The task of translating the International Conference on Population and Development’s (ICPD) Programme of Action (PoA) into meaningful change for women and girls globally includes some important detail work. Several years ago, my organization – the Center for Health and Gender Equity (CHANGE) – set out to better define the meaning of key PoA terms. Our guiding question was: “What constitutes comprehensive, rights-based sexual and reproductive health (SRH) care?” We found some useful literature and human rights documents to point us in the right direction, but most importantly, we wanted to make sure our answer was grounded in the lived experiences of women and girls.
Through fact-finding trips to Ethiopia, Botswana, and the Dominican Republic, CHANGE uncovered daunting obstacles to comprehensive care grounded in human rights. We learned of a peer mother program for women living with HIV that expelled volunteers for becoming pregnant. Clinic conditions for birthing women were appalling, with rampant overcrowding, poor quality care, and limited access to postpartum family planning (FP). We met young people without access to the information and tools they need to prevent pregnancy and HIV. And too often we encountered programs that claimed to offer a comprehensive constellation of reproductive health services, including family planning, maternal health, and HIV; however, each service was administratively and geographically separated, making it difficult for women and girls to fulfill their comprehensive sexual and reproductive healthcare needs and achieve continuity of care.
In the midst of these obstacles, we found evidence of the positive impact of comprehensive, rights-based care:
- A clinic in Bahir Dar, Ethiopia was providing a range of SRH services, including fistula repair surgery;
- A program targeting youth in Botswana was training peer educators on teen pregnancy, abortion, condom distribution, and life skills; and
- A grassroots feminist group in the Dominican Republic was offering FP, HIV testing and counseling, and sex education all in one location and driven by community-defined attention to gender inequality.
Supported by an extensive review of the literature, three key lessons emerged from our field research and shaped the development of our framework defining comprehensive, rights-based SRH care. First, comprehensive, rights-based care must be defined from the user perspective, which implies not just that services are linked at the national government or clinic level, but most importantly at the level of the individual. Second, people know comprehensive when they encounter its antithesis – when they have to wait in multiple lines, endure the time-consuming burden of visiting multiple providers, or encounter providers who do not connect their HIV risk and their pregnancy risk. Lastly, people know rights-based when they have a voice in their care, and when they’re treated with respect and dignity.
As we reach ICPD’s 20th anniversary, we can only fulfill its legacy by paying thorough attention to details. A global community of advocates and implementing organizations has contributed to the growing consensus on what these details should be. In particular, the framework and accompanying User’s Guide spearheaded by Futures Group and EngenderHealth offers invaluable guidance on how to design and implement FP programs with full attention to human rights. While CHANGE uses both frameworks as touchstones for our advocacy work, we also hope that they prompt further critical thinking about how we advance and protect rights throughout the range of SRH services women and girls need over the course of their lives.