SPECIAL REPORT
Sexual and reproductive health and rights in the sustainable development goals and the post-2015 development agenda: less than a year to go Marianne Haslegrave Director, Commonwealth Medical Trust (Commat), Deal, Kent, UK. Correspondence: [email protected]
Abstract: Since the International Conference on Population and Development (ICPD) in Cairo in 1994 there have been significant achievements in moving towards the goal of sexual and reproductive health and rights. Yet there have also been disappointments, as demonstrated in the Millennium Development Goals, even though in 2007 a target on reproductive health was added. Most recently, the 20-year review of the implementation of the ICPD Programme of Action, ICPD Beyond 2014, has taken place, which has moved forward the sexual and reproductive health and rights agenda. But, the main arena for future negotiations has changed and the UN is in the process of negotiating the post-2015 development agenda and the sustainable development goals (SDGs). This paper assesses what has been taking place since 2013 and provides information as to how the process for the post-2015 development agenda and the SDGs are likely to move forward. An understanding of what has been achieved, the processes as they are now proceeding and their future development are important for moving towards the ultimate goal of achieving sexual and reproductive health and rights in the next 15 years. © 2014 Reproductive Health Matters Keywords: sexual and reproductive health and rights, post-2015 development framework, ICPD Beyond 2014, sustainable development goals, UNFPA, Open Working Group, UN General Assembly Special Event, civil society, advocacy
Since the adoption of the Programme of Action of the International Conference on Population and Development (ICPD)1 in Cairo in 1994, Governments and civil society advocates can claim many achievements in working towards the ultimate goal of sexual and reproductive health and rights, even though progress might have been uneven. More remains to be done in the context of the post-2015 development agenda and the sustainable development goals (SDGs), that have been set in place to replace the Millennium Development Goals (MDGs), which expire at the end of 2015. This paper is a follow-up to the assessment I published a year ago in RHM as regards the state of the negotiations on both the post-2015 development agenda and the sustainable development goals (SDGs), as they could underpin future action on sexual and reproductive health and rights for the next 15 years.2
Building on the past
102 Contents online: www.rhm-elsevier.com
Doi: 10.1016/S0968-8080(14)44812-2
First, it is important to step back and look at what has already been achieved. Twenty years ago, at the end of the ICPD, 179 governments had adopted a far-reaching Programme of Action that represented a paradigm shift from the traditional macro-demographic perspective to one that placed human rights at the centre of population and development, recognized women’s empowerment, and set out a comprehensive range of issues including sexual and reproductive health and reproductive rights. This agenda has underpinned our work to the present. At the same time, not everything was perfect – Governments did not agree sexual rights and the language on access of young people to sexual and reproductive health information, education and services gave too much emphasis to the role of parents and guardians, as opposed to the best interests of adolescents.1 Nevertheless, progress
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was made with the Beijing Platform for Action, which recognized the human rights of women to control over their own bodies and also the rights of adolescents to acquire knowledge, especially information on sexuality and reproduction taking into account their best interests as a primary consideration.3 Further progress was also made with the adoption at the 21st UN General Assembly Special Session in 1999 of the Key Actions for the Further Implementation of the ICPD Programme of Action.4 The year 2000, however, saw a major setback with the introduction of the UN Millennium Development Goals (MDGs), without a goal on sexual and reproductive health and rights. This was only partially rectified in 2007 with the introduction of MDG Target 5B on universal access to reproductive health by 2015, although it has to be said that some Governments did not fully include this target in their policies and programmes even then.5 While progress might have seemed too slow at times, other gains were made along the way in the outcome documents of some of the sessions of the Commission on Population and Development and the Commission on the Status of Women.
ICPD Beyond 2014: strengthening the case for sexual and reproductive health and rights The review of the implementation of the ICPD Programme of Action, ICPD Beyond 2014, which has been taking place alongside the discussions on the post-2015 development agenda and the SDGs, has been of key importance in advancing the ICPD agenda. Sexual and reproductive health and rights have been included in the outcome documents of nearly all the regional conferences, as well as in other documents, such as the reports of the International Conference on Human Rights and the ICPD Beyond 2014 Technical Expert Group Meeting on Women’s Health: Rights, Empowerment and Social Determinants. These achievements were brought together at the Special Session of the General Assembly on ICPD Beyond 2014 in September 2014, at the end of which the President of the General Assembly introduced an oral decision, by which Member States formally acknowledged the framework for actions for the follow up to the Programme of Action Beyond 2014 and the steps for further
implementation, taking into account their respective statements in the Special Session.6*
What comes next? Now, however, the main focus for moving forward will be through the post-2015 development agenda and the SDGs, as they will be the main drivers for policies and programmes more than the agreements of past major UN conferences, although these will still have an important role in supplementing them. The process for the post-2015 development agenda and the SDGs, leading to the World Summit in New York in September 2015, is extremely complex insofar as it is working towards a truly integrated agenda that is negotiated across the UN key pillars of work, namely economic, environmental and social. The challenge will be to ensure that sexual and reproductive health and rights are included under these pillars. Because it is a new concept, this process is not based on any particular former precedents but it is critically important to understand it as fully as possible in order to be able to use it, not only in the negotiations in the coming months but also in the years ahead to ensure the achievement of the ultimate goal of sexual and reproductive health and rights.
A sometimes glossed over document: the Special Event outcome document While sharing the common ideals and aspirations, two processes evolved for the follow up to the *At this meeting, the President said: "May I take it that the General Assembly, recalling the reports of the SecretaryGeneral circulated in documents A/S-29/3 and A/S-29/4 and the report of the Commission on Population and Development on its forty-seventh session circulated in document A/S-29/5, wishes to take note of the deliberations of the Special Session on the findings and recommendations contained therein?" It should be noted that the “Framework of Actions for the follow-up to the Programme of Action of the International Conference on Population and Development beyond 2014” (A/S-29/3), the “Recurrent themes and key elements identified during the sessions of the Commission on Population and Development” (A/S-29/4) and the “Report of the Commission on Population and Development on its forty-seventh session” (A/S-29/5) define the road map for moving forward and include specific references to sexual and reproductive health and rights in both the regional outcomes and the findings and recommendations of ICPD Beyond 2014.
