WHS 2022: Debating the place of SRHR in achieving ‘health for all’
Panel discussion, chaired by Dr Anshu Banerjee, Director, Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization (WHO) © World Health Summit
In the context of the triple crisis of climate change, conflict and pandemics, development leaders and young people discuss the importance of sexual and reproductive health and rights (SRHR) as a core component of Universal Health Coverage (UHC)
On 16 October, Germany’s Federal Ministry for Economic Cooperation and Development (BMZ) hosted an inspiring event as part of the World Health Summit in Berlin, which focused on putting the needs of women and girls at the centre of efforts to achieve UHC and building more resilient health systems. The session brought together diverse voices, including those of young people from Côte d’Ivoire, Malawi and Zambia, with high level representatives from the governments of Germany, the United States, Senegal and the Palestinian Parliament, and leading figures from UNFPA and the Global Financing Facility (GFF).
The Rt Hon Helen Clark, former president of New Zealand and Board Chair at the Partnership for Maternal Newborn and Child Health (PMNHC), opened proceedings by chairing a lively ‘fireside chat’ on the importance of SRHR in UHC political reforms and efforts to achieve gender equality. She was joined by Dr Bärbel Kofler, Parliamentary State Secretary at BMZ, Dr Natalia Kanem, Executive Director of UNFPA, and Dr Awa Marie Coll-Seck, Minister of State, Senegal.
On behalf of the German Government, Dr Kofler thanked the panelists and audience members for attending and reminded us all that
This discussion is already part of the journey to make SRHR a really big topic, a political topic. What we are all doing here is working towards that goal.Dr Kofler
The WHO’s Dr Anshu Banerjee (Director Maternal, Newborn, Child and Adolescent Health and Ageing Department) went on to moderate an informed and lively panel discussion on how to elevate the place of SRHR in efforts to achieve UHC, with Monique Vledder (Head of Secretariat, Global Financing Facility, GFF), Loyce Pace (Assistant Secretary for Global Affairs, Department of Health and Human Services, United States), Maziko Matemvu (Vice Chair, Adolescent and Youth Constituency at PMNCH), and the Hon Dr Sahar Al Qawasmi (Parliamentarian, Palestinian territories).
How do sexual and reproductive health and rights contribute to UHC and Health for all?
‘Health for all’ is a guiding principle of Universal Health Coverage (UHC). However, it is only achievable if an inclusive, human rights-based approach is taken, which includes marginalized groups and those left furthest behind. This requires approaches that address discriminatory norms and practices, as well as increased attention to SRHR, including maternal and child health. It requires adequate funding for health while reducing dependence on external financing, and it means putting communities at the heart of efforts to improve healthcare.
Sexual and reproductive health and rights impact on women’s capacity to study, work, care for their families and lead happy and fulfilling lives, and are therefore critical to achieving the 2030 Agenda for Sustainable Development. UHC is a specific target of SDG 3 to achieve health and wellbeing for all.
As Executive Director of UNFPA, Natalia Kanem asked on behalf of everyone present,
Is it possible for any country to achieve Universal Health Coverage without sexual and reproductive health and rights? This question is rhetorical and the answer is emphatically no. Any other view is effectively an argument against women’s well-being.Natalia Kanem
How COVID-19 impacted sexual and reproductive health and rights
Nearly three years on from the start of the COVID-19 pandemic, with conflict in Europe and climate-related disasters in Pakistan and elsewhere, WHO data show that a third of countries continue to experience disruptions to essential health services, including care before and after childbirth and safe abortion services, while nearly 40 percent of countries report disruption to family planning services. Data from the Global Financing Facility (GFF) presented by GFF Head of Secretariat, Monique Vledder, show that a quarter of women and children across 38 GFF-supported countries were not able to access the services they needed during the pandemic.
Panelists talked of the many, distressing effects of the pandemic on the lives of women and girls, both in low-income countries such as Malawi, Senegal and Zambia, but also in richer parts of the world. For example, Loyce Pace of the United States Department of Health and Human Services, talked of the effects of the pandemic on front line health workers in the US, both from very high workloads and also the very real trauma of violence and abuse.
With high levels of informal employment in many low-income countries, Dr Awa Marie Coll-Seck, Minister of State to the President of Senegal, highlighted the economic fragility which results from loss of women’s incomes and sharply increased levels of violence against women who were unable to leave their homes.
