FEATURE

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 Marianne Haslegrave Director, Commonwealth Medical Trust (Commat), Deal, Kent, UK. Correspondence: [email protected]

Abstract: Since the 1994 International Conference on Population and Development (ICPD) in Cairo placed reproductive health and rights firmly on the international agenda, civil society and other advocates have worked ceaselessly to ensure that they remain central to women’s empowerment and have taken all opportunities to expand the framework to include sexual health and rights. When the development process changed with the introduction of the Millennium Development Goals (MDGs) in 2000, sexual and reproductive health and rights were excluded, and only in 2007 was universal access to reproductive health added back in. In 2014 and 2015, the future of ICPD Beyond 2014, the MDGs and the post-2015 development framework will be decided, following consultations and meetings across the globe. This paper takes stock of the key influences on efforts to achieve the ICPD agenda and summarises the past, current and planned future events, reports and processes between 1994 and 2014, leading up to the determination of the post-2015 development framework and sustainable development goals. It concludes that the one thing we cannot afford to allow is what happened with the MDGs in 2000. We must not leave the room empty-handed, but must instead ensure the inclusion of sexual and reproductive health and rights as a priority under a new health goal. © 2013 Reproductive Health Matters Keywords: sexual and reproductive health and rights, post-2015 development framework, ICPD Beyond 2014, sustainable development goals, UNFPA, UN Secretary-General’s High-Level Panel, Open Working Group, Rio+20, civil society, advocacy and political process The UN General Assembly Special Event in New York on 25 September 2013 heralded the beginning of the final stages of the process leading to the post-2015 development agenda and the adoption of sustainable development goals (SDGs) that will follow on from the Millennium Development Goals. Of paramount importance for advocates of sexual and reproductive health and rights is the question of how to ensure that these issues are included in this framework? Since the adoption of the International Conference on Population and Development (ICPD) Programme of Action in Cairo in 1994, sexual and reproductive health and reproductive rights have been recognized as integral to successful sustainable development, as well as fundamental human rights.1 Over the years, gains have been made in developing these concepts, often despite intense opposition from conservative forces. ICPD’s 20th anniversary, also known as ICPD Beyond 2014,

will be celebrated at a Special Session of the UN General Assembly in September 2014, 12 months before the adoption of the post-2015 development framework. This paper takes stock of the key influences on efforts to achieve the ICPD agenda and summarises the past, current and planned future events, reports and processes between 1994 and 2014, leading up to the determination of the post-2015 development framework and sustainable development goals. It analyses the current situation and looks at possible entry points for their inclusion in the sustainable development goals.

Contents online: www.rhm-elsevier.com

Doi: 10.1016/S0968-8080(13)42742-8

The past ICPD and sexual and reproductive health and rights since 1994 The ICPD agenda was very broad, introducing a paradigm shift away from the macro-demographic 61

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perspective that had underpinned the outcomes of the previous international population and development conferences in Bucharest in 1974 and Mexico City in 1984. The Programme of Action presented a new vision of the relationship between population, development and well-being, placing human rights at the centre of these policies and addressing a comprehensive range of related issues. Reproductive health and rights, including family planning and sexual health, were placed firmly on the international agenda.1 Furthermore, the Programme of Action called for the inclusion of gender equality and women’s empowerment, as well as the needs of adolescents and young people. Consensus was not possible, however, on the inclusion of sexual rights, for which no shared definition exists to this day, and sexual health was (illogically) subsumed under reproductive health. Nor were enough Governments able to agree on full access to safe abortion, let alone based on a woman’s right to choose. Adolescent access to sexual and reproductive health education, information and services also aroused controversy, which was settled by using earlier language from the Convention on the Rights of the Child that recognized the importance of parental guidance at the same time as the evolving capacity of the adolescent. This was further defined, giving priority to the welfare of the child up to the age of 18 years, in the Platform for Action at the 4th World Conference on Women in Beijing in 1995.2 Significant bench-marks were nevertheless set down, in particular definitions of reproductive health and rights.1 ICPD+5, the first five-year review of progress in implementing ICPD, took place in 1999. It can be considered a “high-water mark” in promoting the ICPD agenda insofar as the outcome document, Key actions for the further implementation of the Programme of Action of the International Conference on Population and Development (Key Actions), moved the agenda forward in some areas. These included that access to safe abortion where permitted by law (the ICPD formulation) should include the training of health care providers to ensure that such abortion should be safe and accessible.3 However, many of the issues resolved by compromise at ICPD, as noted above, were not open for further revision. This has frustrated sexual and reproductive health and rights proponents who, although they saw ICPD as the best available language in 1994, considered it still far from satisfactory. 62

Moving forward and encountering increasing opposition Progress after 1999 might be described as “spasmodic” at best. Each year since 1994, the UN Commission on Population and Development has considered different aspects of the ICPD agenda. But as priorities have evolved and changed, it has become increasingly difficult for progressive language to be introduced in the resolutions that have been adopted, e.g. promoting access to comprehensive sexuality education, or the rights of the lesbian, gay, bisexual, and transgender community. This is because of increasing, stronger and more obtrusive opposition. Anti-abortion organizations were present in Cairo and the Holy See was working with the countries that ultimately entered reservations on the Programme of Action, particularly text on abortion, regulation of fertility and reproductive rights. One statement that was brokered early on and has remained a stumbling block for proponents is the inclusion (in the chapeau to the Principles in Chapter II of the Programme of Action) of explicit recognition of the sovereignty of each country in decisions about implementation. By the time of ICPD+5 and subsequently, opposition organizations have regularly targeted sessions of the Commission on Population and Development, and the political arena has, in general, also become more conservative. Nowadays proponents of the ICPD agenda have to be ready to counteract opposition to a broad spectrum of sexual and reproductive health and rights issues, including access to emergency contraception, comprehensive sexuality education and, of course, abortion. But they also have to counteract challenges on more mainstream issues such as “gender equality” and “access to services”. Procedurally, opponents have taken to organizing lobbying meetings with representatives of national delegations from countries supporting their views in advance of sessions of the Commissions on Population and Development and the Status of Women, in order to solidify their positions. Nevertheless, a number of progressive resolutions have been adopted by the Commission on Population and Development, for example its 2012 resolution on adolescents and youth.4 When there has been a stalemate in negotiations, the deadlock has sometimes been broken by the introduction of a Chair’s text. However, opponents are increasingly dismissing such texts as not being “negotiated” or “agreed language”. While the ICPD

