We, the 140 participants from 19 countries, representing governments, parliaments, civil society, young people and academia, gathered in Sofia, Bulgaria for the Regional Conference “Promoting Health and Rights, Reducing Inequalities: Towards Better Sexual and Reproductive Health Outcomes in Eastern Europe and Central Asia” to review the progress made, and identify priorities, in advancing sexual and reproductive health and reproductive rights in the region, and to discuss the synergies between the ICPD Beyond 2014 regional review outcomes and the post-2015 development agenda,

We reaffirm the continued relevance and importance of the International Conference on Population and Development (ICPD) and its Programme of Action, the ICPD Beyond 2014 regional and global reviews, and the Beijing Platform for Action.

We endorse the outcomes of the high-level regional conference “Enabling Choices: Population Priorities for the 21st Century” held in Geneva, in July 2013, as the culmination of the ICPD Beyond 2014 regional review,

We welcome the significant progress made since the adoption of the ICPD Programme of Action in 1994, particularly in terms of reducing maternal mortality, improving quality of services and increasing availability of modern contraceptives,

We  also recognize that many challenges remain, as highlighted by the regional ICPD Beyond 2014 review, including the increase of HIV infections, low use of modern contraception, and high level of teenage pregnancy,

We recognize that sexual and reproductive health plays a central role in development and that investing in the health and rights of women and girls is smart economics for families, communities and nations. We also acknowledge that sexual and reproductive health makes a significant contribution to sustainable development, building resilient societies, advancing gender equality and ensuring social justice, 

We recognize the indivisibility and universality of all human rights, applicable to all people without distinction.

During our deliberations we identified the following priorities in advancing sexual and reproductive health (SRH) and reproductive rights (RR) and reducing inequalities in Eastern Europe and Central Asia. In order to make progress on these priorities, we need to:

1.     Increase political attention to, and investment in, sexual and reproductive health, with a particular focus on prevention;

2.     Ensure sustainable universal access to the full range of quality SRH services as part of health system transformations towards a progressive realization of universal health coverage, recognizing it as an investment rather than a cost;

3.     Promote sexual and reproductive health and protect reproductive rights throughout the life course, including for persons outside of reproductive age, recognizing the particular needs in early adolescence and, in the context of ageing populations in the region, of older persons;

4.     Ensure that SRH and RR interventions, policies and programmes pay close attention to the socio-economic context in which people live, and the interactions between biological,  behavioural, psychosocial and environmental factors over the life course;

5.     Prioritize family planning, including availability of affordable and acceptable modern contraceptives, accessible at primary health care level, recognizing that evidence in the region shows that family planning does not reduce fertility levels;

6.     Prioritize young people’s SRH and RR by ensuring access to comprehensive sexuality education and youth-friendly services, including modern contraceptives, to empower young people and minimize ill health in later stages of life;

7.     Reduce morbidity and mortality among women of reproductive age, knowing that most of it is entirely preventable when given the appropriate attention and investments, by effectively addressing their leading causes;

8.     Focus a comprehensive integrated response addressing SRH, HIV and co-morbidities on key populations at higher risk of HIV and populations highly vulnerable to HIV, including young people and migrants;

9.     Promote a human rights-based approach to sexual and reproductive health, including by sensitizing health care providers and law enforcement, to reduce inequalities and ensure that no one is left behind;

10.  Strengthen regional collaboration for advancing the ICPD agenda through innovative partnerships and solutions;

We call for the integration of the results of the ICPD Beyond 2014 review into the post-2015 development agenda, with a particular focus on ensuring better sexual and reproductive health outcomes for all, towards more just and equal societies.

We pledge to accelerate implementation of the ICPD Programme of Action through the post 2015 agenda by committing to:

1.     Remove all barriers preventing people from accessing quality sexual and reproductive health information, services and commodities, according to their needs;

2.     Implement effective and evidence-based policies and programmes related to sexual and reproductive health that respond to the needs of all generations and population groups by applying a life-course approach;

3.     Develop normative frameworks and support multi-sectoral collaboration, involving civil society, in promoting health and well-being, with a focus on sexual and reproductive health;

4.     Advocate for adequate national budget allocations, in the context of a responsible transition from ODA, to ensure sustainable implementation of SRH and RR-related policies and programmes by the public, non-governmental and private sectors, with the objective that no one is left behind;  

5.     Promote the collection and use of disaggregated data and qualitative information to inform formulation of evidence-based SRH and RR-related policies and programmes, and monitor their implementation;

6.     Strengthen integration of SRH services at primary health care level, aiming at the prevention of complications of pregnancy and delivery, the provision of quality ante-natal care, addressing unmet needs for family planning, in particular modern contraceptives, and preventing unintended pregnancies, cervical cancer, HIV and other STIs;

7.     Increase investments in young people’s SRH and RR, in particular for girls young women and key populations, including by providing comprehensive sexuality education and access to youth-friendly services and commodities;

8.     Scale up measures for the appropriate decentralization of HIV and AIDS programmes to improve access for communities, including rural and under-served populations, and the integration of HIV and AIDS programmes into primary healthcare and sexual and reproductive health-care services;

9.     Intensify the transfer of knowledge, technology and expertise among countries; develop and implement cross-border initiatives that advance the ICPD beyond 2014 agenda;

10.  Promote community empowerment for marginalized and vulnerable populations at local, regional and national levels;

11.  Integrate the provision of SRH as part of a global health approach in emergency situations and emergency preparedness;

12.  Address gender-based and sexual violence as an issue in its own right and as an exacerbating factor affecting sexual and reproductive health. 

We call upon the Government of Bulgaria and UNFPA to forward this declaration to the Secretary-General of the United Nations and the co-chairs of the inter-governmental negotiating process on the post-2015 development agenda as a contribution of the Eastern Europe and Central Asia region to the discussions on the future development framework.  

This declaration was issued 27 May 2015 by participants in the Regional Conference 'Promoting Health and Rights, Reducing Inequalities: Towards Better Sexual and Reproductive Health Outcomes in Eastern Europe and Central Asia', held in Sofia, Bulgaria.

Download as pdf: Sofia Declaration of Commitment (Russian version)