Addressing SRHR to Attain UHC

By Dr. Githinji Gitahi, Group CEO, Amref Health Africa

We all aspire to live in a world where every individual has access to the highest attainable standard of health without distinction of any kind; a world in which we all enjoy the fundamental right to make decisions about our bodies without facing any kind of opposition or barriers.

Universal Health Coverage (UHC) aims to turn these aspirations into reality by strengthening health systems so that all individuals receive the health services they need without suffering financial hardship. In fact, it has emerged as an essential framework to promote healthy lives and wellbeing for all, informed by the Sustainable Development Goals (SDGs).

However, despite significant progress being made in other areas of health, issues around Sexual and Reproductive Health Rights (SRHR) remain unaddressed, perhaps owing to the taboos surrounding candid and public discussions about sex and reproduction especially in the African context. This, notwithstanding SRHR being at the very core of the right to health and critical to sustainable development.

As the world powers toward achieving UHC, it is imperative we acknowledge that universal health cannot be achieved without the full inclusion of SRHR as a key element, or the advancement of women’s rights as a whole.

These two intimately intertwined issues are expected to be at the fore of global discussions in 2020 as the world marks the beginning of the 10-year countdown to achieving the SDGs, as well as the 25th anniversary of the Beijing Platform for Action. This anniversary will convene governments, development partners, civil society groups and women from all over the world to create a global movement for change that will press for greater advancement of women’s rights, including SRHR, gender equality, decent work, equal pay and end to violence against women.

These rights, among other things, enable adolescent girls and women to make free and informed decisions about their sexual health and reproduction. They allow them to have agency over their own bodies. Beyond that, SRHR have far-reaching positive effects on health and development outcomes, including gender equality, education, employment and overall poverty eradication.

For UHC to be realized we must commit to building a health movement that is inclusive of and promotes SRHR. This begins with ingraining SRHR into every country’s UHC policies and aligning these policies with the SDG targets to ensure universal access to sexual and reproductive health (SRH) services.

In spite of the renewed global focus to tackle challenges such as lack of reliable information, low literacy levels, poor access to services, stigma and discrimination based on age and gender, most of the 4.3 billion people of reproductive age worldwide will still lack access to at least one essential SRH service over the course of their reproductive lives.

Many of them are in Africa, where millions lack access to services including family planning, quality maternal health care and prevention and management of sexually transmitted infections. Adolescent girls and women especially continue to fight to have their rights recognized, battling socio-cultural norms that deprive them of the right to make decisions about their own health. This gender inequality has devastating consequences on the health of communities.

The imbalance of power between men and women for instance is a leading cause of higher rates of HIV and other sexually transmitted infections in women. Women and young girls do not always have the power to choose and ensure safe sex, to decide whether to have children, or even when and how many children to have.

As a result, in 2018, 214 million women in developing countries had an unmet need for modern contraception, contributing to 67 million unintended pregnancies, 23 million unplanned births, 36 million abortions and about 1.6 million adolescents with HIV between the ages of 10 and 19.

Africa particularly continues to struggle with challenges around SRHR among young women and adolescents. 29% of the world’s risky pregnancy terminations occur on the continent, with an estimated 1.4 million unsafe abortions conducted on girls aged 15 to 19 years. In addition, the high prevalence of early and forced child marriage in Western and Central Africa continues to contribute to poor SRH outcomes on the continent. So does Female Genital Mutilation and Cutting (FMG/C), which remains prevalent across Africa despite compelling evidence that the practice has absolutely on health benefits. Instead, it can result in lifelong complications such as increased risk of infertility, difficulty during labour, chronic infections and severe pain, yet 25 and 14 per cent of girls in West and North Africa respectively still undergo the brutal procedure owing largely to a lack of agency over their own sexual health.

These are not just numbers. They represent the lives of millions of young women and adolescent girls whose education is compromised; whose ability to secure decent economic opportunities is weakened, and whose health is impacted due to the increased risk of pregnancy, unsafe abortion, pregnancy-related complications and sexually transmitted infections including HIV.

The special needs and vulnerabilities of this population are often riddled with restrictive legal, cultural, religious and political norms and notions. This limits the accessibility, availability, affordability, quality and acceptability of SRH services targeting young women and adolescent girls, such as SRH education, access to contraceptives, HIV testing and counselling, and STI prevention and management.

The result of this is widespread exclusion and exploitation that trickles down to the next generation, creating a vicious cycle characterized by myths and misconceptions about SRH that prevent young girls, adolescents and women from living full, productive lives and contributing more significantly to economic growth and development.

Educating and empowering this constituent is the solution to many SRHR challenges. Sexuality education is a key component in addressing the social determinants of health. It empowers young people to safely and positively navigate their sexuality, contributing to safer sexual behavior and leading to better health and wellbeing. Informed individuals are more likely to make better SRH choices. It is therefore imperative that every individual should have access to sexuality education to be able to make informed choices and be in a state of complete physical, mental and social well-being in all matters relating to sexuality and the reproductive system, free from coercion, discrimination and violence.

SRH is not a standalone issue, but an important, cross-cutting theme that affects overall health outcomes. We simply cannot achieve UHC without addressing the challenges affecting SRH, which are in turn influenced by the advancement of women’s rights.

As we race toward the 2030 SDG targets and celebrate the progress made since the landmark Beijing agreement of 1995, we can make the year 2020 more than the start of a new decade: it can be the year of bold commitments and action toward the protection of girls’ and women’s sexual and reproductive health rights. Not just because they are women’s rights; but because they are human rights.

As Dr Tedros Ghebreyesus, Director-General of the World Health Organization, puts it: “UHC is the centre of gravity for SDGs. I dare say, SRHR is the centre of gravity for UHC!”