August 2004, Vol 94, No. 8 | American Journal of Public Health 1297
© 2004 American Public Health Association
Stalled on the Road to Reproductive Health
Sofia Gruskin, JD, MIA, Associate Editor
It is an unfortunate sign of the times that much of the current scholarly work in reproductive and sexual health is not about advancing understanding but about reacting to political and ideological challenges to the consensus forged at the 1994 International Conference on Population and Development held in Cairo. Over the past decade, governments, the organizations and agencies of the United Nations system, and nongovernmental organizations have adapted their discourse as well as their operations to more fully consider reproductive and sexual health and move beyond the confines of traditional family planning approaches. Not only has this brought new strength and resources to previously existing efforts, but projects now exist in all corners of the globe that demonstrate the value of this wider conceptualization.
Governments of the world reaffirmed a comprehensive approach to population and development at the 5-year review of the Cairo Program of Action held in 1999. Yet it was also clear that the Cairo agenda needed simplification and clarity, and more attention to how key actions and targets would be achieved in the short and long term. This year marks 10 years since the Cairo conference, and instead of building on the solid gains from the 1999 review, we find ourselves back to arguing for the very existence of many of the components understood through the Cairo consensus as key elements of reproductive health.
Take, for example, prevention and treatment of complications arising from pregnancy and childbirth, the leading causes of death and infirmity among women of reproductive age in resource-poor settings. The 1994 Cairo document recognized the provision of access to adequate health care information, counseling, and services as part of a government’s responsibility for reproductive health. Yet in 2001, at the United Nations General Assembly Special Session on Children, access to this information was seriously challenged by a curious alliance: the United States, Sudan, Iran, and the Holy See. This challenge would vitiate the rights of adolescents to access appropriate and scientifically accurate reproductive and sexual health information and services, as had been agreed to in Cairo.
Then there are the United Nations Millennium Development Goals, arguably the development agenda for the coming decade if not the millennium, in which reproductive health is not explicitly mentioned even though at least 3 of the 8 goals—those dealing with maternal health, child health, and HIV/AIDS—can be understood to be directly linked to reproductive health concerns. What is at stake is not a matter of partisanship: commitment to ensuring access to information and services goes to the heart of a concern for reproductive health.
The majority of public health practitioners as well as the majority of countries in the world have reaffirmed the Cairo framework. The "Cairo plus 10" regional conferences in Latin American, the Caribbean, and the Asia/Pacific region have resulted in governments’ reaffirming the Cairo principles and vowing to intensify their efforts toward implementation. This is reassuring but insufficient. Documenting and eventually improving the reproductive and sexual health needs of populations will require the sustained involvement of affected communities and the combined efforts of governments, intergovernmental and nongovernmental institutions, and the private sector. It is not enough only to organize to keep reproductive health alive. We have a responsibility to carry out the additional work of gathering and publishing the evidence needed to inform beliefs, policies, and practices.
Copyright © 2004 by the American Public Health Association
