstein. Apart from the fact that Stan works for UNFPA, he is
probably the most qualified person to explain the complex linkages. Last year he
was the main force behind the Millennium Project Report: Public Choices, Private
Decisions: Sexual and Reproductive Health and the Millennium Development
Goals’. This book in detail analyses and discusses these various linkages. Stan,
thank you for making this long journey to provide us a ’quick’ guide to SRHR and
the MDGs.
2) The second goal is to focus on the challenges we face in realising the SRHR goals.
In this connection it is a great pleasure to introduce Indu Capoor, who for the last
27 years has been a leader for the Indian women’s rights organization CHETNA
and one of our project partners from our big regional WHRAP-project. She has
extensive experience with concrete issues that civil society organizations and
community-based organizations are up against in the struggle to improve the
SRHR situation and knows very well how working in networks at national,
regional as well on an international level can improve the achievements. Thanks
for taking the time to share some of your many experiences and analysis with us.
From dealing with the challenges seen from a local NGO perspective, we move
our focus to the global work. We feel extremely privileged to be able to welcome
IPPF’s new Director General Gill Greer. IPPF is worlds largest NGO that works for
SRHR, with members in 180 countries. Gill Greer will focus on the way ahead to
reach universal access to reproductive health.
3) The third goal – or maybe the main goal has been to facilitate a political
understanding and focus on the topic.
In principal this has already happened, as the conference is held by the all-party
parliamentary network for sexual and reproductive health, which today has 29
members from the Danish parliament. We hope that the final debate and the
22
follow-up of this conference will help ensure and secure the political commitment
for sexual and reproductive health and rights.
Finally, it is also a very important signal that our Minister for Development Cooperation,
the most senior political representative in the field of development aid, Ulla Tørnæs, has
taken time to open today’s conference. Thank you so much!
Lastly, we are very proud to present nine new fact sheets fresh from the print! Our
ambition with the fact sheets has been to produce two pages for each of the eight MDGs,
which explain how SRHR is relevant as well as a pure necessity to reach each of the
MDGs. The fact sheets also express what we, Sex & Samfund, feel must be done, in
order to improve the SRHR situation and not least reach the MDGs by 2015. No matter
whether you are a parliamentarian, a journalist, a development worker or purely
interested in issues related to development work – you now have easily digestible
information available, which can help you explore the linkages.
Exactly one year ago, we held a big ‘no-sex’ conference. Apart from the fact that this
conference contained many highly interesting presentation about the opposition against
SRHR it also became the beginning of this all-party network in Denmark. Since then, the
network has formally established itself and has during the last nine months or so held
several meetings and conducted a number of extremely interesting activities.
We hope, that today will be yet another example of such an exiting activity and that you
will find the presentations today inspiring and that this ´+SEX´ conference will be an
important springboard for a visionary Danish political fight for the MDGs including SRHR
as a necessary short-cut.
With these opening remarks, it is my pleasure to pass on the word to our Minister for
Development Cooperation, Ulla Tørnæs.
23
ANNEX 5
Opening speech
By the Minister for Development Cooperation, Ulla Tørnæs
Good Afternoon, Ladies and Gentlemen. And thank you, Kirsten (Brosbøl) and Bjarne
(Christensen) for your warm welcome – and for inviting me to this conference.
It is indeed a pleasure to be here today to open a debate on a most important subject:
Sexual and Reproductive Health and Rights and the Millennium Development Goals.
To me, there is no doubt: Promoting and ensuring sexual and reproductive health and
rights is a key priority in itself - but it is also an important tool for achieving the MDGs.
The linkage is there. And today, I will highlight some aspects of the Danish efforts to
pursue this linkage. Allow me, however, at the outset to insert a few comments on the
Danish Parliamentarian Network on Sexual and Reproductive Health and Rights.
I am confident that the network will prove useful in our joint efforts to meet the
challenges related to sexual and reproductive health and rights in the developing
countries. This is the first time I have had the opportunity to participate in one of your
events. I am looking forward to a constructive and dynamic dialogue today – and in the
future.
Ladies and Gentlemen,
Sexual and Reproductive Health and Rights is a topic I feel strongly about - as minister
for development cooperation, as a woman and as a mother.
One of my first undertakings as minister for development cooperation was to develop a
new Danish strategy on Sexual and Reproductive Health and Rights. The strategy was
conceived in March 2005 at the Danish ICPD+10 Conference on challenges and
recommendations for the strengthening of the ICPD goals.
A little more than 9 months later – in May last year – the strategy was born. The
pregnancy and the delivery went well – but I have to admit that it is not easy to bring
up this baby. It is growing, but slowly. I will come back to this a little later.
The Strategy is based on the commitment made by heads of government at the 2005
UN summit: To achieve the ICPD goal of universal access to reproductive health - and to
integrate this goal into strategies to attain the MDGs.
Denmark – among other countries - was instrumental - in linking sexual and
reproductive health and rights and the MDGs. Unfortunately, as most of you are aware,
this linkage was grossly neglected, when the MDGs were introduced in 2000.
Not by Denmark, however. To Denmark, this linkage was - and is - evident and crucial.
Only when people can claim their sexual and reproductive rights will they have a chance
of winning the battle against poverty.
Far too many women in Africa – and around the world - are not enjoying equal rights –
not least with respect to their own body. They cannot decide freely on their sexual and
reproductive health.
Healthy and strong women are essential for the empowerment of women and for
eradicating of poverty. To this end, let me recall some alarming facts:
Sexual and reproductive ill-health, including HIV/AIDS, accounts for over 60% of the
total female diseases in Africa.
In Africa, 1 woman out of 16 risks dying due to complications related to pregnancy or
childbirth - in Denmark, it is 1 woman out of more than seven thousand.
Besides the physical pain, suffering and humiliation – ill health deprives women of their
possibility to fulfil their own potential and to actively participate in the development
process.