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MDGs. The first is the SDG process, which emanated from the UN Conference on Sustainable Development Goals (Rio + 20), which in turn established the Open Working Group (OWG) on Sustainable Development Goals, the Intergovernmental Expert Committee on Sustainable Development Financing (ICESDF) and the High– Level Political Forum on Sustainable Development (HLPF). The second was led by the UN SecretaryGeneral (SG), and included the High-Level Panel of Eminent Persons on the post-2015 development agenda with its report at the end of May 2013, and the Sustainable Development Solutions Network.7,8 In addition, input into this process was gathered through a series of consultations with civil society, academia, the private sector and other stakeholders as part of the “World We Want 2015”.9 While both the SDG process and the UN SG’s initiative were very ambitious and challenging, in general they were proceeding along two separate tracks based on processes that might best be described as “making it up as we go along”. Yet, some markers were put down, the most important of which is the outcome document of the UN General Assembly Special Event towards achieving the Millennium Development Goals (Special Event outcome).10 Adopted by acclamation, it provides the necessary guidance for the processes that have subsequently taken place and sets out the steps for the remaining time to the Summit on the post-2015 development agenda (of which the SDGs are a major part), which is likely to take place on 28–30 September 2015.11,12 In addition to amalgamating the SDG and post-2015 development agenda processes, it also ensured that, in the future, the process would be led by Member States, and not by the UN Secretariat. The Special Event outcome, moreover, emphasizes the importance in the post-2015 development agenda of certain key principles, such as universality, national ownership, mobilization and effective use of all resources, the promotion of human rights, gender equality, good governance, the rule of law, and transparency and accountability at all levels. Processes such as the OWG and the ICESDF are also highlighted, with the completion date for their work set at September 2014. A process organized by the President of the General Assembly during 2014 was also established, with input from six events and a stocktaking session under the theme “The Post-2015 Development Agenda – Setting the Stage.” This 104
once again emphasized that Member States are in the driving seat.
Going forward Civil society participation based on the Special Event outcome By the time the 69th Session of the General Assembly opened in September 2014, a resolution had been negotiated, again in accordance with the Special Event outcome, under the leadership of the UN Ambassadors of Denmark and Papua New Guinea, with agreement being reached on nearly all areas of the procedures for the Summit itself. 11 * Of particular relevance, including to sexual and reproductive health and rights advocates, are the paragraphs in the resolution that relate to civil society participation: in addition to the specialized agencies of the UN system, other stakeholders “including parliamentarians, academia, non-governmental organizations, civil society organizations, Major Groups and the private sector” are invited to participate in the Summit. This applies both at the Summit itself, through its interactive dialogues, and during the preparatory process. They are encouraged, moreover, to “consider initiatives and activities in the preparation and the lead up to the Summit”.11 As was the case for the 10-year review of the achievements of the Millennium Development Goals (MDGs) in 2010, the President of the General Assembly will organize and preside over two days of informal interactive hearings before June 2015 involving representatives of nongovernmental organizations, civil society organizations, Major Groups and the private sector. He will then prepare a summary of the hearings to be made available prior to the Summit.11 While it is important to ensure that strong references to sexual and reproductive health and rights are included in these interactive sessions, participation of Member States could be very limited and, depending on the timings, the summary of the hearings may have a limited impact on the negotiations. The specifics for the participation of nongovernmental organizations, civil society organizations, academic institutions and the private sector in the plenary meetings and interactive dialogue of the Summit are set out in Annex IV of the *It was subsequently necessary, however, to renegotiate the date of the Summit.12
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resolution. The process should take into account the principles of transparency and equitable geographic representation, with a proposed list of organizations being submitted to Member States for their consideration on a “non-objection” basis. The list of proposed, as well as final, names will be brought to the attention of the General Assembly (UNGA), noting the general basis for objections. In reality there might be limited opportunities for civil society engagement with many competing priorities from different organizations, of which only a few may be advocates for sexual and reproductive health and rights. Finally, under the resolution, the UN Secretary-General is requested to use existing trust funds to “enhance” the participation of developing country non-governmental organizations, civil society organizations and Major Groups. Again, it is crucial to ensure that such participants have expertise in sexual and reproductive health and rights.11
NGO participation is critically important during the next phase of the negotiations. While Target 5B on universal access to reproductive health was eventually added to the MDGs, there is no guarantee that anything that is not included by the time the negotiations finish will be part of the post-2015 development agenda for the 15 years afterwards, as the draft resolution for the Summit itself does not include negotiations and the follow-up process is as yet undefined.* Furthermore, if sexual and reproductive health and rights are to be part of the SDGs and the post-2015 development agenda, we cannot leave it to governments alone. In the OWG, governments that supported the full inclusion of sexual and reproductive health and rights were predominantly from European and Latin American countries. While several countries from across the regions signed joint statements on sexual and reproductive health and rights,† support was limited from African and Arab countries and some sub-regions of Asia.
