By the Asian-Pacific Resource & Research Centre for Women (ARROW)
Asia Pacific calls for the inclusion of SRHR in the Post 2015 Agenda
Sexual and reproductive health and rights are inextricable from economic, socio-cultural and political rights and must be recognized as a necessary ingredient to achieving gender equality and sustainable development. Almost 20 years after ICPD Cairo, we are still far from achieving Sexual and Reproductive Health and Rights (SRHR) for all. In the run for achieving the Millennium Development Goals (MDGs) in 2015, we also find that the progress towards MDG 5 on Universal Access to Reproductive Health has been unacceptably slow. Women and young people therefore remain at the very bottom among the recipients and beneficiaries of the development agenda. Despite setting targets and indicators for the achievement of the MDGs, we in the Asia Pacific region remain far from achieving our goals and it is at this juncture that we embark on setting forth the next set of indicators to measure our successes and failures. Despite the let-downs till date, it is with concern that we look at the political apathy and lack of will to move towards an affirmative agenda for all.
In the proposed goals and targets for Sustainable Development in the Post-2015 Development agenda, it is a welcome move to include goals towards eliminating poverty, and on ending hunger and achieving food security and adequate nutrition for all; this would however not be possible with the diminishing focus on issues of women’s and young people’s SRHR. The Asia-Pacific region has the world’s biggest share of the most hungry people at 563 million1 with poor people having to spend as much as 60-70% of their income on food, a problem growing with rising food prices. Women and girls constitute almost 60% of the under-nourished population. When women and girls form such a huge constituency of the under-nourished population, their needs must not be marginalized within the development agenda. Marginalisation of health in financial and budgetary allocation processes results in negligible amounts spent on general government health expenditures. This is closely connected to the increasing trend of privatization of service provision and the downloading of responsibility by national governments; connected to this is also the lack of adequate mechanisms and implementation private sector regulation from which the poor and most marginalised are severely affected.2
While proposed goal 3 discusses the attainment of healthy life for all through all ages, this can hardly take place with discounting of issues of maternal mortality and morbidity globally. For instance, although there has been a reduction in the maternal mortality ratio in the Asia Pacific region from 1990-2010, it remains high in South Asia at 220 deaths per 100,000 live births.3 A considerable percentage of all maternal deaths in Southeast Asia and South Asia can be accorded to unsafe abortions. Women also suffer from a range of maternal morbidities including uterine prolapse, obstetric fistula and reproductive cancers. In the region we see gaps in quality and continuity of care provided to women, especially the most marginalised with a context-specific and rights-based approach which contributes to higher mortality and morbidities.2 Over the past decade, women represent 35% of people living with HIV in Asia.4 Despite these figures, women and young girls have remain largely side-lined from the proposed agenda. Growth in religious and political fundamentalism globally have also affected women adversely through practices such as early marriages, often leading to early, unwanted and frequent pregnancies, harmful cultural practices including female genital cutting, and inadequate access to sexuality education and services, including access to contraception and safe abortion. Such limitations make it difficult to achieve universal health coverage for all, let alone sexual and reproductive health and rights for all.
While proposed goal 4 talks about providing equitable and quality education for all, it leaves out from its purview the significance of providing Comprehensive Sexuality Education that would help young people and others to access vital information about their own bodies and health and promote good health for all. Adolescent births remain a challenge; the highest adolescent birth rates are seen in Oceania, with almost 62 births per 1,000 girls aged 15-19.3 Young people are further marginalized with inadequate access to information and services including youth-friendly services and services related to contraception and abortion. Services, wherever available, are focused on married women and girls thus excluding the unmarried young people. We need to recognize that women and young people who are poor, have limited formal education, live in remote and/or rural areas, from tribal groups, from ethnic minorities, from lower castes, LGBTQI people, are displaced, migrants or refugees, are in sex work or live with disabilities, face greater difficulties in accessing comprehensive sexuality education and services, and making decisions about their own bodies.
We applaud the inclusion of proposed goal 5 which talks about issues of gender inequality; we however call for a more nuanced analysis of the laws and policies that criminalize women for accessing abortion, laws that criminalize same-sex sexual relations and laws that criminalize sex work, among others, across different country contexts. Attaining a development agenda that truly encompasses the needs of all its constituencies would be impossible in the marginalization of the agenda for women and young people including persons of diverse sexualities and gender identities.
