6 th June 2007

1. Need for Integrating Sexual and Reproductive Health and Rights in the MDGsA plea from South AsiaMs. Indu Capoor, Founder-Director Centre for Health Education, Training and Nutrition Awareness , Ahmedabad, India 6th June 2007

2. Making MDGs a Reality • The eight MDGs are an unprecedented promise by all world leaders to accelerate global efforts to meet the needs of the worlds’ poorest by 2015. However, universal access to reproductive health services and focus on sexual and reproductive health and rights was missing until recently. • None of the MDGs can be attained without addressing SRHR. Due to absence of SRHR in MDGs, SRHR has received less visibility, less attention, lower priority and less funding.

3. Links between SRHR, poverty and gender disempowerment Sexual and reproductive health among young people is a poverty issue and forced early marriage and early pregnancy is an outcome. Pregnant girls drop out of schools. Without education and employment unmarried pregnant girls are poorly prepared to take responsibility of childcare and face diminishing prospects for income generation. Addressing early pregnancy and empower-ment women for safe motherhood are necessary components for reducing maternal mortality and improving child health.

4. Rachel Born in Europe Eats nutritious food Graduates from a good institution Is active in the job market Chooses her life partner Mother of two healthy children Lives a healthy life! Reni Born in South Asia Often goes hungry Works 10-12 hours Is married at 10 Conceives at 13 Looses 3 children Gives birth to 4 children Receives no care Is often abused Dies at 21 years of age! While MDGs are a goal for the Global Commitment Regional Disparities Exist

5. The scenario in South Asia • South Asia is the worlds most populous region. A significant percentage of the population is denied basic human needs-food, shelter, clothing and education. (Per Capita Income ranges from USD 250 to 840) • A region of Class, caste, gender and race inequalities, political crisis, terrorism and turmoil. • One fifth of the population in South Asia is between the ages of 15 and 24. This is the largest number of young people ever to transit into adulthood, both in South Asia and in the world.

6. The SRHR situation in South Asia • About 74 million women are missing in South Asia. They are the victims of social and economic neglect from the cradle to the grave. The sex ratio is 94/100 as compared to 106/100 at the global level. • South Asia significantly contributes to the global burden of maternal deaths (MMR ranges from 340-800). • More than 80% of adolescent girls and 85% of pregnant women in South Asia suffer from anemia. • In 2004 36% of the total deliveries in South Asia were attended by a skilled health personnel.

7. The gap between policy and practice • At policy level there has been some progress – SRHR related issues are reflected in the youth, health, education policies. However, the reality at the ground is different! The implementation of the policies is the real challenge among other things because the public health systems are weak. • While funding for reproductive health and education has increased, its access by field-based civil society organizations has become extremely difficult, due to the focus on public-private-partnerships.

8. Obstacles • The increasing global opposition against sexual and reproductive rights through budget restrictions – partlicularly the US government (PEPFAR, GAG Rule) • Religious opposition to sexuality education, access to contraceptives, abortion etc. • The culture of silence among women and girls in South Asia

9. What needs to be done? • Build a strong and strategic advocacy partnership. • Create new opportunities for people centered advocacy at the local, national and regional level. • Strengthen civil society and marginalized women’s capacity to effectively advocate for SRHR through field based evidence. • Hold decision makers and service providers accountable. • Conduct simultaneous advocacy and create linkages at state, national, regional and international level.

10. Building Evidence and Ground for Advocacy Capacity enhancement of CBOs and community to articulate the denial of their rights Listening to women narrate experiences of accessing care from the public health System Lack of infrastructure, supplies, absenteeism, corruption Documentation of denial to services in local and national languages Developing policy briefs Scanning the environment for advocacy interventions and opportunities - community, state policies and programme and the political agenda and power from local to national level

11. Advocacy efforts at various levels Advocacy for Women`s Access to Maternal Health Services from the Public Health System Dialogue with the community and elected representatives for consensus building and affirmative action Voices of denial at the state level for state policy action National dialogue with policy makers, media, donor agencies to showcase the evidence of denial and demand for improved health services Dialogue with the block and district public health administrators and media Opportunities, when ever available are seized at all levels, to take community voices to the policy makers

12. Global funding for the MDGs is not at the promised level and you can lobby with your government to put pressure on other donor countries especially in the EU to contribute to programmes that focus on a comprehensive approach: Infant Mortality, young People’s issues and maternal Health. Maintain focus on controversial issues to support the global fight for a gender and rights-based approach and help secure sexual and reproductive rights. Strong and tactful leadership required

13. Strong and tactful leadership required • Pressurize your government to influence negotiations during PRSPs so that the voice of women’s organizations, especially organizations working on advocacy for SRHR are heard and that women’s rights-based programmes are funded. • Review budgets for gaps and increase aid allocation to fund civil society organizations for: • Demand creation of health entitlements • Ensuring accountability mechanisms • Fund for enabling community feedback mechanisms.

14. Strong and tactful leadership required • Hold dialogues with civil society organizations to understand the political and social realities of countries being funded. • Local realities are complex, dynamic and unpredictable, you can advocate for funding sustainable civil society organizations that could deepen the field understanding and link it to practice where health service outreach is poor.

15. Let us join hands for a Healthy South Asia! “Women’s health is a personal and social state of balance and well being in which a woman feels strong, active, creative, wise and worthwhile; where her body's vital power of functioning and healing is intact; where her diverse capacities and rhythms are valued; where she may decide and choose, express herself and move about freely.” - from the 'Women and Health (WAH!) Programme Approach Document, 1993