24
It is not from lack of moral or motivation that girls or women in Africa are not able to
abstain from sex and protect themselves against HIV/AIDS or unwanted pregnancy.
They are not able to claim their rights. They have little or no access to the relevant
health services.
And why is that? The answer is to be found - at least partly – in culturally embedded
norms and behaviour. This is why our Danish strategy is targeting women as well as
men. We have focussed on women. But we must not forget the men. We need a holistic
approach. Women are half the world – and men are the other half!
Let’s have a closer look at the opposition to the Cairo Agenda. The opposition is based
on resistance to young people’s right to access sexual and reproductive health
information and services and the right to abortion. To the opponents, the solution to
unwanted pregnancy, unsafe abortion and protection against HIV/AIDS is an unbalanced
ABC-approach, focussing on A for abstinence.
Evidence shows that Abstinence is not a realistic approach. Information and education as
well as access to contraception including condoms and other relevant health services is
the way forward. In addition, we need to empower women so that they are able to fully
control their own bodies.
To me, it is difficult to understand the opposition to the Cairo Agenda.
How can we empower women and girls: If they are submitted to female genital
mutilation?
If they are forced into marriage at the age of 10 – without knowing how their body
develops and functions? If they are unable to negotiate sex and cannot protect
themselves against unwanted pregnancy and HIV/AIDS? If they have to go through
unsafe abortion?
I ask myself - who would like their daughter or sister to go through this? Who would like
their daughter to start her sexual life unprepared, with fear and possible suffering and
pain?
Human sexuality is surely about reproduction – but it is certainly also about quality of
life and well being both mentally and physically. Above all, it’s about rights.
Ladies and gentlemen,
What are the challenges we are facing right now? And how can Denmark contribute?
First and foremost, we need to ensure that the commitment by heads of government at
the 2005 UN summit is translated from words into action.
The first step was the UN Secretary General’s introduction of a new target under MDG 5
on Maternal Health in 2006. This new target is to achieve universal access to
reproductive health by 2015, and the Secretary General mandated the Interagency and
Expert group on MDG Indicators to select appropriate indicators.
This task is extremely important but has not yet been accomplished. Denmark continues
to urge all relevant partners and stakeholders to contribute constructively to this
process. We must not let go of this chance to ensure rights and greater opportunities for
women.
The new target and indicators are especially important. They will ensure that sexual and
reproductive matters are integrated in the national discussion on poverty eradication.
And equally important, countries will have to report on progress – they will be held
accountable.
Secondly, we must - multilaterally as well as bilaterally - assist countries in integrating
reproductive rights and gender equality into health sector reforms. Improving sexual
and reproductive health, particularly reducing maternal mortality and morbidity, requires
amongst others a functioning health system – not least at the local level.
Thirdly, we must make sure that other stakeholders also remain committed to achieve
the ICPD Agenda and to the principles and rights it stands for. The EU is a vital player
25
and we do our best to ensure that the Union continues its political leadership on the
promotion of sexual and reproductive health and rights.
Major international organisations such as UNFPA, WHO, UNAIDS and the World Bank are
important partners – not least at country level. They must assist countries in
transforming targets and indicators to real changes in people’s lives.
They have the technical knowledge to build capacity. Strengthening health systems is
complex and demanding and requires global efforts and substantial financial
investments. Upgrading and expanding facilities, ensuring reliable supply of commodities
and adequate human resources are key components of health system strengthening.
And in our multilateral assistance to those organisations we will hold them accountable
for progress in this area.
Finally, effective cooperation and coordination between all actors involved is needed.
And that includes NGO’s and other civil society actors. Alignment and harmonisation is
required not only among government donors but also among our partners in the civil
society.
Ladies and gentlemen,
Let me conclude by quoting UNFPA’s Executive Director, Thoraya Obaid: The new MDG
target on access to reproductive health is the maximum we can achieve politically at
global level, at present.
I agree – but at the same time, I would like to underline that we should keep aiming for
more. And Denmark does.
Denmark will continue to be at the forefront when it comes to promoting sexual and
reproductive rights. We will continue to fight preventing international commitments from
being weakened and important results from being undermined.
We will continue to fight for these rights because they are human rights. And we fight
for them, as they are one prerequisite for eradicating poverty, promoting development
and achieving the MDGs.
Thank you!
26
ANNEX 6
The way ahead to reach universal access to reproductive health
By Gill Greer, Director-General IPPF
It’s a great pleasure to meet with you today. I am delighted to be in Denmark, a country
I have held up as a model both for honouring its ODA commitments, and for its own
pragmatic and successful approach to sexual and reproductive health and rights.
Indeed had other countries followed your example, and we had fully funded and
implemented the ICPD Plan of Action, the G8 meeting would perhaps not now be
discussing how to halt the HIV and AIDS epidemic which is inexorably undermining hard
won development gains, and we would have made more progress in eliminating poverty.
We know we will not halt the feminisation of HIV and AIDS or the birth of a generation
of HIV+ children unless we invest in sexual and reproductive health, including family
planning, although some choose to ignore the stunning logic that the same act of sex
can result both in pregnancy and HIV.
Let me start by considering our current situation.
Partly as a result of the unmet need for information, services and supplies, combined
with a lack of empowerment, many millions of women have an unwanted pregnancy. As
a result millions suffer debilitating injury and illness and nearly 70,000 die annually from
unsafe abortion, 200 a day. Not only is this a huge individual cost – but it has
implications for productivity and health costs. Furthermore, such statistics highlight a
fundamental denial of human rights, of the right to the evident attainable standard of
health, and the right to development. The vast majority of these deaths, resulting from
unsafe abortions, occur in developing countries, and most are young women. Most are
also avoidable.
Maternal mortality is not only a largely preventable public health pandemic, it is a denial
of gender justice. We know what we need to do and the means to do it exist – but so far
the will to do it has not been forthcoming. Research demonstrates clearly a relatively
small investment in reproductive health would make such a difference to the lives of
young men, women, infants and children and to every country’s human capital. But this
investment requires strong, yet compassionate political leadership which recognises both
the individual tragedy behind the situation and the collective economic loss to every
community and developing country.
