[MUSIC] Hello everyone. My name is Siri Tellier and I'm an external lecturer with the Copenhagen School of Global Health. I'd like to introduce now, the topic of sexual and reproductive health and rights. Sexual and reproductive health and rights is an expression which has become widely used only in the last few decades. And globally we have come a long way in reaching agreement on identifying the issues involved in reproductive health, how to address them. However, we also have to recognize that this is an area of health where strong disagreement remains on certain issues. Not so much related to the facts, but related to our values. So I should like to go through a few milestones in that development of consensus, or lack thereof. And I shall start with contraception. Let's go back to the 1960s. Rights activists had been advocating for decades that women and men should have access to contraception and more modern methods were becoming available at the time. However quite a number of governments actively restricted and certainly did not support access to the few available methods. Some governments saw family planning as being too controversial. Some wanted to increase their populations and therefore did not want to give their population the means to limit the number of children, that is, they had demographic goals. Countries limiting access included France, the United States and Romania. In developing countries, only about 10% of women were using modern contraception. At the same time, a small number of countries began to go in the opposite direction, wanting to limit their population growth and using more or less forceful family planning programs to achieve that. But then, in 1968, the Human Rights Conference in Tehran declared that it was a human right for men and women to be able to decide on the number of their children. In 1979, this was written into the Convention on Elimination of All Forms of Discrimination Against Women, the so called CEDAW convention. The right which was formulated was the following, that men and women have the same rights to decide freely and responsibly on the number and spacing of their children, and to have access to the information, education and means to exercise these rights. That is, it became established that it is a human right to use or not to use contraception. I mention this in some detail both because it could be seen as a first very specific human right with respect to reproductive health, and at the same time, it's one where we've come a very long way in fulfilling the right. In 1985 came a second milestone, two of the pioneers in the field, Dr. Alan Rosenfeld and Deborah Mayne, drew attention to what they considered the invisible issue of maternal mortality. The first Safe Motherhood Conference was organized two years later in 1987, and it focused first of all on how to make the issue less invisible. For example, by measuring maternal mortality, which had not been done before adequately, but also by gathering evidence on what we could do to prevent maternal deaths. And parallel, a third aspect of sexual reproductive health and rights became clear, mainly that of HIV AIDs, and therefore sexual transmission of disease. That is, we were starting to see a much broader puzzle, and how the different pieces of the puzzle fit together. However, it was in 1994 that the pieces were truly put into place and fit together. The International Conference in Population and Development, also called the ICPT or the Cairo conference because it was held in Cairo, placed the focus not only on family planning, maternal health and sexually transmitted diseases, but also other areas of reproductive health. For example the connection between maternal health and health of children. It showed that together reproductive ill health causes millions of deaths every year. Two reproductive health pioneers in particular, Dr. Nafis Sadik of Pakistan and Dr. Fred Sai of Ghana, guided the conference to achieve a momentous backing from all 179 states present. This truly launched the broad concept of reproductive health as something where continuative care across all ages and all aspects is important. A striking aspect of that conference was the strong presence of women's NGOs and other civil society organizations which helped to expand the strong emphasis on the human right's approach. The consensus from the 1994 Cairo ICPD was followed up the next year in the Beijing Conference on Women, underlining the fact that advancement of women is impossible without reproductive health. Even so, reproductive health was not part of the MDGs as they were formulated in 2001 and it was not included until 2007. With the adoption of the sustainable development goals in September 2015, sexual reproductive health and rights has been included much more centrally than in the original entities. Now I've talked a good deal about the pieces of the puzzle so let me now turn to what we consider to be the components of sexual and reproductive health care. That is how you address it. In 2004, the World Health Organization Health Assembly adopted a strategy which included five priority areas of this broad approach of reproductive healthcare. Number one is improving antenatal, delivery, postpartum and newborn care. That is both the mother and the child. Number two is providing high-quality services for family planning, including infertility services. Infertility is something that people sometimes forget about, but it affect a large number of people both in high, middle and low income countries. Number three, eliminating unsafe abortion. Number four, combating sexually transmitted infections including HIV, reproductive tract infections, cervical cancers and other gynecological morbidities. And number five, promoting sexual health. The 2015 Global Strategy for Women's and Children's and Adolescent's Health built on these components. So altogether we've come a long way in developing a practical and concrete consensus on many areas of sexual and reproductive health and rights, which are supported by universal human rights and frameworks. However, we also have to recognize that major areas of disagreement remain and, in my personal opinion, are unlikely to be resolved anytime soon. They're not so much about the facts, but very much about the values. And of course both are important in developing policy. Some of the most striking disagreements are in the areas of sexual rights, especially related to sexual orientation. They're also related to abortion, sexual relations outside marriage, or early marriage. For example, in Bangladesh, 29% of girls are married before they're 15, and 65% before they're 18. In Niger, it's 30 and 77% respectively. Now, let me take another area that has to do with culture and rights. Does one have precedence over the other? Are they at odds with each other? With respect to culture, I should like to paraphrase another of the great pioneers of the concept of reproductive health, namely Dr. Mahmoud Fatela of Egypt. He and his colleagues have noted that reproductive health is not like other areas of health. It's not like measles, heart disease. It's central to cultural identity and cultural survival, and therefore if you want to address it, you have to acknowledge the existence of cultural values and practices. That includes, I would add, understanding your own cultural values. After all, we all have cultures. With respect to human rights in principle, any country which has ratified a particular humans rights treaty, has accepted that as the law of the country concerned. Therefore you cannot just say that you do not want to follow an actual law because it's against your culture. But to my mind, although they're sometimes at odds, human rights and cultural values need not be. The first mistake to my mind is to think that human rights are an imposition from outside, and cultural values somehow represent deep and unchanging values held by all members of society. To my mind, neither is true. Human rights are developed over time as part of a consensus process, and therefore represent shared culture. Cultural values at times are not shared by everyone in their particular society, and certainly do change over time. And more often than not, they can compliment each other. For example, with regard to child marriage, there's an ongoing process where cultural leaders, scientists, and human rights activists are increasingly identifying a joint position that child marriage is not a positive thing. That is my take on that issue and this is my short introduction to sexual and reproductive health and rights. Thank you very much. [MUSIC]
