During day two of this conference, the delegates discussed ways to ensure that SRHR is part of the emerging development framework. The final R in that is for ‘rights’. This seems to be a real sticking point. There are those who can get onboard with sexual and reproductive health, but there is some apprehension about rights. What is your experience with this?
Dangor: The issue of rights is seen as controversial to some people because they don’t understand what rights are included, what rights are excluded. I think we need to reframe it: one cannot guarantee services to any individual in any country unless that service is backed-up by the person having the right to those services.
Part of the work here is dialoguing with people. Discussing what the rights would be. What they mean, what they don’t mean. Is there any justification for excluding anybody from the international human rights instruments? Whether it’s social rights, political rights, cultural rights, economic rights. You can’t separate them – they are all integrated and interdependent.
Kissi: There has been a lot of paranoia in many of our countries around the issue of rights. We need to unpack this and help policy makers understand exactly what we mean when we say rights.
Can you give me an example?
Kissi: When some people hear “rights” they only think of one or two issues: sexual orientation and gender identity. And they think of abortion. That’s it. So everything else that comes with it – the right to health, the right to education, the right to be free from discrimination, the right to protection from inhumane treatment, torture, violence – none of this comes to mind. If we start from principles like that, I think we’ll get a lot more people on board.
African countries have the highest maternal mortality rates for young women in the world. At the same time, there is an enormous amount of resistance in this region to SRHR being included in the post-2015 development framework. Why is that?
Dangor: A lot of the mortalities and morbidities are linked to unsafe abortion. Safe abortion under the right conditions saves lives. Unsafe abortion actually results in massive bleeding, all sorts of illness, and very often death. The other kind of complications linked to maternal mortality is the link of HIV and AIDS. When you talk about SRHR, you must talk about HIV and contraception. That’s why we talk about modern means of contraception – to prevent pregnancy but also to prevent sexual transmitted diseases.
Maternal mortality is also a problem because of existing health systems. Lack of investment and poor access to resources. That’s the big bug bear of African countries. We are denied the ability to mobilize our own resources because we are not in control of the resources that we have internally. It’s always circumscribed by global financial rule or some other northern national doing the extraction. Or taxation moving out of the system. These things are all interlinked. They all compound the problems of maternal mortality. So when we tackle them, we have to tackle them in their entirety. We’re actually asking for changing the rules so that we can take control of our oil resources, our coal resources, our gas resources – and use these for the development of our own countries in a way that makes sense.
As you continue your work to ensure that SRHR is included in the development framework, what are your main priorities over the next few months?
Dangor: We need to ensure that we don’t change the 17 targets that have been identified. We had lots of negotiations to get at least acceptable language on reproductive rights. Now, we need to look at those indicators, look at how we refine them to ensure delivery. For example, comprehensive sexuality education is a key component of SRHR. Unsafe abortion as a target must be dealt with. One of the indicators needs to talk about reducing maternal mortality and morbidity linked to unsafe abortion.
Kissi: I agree that the 17 goals provide a very solid basis. In my ideal world, there would be an opportunity to open up a bit, to include more of the issues that affect young people. I don’t think we have succeeded in prioritizing youth in the new framework.