But all too often this much needed leadership, and the actions that should follow, are
stifled by caution, and fear of controversy, because issues of reproductive health and
rights strike at the most intimate areas of our lives, and focus on very different
perspectives of what it means to be a woman, or a young person, in the 21st century.
And so, the implementation of the promises made by governments and parliamentarians
is delayed yet again, often by debates about the relationship between religion and the
state, between public policy and each individual’s conscience and private behaviour. As a
result, issues of morality and mortality become tragically entangled, resulting in
needless deaths of millions a year from AIDS, and pregnancy related causes.
That is why recent attempts at the World Bank to remove family planning and
reproductive health from policy documents and any agreements was so dangerous – yet
this was the catalyst for advocacy by civil society and Parliamentarian groups like yours
27
resulting in government pressure to reinstate these critical components. This shows
what you can do – but we should not need such a crisis to catalyse and redouble our
efforts to reach the Access target.
But there is a risk that we will continue to debate the moral implications of language and
fail to act, while a young person is infected with HIV every 14 seconds, and women and
girls will die because we fail to prioritise investment in sexual and reproductive health,
including supplies of commodities.
So … what should we do to make sure services and supplies and information are
available? Firstly we need to accept responsibility – each one of us, for all too often we
want to change the world but not ourselves but each of us has a role to play. The
elimination of poverty and the achievement of universal access to reproductive health
and the elimination of HIV and AIDS will not be achievable by any one individual,
organisation or government. It will be the sum total of all our acts – and each of us must
decide what part we will play, and what we will do differently. Achieving these goals will
require local and global action and local and global advocacy – for these are global
challenges – for in the words of a New Zealand poet – ‘under the sea all lands are joined
together.’
What exactly do we mean by universal access? Simply, that enough confidential quality
services, education information, and commodities, whether in remote rural areas or
urban slums, are available, accessible and acceptable to meet the different needs of all
individuals, including the most marginalized and vulnerable, among them youth, sex
workers, men who have sex with men, drug users, migrants and refugees. This requires
that people can safely reach services without travelling for a long time or high cost, or
can be reached by providers like IPPF Member Associations delivering mobile clinic
services by jeeps and boats, and, for example, that those with disabilities are also
recognized as having sexuality. Clearly, services and treatments must be based on
principles of equity to ensure that poor people do not bear a relatively higher cost
burden.
Universal access requires that services are of adequate quality (including the availability
of skilled medical personnel, approved drugs and equipment, and proper infrastructure
including safe water and sanitation); and that providers do not discriminate on the basis
of sexuality, gender, ethnicity and age. Reproductive health supplies are critical.
Currently donors provide approximately 2.7 condoms for each man in Africa. To raise
people’s knowledge and awareness and then fail to deliver the means for them to
manage their sexual and reproductive health needs is wrong. It is also critical that
people are able to exercise their sexual and reproductive rights, in confidence, without
control or coercion and that public and political attitudes based on stigma and
discrimination do not prevent people accessing information and services. Furthermore it
means, quite simply, recognizing that gender roles and stereotypes, and violence
against women and girls, prevent women from accessing support, information and
services even when they do exist. However when women have the opportunity, and can
access information and services they can control their fertility and other aspects of their
lives.
The 1986 Declaration of the Right to Development stated that development must be
participatory, and we must involve people themselves in identifying problems and
implementing solutions. We must, therefore, involve young people. Today we have the
largest generation of young people ever. This means unprecedented numbers are about
to enter their reproductive years – some call this phenomenon a ‘youthquake’. Many are
unemployed, without any hope of a future, and desperately need honest, objective
28
factual information as well as access to contraceptives, and condoms for protection
against STIs, HIV and unplanned pregnancy. As you have demonstrated in Denmark,
comprehensive sexuality education that reaches those both in and out of schools, that is
gender sensitive, and openly discusses relationships, decision making, communication
and good citizenship is vitally important.
In the best of all possible worlds parents are the best role models for intimate
relationships and a positive future, but often it is teachers who play a critical role, not as
gatekeepers, but providing the support, and role models that may help young people to
develop the resilience that can assist them to seek a meaningful life, and make the
informed decisions that are vital for them, their children and our planet.
Health practitioners who are willing and able to provide non-judgmental, evidence
based, confidential services to young people, including gay, lesbian, bisexual and
transgender youth and are also critical to empowering young people to achieve health
and wellbeing.
It is critical too that we engage the media, faith based bodies and the private sector in
constructive dialogue and joined-up comprehensive action if we are to reach our goal of
universal access. But, if we continue to shroud public debate in hypocrisy, if 200 million
women cannot space their pregnancies effectively, if millions of adolescents are denied
the information and means to keep themselves safe, then STI will continue to spread
inexorably in the silence of stigma, and unplanned pregnancies and mother to child
transmission of HIV will be inevitable results.
Non-one should die as a result of sex, as millions do, through pregnancy related causes
and AIDS. Clearly the elimination of stigma and discrimination are essential in the fight
to achieve access.
As you know, over 39 million people are living with HIV worldwide and the majority of
HIV infections occur through sex. Now, more than half of people living with HIV are in
the 15-24 age group, young women making up over 60% of those infected in subSaharan African countries. Poor sexual and reproductive health, including the
transmissions of HIV, is strongly linked to gender inequality, discrimination, sexual
violence, conflict and displacement of people, and poverty. It is vital that we link HIV
and sexual and reproductive health services, and use fact-based research, (rather than
ideology) to inform our programming. We know, for example, that condoms are over
90% effective as protection against HIV. Those who deny this, those who oppose our
work based on evidence, and the realisation of 21st century living, contribute to
needless tragic deaths and a generation of HIV positive children.