Negotiations leading up to the Summit The extent to which civil society will be able to participate in the negotiations leading up to the Summit is gradually becoming clearer. In October 2014, the President of the General Assembly appointed two Co-Facilitators to guide the process – Ambassador Macharia Kamau of Kenya, who was an OWG Co-Chair, and Ambassador David Donoghue of Ireland, who was an active supporter of sexual and reproductive health and rights in the OWG negotiations. Their remit is to “lead open, inclusive, and transparent consultations on the post-2015 development agenda, including the organization and modalities for the inter-governmental negotiations and the remaining issues related to the Summit for the adoption of the post-2015 development agenda”.13 Following informal negotiations, the Co-Facilitators issued a “food for thought” paper which states that there is broad support for an “inter-governmental process, which is open, inclusive and transparent and which builds on the working methods used successfully by the Open Working Group on the SDGs”. It also refers to “provision for regular structural engagement with Major Group and other stakeholders”. This will presumably mean that civil society through the Major Groups and Other Stakeholders, a mechanism that has been used both in the negotiations for Rio+20 and the OWG, will be able to contribute during the meetings, by making both oral interventions and written statements.14
Civil society watchdogs and the UN game Civil society organizations must be able to carry out their “watch dog” role going forward, particularly as some delegates do not always reflect their governments’ positions, instead playing what might be called the “UN game”, that is, reflecting what is most expedient in the context of other negotiations taking place at the UN. Sexual and reproductive health and rights is a *There might be possibilities for targets to be added during review processes on progress in the achievement of the post-2015 development agenda in the future. This happened at the Summit in 2005 and led to the introduction of Target 5B on universal access to reproductive health by 2015. In the case of Target 5B, it partially remedied the lack of a goal on sexual and reproductive health and rights; however, it was not fully implemented by all countries and never achieved the same status or priority as Target 5A on reducing maternal mortality. †
Three Joint Statements affirming sexual and reproductive health and rights were delivered during the OWG: a statement was made at the 13th and final Session of the OWG (July 2014) by South Africa on behalf of 58 Member States on sexual and reproductive health and rights in the SDGs and post-2015 development agenda; a joint statement was delivered by Argentina on behalf of 50 countries at the February 2014 (8th) session; and a third was delivered by Uruguay on behalf of 24 countries at the 4th Session of the OWG (June 2013).
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contentious issue in the UN and must not be traded away as part of a “package” involving other contentious issues. Historically, this happened during the final negotiations of the outcome document of the Rio+20 conference in 2012, which includes no specific reference to either reproductive rights or sexual and reproductive rights. One might now say: “Once bitten, twice shy.”15 While individual representatives of NGOs are often most effective when they are included on national delegations, access for NGOs to the preparatory process is also imperative. The influence of civil society outside the meeting rooms at the UN will be far, far less effective than being able to participate inside the rooms. Secretary-General’s Synthesis Report The Special Event outcome document calls on the Secretary-General “as an input to the intergovernmental negotiations to be launched at the beginning of the 69th session of UNGA… to synthesize the full range of inputs then available”. This Synthesis Report is being prepared at the time of writing and in accordance with the Special Event outcome will be available before the end of 2014. It is anticipated that it will include the 17 goals and 169 targets as in the OWG report,16 as well as addressing accountability and means of implementation. Summit outcome document The “food for thought” paper defines what will be in the Summit outcome document. It will include an introductory declaration; the SDGs, targets and indicators; means of implementation and a new Global Partnership; and a framework for monitoring and review of implementation, which will probably involve the HLPF. A further element could be “the possible implications of the post-2015 agenda for the UN system and its institutions”. As agreed by the General Assembly in September 2014, in its resolution A/RES/ 309, the main basis for future negotiations will be the OWG report.16 There will also be other inputs, including the Synthesis Report. The importance of this for sexual and reproductive health and rights is discussed below, but once again the role of the General Assembly to lead the process is evident. Ten sessions are scheduled to be held in 2015 between January and the end of July to negotiate the process, which will be conducted alongside other processes such as the negotiations for the Financing for Development Conference in Addis 106
Ababa in July 2015 (which should provide input on the means of implementation) and the UN Framework Convention on Climate Change. Process going forward: further along in uncharted waters It can be seen that the process going forward is gradually becoming clearer. However, there are a number of important pointers that can be used to move towards the full inclusion of sexual and reproductive health and rights, or at the very least to hold the status quo. The OWG report includes two targets that address issues related to sexual and reproductive health and rights. The first is Target 3.7 under Goal 3, Ensure healthy lives and promote well-being for all at all ages: “By 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.” (Goal 3, Target 3.7) The second is Target 5.6 under Goal 5, Achieve gender equality and empower all women and girls: “Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the ICPD and the Beijing Platform for Action and the outcome documents of their review conferences.” (Goal 5, Target 5.6) While recognizing that the OWG report excludes sexual rights (a highly contentious issue in the UN arena) as well as comprehensive sexuality education, Targets 3.7 and 5.6, when taken together, address access to sexual and reproductive health information, education and services and reproductive rights for women and girls. It would, of course, have been preferable to have reproductive rights in Goal 5 without any qualifiers, namely the references to the ICPD Programme of Action and the Beijing Platform for Action. However, the “outcome documents of their review conferences” include the ICPD Beyond 2014 Regional Review Conferences, most of which in their outcome documents have strong references to sexual and reproductive health and rights.* *The outcome document of the Regional Review Conference for the Arab States does not include sexual and reproductive health and rights, although it does refer to sexual and reproductive health and reproductive rights.
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It appears that the Co-Facilitators are not proposing to negotiate the 17 goals, although there could be some technical proofing of the proposed targets. The UN Statistical Commission would also assist in developing the “indicators to measure progress against the targets,” although this will have to be confirmed by Member States. The negotiations, therefore, in the first seven months of 2015 will be of critical importance in securing sexual and reproductive health and rights for the next 15 years. The context for their achievement will be set in the document as agreed at the Summit in September.
But the story does not stop there – following the Summit, the implementation will begin, and it is at this point that advocates who have worked hard for the inclusion of sexual and reproductive health and rights in the post-2015 development agenda and the SDGs will have to turn their attention to implementation at the national and regional levels and monitoring and accountability through the High–Level Political Forum on Sustainable Development, using the goals, the targets, the indicators and the means of implementation, for which we will have been working for over two years.
