Putting reproductive health back on the agenda

The Cairo Agenda – a set of international agreements – which came out of the International Conference on Population and Development in 1994, shifted policy focus away from population control. Access to good quality reproductive health care for both women and men was promoted as a right. The more recently agreed Millennium Development Goals (MDGs) however, narrowed the focus down to maternal mortality. While it is crucial to address maternal mortality, it is important to bring reproductive health back into the picture as without this the MDGs will not be met.

An article from the Institute of Development Studies in the UK assesses the progress in meeting the international commitments to reproductive health. Arguing for a renewed emphasis on the broader subject of reproductive health, it notes the political nature of targets and goals in international development.

The Cairo Agenda and the MDGs represent two different ways of setting international goals. Whereas the Cairo Agenda was led by advocacy, the MDGs were driven by international bureaucracies. Careful coalition building enabled the Cairo advocates to drive through a progressive consensus against opposition from some national interests. However, the absence of advocacy from the setting of the MDGs weakened the capacity of the international bureaucracy to withstand pressure from a certain group of countries and conservative interests which opposed the rights based agenda. Despite this, reproductive health remains a powerful vision which has been reaffirmed by the World Health Organization in its approach to the implementation of the MDGs.

The researcher warns, however, that the goals and targets of the Cairo Agenda and the MDGs cannot be met within their respective timeframes because:

• Financing of reproductive health is complex and draws from a wide range of sources.
• International pledges for Cairo have still not been met and rich countries do not have a good record on meeting their commitments to development aid: a significant amount of the international funds went to family planning programmes in the 1990s while maternal health received only 0.2 per cent of the total.
• Extremely low levels of resources allocated to the health sector in some of the poorest countries make it impossible to provide even basic universal coverage of essential reproductive health services: in several sub-Saharan African countries less than US$10 per person is currently spent annually.
• Achievements over the last decade have been mixed and not always easy to track as reliable indicators and data are lacking or missing: many developing countries lack the capacity and infrastructure to collect information through their existing systems.

People are paying more for health services and they are increasingly using the private sector, including for reproductive health services, and this needs more policy attention than it is currently receiving. The link between greater resources and better health outcomes is not necessarily direct and progressive.

Policy-makers have to recognise that:

• Funding needs to be more targeted: for example, addressing maternal mortality, requires investments in primary health programmes to be combined with improvements of referral systems and trained assistance.
• Provision of effective services is not just a question of resources because factors such as poor governance and accountability lead to low quality, under-utilised services: issues such as poor supervision of staff or low salaries contributing to informal payments to staff will have to be tackled effectively.
• Reforming health systems is a prerequisite for improving reproductive health care and addressing the health care delivery constraints which contribute to high levels of maternal mortality.
• High levels of gender inequality result in poor reproductive health outcomes and this cannot be tackled by the health sector alone: women need to take greater control of decisions which affect their lives because household power and community structures, norms and practices could lead to delays in seeking treatment or denial of care.

It is important to retain the broad vision of reproductive health care contained in the Cairo Agenda. This will always be a political issue and cannot be achieved without a broad commitment to human rights and gender equality. Advocacy efforts have to be maintained both at international and national levels because of this. The narrower targets of the MDGs in maternal health will not be achieved without this broader commitment to these issues.

Source(s):
Reproductive Health for All?’ by Hilary Standing in Richard Black and Howard White (eds.) Targeting Development: Critical Perspectives on the Millennium Development Goals London: Routledge, 2004

id21 Research Highlight: 13 September 2004

Further Information:
Hilary Standing
Institute of Development Studies
University of Sussex
Brighton
BN1 9RE
UK

Tel: +44 (0) 1273 606261
Fax: +44 (0) 1273 621202 / 691647
Contact the contributor: H.Standing@ids.ac.uk

Institute of Development Studies (IDS), UK

Other related links:
'Realizing rights: transforming approaches to sexual and reproductive well-being'

'Family franchise: reproductive healthcare and the private sector'

'Motherhood in the city: poor urban women and maternal health care provision in sub-Saharan Africa'

Reproductive Health Gateway

Reproductive Health Information form Marie Stopes International