In every sphere, unequal power relationships between women and men, as well as
differences in poverty levels and education prevent millions of women worldwide from
being able to control their lives, or have access to adequate sexual and reproductive
health care, negatively impacting on their overall health status and development.
Opposition to the target of universal access to reproductive health is inextricably linked
to beliefs about women’s place in society.
In many parts of the world, women are at risk of contracting HIV because hidden social
norms encourage their husbands to behave promiscuously. At the same time both
married and unmarried women are so often unable to insist on condom use, and
frequently not allowed to access contraception. Violence against women is endemic and
this in turn has a major impact on SRH including unplanned pregnancy, STIs and HIV.
29
The recognition of the simple fact that women, like men, are human, and, therefore,
entitled to human rights lies at the very heart of any attempt to reach the target of
universal access to reproductive health.
We also need to address weak and fragmented health systems with inadequate
infrastructure and work force. I applaud Denmark’s commitment to capacity building in
Africa – it is critical to inject the resources necessary to boost public health systems,
develop primary care and enable sexual and reproductive health providers to do their
jobs effectively. Yet only two African countries currently commit 15% of their budget to
health as promised, and sexual and reproductive health is seldom highlighted in country
plans, PRSPs, SWAPs – or even by the Global Fund, in spite of the intimate link to
HIV/AIDS.
A further obstacle is the persistence of social and health inequalities. Women and infants
remain the most vulnerable. In parts of sub-Saharan Africa women have a 1 in 6 chance
of dying in childbirth, while in Denmark the rate is 1 in 9800. These disparities
demonstrate an unacceptable level of social and gender injustice denying women of their
most basic human rights.
It is virtually impossible to bridge the gaps in sexual and reproductive health when
poverty and inequalities in housing, education, water and sanitation continue unchecked.
A woman has little chance of exercising her sexual and reproductive rights if she does
not have access to any health care, if she hasn’t had the chance to attend school, or is
unemployed. Inequalities in society lead to inequalities in health, and poor sexual and
reproductive health follows this pattern of social exclusion which needs to be addressed
first if we are to move forward. Poor sexual and reproductive health is, therefore, both a
contribution to poverty and the result of poverty, a vicious circle.
Recent history has demonstrated how effective parliamentarians can be in ensuring that
access to reproductive health has become part of the global development framework, by
calling in 2004 for a 9th MDG ensuring that 151 world leaders issued a strong statement
in the World Summit Outcome Document in 2005:
“achieving
strategies
contained
improving
combating
universal access to reproductive health by 2015 [and to integrate] this goal in
to attain the internationally agreed development goals, including those
in the Millennium Declaration, aimed at reducing maternal mortality,
maternal health, reducing child mortality, promoting gender equality,
HIV/AIDS and eradicating poverty.”
This major accomplishment, in spite of enormous opposition pressure from different
conservative groups, including the US government, was followed by an agreement in
2006 to include the new target of universal access to reproductive health in the MDGs,
as an integral part of MDGs. This, together with the 2006 Maputo Plan offers us all new
opportunities to improve sexual and reproductive health, reduce poverty and halt the
ongoing ravages of the HIV/AIDS epidemic which threatens to undermine all economic
gains. It is essential that you ensure that your government, and the EU hold fast to
these gains including the target and indicators, despite opposition, otherwise we will
continue to see needless death and disease drive back development.
The new Aid Architecture and Paris Declaration mean that there are important
opportunities for change at the country level. The sexual and reproductive health
community, which has at times been very effective at the international level, now needs
to focus more attention with other NGOs and their partners, on the policies and political
30
negotiations taking place in each country. Bilateral and multilateral aid agencies will
direct more funds through national governments, and decisions on sexual and
reproductive health budgets are increasingly made by recipient governments rather than
donor institutions. Undeniably this is, of course, appropriate but many governments do
not consider sexual and reproductive health a priority. This makes advocacy at the
country level more important. At the same time, core funding for international
organizations like IPPF is still vitally needed because international networks and alliances
like ours provide much needed support for local NGOs, and advocates which are
struggling to hold their national governments accountable for meeting their country’s
sexual and reproductive health needs. Many NGOs rely on core funding from
organizations like IPPF to provide their infrastructure, in order to be able to provide
services, and invest in seeking local funding.
A released report by The Alan Guttmacher Institute (AGI) and UNFPA demonstrates that
neither donor nor recipient countries can afford not to expand their financial
commitment to three key goals of sexual and reproductive health: preventing
unintended pregnancy; improving maternal health; and preventing, diagnosing and
treating sexually transmitted infections; including HIV/AIDS. It demonstrates that the
return on investments would be invaluable —and not just in terms of unintended
pregnancies, abortions averted and lives of mothers and infants saved.
The true impact of sexual and reproductive ill health has gone largely unrecognized, and
the full benefits of preventing such ill health have been vastly undervalued.
In recent years we have also had the European Consensus and Parliamentarians Call to
Action, and the 2005 Edinburgh Declaration for Parliamentarians from the G8, and most
recently, a meeting of G8 Parliamentarians in Berlin last week.
These are all important documents which offer us new and real opportunities to take
action to save lives and build sustainable social and economic development. But as
parliamentarians you cannot achieve this alone. The partnerships with civil society which
are so central to the ICPD Plan of Action are even more critical today. IPPF, as one of
the largest international NGOs with 151 Member Associations, working in 180 countries,
is fully committed to strong partnerships with government, parliamentarians and other
non-government organisations working in health and development. Our Member
Associations have grown from a real need within their communities. Their knowledge of
these communities and their service delivery, particularly with the most marginalised
and socially-excluded, informs their advocacy, gives them credibility, and enables them
to play a key role even in situations of conflict. They are there to work with you and
implement our strategic framework as part of achieving the MDGs. We are also
strengthening their role as advocates, to make sure sexual and reproductive health is
included in country health and development plans, PRSP, SWAPs and infrastructure
development and to support you in monitoring these programmes.
