In the changing landscape of sexual and reproductive health and rights, research and evidence needs to be heard
Two decades ago, in 1994, the Cairo International Conference on Population and Development marked a turning point by putting gender equality, women's empowerment and sexual and reproductive health and rights at the very heart of development. If the world is to fully achieve the Sustainable Development Goals to which it has committed, sexual and reproductive health cannot be pushed to one side and the gains made in recent years be lost. Now, more than ever, governments, policy-makers, researchers and scientists need to focus efforts on ensuring sexual and reproductive health care is of the best quality, based on scientific evidence and made available to all. Ensuring that it is equitable will mean, in particular, meeting the sexual and reproductive health needs of women, girls, marginalised and hard-to-reach populations.
But what are the actions that will improve sexual and reproductive health? The answer to this question will vary from country to country and from community to community, yet there should always be one common thread. Whatever action is chosen, it should be guided by evidence drawn from scientifically-sound research. Such evidence is critical to the development of high-quality health care programmes and policies. Clinicians cannot be left to guess at what care should be provided; programme managers and policy-makers should have a sound basis for their decisions on what equipment, personnel and facilities are needed; and governments need evidence to inform laws and policies as well as decisions on where and how to spend limited and valuable resources. Programmes and policies based on scientific evidence will also be more cost-effective, a concern to all countries struggling to provide people with the best possible care at an affordable price.
Today, more than twenty years after Cairo, full enjoyment of sexual and reproductive rights remains but an aspiration for millions of women and girls. Each day, around 800 women die giving life. Health care providers struggle with clinical decisions in the absence of clear, evidence-based guidance. Policy-makers urgently need evidence to justify legislation and policies and for programme planning.
More than 225 million women want to delay or avoid childbearing but are not using modern contraception – most of them in the poorest countries and in the most disadvantaged groups. Countries need evidence to understand how to address the gaps in access to high-quality, acceptable contraception.
Research in the field of medical abortion may have led to a reduction in the number of women dying from unsafe abortion, yet still some 22 million unsafe abortions are estimated to take place worldwide each year, almost all in developing countries. Policy-makers and programme managers need further research and evidence on which to base decisions on the provision of abortion care and services.
“Evidence is critical to the development of high-quality health care programmes and policies. Clinicians cannot be left to guess at what care should be provided; programme managers and policy-makers should have a sound basis for their decisions on what equipment, personnel and facilities are needed; and governments need evidence to inform laws and policies.”
Ian Askew, Director, Department of Reproductive Health and Research
“Rigorous research is an essential precursor to sound public health policy, but it can’t exist in a vacuum. As members of the sexual and reproductive health and rights community, we must continually push ourselves to ask new questions, conduct new research, analyze and explain the findings, and then use them to advocate and educate.”
Ann M. Starrs, President & CEO, Guttmacher Institute
“Scientifically-sound evidence about sexual and reproductive health and rights is a crucial for constructive dialogue, informed policy, and impactful programs. More than delivering analysis, we must build an evidence base that meets the needs of policymakers and respects the rights of individuals to receive quality care.”
Julia Bunting, President, Population Council
1 in 3 girls in developing countries is married before the age of 18. Marriage too early, leads to pregnancy too soon, effectively closing the door to education and other opportunities for a better life. Investments, including in research, are critically needed to guarantee their sexual and reproductive health and rights and expand their capabilities through quality health care and education, freedom from violence and harmful practices such as child, early and forced marriage, and female genital mutilation. Providing research on issues such as these may enable to countries to commit to internationally-agreed goals adopt strategies that address them.
Adolescents and young people lack access to comprehensive sexuality education are not always able to access services freely, without the consent of their husbands and/or their parents. For this generation, in particular, carefully designed and tested tools which use new technologies and communications platforms could be effective in assisting healthcare providers to deliver scientifically-accurate sexuality education.
The promotion, protection and fulfilment of sexual and reproductive health and rights are currently experiencing marked resistance around the world. Lack of sufficient funding; stigmatization of users and providers of sexual and reproductive health services; increasing restrictions on access to, and provision of, information and services; together with legal barriers and a lack of respect for rights continue to threaten the generation, communication and utilization of scientifically-accurate evidence. Such evidence is critical for both understanding the needs of diverse populations as well as for the development of valid norms and standards that can be used to provide safe, effective, acceptable and affordable sexual and reproductive health services.
All countries have an important role to play in research, not only in terms of their responsibility to ensure that the health care they provide to their citizens is of the best possible quality and accessible to all, but also in the development of the capacity to conduct and communicate the research and evidence that underpin health policies and programmes.