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Programme of Action continues to provide a firm basis for negotiations, agreed language from other fora is also introduced. This includes not only language in documents such as the Beijing Platform for Action, but also, for example, Human Rights Council resolutions. In this regard, individuals such as both the Special Rapporteurs on the Right to Health have been particularly helpful in introducing language that might be considered controversial. Nonetheless, at present, it appears that the practice of using earlier consensus language is being eroded, with the concept of sexual and reproductive health and rights still being treated as highly contentious. Progress has been easier at the regional level, as can be seen in the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (Maputo Protocol) under which countries that have ratified it can authorise abortion in a number of situations.5 * In addition, the Plan of Action on Sexual and Reproductive Health and Rights (Maputo Plan of Action) addresses unsafe abortion, calling for “safe abortion services to the full extent of the law”.6 While it may be argued that these agreements make little difference on the ground, with implementation being a country-by-country struggle, the Protocol was ratified by Governments and the Maputo Plan of Action was agreed at Ministerial level. Furthermore, the continuing lag in effective implementation has not prevented repeated reaffirmation of the Maputo Plan. Hence, opposition may not be the only barrier involved. Such agreements on abortion could not have been achieved at the UN in New York, an arena where delegates may sometimes try to “flex their diplomatic muscles”, while taking scant notice of instructions from home, which could seriously hamper future progress. This has been evident most recently in negotiations in the Commissions on Population and Development and the Status of Women. Delegates and UN Secretariat members alike have commented on it, most recently, Dr Babatunde Osotimehin, the Executive Director of UNFPA at the European NGOs (EuroNGOs) Annual Conference in October 2013.7 The Holy See, mean*“…protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the fetus.”5

while, continues to exercise a great deal of influence through its observer status. Their gentle (or otherwise) “reminders” to some delegations can serve to rein in possibilities for progressive language. And, unholy alliances involving a motley assortment of the most conservative countries have resulted in more stalemates. Then, of course, the growth of the highly conservative opposition in the USA has had an external impact at various times over the past 19 years. Role of civil society, particularly women’s organizations Civil society, particularly non-governmental organizations, has been pivotal in promoting sexual and reproductive health and rights since before Cairo. A coalition of women’s organizations, coordinated by the International Women’s Health Coalition (IWHC), were to a large extent responsible for their inclusion in the ICPD deliberations alongside supportive government delegations. Others, including the International Planned Parenthood Federation (IPPF) with its charter on sexual and reproductive rights,8 Population Council, Guttmacher Institute with its costing of the ICPD Programme of Action,9 Development Alternatives with Women for a New Era (DAWN); and Asian-Pacific Resource Centre for Women (ARROW), to name but a few, have played an important role both as advocates at the national, regional and international level, and in carrying out crucial supporting research. Civil society has also taken on the battle against conservative forces, with the sexual and reproductive health and rights community becoming increasingly more effective. They have reached out to other organizations for support, including those working on human rights, such as Amnesty International, and on migration. They have also worked with more mainstream women’s organizations, which promote women’s empowerment through economic rather than social initiatives, who however may consider that sexual and reproductive health and rights get in the way of their own agendas. Violence against women and early and forced marriage, on the other hand, present areas of common ground on which they can come together. In addition, youth groups and coalitions have increasingly gained recognition and demanded the right to be heard, so much so that at the recent Economic Commission for Europe Conference, they worked together and were called on regularly by the 63

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Chair as the “youth delegation” to contribute to the discussions. Reviewing progress If the “report card” on progress since 1999 has been uneven, the low point was undoubtedly after the Millennium Summit. While reproductive health was promoted in the international development goals,10 for complex reasons there was no effective push for sexual and reproductive health and rights during the development of the Millennium Development Goals (MDGs), and they were not included.11 There were also other glaring omissions, such as no employment goals or targets. So MDG target 1B “ Achieve full and productive employment and decent work for all, including women and young people” had to be added following the progress review in 2005 at the same time as target 5B “Achieve, by 2015, universal access to reproductive health”. Unfortunately, in many countries target 5B has never really caught on and has been given neither priority nor the necessary resources for implementation. Furthermore, despite clearly defined indicators and efforts to promote it,12 * progress (if any) has not always been measured or reported on. Other issues have also fallen off the agenda at various times, only to be retrieved through actions or interventions by Governments, foundations or advocates. An interesting example has been family planning. One of the major concerns in 1994 was that the introduction of reproductive health and rights would mean that family planning would be forgotten or at least no longer centre stage. Despite recognition in the Programme of Action that men and women have the right “to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice”,1 this is precisely what happened, mostly because priority attention and funding were shifted to HIV and AIDS rather than sexual and reproductive health, and to such an extent that for the past five years, concerted efforts have had to be made to highlight its importance again. This culminated in the Family Planning Summit in London in 2012 and FP2020.13 *MDG Target 5B indicators are: 5.3 Contraceptive prevalence rate; 5.4 Adolescent birth rate; 5.5 Antenatal care coverage (at least one visit and at least four visits); 5.6 Unmet need for family planning.12

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Reviews of progress in the implementation of the ICPD Programme for Action have taken place every five years. A global survey and report were part of the 2004 ten-year review, for example.14 After 1999, however, the culmination of these reviews has been limited to ‘”special commemorative events”, usually in the form of a single session of the UN General Assembly, at which a number of statements are made, but with no real debate, negotiated document or outcomes. In 2014, there will again be a Special Session involving Heads of Government and other high-level participants, but no negotiated document.15 Thus, for the past 13 years the mood might be characterized as “proceeding with caution”.