As parliamentarians you are, in the words of your Ottawa IPCI Declaration, “the bridge”
between the people and their governments, you are the advocates for your people’s
rights and needs, but unlike other advocates you also have power as legislators and
policymakers.
You can be the champions who provide the leadership that will protect rights, and turn
words and promises into action and there are many examples of where this has been
achieved.
31
But to achieve universal aims to reproductive health will require your renewed individual
and collective commitment, a determination from each of you to work with other
parliamentarians here, across the EU, and internationally, and lead the call for real
investment in sexual and reproductive health. This means the inclusion of sexual and
reproductive health in all recipient governments’ national development plans, national
HIV and AIDS plans, poverty reduction strategies and budgets. As part of this, you can
also involve NGOs by asking them to tell you the stories of their communities, and how
lives can be transformed for so little cost. NGOs, like the Member Associations of IPPF,
are there to share your vision and achieve it. You are in the position to ask the
important questions about specific budgets, ODA funding infrastructure, and workforce
development, health sector reform, and implementation by recipient governments. You
also have the power to monitor progress, to ensure that the new global architecture
leads to the achievement of access to reproductive health rather than allow sexual and
reproductive health and rights to become invisible again.
In my country the indigenous Maori people have a saying: “I ask the flax bush what is
the most important thing in the world and it replies: he tangata, he tangata, he tangata,
it is people, people, people”. And that is why your presence here today, your
discussions, your leadership, and most importantly your actions are so important.
32
ANNEX 7
Stan Bernstein’s Power Point Presentation
Entering the MDGs
A “Simple” Guide for Travelers in the
ICPD and the MDG Galaxy
+SEX Meeting
Copenhagen, Denmark
6 June 2007
Stan Bernstein
Senior Policy Adviser, Office of the Director
Technical Support Division
June 2007
bernstein@unfpa.org
PP 1
• As committed to by the world’s leaders at the World Summit
in September 2005
• As recommended by the Secretary General in his Report on
the Work of the Organization in August 2006
• As noted by the General Assembly in October 2006
• As affirmed by the Interagency and Expert Group on MDG
Indicators
• A new target has been added to MDG Goal 5 “Improve
maternal health”: “Universal access to reproductive health by
2015”. Key indicators have been proposed by the IAEG on
MDG Indicators. The process needs support in its final stages.
• It must now be in national and international monitoring
reports on MDG progress and integrated in development
plans, action strategies and budgets.
PP 3
The Original MDGs:
Where is SRHR?
• The IPCD Goal of Universal Access to
Reproductive Health by 2015 disappeared from
the proto-MDGs after June 2000 and stayed out
• The components of the ICPD definition of
Reproductive Health were distributed among
various other goals: maternal health (esp.
mortality reduction), HIV/AIDS (family
planning?)
• The contribution to multiple MDGs was lost
• A long series of regional meetings, Commission
on Population and Development resolutions and
donor country representations redressed this gap
PP 2
Where are we now?
• Significant numbers of women and couples lack
access to key RH information and services
• Poorer countries and poorer people within countries
suffer the greatest deficits
• Rural and poor peri-urban population lack access
• Young people lack access
• Successful models exists but they must be scaled up
to reach everybody
We are almost at the mid-point between the Millennium
Summit and the target date.
PP 4
33
Proportion of desires for
family planning met (by wealth quintile)
There has been progress on
MDG5: but not in outcomes
Proportion of births attended by skilled health personnel
Proportion of desires satisfied for all contraceptive methods
by wealth quintile (1:poorest, 5:richest)
Survey period: 1996-2004
World
Western Asia
100.0%
South-Eastern Asia
90.0%
Southern Asia
Eastern Asia
2004
80.0%
1990
70.0%
Poorest
60.0%
Second
Latin America and the Caribbean
Middle
50.0%
Sub-Saharan Africa
Fourth
Richest
40.0%
Average
Northern Africa
30.0%
0
20
40
60
80
20.0%
100
10.0%
Source: UN Statistics Division, MDG Indicators database
2
0.0%
Africa*
PP 5
Latin America & Caribbean**
Central Asia***
North Africa & West Asia
Global Average
PP 8
Skilled attendance among the Poorest
and Richest Women
93 100
100
MMR and Unmet Need
98
94
Maternal Mortality Ratio by level
Unmet Need for Family
Planning, Total,
Per Cent
81
Percent of women ages 15-49
Asia****
80
Low MMR: <100
9.89
Modearte MMR: 100-299
11.26
High MMR: 300-549
23.19
Very high MMR: >550
25.87
60
42
40
20
31
25
20
15
4
1
0
Cambodia
Bangladesh
Armenia
Egypt
Poorest 20%
Ethiopia
Peru
Richest 20%
Source: Calculations generated from data from SWOP (MMR) and DHS/MICS (UNM)
4
Source: World Bank, 2004, Round II Country Reports on Health, Nutrition, and Population
Conditions Among the Poor and the Better-Off in 56 Countries
PP 6
PP 9
Contraceptive use is increasing
Young women are the most likely to have an
unmet need
Contraceptive prevalence in selected regions, 1990 and 2005
% of married women 15-49 with unmet need
100
15-24
25-34
35+
12.3
Sub-Saharan Africa
21.3
40.2
South-central Asia
54.0
80
41.7
Northern Africa
59.1
47.0
South-eastern Asia
60
59.7
50.1
Western Asia
49.7
1990
50.4
CIS, Asia
60.5
Latin America and the
Caribbean
2005
40
62.4
25
71.5
62.7
CIS, Europe
16
20
63.3
77.9
Eastern Asia
10
89.4
52.0
Developing regions
Central Asia
68.4
0
10
20
30
40
50
60
10
13
7
11
24
23
15
9
8
0
62.7
69.8
Developed regions
21
17
12
70
80
90
100
Percentage using contraception among women aged 15-49 who are married or in union
Latin America
& Caribbean
North Africa
& West Asia
South &
Southeast
Asia
Sub-Saharan
Africa
Guttmacher Institute
PP 7
PP 10
34
Scaling up:
routes to coverage
Unmet need among married women is usually
higher in rural areas
% of married women 15-49 with unmet need
100
Urban
Rural
80
60
40
20
11
12
14
8
8
12
12
20
15
25
0
Central Asia
Latin America &
Caribbean
North Africa &
West Asia
South &
Southeast Asia
Expanding coverage: alternate modalities – pooling
risk, mobilizing demand and action
• Social insurance schemes
• Social protection funds
• Vouchers and private incentives
• General resource availability; e.g., micro-credit
• Civil society involvement
• Expanding the range of actors – beyond the health
system
• Full integration in the health system
Sub-Saharan
Africa
Guttmacher Institute
PP 11
PP 14
The World Summit Outcome
Added recommendations & responses
• The leaders of the world recommended at the World
Summit (paragraph 22) that all countries undertake
MDG-oriented development strategies. These are to
follow the Paris Principles.
