6th June 2007

Centre for Health Education, Training and Nutrition Awareness , Ahmedabad, India

Need for Integrating Need for Integrating Sexual and Sexual and Reproductive Health Reproductive Health and Rights in the and Rights in the MDGsMDGs A plea from South A plea from South AsiaAsia

Ms. Indu Capoor, Founder-Ms. Indu Capoor, Founder-DirectorDirector

Making MDGs a RealityMaking MDGs a Reality The eight MDGs are an unprecedented The eight MDGs are an unprecedented

promise by all world leaders to accelerate promise by all world leaders to accelerate global efforts to meet the needs of the global efforts to meet the needs of the worlds’ poorest by 2015. However, universal worlds’ poorest by 2015. However, universal access to reproductive health services and access to reproductive health services and focus on sexual and reproductive health and focus on sexual and reproductive health and rights was missing until recently.rights was missing until recently.

None of the MDGs can be attained without None of the MDGs can be attained without addressing SRHR. Due to absence of SRHR in addressing SRHR. Due to absence of SRHR in MDGs, SRHR has received less visibility, less MDGs, SRHR has received less visibility, less attention, lower priority and less funding. attention, lower priority and less funding.

Links between SRHR, poverty Links between SRHR, poverty and gender disempowermentand gender disempowerment

Sexual and reproductive health among young Sexual and reproductive health among young people is a poverty issue and forced early people is a poverty issue and forced early marriage and early pregnancy is an outcome. marriage and early pregnancy is an outcome.

Pregnant girls drop out of schools. Without Pregnant girls drop out of schools. Without education and employment unmarried education and employment unmarried pregnant girls are poorly prepared to take pregnant girls are poorly prepared to take responsibility of childcare and face responsibility of childcare and face diminishing prospects for income generation.diminishing prospects for income generation.

Addressing early pregnancy and empower-Addressing early pregnancy and empower-ment women for safe motherhood are ment women for safe motherhood are necessary components for reducing maternal necessary components for reducing maternal mortality and improving child health.mortality and improving child health.

While MDGs are a goal for the Global While MDGs are a goal for the Global Commitment Commitment

Regional Disparities ExistRegional Disparities Exist

RachelRachelBorn in EuropeBorn in Europe

Eats nutritious foodEats nutritious foodGraduates from a Graduates from a

good institutiongood institutionIs active in the job Is active in the job

marketmarketChooses her life Chooses her life

partnerpartnerMother of two healthy Mother of two healthy

children children Lives a Lives a

healthy life!healthy life!

ReniReniBorn in South AsiaBorn in South AsiaOften goes hungryOften goes hungryWorks 10-12 hoursWorks 10-12 hours

Is married at 10Is married at 10Conceives at 13Conceives at 13

Looses 3 childrenLooses 3 childrenGives birth to 4 Gives birth to 4

childrenchildrenReceives no careReceives no careIs often abusedIs often abused

Dies at 21 years of Dies at 21 years of age!age!

The scenario in South AsiaThe scenario in South Asia South Asia is the worlds most populous region. A South Asia is the worlds most populous region. A

significant percentage of the population is denied significant percentage of the population is denied basic human needs-food, shelter, clothing and basic human needs-food, shelter, clothing and education. (Per Capita Income ranges from USD education. (Per Capita Income ranges from USD 250 to 840)250 to 840)

A region of Class, caste, gender and race A region of Class, caste, gender and race inequalities, political crisis, terrorism and turmoil.inequalities, political crisis, terrorism and turmoil.

One fifth of the population in South Asia is One fifth of the population in South Asia is between the ages of 15 and 24. This is the between the ages of 15 and 24. This is the largest number of young people ever to transit largest number of young people ever to transit into adulthood, both in South Asia and in the into adulthood, both in South Asia and in the world.world.

The SRHR situation in South The SRHR situation in South AsiaAsia

About 74 million women are missing in About 74 million women are missing in South Asia. They are the victims of social South Asia. They are the victims of social and economic neglect from the cradle to and economic neglect from the cradle to the grave. The sex ratio is 94/100 as the grave. The sex ratio is 94/100 as compared to 106/100 at the global level. compared to 106/100 at the global level.

South Asia significantly contributes to the South Asia significantly contributes to the global burden of maternal deaths (MMR global burden of maternal deaths (MMR ranges from 340-800).ranges from 340-800).

More than 80% of adolescent girls and 85% More than 80% of adolescent girls and 85% of pregnant women in South Asia suffer of pregnant women in South Asia suffer from anemia.from anemia.

In 2004 36% of the total deliveries in South In 2004 36% of the total deliveries in South Asia were attended by a skilled health Asia were attended by a skilled health personnel.personnel.

The gap between policy and The gap between policy and

practicepractice At policy level there has been some progress At policy level there has been some progress

– SRHR related issues are reflected in the – SRHR related issues are reflected in the youth, health, education policies. However, youth, health, education policies. However, the reality at the ground is different! The the reality at the ground is different! The implementation of the policies is the real implementation of the policies is the real challenge among other things because the challenge among other things because the public health systems are weak.public health systems are weak.

