Asia Pacific Reiterates Calls for Renewed Consensus and Global Commitment to Create a More Equal, Equitable, Just and Sustainable World
The world we want is far from the world we have. Twenty years after the implementation of the ICPD Programme of Action, we need to recognise progress has been made – maternal mortality ratios and infant mortality rates have decreased, access to contraception has improved and life expectancy has increased. However, much remains to be accomplished. The ICPD Programme of Action helped shift population policies from demographically driven targets towards a people-centred approach, putting aspirations and choices of individuals and couples at the centre of development. The ICPD Programme of Action also presented a holistic development document, which marked the pathways towards creating a more just, equal, equitable and sustainable world.
Twenty years later, we are still far from achieving sexual and reproductive health and rights (SRHR) for all. Asia, where we live and work, is a diverse region of inequalities and paradoxes, ranging from small island states to populous sub-continents. Home to 61.3% of the world’s people, as well as 60.4% of all women and 62.6% of youth, the region has two-thirds of the world’s poor, as well as 62.5% of the world’s hungry, and 42% of maternal deaths with as high as 27% of these maternal deaths resulting from unsafe abortions. In the area of SRHR, 63% of the 222 million women who have an unmet need for contraception in 2012 come from Asia.[i] Outside of sub Saharan Africa, South Asia has the highest number of maternal deaths, with most of these occurring among young marginalised women. An estimated 2.8 million women in Asia and the Pacific suffer from morbidity due to pregnancy and childbirth that in many cases remain untreated and cause lifelong pain and psychological suffering.
Socio-economic inequities are closely inter-linked with higher rates of unintended births. Although total fertility rates have declined sharply to 2.2 children per woman in 2009, women from the least-developed countries, women with lower education, poor women and women who live in remote, hard-to-reach areas, as well as urban slums, have less access to contraception and hence, less control over fertility, and have more children than they actually want. This is especially pertinent in a region which has seen high but unequal economic development. Marginalised groups such as migrant women, people with disabilities, and indigenous women particularly have difficulties accessing services and exercising their rights. Amongst the marginalised groups, it is critical to point out that unintended pregnancies among adolescents and young women in the region are high, with almost 1 in 10 girls becoming pregnant by age 16 in South and Southeast Asia. Hence, the sexual and reproductive health and rights agenda is also the equality agenda of this century.
Realisation of sexual and reproductive health and rights has been particularly difficult and we have seen poor and uneven progress in attaining these indicators.[ii] For example, our NGO partners report that[iii]: in Pakistan, 75% of women living in rural areas deliver at home and do not have access to emergency obstetric care. In Mongolia, 75% of maternal deaths occur among nomadic herders, unregistered migrants and unemployed women. In India, 92 women are raped every day and 1 in every 4 married women experience physical or sexual violence by their husbands. In Nepal, 27% of married women have an unmet need for family planning services; adolescent women give birth to 81 out of every 1,000 children.
We must be cognisant of the fact that sexual and reproductive health and rights are inextricable from economic, socio-cultural and political rights and must be recognized as necessary ingredients to achieving gender equality and sustainable development.
Why are sexual and reproductive rights a prerequisite for equality, especially gender equality? Three core elements which embody the concept of sexual and reproductive rights are integral to individual autonomy:
to freely decide on matters of sexuality and reproduction;
to have the right to consent; and
to have bodily integrity.
Every individual must have the right to decide whom we can love, whom we can have consensual relations with and when, and whom we can enter into marriage with and when.
We must have the right to decide how many children to have if at all, when to have them and how frequently.
We must have the right to a life free from all forms of discrimination and violence.
We also call attention to the fact that sexual and reproductive health and rights do not exist in isolation: the full realisation of SRHR for all being severely affected by the intersection of persisting inequalities and new and emerging issues.
Sexual and reproductive health and rights for all remains unattainable when people are deprived of their most basic rights such as the right to food and nutrition for all. The Asia-Pacific region has the world’s biggest share of the hungriest people at 563 million,[iv] 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 are over-represented in this context, constituting almost 60% of the under-nourished population. In Asia, there is a hierarchy in food consumption, where adult men and boys eat first and girls and women eat last, leaving them very little food in poor households. This is one of the reasons hunger and malnutrition is higher among girls and women in South Asia. Poverty and hunger results in micronutrient deficiency, which directly affects mental/cognitive growth and functioning; under-nutrition results in anaemia, wasting and stunting. This has long-term effects on overall well-being and health of women and girls – it is estimated that half of all pregnant women worldwide suffer from iron deficiency anaemia, and this is made worse by repeated pregnancies.[v] Anaemia is one of the contributing reasons for high maternal mortality. At the same time, this limits girls from fully realising their potential and impacts educational, health, social attainments.