• The G8 Summit at Gleneagles included commitments
for resource increases commensurate with the levels
needed to ensure rapid progress on the MDGs
• Regional processes are adapting SRHR supportive
policy and operational strategies: the AU
Comprehensive framework and the Maputo Plan of
Action
PP 12
National development strategies
• National strategies include expanding service delivery
points, integrating services in basic service packages
and integrating components with each other (e.g.,
HIV/AIDS and SRH).
• The national development plans have increasingly
become and will become the action plan to achieve
the MDGs.
• Plan ahead: Developing human resources and
institutional capacity takes time and investment.
Incentives (not only financial) need to be sufficient to
retain staff.
PP 15
Scaling up:
principles
• Definition: The process of expanding the scale of
activities with the ultimate objective of increasing the
number of people and increasing the impact of the
intervention with a specific objective of regularizing it
into routine public sector health services for interventions
that have been well evaluated with demonstrated evidence
• Universal access to RH means ensuring that each person
who wants a service can get it – it is available, accessible,
acceptable, affordable and of quality
• Promoting UARH requires comprehensive integrated
approach with stress on expanding rights and promoting
women’s empowerment (beyond the MDG measures) and
participation and promoting men’s involvement.
PP 13
Engaging in all stages
of national planning
• Poverty analysis—provides the rationale for intervention, or
the ‘why’, ‘what’ and ‘where’;
• Strategy—outlines the ‘how’ to reduce poverty;
• Costing—evaluates ‘how much’ it costs for the policies as
outlined;
• Budgeting—articulates the distribution of funds among
competing priorities;
• Policy matrix—clarifies ‘who’ does ‘what’ in the
implementation;
• Monitoring indicators—track progress towards poverty
reduction based on the outlined targets/objectives
PP 16
35
Monitoring and evaluation:
principles
Needs assessments and
situational evaluation
•
Identifying a range of necessary
interventions;
For each intervention define targets;
Compare lists of interventions to avoid
overlaps;
Cost the needs by adding coverage targets
and unit costs in costing models;
Develop a financing strategy.
•
•
•
•
PP 17
Improving data and performance monitoring is a
must.
• Coverage, contents and quality. Using
marginalized groups as signals of generalized
access (rural, poor and the young). Mobilizing
resources from multiple sources for impact.
• Creating constituencies – organizing community
reporting and action, participatory approaches
• Monitoring budgets and resource flows
(reproductive health accounts)
• Results-based monitoring of aid effectiveness
needs to include key SRHR indicators
PP 20
Aligning initiatives:
Monitoring and evaluation:
methods
the challenge for donors, policy makers and implementers
• Other initiatives need an RH vision (e.g., Global
Fund on HIV/AIDS – RH integration – effective
linkage, priority to prevention; Road Maps for
Maternal Health and Child Survival; Scaling Up for
Health in Africa)
• Logistics and commodity security – including RH
security (Global Programme for RH Commodity
Security)
• Strengthening health systems as a whole (not just
disease-specific programmes); but going beyond
health
• Influencing and investing in regional initiatives: E.g.
the African Union and the Maputo Plan of Action
PP 18
Aligning reports and actors – making efforts
accountable
• major administrative units (states, provinces, districts)
• political units (parliamentary constituencies)
Selecting units that can influence policy, legislation and
budgets and increase accountability.
Mapping service coverage and outcomes can identify
gaps and strategies.
If progress on SRHR is monitored, it will count!
PP 21
Sector wide approaches
•
SWAps: a method of coordinating donor support in a particular sector, so
that all significant government and donor funds support a single policy and
expenditure program led by the government.
• Goals of SWAps:
– reducing earmarked money
– eliminating geographic and programmatic fragmentation associated with
individual donor priorities
– coordinated missions and reviews
– a comprehensive budget that consolidates sources of financing
(government, donor and other) to the sector
•
The national development plan should reflect the commitments to policies
and programs developed through SWAps and SWAps should become more
aligned with the poverty-reduction orientation of the national development
plan
•
The budgeting should be incorporated in Medium Term Expenditure
Frameworks.
PP 19
How can Denmark stay engaged
• Support the ICPD/MDG principles in regional
discussions and in aid priority setting and monitoring
• Form donor coalitions (and support UNFPA) to raise
the issue in national policy dialogues
• Support the call for 10% of ODA going to SRHR,
with special attention to gender equality concerns
• Preserve, protect and expand the European Consensus
• Vigorously implement the Africa Strategy with a
fully integrated approach to SRHR
• Promote and support NGO engagement
PP 22
36
ANNEX 8
Indu Capoor’s Power Point Presentation
Need for Integrating
Sexual and
Reproductive Health
and Rights in the MDGs
MDG I
Eradicate Extreme Poverty & Hunger
Early marriage and Early preganacy contributes
to intergenerational transmission of poverty
through a variety of pathways.