2013: the here and now 2013 may turn out to be as important for the inclusion of sexual and reproductive health and rights in the post-2015 development agenda as 1994 was. This section of the paper aims to explore the current processes to assist advocates. It must, however, be remembered that this is “work in progress” and the processes are in a constant state of flux. At this writing, there are three key processes taking place: (1) ICPD Beyond 2014; (2) UN Secretary-General’s initiatives and the post-2015 development agenda on the back of the MDGs; and (3) post-Rio+20 consultations (International Conference on Sustainable Development). There are others that could also have an influence that will also be discussed briefly. (1) ICPD Beyond 2014 The review process of the ICPD Programme of Action has led from the outset towards the major ICPD Beyond 2014 review and was in place long before the post-2015 development agenda work began. The enabling resolution, adopted at the 65th Session of the General Assembly,16 set out a clearly defined process. It recommitted Governments to achieving the ICPD goals and objectives and extended ICPD beyond 2014. In addition, it called on UNFPA to lead an Operational Review of the implementation of the Programme of Action, thereby including both governmental and UNFPA-led processes. The General Assembly Special Session, mentioned above, will be held on 22 September 2014.15 A Global Survey was carried out as a basis for the Operational Review; replies were received from 176 countries. It addressed population

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dynamics and sustainable development; youth; ageing and the needs of older persons; the needs of persons with disabilities; the needs of indigenous peoples; urbanization and internal migration; international migration and development; family, well-being of individuals and societies; reproductive rights and reproductive health; sexual health, morbidity and mortality; gender equality, equity and empowerment of women; and population, development and education. A parallel survey, allowing some comparisons with government perceptions, has also been completed by 453 national, regional and international civil society organizations. The Global Survey results have been analysed and are being reported on under four ICPD-related principles: dignity; health; security of place; and good governance; and highlighting accomplishments, shortfalls and Government commitments.17 Two major international meetings have also contributed to the Operational Review. In December 2012 a Global Youth Forum was held in Bali, co-hosted by the Government of Indonesia and UNFPA. It was “the first UN mandated process, led by global youth, for global youth” bringing together more than 3,000 onsite and virtual delegates and culminating in the adoption of the Bali Declaration, a progressive document that was transmitted directly to the UN Secretary-General.18 The second meeting was the ICPD International Conference on Human Rights, held in the Netherlands in July 2013. Hosted by the Dutch Government, in partnership with UNFPA and the Office of the High Commissioner for Human Rights, it involved more than 300 Government, civil society and UN agency representatives to focus on “the nexus between human rights, equality, accountability and population and development, with a focus on gender, discrimination, empowerment and sexual and reproductive health and rights”.19 An Expert Meeting on Women’s Health – Rights, Empowerment and Social Determinants was also held in Mexico City in September-October 2013. All these meetings have provided input without inter-governmental negotiated agreements.

duced excellent new agreed, negotiated language into the process. The outcomes of these meetings are important as this language can also be referenced in negotiations on the post-2015 development agenda. All the regions except Western Asia have included references to “sexual and reproductive health and rights” as well as “comprehensive sexuality education”. Furthermore, there is strong language on issues related to gender-based violence and early and forced marriage. The Conference for Latin America and the Caribbean agreed a particularly strong document, the Montevideo Consensus, that includes:20

Progress at regional level Regional ICPD Beyond 2014 conferences have been held in all UN regions* and some have intro-

Bringing the ICPD process together The next step in the ICPD Beyond 2014 review process, leading up to the Special Session, is already underway, i.e. bringing everything together into two reports. The first is a long report that will include the Global Survey results. The second will be a shorter Secretary-General’s report. Both reports will be tabled before the 47th session

*The UN Economic and Social Commissions for Western Asia (ESCWA) and Asia and the Pacific (ESCAP), and the UN Economic Commissions for Africa (ECA), Europe (ECE) and Latin America and the Caribbean (ECLAC).

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the right to make free and informed choices about sexuality regardless of sexual orientation and gender identity, recognition that the penalization of abortion directly increases maternal mortality rates and that states should make efforts to provide safe and legal abortion services while removing legislation which prohibits access to such services, and protection of women’s rights and autonomy, promoting the full exercise of their sexual rights and reproductive rights, gender equality and the elimination of discrimination and violence as fundamental to Governments’ commitments to advance development with equality.20

The most difficult negotiations took place in the Africa regional meeting, co-organized by the Economic Commission for Africa and the African Union, due to concerns about sexual orientation and gender identity. While the text under negotiation had no language on these issues at any time, some African governments were concerned that standard language on protecting human rights “without distinction of any kind” would obligate them to take action to protect these rights. Yet, some 16 countries entered reservations on the Addis Ababa Declaration on Population and Development in Africa beyond 2014, and one country voted against adoption of the document altogether.