References 1. United Nations General Assembly. Report of the International Conference on Population and Development. A/94/10/18. Programme of Action. New York: UN; 1994. 2. Haslegrave M. Ensuring the inclusion of sexual and reproductive health and rights under a sustainable development goal on health in the post-2015 human rights framework for development. Reproductive Health Matters 2013;21(42):61–73. Doi: 10.1016/ S0968-8080(13)42742-8. 3. United Nations General Assembly. Report of the Fourth World Conference on Women. A/CONF.177/20/ Rev.1. New York: UN; 1995. http://undocs.org/A/CONF. 177/20/Rev.1. 4. United Nations General Assembly. Report of the Ad Hoc Committee of the Whole of the Twenty-First Special Session of the General Assembly, Key Actions for the Further Implementation of the Programme of Action of the International Conference on Population and Development. A-S-21/5/Add.1. New York: UN; 1999. http://undocs.org/A/S-21/5/Add.1. 5. UN Statistical Division. Millennium Development Goal Indicators. 15 January 2008. http://mdgs.un. org/unsd/mdg/Host.aspx?Content=Indicators/ OfficialList.htm. 6. (Part 4) ICPD beyond 2014 - General Assembly, 29th special session, 1st plenary, 22 September 2014 (video). WebTV. http://webtv.un.org/meetings-events/generalassembly/watch/part-4-icpd-beyond-2014-generalassembly-29th-special-session-1st-plenary/ 3801776472001. 7. UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. 2013. http://www.post2015hlp.org. 8. Sustainable Development Solutions Network. http://unsdsn.org.
9. United Nations General Assembly Special Event Outcome Document. September 2013. http://www.un.org/ millenniumgoals/pdf/Outcome%20documentMDG.pdf. 10. Special Event 25 September: Outcome Document. https://papersmart.unmeetings.org/media2/157808/ outcome-documentmdg.pdf. 11. Letter from John W Ashe, President of 68th Session of the UN General Assembly to Permanent Representatives. 15 September 2014. http://www.un.org/en/ga/president/ 68/pdf/letters/9152014Post-2015%20Summit% 20modalities%20-%20Draft%20Resolution%20-% 2015%20September%202014.pdf. 12. Letter from Sam K Kutesa, President of 69th Session of the UN General Assembly to Permanent Representatives. 30 October 2014. http://www.un.org/pga/wp-content/ uploads/sites/3/2014/10/301014_post-2015development-agenda.pdf. 13. Letter from Sam K Kutesa, President of 69th Session of the UN General Assembly to Permanent Representatives. 17 October 2014. http://www.un.org/pga/wp-content/ uploads/sites/3/2014/10/171014_post-2015development-agenda.pdf. 14. Food for thought paper: Modalities for the intergovernmental negotiations on the post-2015 development agenda. 17 November 2014. http://www. un.org/pga/wp-content/uploads/sites/3/2014/11/141114_ post-2015-agenda.pdf. 15. United Nation General Assembly. The Future We Want. A/RES/66/288. 2012. paras 145–146. http://www. uncsd2012.org/content/documents/814UNCSD% 20REPORT%20final%20revs.pdf. 16. United Nations General Assembly. Report of the Open Working Group on Sustainable Development Goals established pursuant to General Assembly resolution 66/288. Adopted 10 September 2014. http://undocs.org/ A/RES/68/309.
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Résumé Depuis la Conférence internationale sur la population et le développement (CIPD) au Caire en 1994, de nets progrès ont été accomplis pour faire avancer l’objectif de la santé et des droits sexuels et génésiques. Pourtant, il y a eu aussi des déceptions, ainsi que le montrent les objectifs du Millénaire pour le développement, même si une cible sur la santé génésique a été ajoutée en 2007. Plus récemment, une enquête a examiné les 20 ans de mise en œuvre du Programme d’action de la CIPD, « La CIPD au-delà de 2014 », et a fait progresser l’ordre du jour de la santé et des droits sexuels et génésiques. Mais la scène principale des futures négociations a changé et les Nations Unies définissent actuellement le programme de développement de l’après-2015 et les objectifs pour le développement durable (ODD). Cet article évalue les événements depuis 2013 et décrit quelle sera la progression probable du processus d’établissement du programme de développement de l’après-2015 et des ODD. Il est important de bien comprendre les réalisations, les processus actuellement engagés et leur évolution future pour progresser vers le but final qui est de parvenir à la santé et aux droits sexuels et génésiques ces 15 prochaines années.
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Resumen Desde la Conferencia Internacional sobre Población y Desarrollo (CIPD), celebrada en El Cairo en 1994, se han visto logros significativos para cumplir con el objetivo relacionado con salud y derechos sexuales y reproductivos. No obstante, también ha habido decepciones, como se demuestra en los Objetivos de Desarrollo del Milenio, a pesar de que en el año 2007 se agregó una meta relacionada con salud reproductiva. Más recientemente, se llevó a cabo la revisión de 20 años de la ejecución del Programa de Acción de la CIPD, CIPD después de 2014, la cual puso en marcha la agenda de salud y derechos sexuales y reproductivos. Pero la principal arena para futuras negociaciones ha cambiado y la ONU está en el proceso de negociar la agenda de desarrollo post-2015 y los objetivos de desarrollo sostenible (ODS). En este artículo se evalúa lo que ha ocurrido desde 2013 y se proporciona información sobre cómo se desarrollarán los procesos para la agenda de desarrollo post-2015 y los ODS. Para alcanzar la meta final de lograr salud y derechos sexuales y reproductivos en los próximos 15 años, es importante entender lo que se ha logrado, los procesos en curso y su futuro desarrollo.
