Sexual and reproductive health rights (SRHR) are being restricted, human rights defenders are being silenced, and evidence-based policy is being replaced by ideology – “but we are not powerless or voiceless”, said Dr Tlaleng Mofokeng, the United Nations Special Rapporteur on the Right to Health.

She urged governments and organisations to use the “right to health” approach to break down “siloes” to ensure all people have access to the health services they need. 

“There should be no competing agendas between maternal health, sexual and reproductive health rights, and universal health coverage,” she told a meeting hosted by the Centre for Health Diplomacy and Inclusion (CeHDI) on the sidelines of the International Conference on Family Planning (ICFP) on Tuesday.

“They are all part of the same promise of human dignity,” said Mofokeng. 

CeHDI CEO Haileyesus Getahun told the meeting that the right to health is enshrined in “several international laws and agreements”, primarily the International Covenant on Economic, Social and Cultural Rights which has been signed by 174 countries.

“The right to health is a gateway to universal coverage, to providing every [health] service and for anyone,” said Haileyesus.

Universal right

“The right to health is universal precisely because it depends on shared resources and collective responses,” added Alison Drayton, Assistant Secretary General of the Caribbean Community, CARICOM.

“Operationalising the right to health requires systems, partnerships and accountability,” she added. “CARICOM member states are working collectively to translate rights into action. We are investing in integrated family health care, gender responsive budgeting and data systems that make inequities visible.”

Dr Ana Luiza Caldas, Brazil’s Vice-Minister of Health, said that her country has made significant progress in consolidating universal health coverage through primary health care.

For 35 years, the Brazilian health ministry has focused on strengthening its connections with communities, starting at the local council level. Its SRH services cover a wide range of contraceptive options, including free condoms at schools, said Caldas.

Never seen a condom

Indonesian journalist Betty Herlina admitted that she had seen a condom for the first time in her life at the conference – simply because sex is not a topic for open discussion in her country.

“This is prohibited in Indonesia,” said Herlina, adding that if she displayed a condom in public, she would be branded as “too liberal”, a feminist and advocating “free love”.

“This is a bias we need to break,” she said. “We cannot teach any children about sex education, but there’s a lot of sexual harassment, especially in [religious] schools, and most of the perpetrators are ulama, our religious leaders.”

Ayesha Amin, founded Baithak, an organisation dedicated to challenging taboos in Pakistan. She works on three levels: providing safe spaces for marginalised and climate-affected girls and women to ask questions about sexual and reproductive health, encouraging their leadership and working with young men.

Her organisation has supported the formation of the Sisterhood Collective run by a network of 25 young feminist activists.

“Every time a disaster hits, these women go and demand SRHR as a non-negotiable. They demand that pregnant women have access to maternal care and safe delivery, that adolescent girls have access to WASH facilities, that women have access to dignity and safety in those flood camps,” said Amin. Pakistan is particularly vulnerable to flooding.

“Right now, the decision-making around women’s bodies and bodily autonomy in SRHR is being done by men,” said Amin. “So changing those mindsets through male engagement, enabling men to become allies, creates spaces for women in decision-making.”

Huge backlash

The ICFP, currently being hosted in Colombia, comes at a time of huge pushback against sexual and reproductive health and rights, currently led by the United States under President Donald Trump.

Aside from defunding global health programmes – from HIV to SRH – the US is pushing an anti-abortion allaince centred on the Geneva Consensus Declaration, which asserts that abortion is not a right.

On the eve of ICFP, UNFPA Executive Director Diene Keita said that “access to contraception is under threat, due to global funding shortfalls”. 

“UNFPA is seeing contraceptive stocks dwindle in communities that rely on international family planning funding,” she added.

“Health systems are bracing for a rise in unintended pregnancies, which are in turn linked to higher rates of maternal death, including due to unsafe abortion. 

“And the impacts are likely to extend far beyond health care: We can expect to see adolescent pregnancies, school dropouts, and even increased risk of gender-based violence.”

UNFPA estimates that for every $1 invested in unmet contraception needs yields $27 in economic benefits.