ICPD 10: reasserting reproductive health in the global agenda.

The 2004 global and regional roundtables reviewing and monitoring progress of the Cairo Programme of Action (POA) implementation concluded that this document remains a critical comprehensive UN document which outlines an agenda and framework linking human rights principles with population and development, poverty eradication, social justice, gender equality, women's empowerment, sexual and reproductive health and rights (SRHR) and NGO participation. Ten years into the POA, progress in implementation in the Asia-Pacific region remains poor. ARROW's eight-country regional monitoring study revealed that one million women have died unnecessarily in childbirth, pregnancy and unsafe abortion since Cairo. Only China has attained the goal of reducing maternal mortality by 50% by the year 2000. Nationally, the ICPD POA has not yet been clearly institutionalised in national development frameworks like women's development, health, population and in poverty. Although there has been significant progress in the region in the area of violence against women and the creation of national machineries like ministries and commissions, women are still not able to exercise control over their reproductive and sexual lives due to the following barriers.

In the last ten years globally, poverty has increased and public health systems have deteriorated as the neo-liberal framework, under the guise of health sector reforms, places cost effectiveness and efficiency over social justice and equity objectives. As a direct result of reforms in the health sector, which often comes in the form of user fees, poor and marginalised women's access to SRHR services has been reduced. Women's groups have lost ground in engaging the UN process due to rising political and religious conservatism sweeping the globe. Instead of pushing forward with our agenda, women's groups are expending time and energy on defending the language of documents like the ICPD POA and the Beijing Platform for Action. The Bush Administration in collusion with the Organisation of Islamic Countries (OIC) and the Vatican have created a difficult environment for NGO advocacy intervention as evidenced at both the ICPD and Beijing + 10 reviews when sexual and reproductive health rights came under attack.

Some NGO movements have strengthened in the last decade, such as the social justice, anti-globalisation and HIV/AIDS activism movements. However women's health groups have not only been unsuccessful in organising themselves effectively internationally but have also not effectively linked up to other social movements. NGOs must now find more creative and collaborative mechanisms in and outside the UN process to reassert our agenda at the global level. Governments must commit to the ICPD POA's call that NGOs and civil society be allowed to play a key role in decision-making in the planning, implementing and evaluating of policies that are women-centred and which embrace the human rights framework. Governments must be held accountable for their commitments and follow through on their commitment to build genuine partnerships with diverse NGOs including women's activist NGOs.

Poverty reduction and development goals cannot be realistically achieved as long as universal comprehensive access to sexual and reproductive health (SRH) services is not available. The absence of SRHR as a specific goal in the Millennium Development Goals (MDGs) limits the amount of resources that countries invest into sexual and reproductive health programmes as MDGs have become the basis of country-based Poverty Reduction Strategy Papers and Sector Wide Approaches. The MDGs focus on poverty and high mortality diseases reduction and the challenge now is to show the clear links of SRH to this poverty framework. Women's health groups and relevant UN agencies must work strategically towards the upcoming five-year MDG review process at both the national and international levels, to advocate strongly to include sexual and reproductive health indicators in Goal Five of the MDGs, to improve maternal health and for SRHR to be recognised as a crosscutting concern in the other eight goals.

So much remains to be done at all levels that it is critical for overstretched and underfunded governments and NGOs to decide where to strategically begin. ARROW and our women activist NGO partners have developed the following list of actions.

Recommendations for Action

* Governments to urgently evaluate the country-specific impact of current health sector reforms on the availability, accessibility and affordability of SRH services, especially on the most vulnerable and marginalised communities.

* Governments must not impose user fees for essential SRH services such as childbirth, family planning, abortion and reproductive health cancer. Ensure social insurance covers these areas and provide these services for free or at minimal cost.

* Governments must prioritise SRHR policies and increase budget allocations for primary healthcare, especially SRH.

* Governments must institutionalise effective national, state and local committees to plan, monitor and evaluate ICPD implementation that include the participation of civil society.

* Donors must include inbuilt reviewing, planning, monitoring and evaluation mechanisms in donor loans and grants to ensure that health sector reforms are based on social justice principles of human rights to health and women's rights, and not just on efficiency and other economic justifications.

* Donors must ensure that access to affordable and quality SRH services is integrated into all bilateral funding and loans and that the promotion of human rights and reproductive rights is a high priority in funding in all national development policies, programmes and poverty reduction strategies.

* Donor countries and organisations must not be motivated by conservative ideologies and impose such ideologies on sovereign nation states. Instead, aid should be based on universal human rights, and in accordance with the priorities and needs of countries.

* UNFPA and WHO to lead the development and promotion of model country ICPD planning, implementation and monitoring systems with agreed on objectives, indicators, annual accountability reports and clear NGO roles.

* UN agencies must develop national indicators that reflect SRHR and women's empowerment in a more comprehensive manner, such as indicators on incidence of rape and domestic violence, percentage of land owned by women, and so on.

* NGOs must strengthen or form effective SRHR networks, alliances or coalitions at the international, national, state and local levels among reproductive health, HIV/AIDS, women's activists, human rights and youth NGOs to strategically plan and implement advocacy strategies on critical SRHR issues.

* NGOs should produce bi-annual alternative ICPD country monitoring reports, report on or initiate legal action against SRHR violations and provide clear frameworks, models and tools for governments, and donors and participate in the planning, implementation and evaluation of rights-based SRH services and population and development policies.

* By Rashidah Abdullah, Executive Director, Asian-Pacific Resource and Research Centre for Women.

* Endnotes ARROW ARROW. 2004. Monitoring ICPD Ten Years On. Kuala Lumpur: ARROW. [Unpublished] Website: www.arrow.org.my