A new development paradigm post-2015, a comprehensive goal for health that includes sexual and reproductive health and rights, and another for gender equality

An important part of the discussion about the MDGs is Sexual and Reproductive Health for women and girls. What will a new paradigm on health look like?

Here is an editorial from Reproductive Health Matters that brings home the point -

These are our bottom lines… We are counting on all governments to have the courage to champion the ‘controversial’ issues by addressing the difficult realities, many of which are related to the root causes of inequalities… 1. Keep your Promises. 2. Champion our Sexual Rights. 3. We Demand Economic Justice. 4. Leave us a Healthy Planet. 5. We are Stakeholders, not a Target Group.” (Post-2015 Consultation Youth Statement, October 2013)¹

What a wordstorm the ICPD Beyond 2014 and Post-2015 Sustainable Development agendas have unleashed! What a tsunami of consultations, meetings, reports, statements, shopping lists of wishes and demands, and overflowing expectations has been pouring in from every corner of the globe! I don’t know how the UN Secretary-General deals with it, but my inbox can barely cope. On the other hand, this storm has brought in a treasure trove of comments, policy analysis and critiques, which I’d like to share with you. And the same is true of the excellent papers in this journal issue.
There are two issues I want to emphasise in this editorial which, together, reflect the crux of what this journal issue is about and what I think is going on in the world beyond the verbal explosion:

•We have the opportunity to articulate sustainable development goals which avoid the many limitations of the MDGs and broaden the remit of responsibility and commitment to improving global health and human rights. These must of course include health, gender equality, and sexual and reproductive health and rights. There is strong evidence, however, including in these pages, that efforts to implement gender equality are only barely succeeding, and many governments are grossly under-funding health in spite of existing, long-standing commitments, particularly in Africa,² though Africa is far from alone. The new goals need to be configured in the recognition that they are inter-dependent and must be based in a human rights approach, which means no one can be left out. Until this commitment can be achieved in principle, a new development paradigm and with it new goals will remain an aspiration that cannot be expected to succeed.

The MDGs on health scuppered the focus on comprehensive sexual and reproductive health and rights (SRHR) articulated officially for the first time in the ICPD Programme of Action, and MDG5 pretty much narrowed the agenda to reducing maternal mortality, to the detriment of almost all other SRHR issues. Maternal mortality has fallen but not enough and not at all in the poorest countries, while skilled attendance at birth has not risen concomitantly. We SRHR advocates are faced with a number of urgent problems. Specific aspects of health will not become goals, SRHR certainly not. So how can we ensure, this time around, that sexual and reproductive health and rights as a whole get included in the post-2015 sustainable development goal for health, along with all the other pressing health and development issues being championed by others?

Who is taking the leadership in our movement this time round? Do we have a plan? A strategy?
Some of these issues/questions are immediately outward-looking. They demand global, national and local action from the inter-governmental, governmental, donor, health system and health policy communities, as well as civil society, ultimately looking for solutions at country level. Others are initially inward-looking. We in the SRHR advocacy community are brilliant at articulating our issues and what is needed to achieve them if only…. But we sometimes seem to get stuck there. The opposition to our issues is not getting any weaker. What will be included under all the goals is being debated and negotiated at all levels, right now, within a complex network of players, and those of us who are expert at this work need to be in there as the list of goals and their details are drawn up, negotiated and re-negotiated, every day between now and 15 September 2015. Even more of us should be negotiating at country level with our national leadership. Are enough of us doing this right now? How do we get a consensus among us as to what, besides SRHR and gender equality, our community supports and is fighting for in the wider arena? ICPD was anything but a doddle, but it looks like child’s play by comparison to this.