Opinion: We can't advance health without advancing rights

Seventy years ago, amidst the rubble and ruin of the world wars’ aftermath, world leaders proclaimed the Universal Declaration of Human Rights, affirming that we are all born equal in dignity and rights. It was the same year that the World Health Organization was established. Seven decades on, the legacy of those decisions has meant tremendous progress globally.

Today, the right to health is underpinned in law and understood to be indispensable to a life of dignity and well-being. In turn, universal human rights to nondiscrimination, information, participation, and consent are recognized broadly as necessary for the enjoyment of the right to health.

However, progress has not been inclusive.

When it comes to sexual and reproductive health and rights, at times progress has met resistance and even outright hostility. Hostility has been directed against, for example, the rights of women to have control over their own bodies and in their own lives. While preventable maternal and infant mortality and HIV transmission have decreased, these gains are tenuous so long as governments fail to embrace a comprehensive agenda for sexual and reproductive health and rights.

In many places, stigma and shame still dominate what should be dignifying access to essential services and commodities. Yet, sexual and reproductive health and rights are firmly grounded in international human rights standards. These well-recognized norms protect our right to decide whether and when to be sexually active, to live and express our own sexuality, and to determine whether and when to have children.

To encourage accelerated progress, the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights came together in early 2016 with 16 multidisciplinary experts from Africa, Asia, Europe, the Middle East, and North and South America.

The commission presented its bold vision for sexual and reproductive health and rights last month in South Africa. This vision takes an integrated approach, affirming that the achievement of sexual and reproductive health relies on the realization of sexual and reproductive rights.

As the United Nations deputy high commissioner for human rights, I served as a member of the advisory group to the commission, and welcome its urgent call for the adoption of an evidence-based and comprehensive global agenda, with human rights at the center.

The urgency of this call is made gravely apparent by the data. Each year worldwide, 25 million unsafe abortions take place, while as many as 180 million couples may be affected by infertility and nearly 2 million people become infected with HIV. And at some point in their lives, around 1 in 3 women are subjected to gender-based violence.

These stark realities are often neglected in health policy development and program implementation, so the Guttmacher-Lancet Commission recommends an essential package of interventions to bridge unsustainable gaps in health services and programs.

The package includes commonly recognized components of sexual and reproductive health, including contraceptive services, maternal and newborn care, and prevention and treatment of HIV/AIDS. It also includes the less-commonly provided interventions necessary for a holistic approach to sexual and reproductive health and rights, such as care for sexually transmitted infections other than HIV; comprehensive sexuality education; safe abortion care; prevention, detection, and counselling for gender-based violence; prevention, detection, and treatment of infertility and cervical cancer; and counselling and care for sexual health and well-being.

The Guttmacher-Lancet Commission’s agenda is right in principle and smart in practice. It is also achievable and affordable. For example, meeting the needs for modern contraception, safe abortion, and maternal and newborn health care in developing regions would cost just $9 per person per year. That is a manageable investment for most countries, especially since half of that amount is already spent to maintain current levels of care.

Going the extra step would yield enormous returns. The most recent data shows that fully meeting the need for modern contraception in developing regions and ensuring that pregnant women and their newborns receive essential care, would result in an 80 percent decline in newborn deaths and a 73 percent decline in maternal deaths from 2017 levels.

For these gains in rights-based service provision to be achieved, health systems require sustainable and predictable financing.

Ministries of health and finance should make these essential sexual and reproductive health interventions a joint priority and ensure their inclusion in national health budgets. National governments and donor agencies should also ensure that the essential components of sexual and reproductive health and rights continue to be explicitly included in the financing frameworks for global development initiatives, such as the Sustainable Development Goals and universal health coverage; the Global Strategy for Women’s, Children’s and Adolescents’ Health; and the World Bank’s Global Financing Facility.

More inclusive progress can be achieved by taking certain steps. Recognizing that national health systems are at different stages of development — some countries may need to determine priorities for the short term while making institutional reforms to lay the foundation for future improvements. Upholding sexual and reproductive health and rights demands tackling underlying power structures that entrench discrimination, whether based on gender, age, ethnicity, sexual orientation, health status, migration status or other identities. Political decisions to oppose services required only by women, such as safe abortion services, or to deny adolescents certain information, such as comprehensive sexuality education, must be denounced.

Human rights standards provide a framework of accountability for effective strategy prioritization, emphasizing the need for participatory and transparent policy discussions, as well as accountability for system failures. Trade-offs are inevitable, but respect for and protection of human rights are indispensable. Countries should work systematically toward guaranteeing in law, policy, and practice the essential package of sexual and reproductive health interventions for their entire population, specifically so that people and communities can receive those services without stigma, discrimination or financial hardship.

There are successes to defend but more inclusive progress to be achieved. We know what to do and how to do it, and we can be confident that doing so makes good social and economic sense. What will it take for leaders to act?