by Thérèse Delvaux, Public Health Department, ITM
The Safe Motherhood initiative was launched in 1987. After an era of maternal and child health (MCH) services often limited to the provision of antenatal care services, preventive care services for children and vertical family planning services that were successful in some settings, a landmark paper published in the Lancet served as a wake-up call to the international community. In “Maternal mortality, a neglected tragedy. Where is the M in MCH”, Rosenfield & Maine emphasized there was an urgent need to address main complications of pregnancy and delivery, and focus on quality obstetric care services.
In 1994 the Cairo international Conference on Population and Development (ICPD) was ground-breaking: there was a further shift from the “M” of mothers to women’s health and the concept of sexual and reproductive health and rights (SRHR) was introduced; the event also placed gender equality and human rights at the heart of human development. The move towards comprehensive sexual and reproductive health and rights was based on the growing evidence that maternal health and pregnancy and childbirth outcomes cannot be improved without paying attention to sexual and reproductive health and rights.
The adoption of MDGs in 2000, with the inclusion of “Reducing maternal mortality by three quarters by 2015” as the only MDG 5 goal, narrowed down the SRHR agenda by primarily focusing on maternal health, and in particular, on achieving substantial reductions in the high levels of maternal mortality in many developing countries through skilled attendance at birth. Only in 2007 target MDG 5B was added, referring to universal access to SRHR.
It is safe to say that framing women’s health as MCH has made a come-back after a short break in the immediate post-ICPD period (1994-2000). Although unsafe abortion represents an important cause of maternal mortality, a number of donors avoid considering interventions dealing with unsafe abortion – if not those addressing complications of unsafe abortion, those advocating for increased access to safe abortion – as part of maternal health programs. Family planning back is back on the international agenda following the Family Planning summit held in 2012 in London. This was needed in order to address unmet need for contraception and provide access to a wider range of contraceptive methods. Family planning became a neglected issue in the years after the Cairo conference, partly due to the emergence of HIV as a major public health issue which attracted a lot of attention and funding – some countries even witnessed a rise in their fertility rate in the last decade.
With maternal and child health, and more recently family planning, becoming increasingly the focus of global attention, are we back again in the MCH pre-Cairo era? Probably not, but there is a threat that limited funding and a mainstream focus on maternal health / family planning might undermine the broader sexual and reproductive health agenda and jeopardize sexual and reproductive rights. Issues such as young people’s sexuality, abortion and non-procreative sex, which are harder to deal with and only raised through a SRHR approach, could very well disappear from the global agenda.
So adequate advocacy, policies and services are definitely needed. We need to make sure that within the post-2015 agenda, the Cairo program of action remains a cornerstone and that sexual and reproductive health and rights are included. In addition, as research drives policy, research with a clear focus on sexual and reproductive health and rights needs to be funded and supported, otherwise SRHR issues are unlikely to be taken seriously by policy makers, let alone program managers, academics and researchers and students…