A plea from South Asia
Ms. Indu Capoor, FounderFounder-Director
Poor reproductive health among youth is a
poverty issue.
MDGs and SRHR
Centre for Health Education, Training and Nutrition Awareness , Ahmedabad,
India
3
6th June 2007
PP 3
PP 1
MDG II
MDGs & SRHR
1.
2.
3.
4.
5.
6.
7.
8.
Eradicate extreme poverty & hunger
Achieve universal primary education
Promote gender equality & empower women
Reduce child mortality
Improve maternal health
Combat HIV/AIDS, malaria & other diseases
Ensure environmental sustainability
Develop global partnership for development
Achieve universal primary education
Pregnant girls either dropout or are expelled from
schools, either by law or from the failure of
schools to enforce the rights of girls.
MDG III
Promote gender equality & empower women
Without education or employable skills,
unmarried pregnant girls are often poorly
prepared to take responsibilities of childbearing
and face diminishing prospects for income
generation.
Unversal access to Reproductive Health services
and focus on Sexual and Reproductive Health
and Rights Missing …
MDGs and SRHR
PP 2
4
PP 4
37
MDG IV/V
SRHR & the MDGs
Reduce child mortality and Improve maternal
health
Addressing early pregnancy and
empowering women for safe motherhood
are necessary components of reducing
maternal mortality and improving child
health.
• 40+ million people living with HIV
• 500.000+ maternal deaths/ year
• Pregnancy related problems the MAIN cause
of death for 15-19 yr old girls
up to 20% of global disease burden
up to 32% of women’s disease burden is
attributable to sexual and reproductive ill health.
Access to Reproductive Health services and
Information Underlies all the MDG’s.
MDGs and SRHR
5
PP 5
PP 8
While MDGs are a goal for the Global Commitment
MDG VI/VII
Regional Disparities Exist
Combat HIV/AIDS, malaria & other diseases
Reni
Poor access to health services and reproductive
health can and do negatively impact on physical,
social and economic development.
Born in South Asia
Often went hungry
Worked for 10-12 hours
Abused daily
Married at 10
Conceived at 13
Lost 3 children
Gave birth to 4 children
Received no care
Abused daily
Died at 21 years of age!
Ensure environmental sustainability
Violation of fundamental human rights and
reproductive rights leads to unsafe environment
for comprehensive health and development.
MDGs and SRHR
6
PP 6
Rachel
Born in Europe
Ate nutritious foods
whenever hungry
Graduated from the best
institution
Made a career in international
health
Chose her life partner
Mother of two healthy
children
Lives a healthy life!
MDGs and SRHR
9
PP 9
Making MDGs a Reality
Need to Focus on South Asia
• The eight MDGs are unprecedented promise by
all world leaders to accelerate global efforts to
meet the needs of the worlds’ poorest by 2015.
• However, MDGs cannot be attained without
addressing SRHR. Due to absence of SRHR in
MDGs, SRHR has received less visibility, less
attention , lower priority and less funding.
MDGs and SRHR
7
• Is world`s most populous region.
Significant percentage of population denied basic
human needs-food, shelter, clothing and
education.
(Per Capita Income ranges from USD 250 to 840)
• A region of
Class, caste, gender and race inequalities.
Political crisis, terrorism and turmoils.
• One fifth of the population in South Asia is
between the ages of 15 and 24.
• This is the largest number of young people ever to
transit into adulthood, both in South Asia and in
the world .
MDGs and SRHR
10
PP 7
PP 10
38
Building Evidence and Ground
for Advocacy
Need to Focus on South Asia
• About 74 million women are missing in South Asia.
They are the victims of social and economic
neglect from the cradle to the grave. Sex Ratio94/100 as compared to global 106/100.
• Significant contribution to the global burden of
maternal deaths.(MMR ranges from 340-800).
• More than 80% of adolescent girls are anemic
• Close to 85 percent of pregnant women in South
Asia suffer from anemia.
• Fewer than one-third of the total births in South
Asia are attended by a qualified, trained health
attendant.
MDGs and SRHR
Capacity
enhancement of
CBOs and
community to
articulate the
denial of their
rights
Lack of infrastructure,
supplies, absenteeism,
corruption
Documentation of
denial to services in
local and national
languages
Developing policy
briefs
Scanning the environment for advocacy interventions and
opportunities - community, state policies and programme and
the political agenda and power from local to national level
11
PP 11
Listening to women
narrate experiences of
accessing care from
the public health
System
MDGs and SRHR
14
PP 14
Advocacy efforts at various levels
How is Regional Advocacy done?
Dialogue with
the community
and elected
representative
s for
consensus
building and
affirmative
action
• Building a strong and strategic advocacy
partnership.
• Creating new opportunities for people
centered advocacy at the regional level.
• Strengthening civil society and marginalized
women’s capacity to effectively advocate for
SRHR through field based evidence.
• Holding decision makers and service providers
accountable.
• Simultaneous advocacy and linkages at state,
national, regional and international level.
Dialogue with
the block and
district public
health
administrators
and media
Advocacy for
Women`s
Access to
Maternal
Health
Services
from the
Public Health
System
Voices of denial
at the state level
for state policy
action
National dialogue
with policy
makers, media,
donor agencies to
showcase the
evidence of
denial and
demand for
improved health
services
Opportunities, when ever available are seized at all levels,
to take community voices to the policy makers
MDGs and SRHR
12
PP 12
MDGs and SRHR
PP 15
Increasing Women’s Access to
Maternal Health Services in India
An example
WHRAP Regional Advocacy
Mechanism….
Two pronged strategy
1. Capacity building of CBOs and
Community on right to health and
entitlements from public health system.
2. Evidence based Advocacy starting from
field service providers to the National
level.
MDGs and SRHR
PP 13
15
• Establishment of the Regional Task
Force (RTF) for Advocacy on Sexual and
Reproductive Health and Rights
• RTF comprises of eminent advocates,
policymakers, technical experts and
civil society members.