Sexual and reproductive health and rights in the sustainable development goals and the post-2015 development agenda: less than a year to go Marianne Haslegrave Director, Commonwealth Medical Trust (Commat), Deal, Kent, UK. Correspondence: [email protected]
Abstract: Since the International Conference on Population and Development (ICPD) in Cairo in 1994 there have been significant achievements in moving towards the goal of sexual and reproductive health and rights. Yet there have also been disappointments, as demonstrated in the Millennium Development Goals, even though in 2007 a target on reproductive health was added. Most recently, the 20-year review of the implementation of the ICPD Programme of Action, ICPD Beyond 2014, has taken place, which has moved forward the sexual and reproductive health and rights agenda. But, the main arena for future negotiations has changed and the UN is in the process of negotiating the post-2015 development agenda and the sustainable development goals (SDGs). This paper assesses what has been taking place since 2013 and provides information as to how the process for the post-2015 development agenda and the SDGs are likely to move forward. An understanding of what has been achieved, the processes as they are now proceeding and their future development are important for moving towards the ultimate goal of achieving sexual and reproductive health and rights in the next 15 years. © 2014 Reproductive Health Matters Keywords: sexual and reproductive health and rights, post-2015 development framework, ICPD Beyond 2014, sustainable development goals, UNFPA, Open Working Group, UN General Assembly Special Event, civil society, advocacy
Since the adoption of the Programme of Action of the International Conference on Population and Development (ICPD)1 in Cairo in 1994, Governments and civil society advocates can claim many achievements in working towards the ultimate goal of sexual and reproductive health and rights, even though progress might have been uneven. More remains to be done in the context of the post-2015 development agenda and the sustainable development goals (SDGs), that have been set in place to replace the Millennium Development Goals (MDGs), which expire at the end of 2015. This paper is a follow-up to the assessment I published a year ago in RHM as regards the state of the negotiations on both the post-2015 development agenda and the sustainable development goals (SDGs), as they could underpin future action on sexual and reproductive health and rights for the next 15 years.2
Building on the past
102 Contents online: www.rhm-elsevier.com
Doi: 10.1016/S0968-8080(14)44812-2
First, it is important to step back and look at what has already been achieved. Twenty years ago, at the end of the ICPD, 179 governments had adopted a far-reaching Programme of Action that represented a paradigm shift from the traditional macro-demographic perspective to one that placed human rights at the centre of population and development, recognized women’s empowerment, and set out a comprehensive range of issues including sexual and reproductive health and reproductive rights. This agenda has underpinned our work to the present. At the same time, not everything was perfect – Governments did not agree sexual rights and the language on access of young people to sexual and reproductive health information, education and services gave too much emphasis to the role of parents and guardians, as opposed to the best interests of adolescents.1 Nevertheless, progress
M Haslegrave. Reproductive Health Matters 2014;22(44):102–108
was made with the Beijing Platform for Action, which recognized the human rights of women to control over their own bodies and also the rights of adolescents to acquire knowledge, especially information on sexuality and reproduction taking into account their best interests as a primary consideration.3 Further progress was also made with the adoption at the 21st UN General Assembly Special Session in 1999 of the Key Actions for the Further Implementation of the ICPD Programme of Action.4 The year 2000, however, saw a major setback with the introduction of the UN Millennium Development Goals (MDGs), without a goal on sexual and reproductive health and rights. This was only partially rectified in 2007 with the introduction of MDG Target 5B on universal access to reproductive health by 2015, although it has to be said that some Governments did not fully include this target in their policies and programmes even then.5 While progress might have seemed too slow at times, other gains were made along the way in the outcome documents of some of the sessions of the Commission on Population and Development and the Commission on the Status of Women.
ICPD Beyond 2014: strengthening the case for sexual and reproductive health and rights The review of the implementation of the ICPD Programme of Action, ICPD Beyond 2014, which has been taking place alongside the discussions on the post-2015 development agenda and the SDGs, has been of key importance in advancing the ICPD agenda. Sexual and reproductive health and rights have been included in the outcome documents of nearly all the regional conferences, as well as in other documents, such as the reports of the International Conference on Human Rights and the ICPD Beyond 2014 Technical Expert Group Meeting on Women’s Health: Rights, Empowerment and Social Determinants. These achievements were brought together at the Special Session of the General Assembly on ICPD Beyond 2014 in September 2014, at the end of which the President of the General Assembly introduced an oral decision, by which Member States formally acknowledged the framework for actions for the follow up to the Programme of Action Beyond 2014 and the steps for further
implementation, taking into account their respective statements in the Special Session.6*
What comes next? Now, however, the main focus for moving forward will be through the post-2015 development agenda and the SDGs, as they will be the main drivers for policies and programmes more than the agreements of past major UN conferences, although these will still have an important role in supplementing them. The process for the post-2015 development agenda and the SDGs, leading to the World Summit in New York in September 2015, is extremely complex insofar as it is working towards a truly integrated agenda that is negotiated across the UN key pillars of work, namely economic, environmental and social. The challenge will be to ensure that sexual and reproductive health and rights are included under these pillars. Because it is a new concept, this process is not based on any particular former precedents but it is critically important to understand it as fully as possible in order to be able to use it, not only in the negotiations in the coming months but also in the years ahead to ensure the achievement of the ultimate goal of sexual and reproductive health and rights.
A sometimes glossed over document: the Special Event outcome document While sharing the common ideals and aspirations, two processes evolved for the follow up to the *At this meeting, the President said: "May I take it that the General Assembly, recalling the reports of the SecretaryGeneral circulated in documents A/S-29/3 and A/S-29/4 and the report of the Commission on Population and Development on its forty-seventh session circulated in document A/S-29/5, wishes to take note of the deliberations of the Special Session on the findings and recommendations contained therein?" It should be noted that the “Framework of Actions for the follow-up to the Programme of Action of the International Conference on Population and Development beyond 2014” (A/S-29/3), the “Recurrent themes and key elements identified during the sessions of the Commission on Population and Development” (A/S-29/4) and the “Report of the Commission on Population and Development on its forty-seventh session” (A/S-29/5) define the road map for moving forward and include specific references to sexual and reproductive health and rights in both the regional outcomes and the findings and recommendations of ICPD Beyond 2014.
