South Asia Advocacy for Integrating Sexual and Reproductive Health and Rights in MDGS by

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Need for Integrating Sexual and Reproductive
Health and Rights in the MDGs A plea from South
AsiaMs. Indu Capoor, Founder-Director
Centre for Health Education, Training and
Nutrition Awareness , Ahmedabad, India
6th June 2007
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Making MDGs a Reality

• The eight MDGs are an unprecedented promise by
  all world leaders to accelerate global efforts to
  meet the needs of the worlds poorest by 2015.
  However, universal access to reproductive health
  services and focus on sexual and reproductive
  health and rights was missing until recently.
• None of the MDGs can be attained without
  addressing SRHR. Due to absence of SRHR in MDGs,
  SRHR has received less visibility, less
  attention, lower priority and less funding.

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Links between SRHR, poverty and gender
disempowerment

• Sexual and reproductive health among young people
  is a poverty issue and forced early marriage and
  early pregnancy is an outcome.
• Pregnant girls drop out of schools. Without
  education and employment unmarried pregnant girls
  are poorly prepared to take responsibility of
  childcare and face diminishing prospects for
  income generation.
• Addressing early pregnancy and empower-ment women
  for safe motherhood are necessary components for
  reducing maternal mortality and improving child
  health.

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While MDGs are a goal for the Global Commitment
Regional Disparities Exist

• Rachel
• Born in Europe
• Eats nutritious food
• Graduates from a good institution
• Is active in the job market
• Chooses her life partner
• Mother of two healthy children
  Lives a healthy life!

• Reni
• Born in South Asia
• Often goes hungry
• Works 10-12 hours
• Is married at 10
• Conceives at 13
• Looses 3 children
• Gives birth to 4 children
• Receives no care
• Is often abused
• Dies at 21 years of age!

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The scenario in South Asia

• South Asia is the worlds most populous region. A
  significant percentage of the population is
  denied basic human needs-food, shelter, clothing
  and education. (Per Capita Income ranges from USD
  250 to 840)
• A region of Class, caste, gender and race
  inequalities, political crisis, terrorism and
  turmoil.
• One fifth of the population in South Asia is
  between the ages of 15 and 24. This is the
  largest number of young people ever to transit
  into adulthood, both in South Asia and in the
  world.

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The SRHR situation in South Asia

• About 74 million women are missing in South Asia.
  They are the victims of social and economic
  neglect from the cradle to the grave. The sex
  ratio is 94/100 as compared to 106/100 at the
  global level.
• South Asia significantly contributes to the
  global burden of maternal deaths (MMR ranges from
  340-800).
• More than 80 of adolescent girls and 85 of
  pregnant women in South Asia suffer from anemia.
• In 2004 36 of the total deliveries in South Asia
  were attended by a skilled health personnel.

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The gap between policy and practice

• At policy level there has been some progress
  SRHR related issues are reflected in the youth,
  health, education policies. However, the reality
  at the ground is different! The implementation of
  the policies is the real challenge among other
  things because the public health systems are
  weak.
• While funding for reproductive health and
  education has increased, its access by
  field-based civil society organizations has
  become extremely difficult, due to the focus on
  public-private-partnerships.

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Obstacles

• The increasing global opposition against sexual
  and reproductive rights through budget
  restrictions partlicularly the US government
  (PEPFAR, GAG Rule)
• Religious opposition to sexuality education,
  access to contraceptives, abortion etc.
• The culture of silence among women and girls in
  South Asia

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What needs to be done?

• Build a strong and strategic advocacy
  partnership.
• Create new opportunities for people centered
  advocacy at the local, national and regional
  level.
• Strengthen civil society and marginalized womens
  capacity to effectively advocate for SRHR through
  field based evidence.
• Hold decision makers and service providers
  accountable.
• Conduct simultaneous advocacy and create linkages
  at state, national, regional and international
  level.

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Building Evidence and Ground for Advocacy
Capacity enhancement of CBOs and community to
articulate the denial of their rights
Listening to women narrate experiences of
accessing care from the public health System Lack
of infrastructure, supplies, absenteeism,
corruption
Documentation of denial to services in local and
national languages Developing policy briefs
Scanning the environment for advocacy
interventions and opportunities - community,
state policies and programme and the political
agenda and power from local to national level
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Advocacy efforts at various levels
Advocacy for Womens Access to Maternal Health
Services from the Public Health System
Dialogue with the community and elected
representatives for consensus building and
affirmative action
Voices of denial at the state level for state
policy action
National dialogue with policy makers, media,
donor agencies to showcase the evidence of
denial and demand for improved health services
Dialogue with the block and district public
health administrators and media
Opportunities, when ever available are seized at
all levels, to take community voices to the
policy makers
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Strong and tactful leadership required

• Global funding for the MDGs is not at the
  promised level and you can lobby with your
  government to put pressure on other donor
  countries especially in the EU to contribute to
  programmes that focus on a comprehensive
  approach Infant Mortality, young Peoples issues
  and maternal Health.
• Maintain focus on controversial issues to support
  the global fight for a gender and rights-based
  approach and help secure sexual and reproductive
  rights.

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Strong and tactful leadership required

• Pressurize your government to influence
  negotiations during PRSPs so that the voice of
  womens organizations, especially organizations
  working on advocacy for SRHR are heard and that
  womens rights-based programmes are funded.
• Review budgets for gaps and increase aid
  allocation to fund civil society organizations
  for
• Demand creation of health entitlements
• Ensuring accountability mechanisms
• Fund for enabling community feedback mechanisms.

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Strong and tactful leadership required

• Hold dialogues with civil society organizations
  to understand the political and social realities
  of countries being funded.
• Local realities are complex, dynamic and
  unpredictable, you can advocate for funding
  sustainable civil society organizations that
  could deepen the field understanding and link it
  to practice where health service outreach is
  poor.

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Let us join hands for a Healthy South Asia!

• Womens health is a personal and social state of
  balance and well being
• in which a woman feels strong, active,
  creative, wise and worthwhile
• where her body's vital power of functioning and
  healing is intact
• where her diverse capacities and rhythms are
  valued
• where she may decide and choose, express
  herself and move about freely.
• - from the 'Women and Health (WAH!) Programme
  Approach Document, 1993