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of the Commission on Population and Development in April 2014. It is unclear at this writing whether there will be a negotiated outcome from this meeting, or whether the recurrent themes that are identified during the Session will be captured only in a third document that was called for in the original enabling resolution, known as an “index report”, which would go forward to the Special Session. ICPD Beyond 2014 is a “contained process” that takes into account the realities of the current international political situation. It has allowed progress to be made, while minimizing attempts by the opposition to derail it, and its successes can be seen, for example, in the Montevideo Consensus and the Bali Declaration of the Global Youth Forum.18,20 The other aspects of the Operational Review, particularly the information gained in the Global Survey, will provide important data and information that can be used going forward. It has been difficult up to now, however, to see how all this will feed into the post-2015 development agenda or how and when this will happen, even as post-2015 work is gathering momentum in other fora. (2) Input into the post-2015 development agenda, on the back of the MDGs The period for achieving the MDGs will end in 2015 and, as well as accepting the need to continue working on the MDGs that are off-track and have not been achieved, work to develop “what comes next” has already started. As with the MDGs, this is being driven by the UN SecretaryGeneral, but with strong support from the UN System Task Team (UNTT), which brings together over 60 UN entities, agencies and the private sector.21 Creating the “substance”: reports initiated by the Secretary-General In preparation for the post-2015 development agenda, the Secretary-General has initiated a number of panels and consultations that have already produced ideas for and comments on the post-2015 development agenda. These panels include expert members and strong advocates who can introduce new ideas if the discourse gets bogged down or is not forward-looking. Other initiatives have also contributed to an inclusive process in which many individuals and organizations have participated, introducing elements that are key for sexual and reproductive health and rights advocates in their reports, summarized below. 66

UN Secretary-General’s High-Level Panel of Eminent Persons The Secretary-General established a High-Level Panel of Eminent Persons (HLP) in August 2012, co-chaired by Indonesian President Susilo Bambang Yodhoyono, President Ellen Johnson-Sirleaf of Liberia and British Prime Minister David Cameron. Its other members, all of whom served in a personal capacity, included representatives of Governments, the private sector, academia, civil society and youth. Civil society consultations and “town hall meetings” were held at three of their five meetings and communiqués were issued after the third and fourth meetings in Monrovia and Bali respectively. The Monrovia Communiqué included a specific reference to sexual and reproductive health. The HLP report, A New Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development, was submitted to the Secretary-General at the end of May 2013. It stated that: “No person anywhere should be left behind.” It called for a stand-alone, illustrative gender goal and an illustrative target − Target 4D on sexual and reproductive health and rights, following strong advocacy from sexual and reproductive health and rights organizations.22 Sustainable Development Solutions Network The Secretary-General also set up the Sustainable Development Solutions Network (SDSN) with Jeffrey Sachs of the Earth Institute, Columbia University, as its Director. It brings together scientific and technical expertise from academia, civil society and the private sector “in support of sustainable development problem-solving at local, national, and global scales,” and its work is structured around 12 thematic groups. The Network’s report, An Action Agenda for Sustainable Development, was issued on 6 June 2013. While its Target 2C refers to “the realization of sexual and reproductive health rights”, it links them to “rapid voluntary reduction of fertility” and “countries with total fertility rates above 3 children per woman…”. Its Target 5A also includes sexual and reproductive health care and family planning in its call to “Ensure universal access to primary health care”. However, it is not difficult to see why so many civil society organizations were hostile when the report was released insofar as it only refers to sexual and reproductive rights in the context of reduction of high fertility rates (both in the targets and in the text itself), without recognition of the full range of sexual and reproductive health rights.23

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Global Compact on Corporate Sustainability The views of the corporate sector on the post-2015 development agenda were made known through the report of the Global Compact on Corporate Sustainability and the United Nations, Perspectives from UN Global Compact Participants on Global Priorities and How to Engage Business Towards Sustainable Development Goals. As might be expected, sexual and reproductive health and rights are not high on the Global Compact agenda, although Goal 4 on universal health coverage in A Design for Sustainable Development Goals, includes “Universal reproductive health services including access to birth control and to a qualified attendant at birth.”24 World We Want 2015 and other processes for civil society input A wider consultation process involving civil society was instigated through the World We Want 2015 website, comprising national level, thematic and on-line consultations.25 Input was gathered from 88 national-level consultations. The results of many of these are posted on the World We Want website. From a cursory look, the inclusion of sexual and reproductive health and rights is somewhat haphazard, possibly depending on the level of involvement of civil society advocates and concerned UN bodies, such as UNFPA. This demonstrates the need for a constant, coordinated advocacy strategy as sexual and reproductive health and rights is still not an issue that will “introduce itself”. Eleven different thematic consultations were also held, following similar processes which had one thing in common − they were very intensive. They included on-line discussions, position and other papers, consultations and briefings with Governments, civil society organizations, academia and the private sector, leading to a high-level dialogue or meeting and a final report with recommendations. The consultations of most relevance to sexual and reproductive health and rights were Health, Population Dynamics, and Inequalities. In addition, Education was important for the inclusion of comprehensive sexuality education. A strategy used by European NGOs to draw attention to and work for the inclusion of sexual and reproductive health and rights was to comment on it online in as many consultations as possible, while providing more extensive input at the most relevant points.26

