Sexual and reproductive health is a human right, essential to human development and the achievement of the Millennium Development Goals. This paper by the Department for International Development (DFID) reviews achievements since the 1994 International Conference on Population and Development (ICPD), sets out DFIDs position on sexual and reproductive health and rights, and its view of the future. Important progress has been made, but there remains much to be done to achieve universal access to reproductive health services by 2015.
Sexual and reproductive ill health includes death and disability related to pregnancy, abortion and childbirth, sexually transmitted infections, HIV and AIDS, and reproductive tract cancers. This accounts for at least 20 per cent of the burden of global ill health for women of reproductive age, and 14 per cent for men. Of all human development indicators, those for sexual and reproductive ill health reveal the largest gaps between low income and developed countries and between rich and poor people within countries. Health service coverage in many high burden countries is currently far short of adequate. Resources could be made better use of through better integration of services for HIV and AIDS and sexual and reproductive health, so that they are complementary and not competitive.
Demand for reproductive health commodities is increasing as populations and awareness grow. Poor sexual and reproductive health and huge unmet need for family planning is threatening wider development, especially in Africa, where UN projections show a population increase from 794 million in 2000 to 2,000 million in 2050.
DFID aims to realise international ICPD targets on sexual and reproductive rights through advocacy and partnership with governments, international and civil society organisations, by promoting social inclusion and human rights, improving knowledge, and by encouraging cooperation between those working on HIV and AIDS and sexual and reproductive health.
- A rights-based approach to sexual and reproductive health can add momentum to policy-making and improvement of services. DFID identifies that an effective rights-based approach must incorporate social inclusion, support for participation through the community, and obligation through legislation and advocacy groups.
- The poorest people have the most to gain from improved access to sexual and reproductive health, but are least able to use and benefit from available services.
- There has been little change in investment in basic sexual and reproductive health services. Often reproductive health is a low priority in budgets.
- Improvements in sexual and reproductive health have been achieved through using existing resources more effectively. The major barrier in comprehensive service provision is too few trained staff.
- Continued investment is required in research, and more policy analysis on the cost and effectiveness of different approaches to integrating services for sexual and reproductive health.
Despite the gains of the past decade, increasing demand for services, threats to international consensus and the HIV and AIDS pandemic all bring extra challenges to the progress made.
- Improving sexual and reproductive health is among the most cost-effective of all development investments.
- The sexual health and reproductive services required must be accountable to poor and vulnerable people, appropriate to local needs, affordable, physically accessible, of high quality and non-discriminatory and non-stigmatising.
- Services provided must be comprehensive, including education, the supply of contraceptives and medicine, and diagnosis, treatment, counselling and care covering family planning, care for women who seek abortion and sexually transmitted disease.
- The critical shortage of service providers must be met with sustained financial and human resource investment.