And, Monique Vledder emphasized the ways in which COVID-19 exacerbated already high financial barriers to accessing health services, particularly for the most vulnerable groups, such as female-headed households and teenagers. Widespread school closures led to a halt in HPV vaccination programmes and also severely impacted on the nutritional intake for children whose main meal is provided at school.
More resilient health systems help Senegal to handle COVID-19
However, not all countries suffered alike, and those that had invested in building more resilient health systems prior to COVID-19 were in a better position to respond when the pandemic arrived. Dr Coll Seck told us that, although many women in Senegal ‘fell out of the health system’ during the pandemic – either reluctant or simply unable to access services – the impact of the pandemic on the country’s service delivery systems was not as severe as it might have been because they could build on what had already been done. For instance, health staff who had been trained to provide reproductive health services were rapidly retrained and deployed to manage COVID-19.
Senegal has benefited from more than a decade of investment to strengthen health systems and reduce maternal, neonatal, child, adolescent and youth mortality, with funding channelled through a highly successful GFF-facilitated multisectoral partnership comprising multilateral and UN agencies, bilateral donors and national government and non-government partners. Reflecting the GFF model which puts countries firmly in the driving seat, Dr Coll Seck said, ‘this is a Senegalese experience, but also an African experience. And this is why our President Macky Sall agreed to co-host with President Trudeau of Canada, the GFF replenishment in May 2021’.
Germany shines a light on SRHR in UHC policy reforms
While Senegal provides a great example of strong, high-level leadership for SRHR, Parliamentary State Secretary Dr Bärbel Kofler pointed out that we still have some way to go to raise the political profile of SRHR. To this end, the German Government is putting women and girls at the heart of its policies.As Dr Kofler stated,
Germany’s feminist foreign policy and development policy puts sexual and reproductive health high on the political agenda. Why? Because realizing sexual and reproductive health and self-determination of women and girls is key to building a more equitable and sustainable world.Dr Bärbel Kofler
Putting self- determination for women and young people at the heart of the development policies and programmes not only requires investing directly in health systems and in building resilience for future crises, but also addressing discriminatory social practices and gender norms and ensuring social protection for all.
In response to a comment by Chair Helen Clark, who called for gender balance in wider development programmes, Dr Anshu Banerjee reminded us that
Nothing will happen without the involvement of men and boys. Men are also on the streets demonstrating in support of women’s right. So there is definitely a glimpse of hope, and we want to hear from them too.Dr Anshu Banerjee
What does it mean to provide comprehensive SRHR?
Comprehensive SRHR encompasses the full range of services including those to address gender-based violence and prevent harmful practices against women and girls, safe abortion services, comprehensive sexuality education and sexual health services for young people.
Despite important progress over recent years, many women – particularly young women – still cannot access the SRHR services they need. This was brought home to the audience by the words of two youth advocates from Zambia, Mary Kanawila, of Dawa Health and Ireen Ntoka from Family Development Initiatives. Mary gave the example of the ongoing debate in Zambia on whether the morning after pill should be available over the counter or only by prescription. She declared
I should not be judged for wanting contraceptives at a young age.Mary Kanawila
Natalia Kanem underlined the fact that a failure to provide comprehensive SRHR services impacts across the whole life cycle of women and their families, and the effects are too often handed down to future generations through the wider societal and economic impacts of poor sexual and reproductive health.
What are young people asking for?
The youth advocates from Malawi, Zambia and Côte d’Ivoire set out a number of clear requests to the leaders around the table. Maziko Matemvu, Vice Chair of the PMNCH Adolescent and Youth Constituency, first and foremost called for governments to be held accountable for delivering on their commitments to provide more money for health, citing in particular the Abuja Declaration and the Eastern and Southern Africa Ministerial (ESAM) Commitment on education, health and well-being for adolescents and young people.
Mary Kanawila and Ireen Ntoka, speaking via video link from Zambia, set out their asks, including age-appropriate information to help different groups of young people take decisions about their SRHR, comprehensive sexuality education that is integrated into school curriculums, and free and affordable reproductive health products and services that are widely available, particularly contraceptives. Ireen also highlighted the need to address young people’s mental health alongside other health services, and to the address stigma associated with young people’s sexual health.
Reinforcing key messages from the other advocates, Kenneth Prudencio, of ASAPSU (L’Association de Soutien à l’Autopromotion Sanitaire Urbaine) in Côte d’Ivoire closed the session by asking panelists to remember four key pillars of a rights-based approach to SRHR; without services that are accessible, available, acceptable and affordable to all, countries cannot achieve UHC.