This interview with Alanna Armitage, Director of UNFPA’s Eastern Europe and Central Asia Regional Office, originally appeared in issue No. 84 of Entre Nous, The European Magazine for Sexual and Reproductive Health.
The 20-year review of the International Conference on Population and Development (ICPD) Programme of Action culminated in 2014. What were the key recommendations in the area of sexual and reproductive health and rights (SRH&R) and has there been any progress in their implementation?
What came out strongly throughout the review process and in the outcome document of the ICPD Beyond 2014 Regional Conference in Geneva is the call for a human rights-based approach to sexual and reproductive health. This means that women and girls need to be able to make informed decisions, that their choices be respected and that they must have access to services and information, without discrimination, coercion or violence.
We organized a follow-up conference in Sofia last year to develop in more detail what this means in practice for our region. We have used both the Geneva outcome document and the Sofia Declaration of Commitment as a guide for our work in promoting universal access to sexual and reproductive health in the region. We are seeing real progress.
At the normative level, a new Action plan for sexual and reproductive health: towards achieving the 2030 Agenda for Sustainable Development in Europe - leaving no one behind is being developed by WHO Member States with strong UNFPA involvement. This reflects stronger government ownership and support. At the technical level, we are advancing the quality of sexual and reproductive health care by developing new alliances, supporting institutional capacity building and advancing sexual and reproductive health standards, guidelines and protocols. There is a sharper focus on innovative approaches for improving maternal health and access to contraception and investing in cervical cancer prevention, youth sexual and reproductive health, and HIV/AIDS.
I believe the notion is gaining traction that realizing the reproductive rights of people is key to unleashing the potential of women and youth and therefore is crucial for development – and for addressing the population dynamics we are facing in this region.
As we are entering a new era with the 2030 Agenda for Sustainable Development now having been kicked off, where do you see the main challenges that need to be addressed in our region when it comes to SRH&R?
We have made a lot of progress over the past two decades. For example, maternal mortality more than halved since the early 1990s in our region. But as the ICPD review has clearly shown, we are still facing a lot of challenges. Disparities remain significant, between countries, but also within them. For example, the risk of dying from maternal causes is still almost twice as high in our region compared to the most developed regions. But if we look at individual countries, we see an enormous spread: from a very high risk of 1 in 390 in Kyrgyzstan to an extremely low risk of 1 in 45,200 in Belarus.
We see a similar situation when it comes to the use of modern contraception. Rates are near the world average of 57% in some eastern European and central Asian countries, but extremely low – even below the average of the least developed countries – in several others, mostly in south-eastern Europe and the Caucasus.
Adolescents and youth still face obstacles in accessing sexual and reproductive health services and information due to a lack of youth-friendly facilities, poor institutional capacities and restrictive policies. Although comprehensive sexuality education is proven to be effective in preventing teenage pregnancy and HIV and other sexually transmitted infections, it is rarely offered in schools. As a result, teenage birth rates are about three times higher than in western Europe.
Cervical cancer, though largely preventable, is up to ten times more common in our region than in western Europe, because of a lack of organized prevention programmes. And nowhere else in the world is the HIV epidemic spreading faster than in our region, with sexual transmission becoming an increasingly dominant factor. Gender-based violence remains widespread and women and girls who have experienced violence need access to essential services. I believe the new 2030 Agenda provides an excellent opportunity to address these challenges through innovative, holistic approaches and more strategic alliances.
What do we need to do differently in this region to achieve breakthroughs towards the goal of universal access to SRH&R?
Through delivering the Millennium Development Goals we gained significant experiences and strong evidence that we can now build on. But under the new Agenda 2030 framework we are shifting gears: towards a genuinely issue-based approach that fully reflects the many interlinkages between the challenges we are working on.
For example, we cannot find sustainable solutions to population dynamics like ageing or low fertility if we don’t make progress on gender equality and SRH&R. We also cannot work on health care reform in isolation, as it can only be successful if it is embedded within supportive social, economic and environmental policies affecting health outcomes.
What is needed is a sharper focus on priorities, stronger issue-based intersectoral alliances with civil society and other partners and wider policy frameworks, facilitating the shift from vertical programmes to integrated approaches aimed at reducing the health inequities. We need more knowledge sharing, across regions and within the region. And we need to reap the potential of public-private partnerships.
Most importantly, we need an even stronger human rights focus. Applying a human rights-based approach to public health is a powerful way to improve health outcomes. For this we need to translate the powerful normative human rights discourse into operational guidance and concrete tools for health planners and service providers, as well as users of health systems. Applying human rights to sexual and reproductive health not only helps governments comply with their binding obligations, but also contributes to improving health outcomes. This is the only way we can build the human capital we need to tackle the challenges we face in this region.
What is your vision for this region for the next 15 years? Where will the region be in 2030 in terms of sexual and reproductive health?
There is a tremendous amount of potential in this region and many lessons to share with the rest of the world. I am convinced that we can achieve breakthroughs in reducing inequalities and making universal access to sexual and reproductive health a reality by ensuring that all individuals can exercise their basic human rights, including those that relate to the most intimate and fundamental aspects of life.
Applying the principles enshrined in the 2030 Agenda and the ICPD will help us deliver a region where every pregnancy is wanted, every child birth is safe and every young person’s potential is fulfilled. It is a tall order, but I believe we are on the right track.