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MDGs. The first is the SDG process, which emanated from the UN Conference on Sustainable Development Goals (Rio + 20), which in turn established the Open Working Group (OWG) on Sustainable Development Goals, the Intergovernmental Expert Committee on Sustainable Development Financing (ICESDF) and the High– Level Political Forum on Sustainable Development (HLPF). The second was led by the UN SecretaryGeneral (SG), and included the High-Level Panel of Eminent Persons on the post-2015 development agenda with its report at the end of May 2013, and the Sustainable Development Solutions Network.7,8 In addition, input into this process was gathered through a series of consultations with civil society, academia, the private sector and other stakeholders as part of the “World We Want 2015”.9 While both the SDG process and the UN SG’s initiative were very ambitious and challenging, in general they were proceeding along two separate tracks based on processes that might best be described as “making it up as we go along”. Yet, some markers were put down, the most important of which is the outcome document of the UN General Assembly Special Event towards achieving the Millennium Development Goals (Special Event outcome).10 Adopted by acclamation, it provides the necessary guidance for the processes that have subsequently taken place and sets out the steps for the remaining time to the Summit on the post-2015 development agenda (of which the SDGs are a major part), which is likely to take place on 28–30 September 2015.11,12 In addition to amalgamating the SDG and post-2015 development agenda processes, it also ensured that, in the future, the process would be led by Member States, and not by the UN Secretariat. The Special Event outcome, moreover, emphasizes the importance in the post-2015 development agenda of certain key principles, such as universality, national ownership, mobilization and effective use of all resources, the promotion of human rights, gender equality, good governance, the rule of law, and transparency and accountability at all levels. Processes such as the OWG and the ICESDF are also highlighted, with the completion date for their work set at September 2014. A process organized by the President of the General Assembly during 2014 was also established, with input from six events and a stocktaking session under the theme “The Post-2015 Development Agenda – Setting the Stage.” This 104
once again emphasized that Member States are in the driving seat.
Going forward Civil society participation based on the Special Event outcome By the time the 69th Session of the General Assembly opened in September 2014, a resolution had been negotiated, again in accordance with the Special Event outcome, under the leadership of the UN Ambassadors of Denmark and Papua New Guinea, with agreement being reached on nearly all areas of the procedures for the Summit itself. 11 * Of particular relevance, including to sexual and reproductive health and rights advocates, are the paragraphs in the resolution that relate to civil society participation: in addition to the specialized agencies of the UN system, other stakeholders “including parliamentarians, academia, non-governmental organizations, civil society organizations, Major Groups and the private sector” are invited to participate in the Summit. This applies both at the Summit itself, through its interactive dialogues, and during the preparatory process. They are encouraged, moreover, to “consider initiatives and activities in the preparation and the lead up to the Summit”.11 As was the case for the 10-year review of the achievements of the Millennium Development Goals (MDGs) in 2010, the President of the General Assembly will organize and preside over two days of informal interactive hearings before June 2015 involving representatives of nongovernmental organizations, civil society organizations, Major Groups and the private sector. He will then prepare a summary of the hearings to be made available prior to the Summit.11 While it is important to ensure that strong references to sexual and reproductive health and rights are included in these interactive sessions, participation of Member States could be very limited and, depending on the timings, the summary of the hearings may have a limited impact on the negotiations. The specifics for the participation of nongovernmental organizations, civil society organizations, academic institutions and the private sector in the plenary meetings and interactive dialogue of the Summit are set out in Annex IV of the *It was subsequently necessary, however, to renegotiate the date of the Summit.12
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resolution. The process should take into account the principles of transparency and equitable geographic representation, with a proposed list of organizations being submitted to Member States for their consideration on a “non-objection” basis. The list of proposed, as well as final, names will be brought to the attention of the General Assembly (UNGA), noting the general basis for objections. In reality there might be limited opportunities for civil society engagement with many competing priorities from different organizations, of which only a few may be advocates for sexual and reproductive health and rights. Finally, under the resolution, the UN Secretary-General is requested to use existing trust funds to “enhance” the participation of developing country non-governmental organizations, civil society organizations and Major Groups. Again, it is crucial to ensure that such participants have expertise in sexual and reproductive health and rights.11
NGO participation is critically important during the next phase of the negotiations. While Target 5B on universal access to reproductive health was eventually added to the MDGs, there is no guarantee that anything that is not included by the time the negotiations finish will be part of the post-2015 development agenda for the 15 years afterwards, as the draft resolution for the Summit itself does not include negotiations and the follow-up process is as yet undefined.* Furthermore, if sexual and reproductive health and rights are to be part of the SDGs and the post-2015 development agenda, we cannot leave it to governments alone. In the OWG, governments that supported the full inclusion of sexual and reproductive health and rights were predominantly from European and Latin American countries. While several countries from across the regions signed joint statements on sexual and reproductive health and rights,† support was limited from African and Arab countries and some sub-regions of Asia.
