In certain regions of the world, there are inadequate resources available to address sexual and reproductive health and rights (SRHR) among people of reproductive age. Both political weaknesses and discrimination against females contributes to the global threat against SRHR. The 2018 Guttmacher-Lancet Commission report published in the Lancet offers a new definition of SRHR, as well as recommendations for health services, actions required in government and society to modify social norms, and policies and laws to protect human rights.
Guttmacher-Lancet Commission’s Definition of SRHR
According to the International Conference on Population and Development, the definition of reproductive rights includes, “the basic right of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children and to have the information and means to do so.” The International Conference on Population and Development has also recently linked reproductive rights with human rights and supports the notion that reproductive healthcare should be directed by population and development policies that aim to advance gender equality and encourage family planning.
The Commission statement reports that SRHR includes 4 main components: sexual health, sexual rights, reproductive health, and reproductive rights. The integrated definition of sexual and reproductive health includes the “state of physical, emotional, mental, and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction, or infirmity.” Additionally, the integrated definition of sexual and reproductive rights must meet the “Availability, Accessibility, Acceptability, and Quality” framework, including accurate education and counseling on sexual and reproductive health, choices of effective and safe contraceptives, and safe and effective abortion services and care.
Worldwide Trends Affecting SRHR
Approximately 4.3 billion people today are of reproductive age. The majority of these people are affected by inadequacies or threats against SRHR. Between 2015 and 2030, the world’s poorest countries will experience the most substantial growth of reproductive-aged individuals; this population will shrink in high-income countries. This change in size and composition of populations will likely affect and/or increase inadequacies in SRHR. Displacement of refugees from war or natural disaster may also affect SRHR, with women and girls representing the most threatened individuals in this group.
Slow changes in gender norms in the developed world may be increasing equality in SRHR among women and men; however, most women still have unequal access to sexual and reproductive health services. Additionally, many men who accept and adhere to a standard norm for masculinity are often reluctant to seek sexual healthcare, necessitating the need for greater education among both sexes. Collaboration between men and women is necessary to overcome these gender norms if SRHR is to be advanced.
Groups Requiring Services
There are specific population groups that have definite SRHR needs and experience obstacles to care. Adolescents represent a crucial population group that require education on sexual and reproductive health, yet this education is often lacking. A lack of education often results in a greater risk for pregnancy and sexually transmitted diseases. In certain regions of the world, this risk is even higher. Social, gender, cultural, and legal barriers often threaten this population’s SRHR. Individuals in the lesbian, gay, bisexual, transgender, queer or questioning, and intersex group also experience barriers to SRHR, particularly in developing countries. The stigma surrounding diverse sexual orientations in these countries can result in reduced access to both medical care and condoms.
Cost Benefits of Investing in SRHR
The Commission suggests that there are significant cost benefits of investing in contraception and maternal and newborn care. Supporting SRHR through greater education and increased healthcare services may result in reductions of unintended pregnancy, driving down the costs associated with care. Additionally, supporting SRHR may help reduce maternal mortality and sexually transmitted diseases, which reduces the need for costly interventions aimed toward reducing said mortality. Social gains are also suggested benefits of addressing SRHR, including the gains in equality among men and women in terms of access as well as motivation to access reproductive and sexual healthcare.
Implications and Recommendations
According to the Commission statement, a broad range of legal and policy reforms are needed to improve SRHR for women. These reforms could include improving access to safe abortions and effective contraceptives. Addressing societal norms, including those regarding gender norms, are also needed. Countries should aim at adopting and applying the comprehensive definition of SRHR mentioned in the report and should support modification of laws, policies, and social norms that help support SRHR.
“Civil society organizations will need to advocate for change and hold governments and other implementing organizations accountable for promises made and obligations incurred,” the investigators concluded.
Starrs AM, Ezeh AC, Barker G, et al. Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission [published online May 8, 2018]. Lancet. doi:10.1016/S0140-6736(18)30293-9