A Million Voices The final topic-related reports that emerged from the World We Want 2015 process contributed to The Global Conversation Begins: Emerging Views for a New Development Agenda (March 2013), the UN Secretary-General’s interim report on the process, and more recently the report A Million Voices: The World We Want – A Sustainable Future with Dignity for All (September 2013). In addition, an on-line survey, My World, was launched, to which some 1.2 million respondents from 194 countries have each contributed their six priorities. The results are included in A Million Voices.25 A Million Voices reaffirms that the current health MDGs will remain priorities after 2015 and calls for an overall goal of “sustainable wellbeing for all” to capture the links between health and other aspects of well-being. It also highlights the need to address problems related to the availability of essential medicines, strengthening health systems infrastructure and increasing the number and skills of trained health personnel. The Health consultation recognized that exclusion in the past of comprehensive sexual and reproductive health and rights “has hindered progress on the MDGs themselves, and equitable progress in overall health outcomes”. It noted that 222 million women worldwide cannot access modern contraception, let alone other sexual and reproductive health services. The consultation called for reaffirmation of the targets of universal access to sexual and reproductive health services, including family planning, and recommended that comprehensive sexuality education be included in school curricula. Gender equality is addressed throughout A Million Voices, noting that women and girls are among those “being systematically left behind”. Gender-based violence is noted as a contributing factor perpetuating inequalities, as a human rights abuse, and as a manifestation of unequal gender power relations. The perspectives and needs of young people are stressed throughout the document and the importance of their education is recognized, as is employment, noting the high levels of youth unemployment in many countries. Sexual orientation is also referred to in the Key Messages and the text, in a discussion of marginalization in the context of inequalities and social exclusion. Population dynamics related to patterns of population growth, population ageing, migration 67

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and urbanization are all also addressed in A Million Voices, emphasizing rights-based and genderresponsive policies. The population dynamics consultations highlighted mainstreaming demographic priorities into the post-2015 development agenda while strengthening “the formation of human capital throughout the life course, with a particular focus on health, including sexual and reproductive health and rights; education, including comprehensive sexuality education”. Both the Health and Population Dynamics consultations also recognized the need to strengthen national capacity to collect and analyse disaggregated demographic and other data. Civil society input through the NGLS consultation The Secretary-General gathered further views from civil society organizations and their networks in different regions on all the available reports at the time. This consultation was led by the UN Non-Governmental Liaison Service (NGLS), which launched its report on the process, Advancing Regional Recommendations on the Post-2015 Development Agenda immediately before the UN General Assembly Special Event.26 In comparison with this report, A Million Voices is more benign and conservative. The NGLS report is heavily rights-based, containing many of the controversial issues that are civil society priorities, including corporate power, trade and investment architecture, and sexual orientation. Furthermore, it strongly supports the inclusion of sexual and reproductive health and rights in the post-2015 development agenda. Report of the UN Secretary-General In August 2013 the long-awaited report of the UN Secretary-General, A Life of Dignity for All: accelerating progress towards the Millennium Development Goals and advancing the United Nations development agenda beyond 2015, was released.27 While the Secretary-General is mandated to report annually on progress in the achievement of the MDGs, this report goes further. It also addresses the transition to a new sustainable development agenda and advancing the UN development agenda beyond 2015. It makes reference to the reports of the High-Level Panel, the Sustainable Development Solutions Network and the Global Compact, for example, as well as the World We Want 2015 processes and The Global Conversation Begins. It advances some of the key concerns of the High-Level Panel, such as leaving no one 68

behind. However, crucially, it ignores their illustrative, stand-alone gender goal and Target 4D on sexual and reproductive health and rights. Instead, it says that gender should be a cross-cutting issue and reverts to the ICPD language of “sexual and reproductive health and reproductive rights”. It is also what might be called “light” on youth issues, and uses the curious wording “sexual and reproductive education” instead of the more widely used “comprehensive sexuality education”. (3) The Future We Want: Outcome Document of the International Conference on Sustainable Development (Rio+20) The third most important process for the future sustainable development goals is mandated by the International Conference on Sustainable Development (Rio+20), held in Rio de Janeiro, June 2012. Its outcome document, The Future We Want, has already had a significant influence on thinking about the post-2015 development agenda and will continue to drive the process for the next nine months.28 In Rio, Governments agreed to develop a set of sustainable development goals “taking into account different national circumstances, capacities and priorities, [that] are consistent with international law, build upon commitments already made, and contribute to the full implementation of the outcomes of all major summits in the economic, social and environmental fields….” These goals should be “action-oriented, concise and easy to communicate, limited in number, aspirational, global in nature and universally applicable to all countries while taking into account different national realities, capacities and levels of development and respecting national policies and priorities… [They] should address and be focused on priority areas for the achievement of sustainable development….”28 In accordance with The Future We Want, an Open Working Group has been established to develop the goals. The Future We Want says that this Group should report to the 68th Session of the UN General Assembly, and be constituted no later than the opening of the 67th session. It should be comprised of 30 representatives, nominated by Member States through the five UN regional groups, “with the aim of achieving fair, equitable and balanced geographic representation”.28 The Open Working Group on Sustainable Development Goals (OWG) was indeed set up during the 67th Session, but it took much longer

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than expected, as so many countries wanted to be members. An innovative procedure had to be worked out, whereby up to three countries could “share” some of the seats and work as a “troika”. Other seats were held by one country only. Thus, France, Germany and Switzerland are sharing one seat, while Hungary and Benin each have a seat for themselves. Two co-chairs were appointed, namely the UN Ambassadors of Hungary and Kenya, and so far it has met four times. A further four meetings are scheduled between November 2013 and mid-February 2014. In addition, an Interactive Dialogue will be held with civil society through the Major Groups and Stakeholders on 22 November 2013, with a second day to follow later on. The fourth session of the Open Working Group, held in June 2013, included Health and Population Dynamics on its agenda. During the debate, sexual and reproductive health and rights were strongly promoted in the statements by both Governments and UNFPA. However, the interim report by the Co-chairs on its work omitted any reference to sexual and reproductive health rights, stating instead that “the importance was highlighted of respecting and fulfilling reproductive rights in accordance with the Programme of Action of the [ICPD]”.29 This wording echoes wording in the Secretary-General’s report, referred to above, and shows the same unwillingness to modify the 1994 ICPD language despite all the subsequent developments in resolutions of the Commission on Population and Development and so many other inter-governmental documents and consultation recommendations, especially regarding sexual rights. Given the problems that are surfacing in getting sexual rights included at the international level, wording that was introduced into paragraph 145 of The World We Want, when it was clear that there was no agreement even on reproductive rights, used the following language: “…[advancing] the commitments leading to sexual and reproductive health and the promotion and protection of all human rights in this context”. While there is disagreement among civil society organizations over this language, I believe the extent to which it can be used to ensure inclusion of sexual and reproductive rights should be considered further.28 The sixth and eighth sessions of the Open Working Group will both be important as they have human rights and inequalities (including gender issues) on their respective agendas.