Climate change is also compounding these challenges. From 2009-2011 alone, there were 55.7 million people displaced by climate-related and extreme weather events in the region.[vi]Inadequate provision of facilities to face climate change intensifies the socio-economic divide, leading to food insecurity and gender-power hierarchies.[vii] Women, in their position as natural resource managers, are hugely impacted through climate change and are at an increased risk for early, child and forced marriage, sexual harassment, trafficking, sexually transmitted infections including HIV and AIDS, and a rising trend in gender-based violence.[viii]
Growth in religious and political conservatism and fundamentalism across countries in the Asia-Pacific region has led to a roll back of significant policy successes in the sexual and reproductive rights agenda. This has affected women adversely through practices such as early, child and forced marriage, often leading to early, unwanted and frequent pregnancies, female genital cutting, and inadequate access to sexuality education and services, including access to contraception and safe abortion services.
This is a point of time in history which enables governments and citizens to re-negotiate the social contract in our societies and to reimagine a world of possibility, of promise and most importantly – of hope.
We are heartened that these challenges are fully recognised by the Report of the Secretary –General on the Framework of Actions for the follow up to the Programme of Action to the ICPD Beyond 2014 (A/69/62) and welcome the fact that governments have committed to recognising these gaps and challenges at the regional population conferences which have resulted in the Montevideo Consensus on Population and Development from ECLAC, the 6th Asian and Pacific Declaration on Population and Development from ESCAP; and the Addis Ababa Declaration on Population and Development in Africa Beyond 2014 from ECA. We hope governments and all stakeholders unequivocally support the regional outcome documents and the Report of the Secretary General on the Framework of Actions – to accelerate the full achievement of the vision of the ICPD Programme of Action.
We call for universal access to sexual and reproductive health information and services, including access to a full range of contraceptive methods; safe abortion services; counselling, quality treatment, including empathetic and trained health service providers; and comprehensive sexuality education provided across different settings. We also call for context-specific, rights-based continuum of quality care for reproductive health.[ix] In doing so, we will achieve a reduction in maternal deaths, including those caused by unsafe abortion. We will also see adolescent births declining, the need for contraception met, and lower numbers of people living with HIV amongst other indicators.
Further, we call on Member States and the international community to ensure universality of sexual and reproductive rights, and universal access to sexual and reproductive health and rights information and services, with particular focus on marginalised groups, including women, adolescents, young people, people of diverse sexual orientation and gender identities, people with disabilities, indigenous peoples, rural women, migrants, ethnic and religious minorities, people living in contexts of disaster, war and conflict, displaced and stateless persons, sex workers, and people living with HIV and AIDS, amongst others, in line with existing international commitments and conventions.
Human beings and the full realisation of their human rights – recognised, attested to, and signed on by all member states present here – must be the goal of any development framework which aims to create a more equal, equitable, just and sustainable world. Nothing less will do.
Asian-Pacific Resource and Research Centre for Women (ARROW)
Asia Pacific Alliance for Sexual and Reproductive Health and Rights (APA)
Asia Pacific Forum on Women, Law and Development (APWLD)
Asian Rural Women’s Coalition (ARWC)
Asmita Woman Publication House (Nepal)
ASTRA Central and Eastern European Women’s Network for Sexual and Reproductive Rights and Health
Bal Samaj Nepal (Nepal)
Beyond Beijing Committee (Nepal)
Bangladesh Nari Progati Sangha (Bangladesh)
Centre for Creative Initiatives in Health and Population (Vietnam)
Centre for Health, Education, Training and Nutrition Awareness (India)
Centre for Human Rights and Development (Mongolia)
Child Society Nepal
Children-Women In Social Service and Human Rights (Nepal)
Creating Resources for Empowerment in Action (India)
