Why Rights Indicators are Essential to Achieving Universal Access to SRHR

February 2, 2016 shutterstock_260668823 copy 2

By Sivananthi Thanenthiren, Executive Director, ARROW (@SivananthiT)

Based on a speech given at a panel discussion organized by the Guttmacher Institute at the International Conference on Family Planning (ICFP), in January 2016.

I always seem to have the pleasure of having the interesting topics to talk about and today the topic allotted to me is rights and indicators. And the critical question people will ask me is can rights be measured? So I put it to you that when you and I are living in our countries we know when our rights are being respected, and we also know when our rights are being taken away, and we definitely know when our rights are violated.

So even though we currently may not have the measurements, but we definitely have this experience and how can we measure this experience? Can progress be tracked with regards to the respect, fulfilment and realisation of rights and can deviations also be tracked? Because even when we have rights, especially in the area of sexual and reproductive rights, we know that somehow they are not concretised, and there are always slippages occuring, sometimes even to the levels that those rights are sometimes non-existent. Hence the measurement of rights is a critical part of the SDG agenda.

Many rights indicators which are crafted are laws and policies and while these are useful – because putting down a law or policy is the way the government indicates that it recognises that this right exists – it should not be the only aspect. For an example the World Abortion Policies which UN-DESA puts out year after year says that abortion is illegal in only 5 countries in the world. When we try to raise the issue of access to safe abortion, the issue is considered as a negligible one because of this data, and yet we know that ground realities are so different and every country in the world has limitations – whether these are financial, legal, service provider related. Furthermore, in the last 20 years, very few countries are able to accept the grounds of ‘abortion on demand’ except for those in Western Europe. So we have not actually been able to move the discourse of rights around abortion very far with this type of indicator.

So I think it is important for us to move to try to measure a ‘fulfilment’ of these rights. While still recognising that it is important to have a recognition of rights in law, for example even for an issue like child, early and forced marriage there are governments who are reluctant to pass laws on a minimum age of marriage. But let’s also try to move governments to fulfil these rights by providing measurement for this.

I suggest three key parameters for this discussion.

When we talk about goals and targets, we very often forget that lives and circumstances of human beings cannot be fitted into these silos of goals and targets. And it is not impossible to link some of these targets and indicators to tell a story of development, rights and SRHR.

So these three key parameters would help us frame a story of the fulfilment of rights.

One, a comprehensive approach, particularly the life-cycle approach. Even a simple indicator like the contraceptive prevalence rate only covers a particular age group. So if we ask what happens to sexual and reproductive life after the age of 50, what do we cater for, what are the programmatic interventions? There are none, because after 50 we are not supposed to be having sex. This explains the rising HIV rates in retirement homes.

Even for maternal mortality ratio (MMR), we need a comprehensive approach although, often governments are asked to report only on a single number. However, for the real MMR to go down, there needs to be key programmatic interventions such as ante-natal coverage, skilled attendance at birth, access to emergency obstetric care, access to post-partum care (as most deaths are during this period), access to services for complications of abortions, and access to services for survivors of violence (which perhaps only Latin America is looking at).

Although the official reporting of the numbers may not permit it, it is essential for us to be able to tell the story of how this indicator is achieved, because it is equally important for us to see where the gaps are in order to make improvements.

Two, non-discrimination. I would like to focus on young people. Although a lot of attention has been given to the issue of adolescents, and the issue has gained traction, I think that if we were to include the lens of the comprehensive life-cycle approach and the lens of non-discrimination, then we could have a better grasp of what the indicator of adolescent birth rate needs to be and done. We have talked about youth-friendly services for a long time, but still but there needs to be a transformation of attitudes.

Evidence shows that young people face greater discrimination in accessing contraceptive services. Studies in Kenya, Zambia, Lao PDR and China show that health providers believe that distributing contraceptives to young people encourages promiscuity. Young women are more affected by double standards on sexual behaviour. Young or nulliparous women are denied contraception because of provider beliefs that contraception is not for women without children. In this context of fulfilling rights, we should also be able to advocate for and argue for privacy and confidentiality from an agency perspective and to do away with parental and spousal consents for accessing SRH services.

In conjunction with reducing the adolescent birth rate, there seems to be this push to providing long-acting reversible contraceptions (LARCS) to young women, but we seriously need to re-think this. Most young women, maybe in different relationships and not sure of where these will go, may not be prepared for a long-term method, and more importantly need dual protection methods: from pregnancy and HIV transmission.

A comprehensive approach on non-discrimination to an issue like adolescent birth rates would also entail passing laws on minimum age of marriage, and not lowering the age of marriage, as some countries are doing. Although it falls in a different goal and indicator, these two are very closely linked. We can’t go and say well we cannot do anything about adolescents getting married because its that tricky issue of culture and religion. But hey once you’re married let me give you a long-term method of contraception doesn’t seem to be very rights-based.

Three, on non-coercion and non-violence as important aspects of rights. Non-coercion can be ensured by enabling informed decision-making and giving women and men the information on and choice of range of methods, what are the possible side effects, and what to do if those side effects occur is absolutely critical. But we also look at the types of incentives and disincentives given to women in order to take up certain methods. There is enough research and evidence to show that this is indeed happening. We also need to ensure that forced sterilisation of disabled and HIV positive women via incentives and disincentives is something that should not happen. There is also the issue of violence, and though violence falls in the gender equality goal but it is also related closely with reproductive health – with contraceptive behaviour, with HIV transmission, with maternal mortality. So we need to be able to make these inter-linkages for our own understanding on how women’s lives are being affected, because women don’t live lives in silos. We also need to recognise the violence faced by women inflicted by service providers.

So why are these important? Why is non-coercion and non-violence important as long as the goals and the targets are met? For me the way we implement the agenda is perhaps the most important thing we can do. Because at the end of the day where does the sustainability come from? It’s a question that donors like to ask isn’t it?

In my experience sustainability for the agenda comes from women and men on the ground; they need to own this agenda, they need to know this right is theirs, that these choices are theirs to makes.

And when these men and women own the agenda, they will hold their governments accountable to fulfilling these rights, then this SRHR agenda is not only the agenda of the people in this room but the agenda of all the people on the ground. And that these rights are our rights, and not imposed by the SDGs, or donors, or by Northern governments. But it is about the ownership of the agenda by people on the ground and governments in the South.