The Future We Want recommends the setting up of a further two bodies. The first is a HighLevel Political Forum to replace the Commission on Sustainable Development. The second is an Intergovernmental Committee of Experts on Sustainable Development Financing. Both had their first meetings before the General Assembly Special Event on 25 September 2013. It should be noted that the Open Working Group and the High-Level Political Forum are set up in accordance with The Future We Want, and emanate from the Rio+20 process. They therefore have different mechanisms for working with civil society, namely through “Major Groups”, where the discussion is generally focused on sustainable development. This is a very different process from that used at the Commissions on Population and Development and the Status of Women, which is based on UN Economic and Social Council consultative status with NGOs. The Major Groups are organized around constituencies, rather than substantive topics. Thus, there can be no Major Group on health or sexual and reproductive health and rights. Instead, there are Groups, for example, for Women; Children and Youth; Farmers, Workers and Trade Unions; Local Authorities; and Non-Governmental Organizations. Although “other stakeholders” are meant to be involved in “Thematic Clusters and Steering Committees”, these processes are far less well defined and should be further developed in the future. Other processes that may have an impact As previously mentioned, there are other processes in place that have impacted on the post2015 development agenda and will continue to do so. They include the High-Level Task Force for ICPD, which has a number of high profile members, including its co-chairs (former Presidents Tarja Halonen of Finland and Joaquim Chissano of Mozambique) and strong civil society advocates for sexual and reproductive health and rights.30 There are also other ongoing UN activities, such as the Commission on the Status of Women, for which the main theme of the 58th Session in 2014 is “Challenges and achievements in the implementation of the Millennium Development Goals for women and girls”, from which the emerging issues will be on the post2015 development agenda. As maternal health has been a priority focus in the MDG process and for the UN Secretary-General, his initiative Every Woman, Every Child has strongly promoted 69

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maternal health, with US $20 billion being committed by more than 250 partners and the very successful Women Deliver Conference in 2013. In reality, however, much of the work of the UN System will be focused on the post-2015 development agenda as the guiding force from 2015 to 2030.

2013–2015: UN General Assembly to follow up on efforts towards achieving the MDGs A Road Map for negotiations on the post-2015 outcome document was agreed at the General Assembly Special Event on 25 September 2013.31 The outcome document sets out the process for moving forward to the adoption of the post2015 development agenda, for which intergovernmental negotiations will start at the 69th UN General Assembly Session beginning 16 September 2014 and continue for most of the following year. Meanwhile, the Open Working Group and the Intergovernmental Committee of Experts on Sustainable Development Financing will continue up to that date, when negotiations will begin. The President of the UN General Assembly has also announced that he will convene General Assembly events under the theme “The Post2015 Development Agenda – Setting the Stage”. All stakeholders including “civil society, scientific and knowledge institutions, parliaments, local authorities, and the private sector” will be invited to be involved. The Secretary-General will synthesize the full range of inputs then available and present a synthesis report before the end of 2014. Finally, a Summit at Heads of State and Government level will be convened in September 2015 to adopt the post-2015 development agenda, in preparation for which the President of the UN General Assembly should convene inter-governmental consultations on “organizational modalities” for this Summit. It should also be noted that in the 25 September 2013 Special Event outcome document, Heads of State and Government reaffirm that they will target the most off-track MDGs and those where progress has stalled, such as “universal access to reproductive health, including maternal health”. This is a different language formulation from that which is usually used, in that it places greater emphasis on reproductive health than maternal health, but it is still far too limited. On the other hand, it does demonstrate that Governments can 70

actually move beyond agreed language when negotiating in certain fora.31 The “resolute promotion of gender equality”, and “the elimination of the range of barriers to women’s and girls’ empowerment” are also recognized in the document as underpinning and advancing progress across all the goals. Finally, national ownership is stressed, while emphasizing that international support is necessary if the MDGs are to be achieved by 2015.

The road to 2015… The agreement on the Special Event outcome document has greatly clarified the process for the next two years, until the adoption of the post-2015 development agenda by the UN General Assembly. One of the difficulties has been that there has been no clarification as to what “sexual and reproductive health and rights” includes in the context of that agenda. A major move in this direction is the launch by UNFPA of its advocacy platform for the post-2015 development framework, Empowering People to Ensure a Sustainable Future for All.32 In this document, whose contents were announced by Dr Babatunde Osotimehin on 24 October 2013, UNFPA calls for:

•

• •

•

a stand-alone goal on gender equality and women’s empowerment, with targets including on women’s sexual and reproductive rights, sexual coercion, child marriage, female genital mutilation/cutting and violence against women, as well as mainstreaming gender equality throughout the framework; a target under a health goal of universal access to sexual and reproductive health and rights; a stand-alone goal on investment in the capabilities of adolescents and youth for sustainable development, including targets on comprehensive sexuality education, access to services for all young people, education and training leading to employment opportunities, and safety for girls in public spaces; and targets under a governance goal or mainstreamed throughout… to improve national capacity to generate, make available and analyse disaggregated socio-demographic and health data.32