Negotiations leading up to the Summit The extent to which civil society will be able to participate in the negotiations leading up to the Summit is gradually becoming clearer. In October 2014, the President of the General Assembly appointed two Co-Facilitators to guide the process – Ambassador Macharia Kamau of Kenya, who was an OWG Co-Chair, and Ambassador David Donoghue of Ireland, who was an active supporter of sexual and reproductive health and rights in the OWG negotiations. Their remit is to “lead open, inclusive, and transparent consultations on the post-2015 development agenda, including the organization and modalities for the inter-governmental negotiations and the remaining issues related to the Summit for the adoption of the post-2015 development agenda”.13 Following informal negotiations, the Co-Facilitators issued a “food for thought” paper which states that there is broad support for an “inter-governmental process, which is open, inclusive and transparent and which builds on the working methods used successfully by the Open Working Group on the SDGs”. It also refers to “provision for regular structural engagement with Major Group and other stakeholders”. This will presumably mean that civil society through the Major Groups and Other Stakeholders, a mechanism that has been used both in the negotiations for Rio+20 and the OWG, will be able to contribute during the meetings, by making both oral interventions and written statements.14
Civil society watchdogs and the UN game Civil society organizations must be able to carry out their “watch dog” role going forward, particularly as some delegates do not always reflect their governments’ positions, instead playing what might be called the “UN game”, that is, reflecting what is most expedient in the context of other negotiations taking place at the UN. Sexual and reproductive health and rights is a *There might be possibilities for targets to be added during review processes on progress in the achievement of the post-2015 development agenda in the future. This happened at the Summit in 2005 and led to the introduction of Target 5B on universal access to reproductive health by 2015. In the case of Target 5B, it partially remedied the lack of a goal on sexual and reproductive health and rights; however, it was not fully implemented by all countries and never achieved the same status or priority as Target 5A on reducing maternal mortality. †
Three Joint Statements affirming sexual and reproductive health and rights were delivered during the OWG: a statement was made at the 13th and final Session of the OWG (July 2014) by South Africa on behalf of 58 Member States on sexual and reproductive health and rights in the SDGs and post-2015 development agenda; a joint statement was delivered by Argentina on behalf of 50 countries at the February 2014 (8th) session; and a third was delivered by Uruguay on behalf of 24 countries at the 4th Session of the OWG (June 2013).
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contentious issue in the UN and must not be traded away as part of a “package” involving other contentious issues. Historically, this happened during the final negotiations of the outcome document of the Rio+20 conference in 2012, which includes no specific reference to either reproductive rights or sexual and reproductive rights. One might now say: “Once bitten, twice shy.”15 While individual representatives of NGOs are often most effective when they are included on national delegations, access for NGOs to the preparatory process is also imperative. The influence of civil society outside the meeting rooms at the UN will be far, far less effective than being able to participate inside the rooms. Secretary-General’s Synthesis Report The Special Event outcome document calls on the Secretary-General “as an input to the intergovernmental negotiations to be launched at the beginning of the 69th session of UNGA… to synthesize the full range of inputs then available”. This Synthesis Report is being prepared at the time of writing and in accordance with the Special Event outcome will be available before the end of 2014. It is anticipated that it will include the 17 goals and 169 targets as in the OWG report,16 as well as addressing accountability and means of implementation. Summit outcome document The “food for thought” paper defines what will be in the Summit outcome document. It will include an introductory declaration; the SDGs, targets and indicators; means of implementation and a new Global Partnership; and a framework for monitoring and review of implementation, which will probably involve the HLPF. A further element could be “the possible implications of the post-2015 agenda for the UN system and its institutions”. As agreed by the General Assembly in September 2014, in its resolution A/RES/ 309, the main basis for future negotiations will be the OWG report.16 There will also be other inputs, including the Synthesis Report. The importance of this for sexual and reproductive health and rights is discussed below, but once again the role of the General Assembly to lead the process is evident. Ten sessions are scheduled to be held in 2015 between January and the end of July to negotiate the process, which will be conducted alongside other processes such as the negotiations for the Financing for Development Conference in Addis 106
Ababa in July 2015 (which should provide input on the means of implementation) and the UN Framework Convention on Climate Change. Process going forward: further along in uncharted waters It can be seen that the process going forward is gradually becoming clearer. However, there are a number of important pointers that can be used to move towards the full inclusion of sexual and reproductive health and rights, or at the very least to hold the status quo. The OWG report includes two targets that address issues related to sexual and reproductive health and rights. The first is Target 3.7 under Goal 3, Ensure healthy lives and promote well-being for all at all ages: “By 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.” (Goal 3, Target 3.7) The second is Target 5.6 under Goal 5, Achieve gender equality and empower all women and girls: “Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the ICPD and the Beijing Platform for Action and the outcome documents of their review conferences.” (Goal 5, Target 5.6) While recognizing that the OWG report excludes sexual rights (a highly contentious issue in the UN arena) as well as comprehensive sexuality education, Targets 3.7 and 5.6, when taken together, address access to sexual and reproductive health information, education and services and reproductive rights for women and girls. It would, of course, have been preferable to have reproductive rights in Goal 5 without any qualifiers, namely the references to the ICPD Programme of Action and the Beijing Platform for Action. However, the “outcome documents of their review conferences” include the ICPD Beyond 2014 Regional Review Conferences, most of which in their outcome documents have strong references to sexual and reproductive health and rights.* *The outcome document of the Regional Review Conference for the Arab States does not include sexual and reproductive health and rights, although it does refer to sexual and reproductive health and reproductive rights.
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It appears that the Co-Facilitators are not proposing to negotiate the 17 goals, although there could be some technical proofing of the proposed targets. The UN Statistical Commission would also assist in developing the “indicators to measure progress against the targets,” although this will have to be confirmed by Member States. The negotiations, therefore, in the first seven months of 2015 will be of critical importance in securing sexual and reproductive health and rights for the next 15 years. The context for their achievement will be set in the document as agreed at the Summit in September.
But the story does not stop there – following the Summit, the implementation will begin, and it is at this point that advocates who have worked hard for the inclusion of sexual and reproductive health and rights in the post-2015 development agenda and the SDGs will have to turn their attention to implementation at the national and regional levels and monitoring and accountability through the High–Level Political Forum on Sustainable Development, using the goals, the targets, the indicators and the means of implementation, for which we will have been working for over two years.
