Although often overlooked, sexual and reproductive rights must also be upheld through universal health coverage
By Suzanne Ehlers, president and CEO of PAI
As PAI’s CEO, I am often asked why we do this work. Of all the avenues to advance human prosperity and development, why sexual and reproductive health and rights? Why when it seems that in too many countries – the United States included – the political climate is at worst hostile and at best indifferent, to the needs and perspectives of women and girls?
Our answer is always that we believe that when women and girls can make their own choices about when and if to become pregnant, they can transform their lives and their communities.
We believe that the best way to catalyse that transformation is through deep partnership and engagement with civil society and communities who best understand the needs of the people they serve and who are both drivers of accountability and sources of technical expertise.
It is our mission to remove the barriers that stand between women and girls and their sexual and reproductive health and rights, because we understand that at its core, the right to health is about the right to self-determination. That is why the promise of universal health coverage based on a primary healthcare approach is so powerful. Its mandate of health for all, that all people have the promotive, preventive, curative, rehabilitative and palliative health services they need – without exposure to financial hardship – represents the highest political and financial commitment to the fulfilment of health as a human right.
At PAI, we also see in universal health coverage an integrated, people-centred expression of many of the solutions we seek as a reproductive rights organisation:
Meeting the unmet needs of the 214 million women globally who do not want to become pregnant but are not using contraception;
Providing respectful, confidential, culturally appropriate – and integrated – care for all people but especially women and girls, young people and other vulnerable populations;
Increasing the availability, affordability and quality of sexual and reproductive health services and supplies,
including improving the range and availability of contraceptive methods; and
Reducing reliance on donor funds for health and increasing country ownership of family planning.
It is clear: the achievement of universal health coverage and the fulfillment of sexual and reproductive health and rights are part of the same equation.
Within that equation, we see primary health care as a critical entry point. As the foundation of the healthcare system, strong primary healthcare systems can ensure equitable coverage, increase access and improve the quality of services that citizens receive. Additionally, a primary healthcare approach includes awareness and address of the social, economic and environmental determinants of health, which are drivers of inequity affecting the health and well-being of women and girls.
Unsurprisingly then, primary healthcare systems are instrumental in meeting the needs of women and girls. Contraceptive services, antenatal and postnatal care, vaccines and nutrition support for infants can all be provided at the primary healthcare level in a high-performing system – helping to accelerate the achievement of the Sustainable Development Goals.
Gaps in the system
Unfortunately, according to the Tracking Universal Health Coverage: 2017 Global Monitoring Report, “at least half the world’s population still lacks access to essential health services. Furthermore, some 800 million people spend more than 10% of their household budget on health care, and almost 100 million people are pushed into extreme poverty each year because of out-of-pocket health expenses.”
As a whole, the health sector remains donor-dependent, underfunded and under-prioritised in most countries. The challenges of mobilising governments, civil society, communities and other stakeholders can seem daunting. But progress is possible – as in Peru where 19 different ministries came together to develop a multi-sectoral adolescent pregnancy prevention strategy and in Ghana where efforts to increase both access to health services and financial protection are ongoing.
Replicating – and sustaining – these successes requires collaboration across sectors by both governments and civil society. It must also be rooted in accessible and actionable data, and it requires financial and technical support for civil society engagement at the global and local levels. Our approach is therefore guided by the core principles of access, equity and quality, which undergird primary health care and universal health coverage. In close collaboration with our global network of partners, we have pursued a number of strategies.
For perhaps the first time in human history, a truly inclusive approach to delivering health care – including sexual and reproductive health – is within reach. Thankfully, sustaining momentum for universal health coverage, improving primary health care, and ensuring a just and equitable future for women and girls are all part of the same endeavour.
Our progress towards that goal will only be possible through the ingenuity of our partnerships among civil society, governments, donors and the private sector, fostering accountability and increased country ownership – and an unwavering commitment to upholding the right to health for all.