ONE ON ONE: Helen Clark

A revised definition of reproductive health to include sex and rights -Sexual and Reproductive Health and Rights (SRHR), aroused tempers during the just concluded ICPD25 Nairobi Summit.

But in an exclusive interview, Helen Clark, the Board Chair of the Partnership for Maternal, Newborn and Child Health (PMNCH) sought to shed some light on the term.

What is the state of sexual and reproductive health and rights (SRHR), especially in Sub-Saharan Africa?

There has been progress on SRHR, but a lot remains to be done. Unfortunately, progress has been slower in Sub-Saharan Africa than elsewhere.

For example, according to the latest UN figures, Sub-Saharan Africa accounts for roughly two thirds of maternal deaths worldwide, and rates in the region are decreasing at a slower pace than they are elsewhere.

The unmet need for contraception in the region remains high. According to the Guttmacher-Lancet Commission, in 2017, 214 million women of reproductive age in developing regions had an unmet need for modern contraception.

When considering SRHR, we must also consider reproductive cancers. According to WHO, in Africa, 34 out of every 100 000 women are diagnosed with cervical cancer each year and 23 out of every 100 000 women die from cervical cancer every year.

In February, there was a call to action on SRHR, how was it received?

The February PMNCH Call to Action on SRHR was in the context of the growing momentum worldwide around achieving universal health coverage (UHC), but also of the invisibility of SRHR in these conversations.

We wanted to highlight, first, that women, children, and adolescents account for two-thirds of the world’s population, and that meeting their needs and upholding their rights should be a primary rationale for investing in UHC.

Second, many of the needs of this two-thirds of the population relate to SRHR. We don’t want countries to exclude essential services in their benefit packages for political or ideological reasons, and we felt that it was important to get a groundswell of support for this position.

The response to the call to action has been very positive, over 300 organizations to date have signed on to it. But our work is far from done.

In September, the UN General Assembly Political Declaration on UHC included some language on SRHR, but a group of countries disassociated themselves from that part of the text. So, clearly more dialogue is needed to make the case for SRHR in UHC in all countries.

What are some of the challenges in attaining Universal Health Coverage?

One of the challenges for countries is to decide what to include in their health benefits package. In this context, there is a renewed push for increased investments in primary health care – in frontline services delivered to people in their communities.

Another challenge is coverage. There is a concept called ‘progressive universalism’ which means, in essence, that the last should be served first, our top priority should be to reach those who are currently worst off.

Often it is women, children, and adolescents who are most marginalized, along with indigenous peoples, ethnic minorities, the poorest people, people with disabilities, and sexual minorities.

Funding is always a challenge, but what is most important in that respect is political will.

What are the gaps in the coverage of SRHR interventions especially in developing nations? What can be done to improve the situation?

Despite progress globally, SRHR interventions continue to be one of the most pressing and consistent gaps globally for women, girls, and adolescents.

Overall, progress has been uneven, and there are gaps across most, if not all, SRHR interventions in low and middle-income countries.

Political leadership, at the highest level, which prioritises SRHR is essential. Increased investment in the quality and coverage of SRHR services is required.

What are the sexual and reproductive health rights and interventions PMNCH is advocating for?

PMNCH is advocating for the more comprehensive definition of SRHR which includes rights, for example, the right to decide freely and without coercion if, when, and with whom to have children.

It includes key interventions and services – including access to modern contraception, to antenatal and post-natal care, and to safe abortion and post-abortion care, to name a few.

But this definition also includes services to prevent and respond to gender-based violence; services to deal with infertility, and the prevention and management of reproductive cancers.

What is your stand on SRHR during the Nairobi Summit?

Ideologically driven forces are seeking to roll back hard-won gains, to slash funding for essential services, and to remove references to these services and rights from international agreements.

My stand on SRHR during the Nairobi Summit has been that we need to be bold. We have made progress since Cairo in 1994 – but that progress still falls short for many women and girls - and that can be a life and death matter.

At a time when there is growing political momentum in countries to provide affordable, quality health for all – universal health coverage, we must seize the opportunity to ensure that SRHR interventions are included in national health plans, with the financial resources to back them up.