While this is still in some senses a work in progress, it provides a strong advocacy framework to work from and take down the road. Civil

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society organizations and others may wish to place greater emphasis on various components of this package, or add to or modify it, but at least it is something concrete and progressive, and a good starting point. Given the history of the process of implementation of the ICPD Programme of Action and the growth of opposition to it, no one can pretend that getting comprehensive sexual and reproductive health and rights into the post-2015 development agenda will be easy. At this point, it is also still difficult to see how the ICPD Beyond 2014 outcomes will be fed into the process, other than as one part of the Secretary-General’s synthesis report at the end of 2014 as the two processes continue to run on two parallel tracks. But the outcome of the General Assembly Special Event shows that in the lead-up to 2015, they can converge. Going forward, it will be important to use all opportunities, including the Open Working Group process and the President of the General Assembly’s events. These will probably focus on the following:

• • • • • •

What role should women, the young and civil society play in the new development agenda? How can human rights and the rule of law be incorporated? How can the benefits of South-South cooperation be maximized? How can new and existing partnerships be strengthened? How can stable and peaceful societies be built? How do we address the persistent challenges of access to clean water, sanitation and energy?

It should be noted, however, that in addition to working through the Major Groups in the Open Working Group process, there is likely to be a strong emphasis on environmental and sustainable development, the first two pillars of Rio+20, as opposed to the third pillar of social development. In this connection, when

negotiations in Rio became difficult, issues related to the environmental and sustainable development agendas took precedence over social development, governance concerns, sexual and reproductive health and rights issues, and accountability modalities. A further caveat that tempers the optimism engendered by the new UNFPA framework is the “cautious” approach to language on sexual and reproductive health and rights in the UN Secretary-General’s interim report and the reports of the Open Working Group’s co-chairs, which do not move beyond the language of ICPD. Thus, the stage is set for future negotiations.

A final clarion call… The process leading up to the post-2015 development agenda is complex, but hundreds if not thousands of people have already engaged in it who want to see sexual and reproductive health and rights included as a priority in the new sustainable development goals. There is no option other than to move forward within the modalities being set at the highest levels. The one thing we cannot afford to allow again is what happened with the MDGs in 2000; this time, we must not leave the room empty-handed. Acknowledgements Many thanks to all those who provided valuable information, ideas and assistance during the preparation of this paper. I wish mention, in particular, Patrizia Pompili and Benedetta Pagotto (EuroNGOs Secretariat), Sarah Shaw (International Planned Parenthood Federation), Yvonne Bogaarts and Hilde Kroes (Rutgers WPF), Françoise Girard and Shannon Kowalski (International Women’s Health Coalition), and Sascha Gabizon (Women’s Major Group). My thanks also go to Diego Palacios, Executive Co-ordinator for the Post-2015 Development Agenda at UNFPA.

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. United Nations General Assembly. Report of the Fourth World Conference on Women. A/CONF.177/20/Rev.1. New York: UN; 1995.

3. 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.

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M Haslegrave. Reproductive Health Matters 2013;21(42):61–73 4. United Nations Economic and Social Council. Commission on Population and Development. Report on the forty-fifth session (15 April 2011 and 23–27 April 2011. Official Records 2012, Supplement No. 5. E/2012/25, E/CN.9/2012/8. New York: UN; 2011. 5. African Commission on Human and Peoples’ Rights. Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (Maputo Protocol), Article 14(2)(c). http://www.achpr.org/ instruments/women-protocol/ 6. Africa Union Commission. Plan of Action on Sexual and Reproductive Health and Rights (Maputo Plan of Action) Sp/MIN/CAMH/5(1). POA for Implementing the Continental Sexual and Reproductive Health and Rights Policy Framework 2007–2010, Output 5.3.1a. 7. EuroNGOs. The European NGOS for Sexual and Reproductive Health and Rights, Population and Development. http://www.eurongos.org/. 8. International Planned Parenthood Federation. IPPF Charter on Sexual and Reproductive Rights. Reprinted 2003. http://www.ippf.org/resource/IPPF-Charter-Sexualand-Reproductive-Rights. 9. Singh S, Darroch JE, Ashford LS, et al. Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health. New York: Guttmacher Institute; UNFPA; 2009. http://www.guttmacher.org/ pubs/AddingItUp2009.pdf. 10. International Monetary Fund, Organization for Economic Cooperation and Development, United Nations, World Bank Group. A Better World for All: Progress towards the International Development Goals. Goal 6. p.16-17. Washington DC. 2000. 11. Hulme D. Reproductive Health and the Millennium Development Goals: Politics, Ethics, Evidence and an ‘Unholy Alliance’. University of Manchester Brooks World Poverty Institute. 2009. http://www.bwpi. manchester.ac.uk/resources/Working-Papers/bwpi-wp10509.pdf. 12. UN Statistical Division. Millennium Development Goal Indicators. 15 January 2008. http://mdgs.un.org/unsd/ mdg/Host.aspx?Content=Indicators/OfficialList.htm. 13. Family Planning 2010. http://www.familyplanning2020.org. 14. UN Population Fund. Investing in People: National Progress in Implementing the ICPD Programme of Action 1994–2004. New York: UNFPA; 2004. 15. United Nations General Assembly. Resolution A/67/250. 16. United Nations General Assembly. Resolution A/65/234. 17. UNFPA. Messages and Preliminary Findings from the ICPD Beyond 2014 Global Review, 24 June 2013. 18. ICPD Beyond 2014. ICPD Global Youth Forum Bali Declaration, 2012. http://icpdbeyond2014.org/about/ view/13-icpd-global-youth-forum.

