UN: Reproductive Health Goal Dropped

The World Bank, IMF, OECD and the United Nations have dropped the goal to 'make accessible, through the primary health care system, reproductive health to all individuals of appropriate ages as soon as possible and no later than the year 2015.'
The International Women's Health Coalition report that the World Bank, IMF, OECD, and the United Nations (including UNFPA, UNICEF and UNDP) are currently engaged in a review of the International Development Goals and the goals of the United Nations' Millennium Declaration.

Following a senior experts group meeting in New York on 21 June, Michael Doyle, the UN Assistant Secretary General responsible for drafting the UN's Millennium Declaration "roadmap," circulated a proposal for a unified set of goals, targets, and associated indicators. These goals and indicators would be used in unified UN frameworks, country level strategies, etc. Reporting on progress towards the Millennium Development Goals at the global and country levels would be co-ordinated by UNDESA and UNDP, respectively. The Millennium Development Goals are to be submitted to the General Assembly in September 2001 for approval.

As you know, what gets measured is what people come to value. Unfortunately, the Cairo goal to "make accessible, through the primary health care system, reproductive health to all individuals of appropriate ages as soon as possible and no later than the year 2015" (paragraph 7.6 POA) - which was included in the International Development Goals - is not part of the current proposal put forward by this experts group. Discrete goals and indicators related to maternal mortality, contraceptive prevalence rates and HIV/AIDS are included, but nothing about the full, integrated range of sexual and reproductive health services, which was the point of ICPD.
The arguments used to explain the absence of this Reproductive Health (RH) goal are:

1. That it was not part of the Millennium Declaration. This is true. However, the Reproductive Health goal was agreed at ICPD and reaffirmed in Copenhagen, Beijing and at the ICPD Plus Five and Beijing Plus Five. It was also part of the International Development Goals put forward by the UN, IMF, OECD, and World Bank earlier in 2000 on the basis of previously agreed goals and targets. By contrast, the Millennium Declaration was a document prepared in a non-transparent way, and adopted at the UN's Millennium Assembly without negotiation and without the benefit of technical advice to the heads of state who signed on to it.

2. That the ICPD RH goal was somehow the product of Northern feminists and that conservative Muslim states won't stand for it. We of course know that's not the case. Further, we understand that substantial pressure from the Holy See and a few conservative countries (who reserved on "reproductive health" in Cairo and consistently thereafter) was instrumental in making sure the phrase "reproductive health" and the RH goal did not make it into the Millennium Declaration. (In fact, the Holy See is extremely active on this issue in the current preparations for the UN's Child Summit). We are now facing the very real possibility that these opponents of ICPD will succeed in removing RH and the RH goal indirectly where they could not do it directly in past negotiations.

3. That the Millennium Declaration is a "higher order" of document than Cairo and Beijing or the Plus Fives. This is not true; the Millennium Declaration is a non-binding GA resolution. The Millennium Declaration in fact received much less careful consideration by governments than the ICPD, Beijing and Plus Five agreements and was not prepared and agreed in a transparent manner.

4. That a contraceptive prevalence indicator, or maternal mortality or HIV goals can stand in lieu of the broad RH goal. This is not so, since the whole point of ICPD was an integrated sexual and reproductive health offering, instead of a vertical focus on one service, be it contraceptive use or skilled birth attendants. The RH goal must be put back in as the central framework of the ICPD agenda, and the words "reproductive health" included in the Millennium Development Goals.

5. That the RH goal can't be measured. In fact, at ICPD Plus Five review, governments agreed on what should be measured to determine whether or not the RH goal has been met. In para. 53, the ICPD Plus Five Document provides that governments should ensure that "by 2015 all primary health care and family planning facilities are able to provide, directly or through referral, the widest achievable range of safe and effective family planning and contraceptive methods; essential obstetric care; prevention and management of reproductive tract infections, including STDs; and barrier methods, such as male and female condoms and Microbicides if available, to prevent infection. By 2005, 60 percent of such facilities should be able to offer this range of services, and by 2010, 80 per cent of them should be able to offer such services." ICPD Plus Five then sets out specific goals for each of these services: para. 58 on closing the contraceptive gap, para. 64 on skilled birth attendants, and para. 70 on access by young people aged 15-24 (not only pregnant women!) to information, education and services to protect themselves against HIV infection; and HIV infection rates in young people.

Unfortunately, we are told that none of the participants in the June expert meeting (which included UNFPA, UNICEF, UNDP, World Bank, and OECD representation, but not WHO) defended the overall RH goal, and that they will need pressure - especially from Southern groups - to remember what was agreed in Cairo and why we think it is important.
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International Women's Health Coalition
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International Women's Health Coalition