Time to act – reaching the sexual and reproductive health goals of Agenda 2030

In September 2016, the 66th session of the WHO Regional Committee for Europe adopted the Action Plan for Sexual and Reproductive Health: towards achieving the 2030 Agenda for Sustainable Development in Europe – leaving no one behind and its resolution. The resolution enshrines the commitment of 50 Member States to a set of principles for sexual and reproductive health (SRH) and confirming the vision of the SRH Action Plan: “The WHO European Region is a region in which all people, regardless of sex, age, gender, sexual orientation, gender identity, socioeconomic conditions, ethnicity, cultural background and legal status, are enabled and supported in achieving their full potential for SRH and well-being; a region where their human rights related to SRH are respected, protected and fulfilled; and a region in which countries, individually and jointly, work towards reducing inequities in sexual and reproductive health and rights” 1. Sexual and reproductive health and rights (SRHR) explicitly feature in the 2030 Agenda for Sustainable Development 2, and the commitments made almost 25 years ago at the International Conference on Population and Development 3. The Action Plan also reflects the objectives of the European policy framework for health and well-being “Health 2020” 4, the Global Strategy for Women, Children and Adolescent Health 5, and other relevant global and regional strategies and action plans. Two years after the Action Plan was taken on board, WHO/Europe, the UNFPA Regional Office for Eastern Europe and the Central Asia and Public Health Agency of Sweden will convene at a multi-country regional meeting and collaborate by bringing together national policy-makers and SRHR experts from over 20 Member States. The meeting will review the progress made towards achieving the SRH targets for the 2030 Agenda and a vision of SRHR equality in the European region. The organizations will also discuss facilitating factors and barriers in the implementation of the Action Plan at a country level, highlight the main challenges in different countries and identify practical action points for addressing these issues, including approaches to decrease inequalities in SRHR outcomes and thus leave no one behind. Remarkable progress has been achieved over the past 20 years in the WHO European Region. Maternal and child mortality have decreased substantially, contraceptive prevalence has increased and abortion ratio has fallen 6, 7. Significant improvements with regards to the essential interventions, defined by the WHO in relation to reproductive, maternal, child and adolescent health, have also been made. Nevertheless, the region still reveals a wide variation between countries; infant mortality rates in countries with the highest rates are 20 times those with the lowest, while the highest national maternal mortality rate in the region is now estimated to be 25 times the lowest 8. Unmet family planning needs differ widely across the region – from 5% to nearly 23% – and are highest amongst the most vulnerable such as those with a low socio-economic status, migrant populations, and adolescents. Insufficient focus has been given to expanding access to services for safe abortion; prevention and management of sexually transmitted diseases; infertility; and sexual health services for adolescents. Despite the proven effectiveness and value of investing in sexuality education to support young people with evidence-based information and equip them with life-skills, it is still met with a great deal of resistance. Clearly, there is a need to challenge misconceptions around sexuality education. Restrictive policies in SRH care within certain countries are leading to the rise of cross-border care for treatments such as infertility and abortion. These limitations are also creating further barriers, inequalities, social injustices and safety issues within and across Europe. Sexual and reproductive health services constitute a significant proportion of interventions to be delivered and integrated at the primary care level. Nevertheless, the integration of such services across Europe varies greatly, is often fragmented and fails to deliver quality and comprehensive access to information and services 9. In October 2018, the world's nations will be celebrating 40 years of the adoption of the Alma-Ata Declaration on Primary Health Care (PHC). The renewed Declaration, to be discussed in October, is expected to reconfirm emphasis on primary care as the main driver of people-centered health systems leading to universal health coverage 10. While making health care truly universal will require a shift towards health systems designed for and around people, as opposed to around diseases, health institutions or organizations, the inclusion of sexual and reproductive health services across a person's life-course as one of the basic components of quality health care is not an automatic given, and does not translate into funding for SRHR. In this context, there are number of pressing topics that need to be discussed and approaches that need to be developed. Among them are clear guidance for delivering people-centered health care services meeting the realities of the WHO European Region, well-defined content of what services and interventions are included in benefit package to address the SRH needs of all individuals across their life-course so that universal health coverage translate into improved access to SRH services and SRH in general. The quality on the path to universal access to SRH services also has to be a central focus with coverage expansion as poor quality health care imposes additional expenditure on households and health system. All these also have implications for financing and development of human resources with the right competencies, particularly in primary health care. Renewed commitment to primary care and positioning people-centrered PHC as a core strategy for achieving universal health coverage provides a window of opportunity to address concrete barriers and enablers for SRHR. The recent report from the Guttmacher-Lancet Commission on SRHR offers a broad, holistic definition and puts forward a future-oriented, progressive agenda for SRHR to achieve the 2030 Agenda and beyond 11. Tackling the complexity of SRHR in constantly changing political contexts will not be easy. Only with continued advocacy in paving the way for prioritization of SRHR on the global, regional and national health agenda, and progressive realization of SRHR with evidence-informed action, including scaling up of implementation of available tools and resources in support of best policy and practice in the context of delivering integrated people-centered universal health care, we will be able to advance on sustainable development.

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