13
MDGs and SRHR
16
PP 16
39
Concrete outcomes:
Advocacy for SRHR in MDGs in
South Asia
Need for strong and tactful EU
Leadership
• Based on local evidence, Regional Review of
MDG by civil society organizations to identify
scope for integrating SRHR in MDGs .
• Developing alternative SRHR indicators for MDG5-Maternal Health (April’05).
• National level advocacy for SRHR in MDGs
through country reports (August’05).
• Representation at the UN review of MDGs
(September’05).
• Pressurize own government to influence
EU negotiations during PRSPs so that
the voice of women’s organizations,
especially organizations working on
advocacy for SRHR is heard in the
negotiations and that programmes are
based on what based the women of the
country would prefer rather than
funding only technical assistance.
MDGs and SRHR
MDGs and SRHR
17
PP 17
20
PP 20
Lessons Learnt
Need for strong and tactful EU
Leadership
• Advocacy is about utlilising opportunities and
space and hence needs scope for improvising.
• It is critical to place the issues in the political
agenda of the country.
• Country specific strategies needs to be adopted
keeping the current context in view.
• South Asia has several commonalities but the
political situation in each country and political
relations among the countries influence regional
advocacy.
• Use of rights-based approach is very effective at
community level.
• Working strategically and effectively with the
media is critical.
• Review budgets of countries for gaps
and increase AID allocation to fund civil
society organizations for:
Demand creation of health entitlements
Ensuring accountability mechanisms
Fund for enabling community feedback
mechanisms.
Ownership is key for building a partnership
MDGs and SRHR
18
PP 18
MDGs and SRHR
PP 21
Need for strong and tactful EU
Leadership
Need for strong and tactful EU
Leadership
• Global funding for the MDGS has not kept
promises made and you can lobby with your
country to put pressure on other donors
countries specially in the EU to contribute to
programmes that focus on Life cycle approach:
• Hold dialogues with civil society organizations
to understand the political and social realities
of countries being funded.
• Local realities are complex, dynamic and
unpredictable, you can advocate for funding
sustainable civil society organizations that
could deepen field understanding and link it
to practice where health services outreach is
poor.
Infant Mortality
Young People’s issues
Maternal Health
With Gender sensitivity and rights based approach
MDGs and SRHR
PP 19
21
19
MDGs and SRHR
22
PP
22
40
Let us join hands for a Healthy South Asia!
Need for strong and tactful EU
Leadership
“Women’s health is a personal
and social state of balance
and well being
in which a woman feels strong,
active, creative,
wise and worthwhile;
where her body's vital power of
functioning
and healing is intact;
where her diverse capacities
and rhythms
are valued;
where she may decide and
choose, express herself and
move about freely.”
• Accessing fund from EU has become
extremely difficult as it requires high
degree of professional expertise.
• Strict adherence to implementing
guidelines limits the scope of
innovation.
• Capacity building of civil society
organizations is critical in this area.
MDGs and SRHR
PP 23
- from the 'Women and Health (WAH!)
Programme
Approach Document, 1993
MDGs and SRHR
23
24
PP 24
41
ANNEX 9
Resources on Linking Sexual and Reproductive Health and Rights
to the MDGs
Websites
FACT Sheets; How Access to Sexual & Reproductive Health Services is Key to the MDGs
http://www.populationaction.org/Publications/Fact_Sheets/FS31/RH_MDGs.pdf
Global HIV/AIDS: The Politics of Prevention Issue Brief
http://www.plannedparenthood.org/news-articles-press/politics-policyissues/international-issues/hiv-prevention-6481.htm
The Guide to Reproductive Health, HIV/AIDS and Population Assistance;
http://www.euroresources.org/guide_to_population_assistance/denmark/introduction.ht
ml
Universal Access to Comprehensive Sexual and Reproductive Health Services in Africa.
Special Session of the African Union Conference of Ministers of Health Maputo
Mozambique
18 – 22 SEPTEMBER 2006:
http://www.africaunion.org/root/AU/Conferences/Past/2006/September/SA/Maputo/doc/en/Working_en/2
-Report_of_Experts_21_Sept.pdf
Population Growth – Impact on The Millennium Development Goals
Written Evidence Submitted by Marie Stopes International to the All Party Parliamentary
Group on Population, Development and Reproductive Health
http://www.appgpopdevrh.org.uk/Publications/Population%20Hearings/Evidence/MSI%20evidence.doc
Strengthening linkages for sexual and reproductive health, HIV and AIDS: progress,
barriers and opportunities for scaling up. Final report August 2006 DFID Health Resource
Centre
http://www.dfidhealthrc.org/publications/HIV_SRH_strengthening_responses_06.pdf
Interim Report of Task Force 4 on Child Health and Maternal Health April 19, 2004
http://www.unmillenniumproject.org/documents/tf4interim.pdf
All party Parliamentary Group on Population, Development and Reproductive Health
http://www.appgpopdevrh.org.uk/Publications/Annual_reports/Annual%20Report%202004-2005.pdf
Working together for better health by DFID
http://www.dfid.gov.uk/pubs/files/health-strategy07.pdf
How Reproductive Health Services work to reduce poverty
http://www.populationaction.org/Publications/Fact_Sheets/FS14/Summary.shtml
42
Millennium Development Report “Public Choices, Private Decisions: Sexual and
Reproductive Health and the Millennium Development Goals” by Stan Bernstein and
Charlotte Juul Hansen 2006
Millennium Report. “Investing Development- A Practical Plan to achieve the Millennium
Goals by Professor Jeffrey D. Sachs, Special Advisor to the Secretary-General on the
Millennium
Development
Goals:
http://www.unmillenniumproject.org/documents/MainReportComplete-lowres.pdf
43
ANNEX 10
Media Coverage of the
Conference
Article in Politiken 06.07.2007
44