Although proposed goals 6 and 7 discuss issues of secure water and sanitation, access to sustainable and modern energy services, it is also important to note here the inequitable ways in which climate change affects and impacts women globally. Inadequate provision of facilities to face climate change intensifies the socio-economic divide, leading to food insecurity and gender-power hierarchies. Women, in the position of natural resource managers, are hugely impacted through climate change and are at an increased risk for early marriages, sexual harassment, trafficking, sexually transmitted infections including HIV/AIDS, and a rising trend in gender-based violence.5 Cross-region migration due to a host of factors including climate change, wars and conflicts, also affects women’s sexual and reproductive health and rights with restrictions on mobility, wrongful confiscation of identity documents, higher costs of health services, increasing privatisation of healthcare, lack of insurance coverage and screenings for pregnancies and sexually transmitted infections including HIV, oftentimes against their knowledge or will. In 2010, out of 214 million people globally, there were approximately 27.5 million international migrants in Asia, and 6 million international migrants in the Pacific; almost half of both these figures constituted women.6
We at ARROW, along with all our partners in the Asia Pacific region therefore demand that the agenda of women and young people be included more firmly within the development agenda. In reiterating the Kuala Lumpur Call to Action, we affirm the need to recognise gender equality, equity and SRHR as an integral part of sustainable development, and a comprehensive SRHR agenda that looks at the intersectionalities of peoples’ locations must be used in re-shaping the development agenda. We need to review, amend and implement laws and policies that address the concerns of all people including the most marginalized and uphold SRHR for all. For this, we need to ensure good accountability mechanisms in place, and conduct and support ethical, gender-sensitive research, as well as ensure universal access to continuum of quality care2 and comprehensive SRH services at all levels of healthcare and public provisioning. We believe that development for all cannot be achieved with the marginalization of an important and a large constituency of women and young people.
Women and young peoples’ SRHR requires a more nuanced and empathetic approach with due regard to universal access SRHR information and services, access to contraception and abortion, youth-friendly services, and comprehensive sexuality education. Women and young peoples’ needs must also be observed at the juxtaposition of a multiplicity of issues including increasing religious and political fundamentalism(s), climate change and migration and lack of food security and sovereignty for all. Lastly, we fervently believe that in order to make the sustainable development agenda to work, we need to make women and young people count.
UN Food and Agriculture Organisation, the International Fund for Agricultural Development and the World Food Programme. State of Food Insecurity in the World 2012.
Dossa, S. (2012). Rights Based Continuum of Quality Care for Women’s Reproductive Health in South Asia. Position Paper for Women’s Health & Rights Advocacy Partnership in South Asia. ARROW.
UN (2012). The Millennium Development Goals Report 2012. New York, USA: Author.
UNAIDS (Joint United Nations Programme on HIV/AIDS) (2011). HIV in Asia and the Pacific: Getting to Zero. Bangkok, Thailand: Author.
Silliman, J. (2012). Addressing Sexual and Reproductive Health and Rights in the Context of Climate Change. ARROW for Change: Labour Migration, Gender, and Sexual and Reproductive Health and Rights 18(Special edition). Kuala Lumpur, Malaysia.
Marin, M. L. (2013). When Crossing Borders: Recognising the Sexual and Reproductive Health and Rights of Women Migrant Workers. ARROW for Change: Labour Migration, Gender, and Sexual and Reproductive Health and Rights 19(1). Kuala Lumpur, Malaysia.
AFPPD (Asia Forum of Parliamentarians on Population and Development)
Agriculture Cooperative, Nepal
ASEAN Youth Forum
Asia Pacific Alliance for Sexual and Reproductive Health and Rights (APA)
Asia Pacific Women’s Watch
Bal Samaj Nepal
Bangladesh Nari Pragati Sangha, Bangladesh
Beyond Beijing Committee, Nepal
Bipana Dhimal, Yuwalaya, Nepal
CHETNA – Centre for Health, Education, Training and Nutrition Awareness, India
Child in Need Institute (CINI), India
Development Campaign Nepal
Diwakar Pyakurel, Yuwalaya, Nepal
Gadaki Aama Samuha, Nepal
Jagaran Media Center, Nepal
Janahit Mahila Taha Didi Bahini Sanstha, Nepal
Likhaan Center for Women’s Health, Philippines
Nari Kalyan Bachat, Nepal
National Dalit Network, Nepal
National Teacher Association, Nepal
Pacific Sexual & Reproductive Health Research Centre
Persatuan Kesedarah Komuniti Selangor (EMPOWER) Malaysia
Pramada Menon, Queer Feminist Activist, India
Rahnuma-Family Planning Association of Pakistan
Rashidah Shuib, Malaysia
Reproductive Health Association of Cambodia (RHAC)
Rubina Shrestha, Yuwalaya, Nepal
Rural Development, Nepal
Rural Institution for Community Development, Nepal
Rural Women’s Social Education Centre- RUWSEC, India
Rutgers WPF Pakistan
Sabin Sigh, Yuwalaya, Nepal
Sanjog Thakuri, Yuwalaya, Nepal
Santosh Maharjan, Yuwalaya, Nepal
Sisters in Islam, Malaysia
Sri Lanka Women’s NGO Forum
Subash Neupane, Yuwalaya, Nepal
Sushila KC, Yuwalaya, Nepal
TARSHI (Talking About Reproductive and Sexual Health Issues), India
The Faculty of Postgraduate Studies, University of Health Sciences, Laos
The Family Health Association of Iran (FHA Iran)
The Pacific Feminist SRHR Coalition
The Women’s Global Network for Reproductive Rights (WGNRR)
Women and Media Collective, Sri Lanka
Women Empowerment Nepal
Women Study Center, Nepal
Women Welfare Service, Nepal
Youth Welfare Society, Nepal
Yunnan Health and Development Research Association (YHDRA), China
 The definition of marginalization varies across all the countries but includes such communities as the urban poor, rural poor, tribal women, Dalit women, and young women. The strategy of outreach to marginalized women is through partnerships with CBOs. (Source: Women’s Health and Rights Advocacy Partnership- South Asia) http://www.whrap.org/