Danish Family Planning Association (Denmark)
Dharti Development Foundation (Pakistan)
Economical & Social Development Organization (Nepal)
Foundation for Educational Change (Nepal)
Federation of Reproductive Health Associations (Malaysia)
Federation for Women and Family Planning/ASTRA Network (Poland)
Fiji Women’s Rights Movement (Fiji)
Forum of Women’s NGOs of Kyrgyzstan (Kyrgyzstan)
Hasana Magazine (Nepal)
Human Rights and Public Health Forum (Nepal)
Huvadhoo Aid (Maldives)
Ikhtyar for Development, Training, Research and Consultancy (Egypt)
International Women’s Rights Action Watch Asia Pacfiic
Jagaran Media Center (Nepal)
Japan Women’s Watch (Japan)
Khan Foundation (Bangladesh
Khokona Women Awareness Society (Nepal)
Korea Women’s Watch (Korea)
Latin American and Caribbean Women’s Health Network (LACWHN)
Likhaan Centre for Women’s Health (Philippines)
MAP Foundation (Thailand)
Mahila Dakshata Samiti (India)
Dr. Marilen Danguilan (Independent Expert)
Migrant Women Works Group (Nepal)
MONFEMNET National Network (Mongolia)
Dr. Narimah Awin (Independent Expert)
National Alliance of Women (India)
National Alliance of Women Human Rights Defenders (Nepal)
National Dalit Network (Nepal)
National Fisheries Solidarity Movement (Sri Lanka)
National Indigenous Women Forum (Nepal)
National Inter-Religious Network (Nepal)
Nepal Disable Women Association (Nepal)
PATH Foundation (Philippines)
Population Foundation India (India)
Pragatishil Apanga Samaaj (Progressive Society of People with Disabilities) (Nepal)
Reproductive Health Association of Cambodia (Cambodia)
Reproductive Rights Advocacy Alliance Malaysia (Malaysia)
Rural Institution for Community Development
Rural Reconstruction Nepal
Rural Women’s Awareness Organization (Nepal)
Society for Health Education (Maldives)
South Asia Women’s Watch
Rural Women’s Social Education Centre (India)
Shirkat Gah (Pakistan)
Sindh Community Foundation (Pakistan)
TARSHI (Talking about Reproductive and Sexual Health Issues) (India)
University of Health Sciences (Lao PDR)
Women and Children Social Welfare Society (Nepal)
Women Awareness and Vision Centre (Nepal)
Women Awareness Society Nepal (Nepal)
Women Empowerment Nepal (Nepal)
Youth Welfare Society (Nepal)
Women Acting Together For Change (Nepal)
Women’s Health Foundation (Indonesia)
Women and Media Collective (Sri Lanka)
Women’s Rehabilitation Centre (Nepal)
Women Skill Creation Center (Nepal)
Women Study Center (Nepal)
World Young Women’s Christian Association
Youth Advocacy Network (Pakistan)
Yunnan Health and Development Research Association (China)
Endnotes and References:
[i] Singh, S., & Darroch, J.E. (2012). Adding It Up: Costs and Benefits of Contraceptive Services: Estimates for 2012. Guttmacher Institute. http://www.guttmacher.org/pubs/AIU-2012-estimates.pdf
[ii] Thanenthiran, S., Racherla, S., and Jahanath, S. (2013). Reclaiming & Redefining Rights. ICPD+20: The Status of Sexual and Reproductive Health and Rights in Asia Pacific. Kuala Lumpur: The Asian-Pacific Resource & Research Centre for Women (ARROW). http://www.arrow.org.my/publications/ICPD+20/ICPD+20_ARROW_AP.pdf
[iii]ARROW & partner’s SRHR4ALL campaign: https://www.facebook.com/media/set/?set=a.1512198495694118.1073741830.1413103572270278&type=3
[iv]UN Food and Agriculture Organisation, the International Fund for Agricultural Development and the World Food Programme. State of Food Insecurity in the World 2012.
[v] Ravindran,T.K.S. (2014). What it takes: Addressing poverty and achieving food sovereignty, food security, and universal access to sexual and reproductive healthcare services. Bridging the divide: Thematic paper series on linking gender, poverty eradication, food sovereignty and security, and sexual and reproductive health and rights. Kuala Lumpur: ARROW. http://arrow.org.my/publications/ARROW%20Thematic%20Paper%2001.pdf
[vi] ADB. 2012. Addressing Climate Change and Migration in Asia and the Pacific. Philippines: ADB. http://beta.adb.org/sites/default/files/pub/2012/addressing-climate-change-migration.pdf
[vii] Woods, Z (2014). “Identifying opportunities for action on climate change and sexual and reproductive health and rights in Bangladesh, Indonesia and the Philippines.” Kuala Lumpur: ARROW. http://arrow.org.my/download/Scoping%20Study%20-%20Climate%20Change%20and%20SRHR.pdf
[viii]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. http://www.arrow.org.my/uploads/20121218025358_v19n1.pdf
[ix]ARROW (2013). Women’s Health and Rights Advocacy Partnership – South Asia: Rights Based Continuum of Quality Care for Women’s Reproductive Health in South Asia. Kuala Lumpur, Malaysia: Author.