The year 2015 is a momentous year as it marks the target date for reporting the achievements of the Millennium Development Goals (MDGs) and the adoption of the new post-2015 development agenda at the United Nations Summit in September 2015.
The outcome document of the United Nations Conference on Sustainable Development, titled “The Future We Want: Outcome Document Adopted at Rio+20” , set out a mandate to establish an open working group to develop a set of sustainable development goals and targets. This Open Working Group submitted the proposal “Open Working Group Proposal for Sustainable Development Goals” to the General Assembly in 2014 and proposes a set of 17 goals and 169 targets to be achieved by 2030.
The first section of this article is a comparative review of the framing of sexual and reproductive health and rights (SRHR) goals and targets within the SDG and the MDG agenda. In the latter half of the article, I will examine progress towards SRHR indicators within the MDG indicator framework taking the case of the Asia region. This will be followed by a discussion on the way forward towards the incorporation of a comprehensive set of SRHR indicators within the SDG indicator framework currently under development.
Progress towards Sexual and Reproductive Health and Rights within the Post-2015 Sustainable Development Goals and Targets.
At the end of 2014, sexual and reproductive health and rights (SRHR) advocates had some reasons to celebrate. Women’s organizations, NGOs working on SRHR from across the global south and global north succeeded in forging a transformative standpoint by ensuring critical goals and targets relating to SRHR are included in the Open Working Group Proposal for Sustainable Development Goals (See table 1, below). The SDG goals and targets cover issues like maternal mortality; HIV; universal access to SRH services, information and education; equitable quality education for to preserve the human rights of people of all genders, and specific targets to eliminate gender inequality and gender based violence.
While these developments have not been path breaking, as the targets have omitted sexual rights in their framing, this needs to be considered as an important step towards universal access to SRHR for all in the coming 15 years. This step can be an effective way forward to demand the enforcement of the SRHR agenda, its means of implementation, and allocation of financial resources (Goal 17), accountability mechanisms (Goal 16) at global, regional and national levels.
SRHR advocates would also agree that the current SDG framework on SRHR is a progression from the previous limited MDG framework as the targets in the MDG health goal were limited to:
- Target 5A- Reduction of maternal mortality by three quarters and
- Target 5B- Achieving universal access to reproductive health by 2015, (Target 5B on universal access to reproductive health was only added five years later and implemented only 7 years later.)
Let’s review the progress of the two targets in the next section.
The case of Asia region: so what has been the progress towards SRHR indicators within the MDG framework in 2015?
In terms of progress towards SRH indicators within the MDG framework (Table 2, below), we see disappointing results in the Asia region. Despite Southern Asia and South-Eastern Asia sub-regions having made progress in reducing maternal mortality with a 64% and 57% drop between 1990 and 2013, respectively with the exception of few countries even within those regions, maternal mortality continues to remain more than 100 in most of the countries in the region. None of the sub-regions have shown a reduction of maternal mortality ratio by three quarters in 2013.
Since 2000, improvements in the MDG indicator on ensuring that every birth is attended by a skilled health personnel have also been modest. Although Eastern and Central Asia show almost universal coverage in terms of skilled birth attendance, this indicator averaged at a low 52% in the Southern Asia region. In terms of the indicator on four antenatal care visits during pregnancy, this indicator has been most dismal in its performance in Southern Asia with only 36% of pregnant women receiving four or more antenatal visits around 2014.
The indicator on use of contraception among women aged 15-49, married or in union, who were using any method of contraception was at 59% in Southern Asia, with countries like Afghanistan (21.2%), Maldives (34.7%) and Pakistan (35.4%) showing poor contraceptive prevalence.
In terms of unmet need indicator, at least 14% and 12% of married or in-union women of reproductive age, in Southern Asia and South-Eastern Asia wanted to delay or avoid a pregnancy and are not able to do so. Maldives (28.6%) and Nepal (27.5%) have a very high unmet need for contraception in the Asia region.
Further to this, the indicator on adolescent childbearing continues to pose a barrier to adolescents’ and young people’s sexual and reproductive health and rights and well-being. Despite progress, adolescent childbearing particularly remains a problem in Afghanistan, Bangladesh, Nepal, and Lao PDR.
In conclusion, despite having a very limited set of SRHR indicators, the MDG agenda remained unfulfilled in the Asia region with deep inequalities across sub-groups of populations who are marginalized within countries and in between the countries in the region.
What is the way forward for SRHR advocates with respect to the current SDG indicator framework development process? We have an opportunity here!
The process of development of an indicator framework for the goals and targets of the post-2015 development agenda is underway now. The United Nations Statistical Commission at its 46th session in March 2015 endorsed a roadmap for the development and implementation of the global indicator framework for the sustainable development goals and targets, and is working towards the endorsement of the SDG indicator framework in its 47th session to be held in March 2016.
Some SRHR indicator proposals have been put forward by UNFPA, ARROW, The Guttmacher Institute , PMNCH and the High Level Task Force on ICPD for inclusion in the SDG indicator framework.
