UNFPA warns of threats to sexual and reproductive health

The UN Population Fund (UNFPA) has warned in a new report that political and social polarisation has put at risk decades of gains in ending inequalities in sexual and reproductive health and rights, widening the access divide and threatening future progress.

In the report, released on April 17, the organisation says that a relentless, well organised effort to push back against human rights and gender equality is underway, and also cautions that resistance to sexual and reproductive health and rights "is resulting in greater marginalisation for communities already left—or pushed—behind. Efforts to control fertility and restrict bodily autonomy disproportionately affect migrants, people with disabilities, and minority and indigenous communities, among many others."

Speaking to The Lancet, Natalia Kanem, UNFPA Executive Director, said that considerable gains had been made: "The unintended pregnancy rate has fallen by nearly 20% since 1990, the maternal death rate by 34% since the year 2000, and new HIV infections by one-third in the last 15 years." But she also noted that progress in sexual and reproductive health and rights has stalled in many cases: "Annual reductions in maternal deaths have flatlined. The world has made zero progress on saving women from preventable deaths in pregnancy and childbirth since 2016, and one woman in four cannot make her own health-care decisions. In 40% of countries with data, women’s bodily autonomy is diminishing."

"One important reason, our report shows, is that we have not prioritised reaching those furthest behind. We see, for example, that barriers to health care fell fastest for women who are more affluent, educated, and privileged. When we look at ethnic disparities, we see that the groups that have benefited the most are those that had the fewest barriers to begin with. In fact, health-care disparities within countries are oftentimes just as significant, if not greater, than those between countries."

Flavia Bustreo, Chair of the Governance and Ethics Committee at the Partnership for Maternal, Newborn and Child Health, told The Lancet that "the manifestations of regression" of sexual and reproductive health and rights are taking different forms, including diminishing legal access to abortion, criminalising sex for people who are LGBTQ, or consideration of repealing laws banning female genital mutilation. She called for "stronger measures to signal disagreement".

Winnie Byanyima, UNAIDS Executive Director, told The Lancet that the UNFPA report "demonstrates the harm caused by the well-funded, well-organised, and brutal anti-rights campaign to criminalise and punish people for who they are and who they love”. But, Byanyima said, the report also “powerfully conveys the social progress that has been won through determined activism. As the report notes, at the start of the AIDS pandemic, most countries criminalised LGBTQ people, but now two-thirds do not."

New research by UNFPA in a group of low-income and middle-income countries (LMICs) shows that most women had seen a promising overall reduction in problems of access to health care. However, a handful of countries saw little change (Gabon, The Gambia, Malawi, Nigeria, Peru, and Sierra Leone) or evidence of regression (Kenya, Pakistan, and Senegal). In more than half of the countries analysed, ethnic disparities had widened. The UNFPA report says that the call for disaggregating data to identify where, and for whom, unmet sexual and reproductive needs are most dire “has gone unfulfilled”. Rebecca Zerzan, the editor of the report, told The Lancet, "Every country, every society has people who are being left behind...we need to find out where they are through better data and safe data collection, and we need to prioritise the realisation of their rights."

In particular, the report highlights that while some factors such as gender, income, geography, and age are routinely considered in surveys and analyses, “desegregation by ethnicity, race, language, religion or indigeneity remain rare. Disaggregated data showing access to services by HIV status, migration status or LGBTQIA+ identity are even rarer".

UNFPA estimates that spending an additional $79 billion to scale up coverage of 29 essential family planning and maternal health interventions in LMICs by 2030 would avert 400 million unplanned pregnancies, save 1 million lives, and yield $660 billion in economic benefits.

"We always say we have the tools and we know how to use them. Now they need to be used", Clara Menéndez, Director for the Maternal, Child, and Reproductive Health Initiative and Programme at Barcelona Institute for Global Health (ISIGlobal), told The Lancet. "This is the time for highlevel advocacy and for getting these tools to the people who need them."

This news item was originally published on thelancet.com.