We need to revive the rights-based agenda and realign research priorities for women's health, says Priya Shetty.
The activists who fought to put human rights at the centre of women's sexual and reproductive health, at the landmark International Conference on Population and Development held in Cairo in 1994, may have won the battle — but they are still fighting the war.
The conference produced a radical set of resolutions: women should be able to choose when and how often they got pregnant, and could have access to safe abortion; they would be given guidance on sexual health and on preventing sexually transmitted infections; and they would be safe from harmful traditional practices such as forced marriage or genital mutilation.
Yet this rights-based approach to women's health never quite came to fruition. Nearly two decades after the Cairo commitment it's time to revive it, and create a new strategy for research into sexual and reproductive health.
In many ways, the Cairo declaration prefigured the Millennium Development Goals on maternal and child health. For instance, it advocated that by 2015, all girls should have access to not just primary education, but higher education too — vital for better health outcomes.
The declaration also wanted countries to aim for a maternal mortality ratio (MMR) of below 60 maternal deaths per 100,000 live births.
Current MMRs in the developing world are a marker of how poorly these recommendations were taken up. WHO estimates from 2008 show that overall, the MMR was 290. In Sub-Saharan Africa, it was as high as 640; South-East Asia had a ratio of 160, and Latin America and the Caribbean of 85.
What is especially dispiriting about this gap between the target and reality is that of all aspects of women's health, maternal health has actually received the most attention — even to the point of overshadowing all other sexual health issues.
Sidelining sexual health
The renewed call for women's health research to focus once more on rights was made at Forum 2012, organised by the Council on Health Research for Development (COHRED) in Cape Town on 24–26 April, which looked at how developing countries can "move beyond aid" with sustainable health and research strategies.
Sofia Gruskin, director of the Program on Global Health and Human Rights at the Institute for Global Health, University of Southern California, said the tunnel vision on maternal health has sidelined other sexual health issues.
And Marge Berer, founding editor of the journal Reproductive Health Matters, pointed out that women's health isn't just important during reproductive years — menopausal, and post-menopausal health in developing countries is neglected too.
Sonali Johnson, senior programme officer at COHRED, who set the research strategy discussions in motion, says that the rationale behind a new strategy was to ensure that sexual and reproductive health doesn't get neglected once the Millennium Development Goals come to an end in 2015.
Johnson says that a major problem is the disconnect between maternal and child health, often seen as media-friendly, and sexual and reproductive health, associated with sensitive issues such as unwanted pregnancies and unsafe sex.
"However, you cannot address maternal health challenges without examining broader reproductive health issues as they are directly related to development and health indicators", said Johnson. "For example, there is a great deal of evidence linking education to fertility levels and to higher maternal health outcomes among others."
Rights vs. money
Putting human rights back into women's health won't be easy, however, because it has been replaced by another motivator: economics. Improve women's health, the rhetoric goes, and you boost economic productivity.
Global business has, unsurprisingly, latched on to this idea with gusto. For instance, The Nike Foundation's Girl Effect programme, which has partnered with the Bill & Melinda Gates Foundation and the UN, aims to improve girls' health and education to ultimately improve their economic capacity.
The programme states that "adolescent girls are capable of raising the standard of living in the developing world."
Other initiatives too emphasise a key role for women in breaking the cycle of poverty. BSR, a global corporate social responsibility network, launched the HERproject in 2007, which aims to improve women's health through a factory-based education programme.
It might seem paranoid to read anything sinister into these efforts, but linking women's health to economics puts a ludicrous amount of pressure on the shoulders of impoverished girls, while seemingly absolving men of any responsibility.
Women's health should be invested in for its own right. And this translates to a direction to research that an economic incentive won't necessarily provide.
How would it change research priorities? Berer and Gruskin argue that sexual and reproductive health research should be integrated. Research is also needed to review the funding and provision of sexual health services — when the focus is on HIV/AIDS, or when donors adhere to a conservative political agenda, this provision can be biased, restricting women's access to safe abortion.
The conversations about changing direction have only just begun. But they will hopefully create a ripple effect to ensure that women's rights, not economic incentives, are paramount.
Journalist Priya Shetty specialises in developing world issues including health, climate change and human rights. She writes a blog, Science Safari, on these issues. She has worked as an editor at New Scientist, The Lancet and SciDev.Net.