As we advocate for the RIGHT SRHR indicators to be included within the SDG indicator framework, we need to keep these essential points in mind:
- SRHR indicators should assess universal access to sexual and reproductive health information and services, without any discrimination. They should include access to a range of comprehensive SRH services such as treatment of infertility, prenatal care, safe delivery, post-natal care especially in the first 48 hours delivery, access to emergency obstetric care services, safe abortion services and management of consequences of abortion, access to a range of contraceptive methods including both spacing and limiting, treatment of reproductive tract infections and sexually transmitted diseases and reproductive health conditions, prevention, treatment and care of reproductive cancers, access to ART treatment, and a comprehensive response to gender-based violence at primary, secondary and tertiary levels of health care as appropriate;
- SRHR indicators should assess the status of laws, policies and regulations pertaining to gender equality, sexual and reproductive health and rights and gender-based and sexual violence in the countries;
- SRHR indicators should include disaggregated data specified by gender, income, age, race, ethnicity, migration and citizenship status, disability, sexual orientation and gender identity and expression, social exclusion, geographic location, occupation, HIV and health status, marital status, pregnancy status, and other characteristics relevant in national contexts;
- SRHR indicators should emphasis on quality of care and informed choice;
Finally, this is an opportune time for SRHR advocates to ensure we put in place the RIGHT SRHR indicators that are responsive and comprehensive enough to fully realize universal access to sexual and reproductive health and rights, gender equality and social equity for all.
Table 1: Key Sustainable Development Goals and Targets of importance for the SRHR community:
Goal 3: Ensure Healthy lives and promote well-being for all at all ages
Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
Target 3.3: By 2030, end the epidemic of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water borne diseases and other communicable diseases.
Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration reproductive health into national strategies and programmes.
Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all
Target 4.7: By 2030, ensure that all learners acquire knowledge and skills needed to promote sustainable development, including among others, through education for sustainable development and sustainable lifestyles, human rights gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development
Goal 5: Achieve gender equality and empower all women and girls
Target 5.1: End all forms of discrimination against women and girls everywhere
Target 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation.
Target 5.3: Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation
Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome document of their review conferences.
Source: Report of the Open Working Group of the General Assembly on Sustainable Development Goals.
Table 2: An examination of the key MDG goal, targets and indicators pertaining to SRHR in the Asia region, in countries where ARROW is monitoring progress shows the following results
|Millennium Development Goal 5|
|NAME OF THE COUNTRY||Target 5. A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio||Target 5. B: Achieve by 2015, universal access to reproductive health|
|Indicators||Maternal mortality ratio per 100,000 live births, 2013||Births attended by skilled health personnel, percentage. (Most recent data available)||Current contraceptive use among married women (15-49 yrs.), any method, percentage||Adolescent Birth Rate per 1000 women||Antenatal care coverage (at least 4 visits), percentage||Unmet need for family planning, total, percentage|
|Afghanistan||400||38.6 ( MICS 2011)||21.2 (MICS 2011)||90.0 (2010)||14.6 (MICS 2010-2011)||NA|
|Bangladesh||170||42.1 (DHS 2014)||61.8 (2012-13)||83.0 (2012-13)||31.2 (2014)||13.9 (2012-2013)|
|Bhutan||120||74.6 ( NHS 2012)||65.6 (MICS 2010)||28.4 (2012)||81.5 (2012)||11.7 (MICS 2010)|
|Burma||200||70.6 (MICS 2009-10)||46.0 (MICS 2009-10)||16.9 (2007)||73.4 (2007)||19.1 (
|India||190||52.3 (DLHS 2008/09)||54.8 (DLHS 2007-08)||38.5 (2009)||37.0 (2005-06)||20.5 (DLHS 2007-08)|
|Maldives||31||98.8 (MOH 2012)||34.7 (DHS 2009)||13.9 (2012)||85.1 (2009)||28.6 (DHS 2009)|
|Nepal||190||55.6 (MICS 2014)||49.6 (MICS 2014)||87.0 (DHS 2011)||59.5 (MICS 2014)||27.5 (DHS 2011)|
|Pakistan||170||52.1 (DHS 2012-13)||35.4 (2012-13)||48.0 (2012-2013)||36.6 (2012-2013)||20.1 (2012-13)|
|Sri Lanka||29||98.6 (DHS 2006-07)||68.4 (DHS 2006-07)||24.1 (2012)||92.5 (DHS 2006-07)||7.3 (DHS 2
|Cambodia||170||89.0 (DHS 2014)||56.3 (DHS 2014)||57.0 (DHS 2014)||75.6 (DHS 2014)||12.5 (DHS 2014)|
|Indonesia||190||87.4 (RISKESDA 2013-14)||62.5 (2013)||47.0 (2009)||83.5 (RISKESDA 2013-14)||11.4 (DHS
|Lao PDR||220||41.5 (LSIS 2011-2012)||49.8 (2011-2012)||94.0 (2011-2012)||36.9 (LSIS 2011-2012)||19.9 (2011-2012)|
|Malaysia||29||98.8 ( 2014)||49.0 (2004)||13.3 (2012)||NA||NA|
|Philippines||120||72.8 (DHS 2013)||55.1 (DHS 2013)||59.0 (DHS 2013 )||84.3 (DHS 2013)||17.5 (DHS 2013)|
|Thailand||26||99.6 (MICS 2012)||79.3 (MICS 2012)||60.0 (MICS 2012)||93.4 (MICS 2012)||6.9 (MICS 2012)|
|Vietnam||49||93.8 (MICS 2014)||75.7 (MICS 2013-2014)||36.0 (2013)||73.7 (MICS 2014)||6.1 (MICS 2013-14)|
|China||32||99.9 ( NHFPC 2014)||84.6 (2006)||6.2 (2009)||2.3 (
|Caucasus and Central Asia||44%||96%||57%||32||–||14%|
|Kyrgyzstan||75||98.4 (MICS KFR 2014)||42.0 ( MICS 2014)||42.4 (2012)||94.6 (MICS 2014)||18.0 (DHS 2012)|
Note: The data is national level aggregate data and not reflective of inequities and disparities across population groups including marginalized groups within countries
Source: Millennium Development Goals Indicators. The official United Nations site for the MDG Indicators