While funding for reproductive health and While funding for reproductive health and education has increased, its access by field-education has increased, its access by field-based civil society organizations has become based civil society organizations has become extremely difficult, due to the focus on extremely difficult, due to the focus on public-private-partnerships.public-private-partnerships.

ObstaclesObstacles

The increasing global opposition against The increasing global opposition against sexual and reproductive rights through sexual and reproductive rights through budget restrictions – partlicularly the US budget restrictions – partlicularly the US government (PEPFAR, GAG Rule)government (PEPFAR, GAG Rule)

Religious opposition to sexuality Religious opposition to sexuality education, access to contraceptives, education, access to contraceptives, abortion etc. abortion etc.

The culture of silence among women The culture of silence among women and girls in South Asiaand girls in South Asia

What needs to be done?What needs to be done?

Build a strong and strategic advocacy Build a strong and strategic advocacy partnership.partnership.

Create new opportunities for people Create new opportunities for people centered advocacy at the local, national centered advocacy at the local, national and regional level.and regional level.

Strengthen civil society and marginalized Strengthen civil society and marginalized women’s capacity to effectively advocate women’s capacity to effectively advocate for SRHR through field based evidence.for SRHR through field based evidence.

Hold decision makers and service Hold decision makers and service providers accountableproviders accountable..

Conduct simultaneous advocacy and Conduct simultaneous advocacy and create linkages at state, national, regional create linkages at state, national, regional and international level.and international level.

Building Evidence and Ground Building Evidence and Ground for Advocacyfor Advocacy

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

Capacity enhancement of CBOs and community to articulate the denial of their rights

Listening to women narrate experiences of accessing care from the public health System

Lack of infrastructure, supplies, absenteeism, corruption

AdvocacyAdvocacy efforts at various efforts at various levelslevels

Opportunities, when ever available are seized at all levels, to take community voices to the policy makers

Advocacy for Women`s Access to Maternal Health

Services

from the Public Health

System

Dialogue with the block and district public health administrators and media

Dialogue with the community and elected representatives for consensus building and affirmative action

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

Strong and tactful leadership Strong and tactful leadership requiredrequired

Global funding for the MDGs is not at the Global funding for the MDGs is not at the promised level and you can lobby with promised level and you can lobby with your government to put pressure on your government to put pressure on other donor countries especially in the EU other donor countries especially in the EU to contribute to programmes that focus to contribute to programmes that focus on a comprehensive approach: Infant on a comprehensive approach: Infant Mortality, young People’s issues and Mortality, young People’s issues and maternal Health.maternal Health.

Maintain focus on controversial issues to Maintain focus on controversial issues to support the global fight for a gender and support the global fight for a gender and rights-based approach and help secure rights-based approach and help secure sexual and reproductive rights.sexual and reproductive rights.

Strong and tactful leadership Strong and tactful leadership requiredrequired

Pressurize your government to influence Pressurize your government to influence negotiations during PRSPs so that the voice of negotiations during PRSPs so that the voice of women’s organizations, especially women’s organizations, especially organizations working on advocacy for SRHR organizations working on advocacy for SRHR are heard and that women’s rights-based are heard and that women’s rights-based programmes are funded.programmes are funded.

Review budgets for gaps and increase aid Review budgets for gaps and increase aid allocation to fund civil society organizations allocation to fund civil society organizations for:for:

Demand creation of health entitlements Demand creation of health entitlements Ensuring accountability mechanisms Ensuring accountability mechanisms Fund for enabling community feedback Fund for enabling community feedback

mechanisms.mechanisms.

Strong and tactful leadership Strong and tactful leadership requiredrequired

Hold dialogues with civil society Hold dialogues with civil society organizations to understand the political organizations to understand the political and social realities of countries being and social realities of countries being funded.funded.

Local realities are complex, dynamic and Local realities are complex, dynamic and unpredictable, you can advocate for unpredictable, you can advocate for funding sustainable civil society funding sustainable civil society organizations that could deepen the field organizations that could deepen the field understanding and link it to practice where understanding and link it to practice where health service outreach is poor. health service outreach is poor.

Let us join hands for a Healthy Let us join hands for a Healthy South Asia!South Asia!

““Women’s healthWomen’s health is a is a personal and social state personal and social state of balance and well being of balance and well being in which a woman feels in which a woman feels strong, active, creative, strong, active, creative,

wise and worthwhile; wise and worthwhile; where her body's vital where her body's vital

power of functioning power of functioning and healing is intact; and healing is intact;

where her diverse capacities where her diverse capacities and rhythms and rhythms are valued; are valued;

where she may decide and where she may decide and choose, express herself choose, express herself

and move about freelyand move about freely.” .”

- from the 'Women and Health (WAH!) - from the 'Women and Health (WAH!) Programme Programme

Approach Document, 1993Approach Document, 1993