Portal de Periódicos da CAPES

Continue to improve women's health: ICPD Beyond 2014

2014; Elsevier BV; Volume: 90; Issue: 6 Linguagem: Inglês

10.1016/j.contraception.2014.10.001

1879-0518

Babatunde Osotimehin,

Adolescent Sexual and Reproductive Health

The 1994 Cairo International Conference on Population and Development (ICPD) and subsequent agreements established global consensus that, for the overall health and empowerment of women and girls universal access to sexual and reproductive health, is essential. The conference defined sexual and reproductive health as "a state of complete physical and mental well-being (…) people are able to have a satisfying and safe sex life and have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of regulating fertility which are not against the law, (…) access to appropriate health care services (…) to go safely through pregnancy and childbirth, (…) preventing and solving reproductive health problems [including] sexually transmitted diseases." [[1]Programme of Action adopted at the International Conference on Population and Development, Cairo, 5-13 September 1994.http://www.unfpa.org/public/home/publications/pid/1973Google Scholar]. During the last 2 decades since the ICPD, considerable progress has been made in women's sexual and reproductive health, including increases in contraceptive use, expanded access to skilled maternity care and the reduction of new HIV infections. Maternal death has fallen by half, to 273500 in 2011 [[2]Kassebaum N.J. Bertozzi-Villa A. Coggeshall M.S. Shackelford K.A. Steiner C. Heuton K.R. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.Lancet. 2014; 384: 980-1004Abstract Full Text Full Text PDF PubMed Scopus (920) Google Scholar]. Family planning use has increased from 54.8% to 63.3%, and an unmet need for family planning decreased from 15.5% to 12.3% since 1990 [[3]Alkema L. Kantorova V. Menozzi C. Biddlecom A. National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis.Lancet. 2013; 381: 1642-1652Abstract Full Text Full Text PDF PubMed Scopus (311) Google Scholar]. The rates of new HIV infections have plateaued or begun to decline in a number of countries [[4]Ortayli N. Ringheim K. Collins L. Sladden T. Sexually transmitted infections: progress and challenges since the 1994 International Conference on Population and Development (ICPD).Contraception. 2014; ([early online publication])Google Scholar]. Government leadership together with strong support from all partners including United Nations agencies, nongovernment organizations and professional associations among others, contributed substantially to this progress. The United Nations Population Fund made major contributions in many countries and is continuing to support countries to further accelerate the progress toward universal access to sexual and reproductive health. Behind these positive global trends, however, lie significant differences among and within countries. Worldwide, 222 million women in low- and middle-income countries who do not want to become pregnant are not using modern contraception. It is estimated that annually 30 million unplanned births and 40 million abortions, half of them illegal and unsafe, occur [[5]Guttmacher Institute, UNFPA Adding It Up 2012: Costs and Benefits of Contraceptive Services Estimates for 2012.http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/AIU%20Paper%20-%20Estimates%20for%202012%20final.pdfGoogle Scholar]. An estimated 499 million new, sexually transmitted infections, not including HIV, occur, approximately half in girls and women [[6]WHO Global incidence and prevalence of selected curable sexually transmitted infections—2008.http://www.who.int/reproductivehealth/publications/rtis/stisestimates/en/index.htmlDate: 2012Google Scholar]. In regard to women's empowerment and human rights, more girls are attending primary school but few complete or even attend secondary school in many low- and middle-income countries. Violence against women and girls remains pervasive and may be increasing. Poverty and child marriage and other harmful practices are major deterrents to women's utilization of health and other services. The ICPD and subsequent agreements underlined the importance of providing an integrated set of core sexual and reproductive health services (including contraception, maternity care and prevention and treatment of sexually transmitted infections, including HIV) and doing so through the public health system, rather than through vertical programs, are essential steps for the realization of women and girl's human rights. The Programme of Action recognizes that the interests of women and girls are best served when such services and their integration are well designed, coherently implemented and gain efficiencies that ensure they are cost effective and, thus, sustainable. Furthermore, strengthening the health system over time to provide quality, integrated sexual and reproductive health services is a key pillar of action to prevent and treat diverse impacts from violence against women to noncommunicable diseases in women. In recent years, a range of global and national initiatives to enhance access to sexual and reproductive health services have emerged, as national governments, donors and international agencies have worked to achieve universal access to reproductive health. The United Nations Secretary-General's "Every Woman Every Child" initiative is one example at the global policy level. Various countries, including, for example, Bangladesh, Viet Nam, Brazil, Ethiopia, Nepal, and some Nigerian states, Rwanda and Turkey, have redesigned national or subnational health policies and programs in this direction, and numerous donors have also adopted an Sexual and Reproductive Health and Rights approach in their Oversees Development Assistance policies on health and population. Nonetheless, the typical woman or girl living in a low-income country, or in poverty in a middle-income country, has little access to such services and often faces barriers as well social factors, gender inequalities and various human rights violations that jeopardize her development and well-being, including her sexual and reproductive health, and contribute to persistent high morbidity and mortality. In addition, in many countries, fragile underresourced health systems mean that states fail in their duties to meet the sexual and reproductive health needs of women and young people. Innovative and robust initiatives are still needed in many countries to achieve universal access to SRH, while along with multisectoral actions, investments are needed to remove social, legal and economic barriers to service utilization that hinder girls' and women's use of services. The ICPD Programme of Action sets out commitments to address such aspects of women's health as infertility, gender-based violence and reproductive health cancers. However, these concerns have received relatively little attention, although they exact a high toll on women's health, including on their sexual and reproductive well-being. For example, in 2010, breast cancer killed 269000 women in low- and middle-income countries and cervical cancer killed 275000 (International Center for Research on Cancer). Too little investment has been made in removing social and other obstacles to the information, education and services that women and girls need to avoid and address these health threats. Under these circumstances, and as we were nearing the 20th anniversary of the ICPD Action Programme, the United Nations Population Fund has asked a number of global experts to prepare reports that would summarize the progress, or lack thereof, and come up with some recommendations to progress the agenda. These reports, which are the reflection of the expertise of their authors, served as background documents at the "ICPD Beyond 2014: Women's Health Experts Meeting" meeting, which took place during September 27 to October 3, 2013, in Mexico City, Mexico. The articles you will find in this supplement are based on these reports and have been revised by the authors of the background articles after they participated in the meeting in Mexico City. We strongly believe that these articles, which summarize the progress and include the recommendations of distinguished teams with exceptional expertise in their areas of work, will serve as a valuable tool for the global community, in its efforts to reach a consensus on the best track to reach our dream of a prosperous and equal world.