Effectively addressing reproductive health problems calls for an integrated, rights-based approach that draws on the fields of health, ethics, law and human rights. This approach can provide analytical tools to identify root causes and inequities, shape humane and effective programmes and policies, and pressure governments into working proactively. This issue of Outlook, published by PATH, outlines the principles, benefits, obligations and implementation of such an approach.
Three landmark international meetings in the 1990s forged a new consensus on reproductive rights. Individuals have the right to control their sexual and reproductive lives without interference, while governments must ensure equal access to health care, including comprehensive reproductive health services. A rights-based approach can provide health practitioners with an ethical framework and understanding of societal factors. It can improve the effectiveness of interventions and empower clients. International human rights treaty obligations can increase pressure on governments, as well as raise the visibility of health problems like maternal mortality.
Human rights treaties not only place obligations on states but also indirectly create responsibilities for other organisations and individuals:
- Country reporting processes give monitoring committees and civil society an opportunity to influence a government’s actions.
- National governments must adopt appropriate laws and policies, address societal conditions hindering women from enjoying reproductive rights, allocate resources and hold officials accountable.
- Public health programmes must ensure everyone has access to a complete range of affordable, acceptable and good-quality reproductive health information, services and commodities.
- Clients and communities play a role: they may request privacy at clinics, ask for information, complain about breaches of confidentiality and help set social norms.
By drawing on the principles of human rights to guide policy, programme design, and service delivery, reproductive health programmes can protect clients and increase effectiveness.
- Reproductive health managers should assess the impact of current or proposed policies and programmes on clients’ reproductive rights. The focus of assessment should be service delivery, including access to information, technical quality of care, and client-provider interaction. A human rights audit can also be conducted at the facility level.
- Training and supporting providers is vital. Health workers may feel threatened by a rights-based approach, which can be seen as a loss of power. Training curricula on reproductive rights typically stress respect for clients, confidentiality, informed consent, autonomous decision-making, quality of care, and avoiding bias.
- Human rights education directed to the community can instil a sense of entitlement to reproductive rights, empower clients, and change social norms. It is sometimes difficult to translate rights concepts into relevant language, and communities used to thinking collectively may find the focus on the individual uncomfortable. Therefore, projects may ask communities to define rights and responsibilities and let their understanding guide programme strategies.
- In monitoring a rights-based approach to reproductive health, process indicators deserve as much attention as outcomes. Many rights focus on how health care is delivered, others will take time to achieve, and reliable data on outcomes is unavailable in many countries. Consequently, evaluation of a programme to reduce maternal mortality should not focus on changes in maternal mortality rates and ratios alone.