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19. ICPD Beyond 2014. International Conference on Human Rights. July 2013. http://humanrights.icpdbeyond2014.org. 20. United Nations Economic Commission for Latin America and the Caribbean. Montevideo Consensus on Population and Development. LC/L.3697. 2013. http:// www.cepal.org/celade/noticias/documentosdetrabajo/9/ 50709/2013-596-montevideo_consensus_pyd.pdf. 21. UN System Task Team on the Post-2015 UN Development Agenda. http://www.un.org/en/development/desa/policy/ untaskteam_undf/untt_members.pdf. 22. UN Secretary-General’s High-Level Panel of Eminent Persons on the Post-2015 Development Agenda. 2013. http://www.post2015hlp.org. 23. Sustainable Development Solutions Network. http://unsdsn.org. 24. United Nations Global Compact. Report to the United Nations Secretary-General. Corporate Sustainability and the United Nations Post-2015 Development Agenda. Perspectives from UN Global Compact Participants on Global Priorities and How to Engage Business Towards Sustainable Development Goals. New York: UNGC; 2013. http://www.unglobalcompact.org/docs/news_ events/9.1_news_archives/2013_06_18/UNGC_ Post2015_Report.pdf. 25. World We Want 2015. http://www.worldwewant2015.org. 26. Alzner S, Jenkins H, et al. Advancing Regional Recommendations on the Post-2015 Development Agenda. A Consultation with Civil Society. New York: UN Non-Governmental Liaison Service; 2013. http://www. un-ngls.org/IMG/pdf/UN-NGLS_Post-2015_Regional_ Consultation_September_2013.pdf. 27. United Nations General Assembly. A life of dignity for all: accelerating progress towards the Millennium Development Goals and advancing the United Nations development agenda beyond 2015. A/68/202. New York: UN; 2013. 28. United Nation General Assembly. The Future We Want. A/RES/66/288. 2012. http://www.uncsd2012.org/content/ documents/814UNCSD%20REPORT%20final%20revs.pdf. 29. United Nations General Assembly. Progress Report of the Open Working Group of the General Assembly on Sustainable Development Goals. A/67/941. New York: UN; 2013. 30. High-Level Task Force for ICPD. http://www. icpdtaskforce.org. 31. United Nations General Assembly Special Event Outcome Document. September 2013. http://www.un.org/ millenniumgoals/pdf/Outcome%20documentMDG.pdf. 32. UN Population Fund. Empowering People to Ensure a Sustainable Future for All. New York: UNFPA; 2013. http://unfpa.org/public/cache/offonce/home/news/pid/ 15466;jsessionid=7EB80F4E488D2F0E969AB0F0D1 A26BE2.jahia01.

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Résumé Depuis que la Conférence internationale sur la population et le développement (CIPD), organisée en 1994 au Caire, a fermement placé la santé et les droits génésiques à l’ordre du jour international, la société civile et d’autres activistes ont travaillé sans relâche pour qu’ils demeurent au centre de l’autonomisation des femmes et ils ont saisi toutes les occasions d’élargir le cadre de travail pour y inclure la santé et les droits sexuels. Quand, en 2000, le processus de développement a changé avec l’introduction des objectifs du Millénaire pour le développement (OMD), la santé et les droits sexuels et génésiques ont été exclus, et ce n’est qu’en 2007 que l’accès universel à la santé génésique a de nouveau été inclus. L’avenir de la CIPD au-delà de 2014, des OMD et du programme de développement de l’après-2015 sera décidé en 2014 et 2015, après des consultations et des réunions autour du globe. Cet article fait le point des influences majeures sur les activités pour réaliser l’ordre du jour de la CIPD et résume les événements passés, présents et futurs prévus, les rapports et processus entre 1994 et 2014, qui aboutiront à la définition du programme de développement de l’après-2015 et d’objectifs du développement durable. Il conclut que nous ne pouvons absolument pas nous permettre de reproduire ce qui s’est passé avec les OMD en 2000. Nous ne devons pas repartir les mains vides ; au contraire, il faut que nous garantissions l’inclusion de la santé et des droits sexuels et génésiques comme priorité au titre d’un nouvel objectif relatif à la santé.

Resumen Desde que la Conferencia Internacional sobre la Población y el Desarrollo (CIPD) celebrada en 1994 en El Cairo puso la salud y los derechos reproductivos en la agenda internacional, la sociedad civil y otros promotores han trabado sin cesar para asegurar que continúen siendo fundamentales para el empoderamiento de las mujeres y han aprovechado todas las oportunidades para ampliar el marco a fin de incluir la salud y los derechos sexuales. Cuando el proceso de desarrollo cambió con la introducción de los Objetivos de Desarrollo del Milenio (ODM) en el año 2000, se excluyeron la salud y los derechos sexuales y reproductivos; fue solo en 2007 que se volvio a incluir el acceso universal a servicios de salud reproductiva. En 2014 y 2015, se decidirá el futuro de la CIPD más allá de 2014, los ODM y el marco de desarrollo post-2015, tras consultas y reuniones mundiales. En este artículo se evalúan las influencias clave en los esfuerzos por lograr la agenda de la CIPD y se resumen eventos, informes y procesos anteriores, actuales y futuros planificados entre 1994 y 2014, que conducen a la determinación del marco de desarrollo post-2015 y los objetivos de desarrollo sostenible. Se concluye que lo único que no podemos permitir es lo que sucedió con los ODM en 2000. No debemos salir con las manos vacías, sino garantizar la inclusión de la salud y los derechos sexuales y reproductivos como una prioridad bajo un nuevo objetivo en salud.

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