References 1. United Nations General Assembly. Report of the International Conference on Population and Development. A/94/10/18. Programme of Action. New York: UN; 1994. 2. Haslegrave M. Ensuring the inclusion of sexual and reproductive health and rights under a sustainable development goal on health in the post-2015 human rights framework for development. Reproductive Health Matters 2013;21(42):61–73. Doi: 10.1016/ S0968-8080(13)42742-8. 3. United Nations General Assembly. Report of the Fourth World Conference on Women. A/CONF.177/20/ Rev.1. New York: UN; 1995. http://undocs.org/A/CONF. 177/20/Rev.1. 4. United Nations General Assembly. Report of the Ad Hoc Committee of the Whole of the Twenty-First Special Session of the General Assembly, Key Actions for the Further Implementation of the Programme of Action of the International Conference on Population and Development. A-S-21/5/Add.1. New York: UN; 1999. http://undocs.org/A/S-21/5/Add.1. 5. UN Statistical Division. Millennium Development Goal Indicators. 15 January 2008. http://mdgs.un. org/unsd/mdg/Host.aspx?Content=Indicators/ OfficialList.htm. 6. (Part 4) ICPD beyond 2014 - General Assembly, 29th special session, 1st plenary, 22 September 2014 (video). WebTV. http://webtv.un.org/meetings-events/generalassembly/watch/part-4-icpd-beyond-2014-generalassembly-29th-special-session-1st-plenary/ 3801776472001. 7. UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. 2013. http://www.post2015hlp.org. 8. Sustainable Development Solutions Network. http://unsdsn.org.
9. United Nations General Assembly Special Event Outcome Document. September 2013. http://www.un.org/ millenniumgoals/pdf/Outcome%20documentMDG.pdf. 10. Special Event 25 September: Outcome Document. https://papersmart.unmeetings.org/media2/157808/ outcome-documentmdg.pdf. 11. Letter from John W Ashe, President of 68th Session of the UN General Assembly to Permanent Representatives. 15 September 2014. http://www.un.org/en/ga/president/ 68/pdf/letters/9152014Post-2015%20Summit% 20modalities%20-%20Draft%20Resolution%20-% 2015%20September%202014.pdf. 12. Letter from Sam K Kutesa, President of 69th Session of the UN General Assembly to Permanent Representatives. 30 October 2014. http://www.un.org/pga/wp-content/ uploads/sites/3/2014/10/301014_post-2015development-agenda.pdf. 13. Letter from Sam K Kutesa, President of 69th Session of the UN General Assembly to Permanent Representatives. 17 October 2014. http://www.un.org/pga/wp-content/ uploads/sites/3/2014/10/171014_post-2015development-agenda.pdf. 14. Food for thought paper: Modalities for the intergovernmental negotiations on the post-2015 development agenda. 17 November 2014. http://www. un.org/pga/wp-content/uploads/sites/3/2014/11/141114_ post-2015-agenda.pdf. 15. United Nation General Assembly. The Future We Want. A/RES/66/288. 2012. paras 145–146. http://www. uncsd2012.org/content/documents/814UNCSD% 20REPORT%20final%20revs.pdf. 16. United Nations General Assembly. Report of the Open Working Group on Sustainable Development Goals established pursuant to General Assembly resolution 66/288. Adopted 10 September 2014. http://undocs.org/ A/RES/68/309.
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Résumé Depuis la Conférence internationale sur la population et le développement (CIPD) au Caire en 1994, de nets progrès ont été accomplis pour faire avancer l’objectif de la santé et des droits sexuels et génésiques. Pourtant, il y a eu aussi des déceptions, ainsi que le montrent les objectifs du Millénaire pour le développement, même si une cible sur la santé génésique a été ajoutée en 2007. Plus récemment, une enquête a examiné les 20 ans de mise en œuvre du Programme d’action de la CIPD, « La CIPD au-delà de 2014 », et a fait progresser l’ordre du jour de la santé et des droits sexuels et génésiques. Mais la scène principale des futures négociations a changé et les Nations Unies définissent actuellement le programme de développement de l’après-2015 et les objectifs pour le développement durable (ODD). Cet article évalue les événements depuis 2013 et décrit quelle sera la progression probable du processus d’établissement du programme de développement de l’après-2015 et des ODD. Il est important de bien comprendre les réalisations, les processus actuellement engagés et leur évolution future pour progresser vers le but final qui est de parvenir à la santé et aux droits sexuels et génésiques ces 15 prochaines années.
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Resumen Desde la Conferencia Internacional sobre Población y Desarrollo (CIPD), celebrada en El Cairo en 1994, se han visto logros significativos para cumplir con el objetivo relacionado con salud y derechos sexuales y reproductivos. No obstante, también ha habido decepciones, como se demuestra en los Objetivos de Desarrollo del Milenio, a pesar de que en el año 2007 se agregó una meta relacionada con salud reproductiva. Más recientemente, se llevó a cabo la revisión de 20 años de la ejecución del Programa de Acción de la CIPD, CIPD después de 2014, la cual puso en marcha la agenda de salud y derechos sexuales y reproductivos. Pero la principal arena para futuras negociaciones ha cambiado y la ONU está en el proceso de negociar la agenda de desarrollo post-2015 y los objetivos de desarrollo sostenible (ODS). En este artículo se evalúa lo que ha ocurrido desde 2013 y se proporciona información sobre cómo se desarrollarán los procesos para la agenda de desarrollo post-2015 y los ODS. Para alcanzar la meta final de lograr salud y derechos sexuales y reproductivos en los próximos 15 años, es importante entender lo que se ha logrado, los procesos en curso y su futuro desarrollo.
