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Realising Rights

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Meeting the Challenge

Poor sexual and reproductive health is a source of enormous suffering for millions of the world's poorest people. High levels of mortality and morbidity as a result of sexual and reproductive health problems compromise efforts to reduce poverty. Yet in many countries the issues remain invisible and taboo. Despite two decades of sustained effort, sexual and reproductive rights are poorly understood and articulated and progress on improving sexual and reproductive health indicators is slow.

We aim to respond to these challenges, using research to raise the profile of sexual and reproductive health and rights in developing countries and working in partnership to find innovative solutions.

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Produced by the IDS Health and Development Information team in collaboration with Eldis and the DFID Health Resource Centre

MORE THAN MATERNITY - NEGLECTED AREAS IN SEXUAL & REPRODUCTIVE HEALTH & RIGHTS

Recent months have seen a resurgence of interest in health in developing countries at international level. Bodies like the International Health Partnership and the High Level Taskforce on Innovative Financing for Health have highlighted aid flows and health system strengthening. Announcements from the United States Administration seem to suggest a return to rights based approaches and a new focus on global health. Maternal health initiatives advocating around access to obstetric care have mushroomed as a result of the world’s poor progress on MDG 5. Whilst this focus on health in developing countries is welcomed, high profile grand partnerships tend not to focus on contested, complicated or stigmatised issues.

The Realising Rights Research Programme Consortium takes a comprehensive approach to sexual and reproductive health and rights with a particular focus on neglected issues. Researchers from Bangladesh, Ghana, Kenya and the UK are exploring neglected or “challenging” areas of sexual and reproductive health and rights, with a strong focus on men’s health, improved access to contraception particularly for poorer women and men, sexuality and rights, masculinities, sexually transmitted infections, gender based violence and unsafe abortion.

These issues are central to development and health. Although access to safe abortion makes human and economic sense it is continually ‘invisibilised’ in maternal health advocacy, despite the fact that it is responsible for an estimated 15 percent of maternal deaths.

Sexually transmitted infections are a major public health issue in many settings. Every year, at least half a million infants are born with congenital syphilis. Maternal syphilis causes another half million stillbirths and miscarriages annually. Yet the tests for syphilis cost a mere US$ 0.93–1.44 per woman screened. Rising numbers of people living with HIV raise important questions about the right to a safe and satisfying sexual life in line with international agreements on sexual and reproductive rights but in many settings women living with HIV are penalised by criminal law. In Sierra Leone, for example, if a woman transmits HIV to her child, she can be fined or jailed up to 7 years or both.

Gender based violence is prevalent in all countries of the world but rarely afforded the attention it deserves. A study from Kenya found that physical and sexual abuse within relationships often leads to repeated exposure to sexual and reproductive health risks, and abused women lack knowledge about these impacts, experience feelings of hopelessness about their health, and are unable to access the health services they need.

Those who are marginalised from dominant norms around sexuality - such as lesbians, gay men, bisexuals, transgender and intersex people, sex workers, single women, women who have sex outside of marriage, and non-macho men - may face not only pressure to conform, but stigma, discrimination and violence if they do not.

As we develop an evidence base in this area the challenge is how it is translated to policy and practical action that would improve the lives of so many - how can we ensure that sexual and reproductive health is appropriately reflected in the larger global narratives that are shaping development action?

Many thanks to Kate Hawkins and Hilary Standing from the Realising Rights Research Programme Consortium, UK, for writing the content for this Health Reporter.

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