2 SRHR Advocates at Swasti Cafe

Last week was an exciting one for the World with the PMNCH Board Meeting and the Nairobi Summit on International Conference on Population and Development (ICPD). #ICPD25 as it is being referred to this year across all social media conversation marks 25 years with partners making bold commitments to transform the world by ending all maternal deaths, unmet need for family planning and gender-based violence and harmful practices against women and girls by 2030. 

Are you wondering why this is such a big deal? At Swasti, I caught up with Shama and Angela to talk about Sexual and Reproductive Health and Rights (SRHR) and why it matters. And I have a great excerpt for you. But first, a little bit about Shama & Angela!

Shama has worked with urban and rural communities in India on health and social development for over 2 decades, especially around access to SRHR services and currently serves as the Chair for Asia Pacific Alliance for Sexual, Reproductive Health and Rights and is the CEO of Swasti. 

Angela has been working on strengthening Health Systems to reach the most marginalized - especially among women, children and adolescents. She currently serves as a board member of the Partnership of Maternal Newborn and Child Health (PMNCH) and is a Partner and Director at Swasti

Here is an excerpt of our no holds barred conversation:

Shrirupa: There is a lot of conversation globally on SRHR - on whether we still need to work on it as a separate component or pour all our focus into Universal Health Care and it kind of tags along. I personally feel there is some loss of translation - where some of us see SRHR as an essential piece in the UHC journey needing special focus and some of us do not. So, I am going to start with something very basic. What is SRHR?

Shama: I hear you. I am actually going to take a step back and talk about the bigger picture. At the end of the day it is going to be about Rights and Access to pathways that help realize those rights.

Sexual and Reproductive Health and Rights (SRHR) is a key component of an individual’s rights and health. Essentially, SRHR is a doorway to UHC. If you don’t have rights, you cannot access UHC.

For every person, through the life-cycle, good health supports Sexual and Reproductive Health and Sexual and Reproductive Health support good health and well-being. Rights are a fundamental aspect of all health including Sexual and Reproductive Health and you cannot slice it up in different ways. Just how a human being is one unified person, so are our rights and our bodies. 

Angela:

Sexual and Reproductive Health (SRHR) to me is actually the Right to Sexual and Reproductive Health, not Rights as an afterthought to sexual and reproductive health. And this is basic.

If we as humans don’t have that basic right, then access to health is moot. And adding to what Shama says- we can forget about achieving UHC, if we don’t ensure every individual has  the agency and empowerment to access their health needs. When women, children and adolescents know about and can use services and products they need, they will live productive and happier lives, that make for healthy and economically progressive communities and ultimately countries. 

I come from privilege, and while I’ve had to occasionally remind people of my rights, I have never had them taken away from me. However, at least 50 million women, children and adolescents are not so lucky.  

Shama: Yes, and I think we also need to look at how systems treat people. 

Angela: Exactly! I was just about to come to that.

SRHR  to me is also about freedom from violence. We all know of and talk frequently about Gender Based Violence, Intimate Partner Violence, female genital mutilation and more, but what about the systemic violence and discrimination perpetuated by society that all (privilege or not) of us continue to experience even today? 

For example, our medicines mostly if not all are tailored to a man’s metabolic systems, the most comfortable way for a mother to deliver her child is while standing and the least efficient being lying down- but systems are tailored to what is easier for the obstetrician. I also consider the social norm of early marriage as systemic GBV where the child/adolescent has no say. Anyway, I can go on forever, so I’ll take a pause. 

Shrirupa: Actually, thank you. This kind of brings me to my next question. When we open our vistas to a more as Shama puts it, big picture understanding of SRHR, we need to accordingly recalibrate our focus. Why is SRHR important?

Angela:

You know, to be honest, I feel ashamed that even in the 21st century, a whole century after women secured their right to vote, that women all over the world are still fighting for their right to live in dignity and respect.

There’s evidence that tells us that at the time when women do the most difficult, yet precious act of bringing a child into this world, one in three of them face abuse. SRHR is basic, it recognizes individuals throughout their life-course. Todays’ discourse on UHC mustn’t dilute the focus on children, women and adolescents who till today are the most disparately affected. 

Shama: Sexual Rights, Sexual Health, Reproductive Rights and Reproductive Health - each of these are fundamental to each person, in varying degrees at different stages of life. For those of us who have had privilege all our lives, it may be difficult to see how these are separate or contextual. 

As an example, expression of ourselves, our personalities, inherently includes sexuality.

If one chose to express as a bi-sexual or a gender-fluid person, they more usually than not, face discrimination because many societies prefer a binary expression. This discrimination in turn leads to violence and denial of services.

Like Angela has said, rights to sexual and reproductive health are fundamental and the services that follow are important at every stage of life. So SRHR cannot be separated from the rights and health of a person or communities. 

Shrirupa: So essentially what both of you are saying is SRHR is central to who we are - like you put it, Shama - “expression of ourselves, our personalities, inherently includes sexuality”, it is beyond the gender binary, it is non divisive, non partisan and at its very core, it is about having those rights protected as Angela has pointed out too. In which case it is fundamental to being a human being. So if you are a human being, you need SRHR and you should have SRHR, irrespective of where you come from or which gender you identify as. But the way I see it, not everyone thinks SRHR is a good investment. So, in your words, why is SRHR a smart investment?

Angela:

SRHR saves lives, it’s cost-effective and way cheaper than paying for the high cost of care after the fact. 

Shama: Every person achieving their full potential is good for all of us - as communities, countries, and economies. SRHR is about protecting the rights and ensuring the appropriate care and support at the right time.

There is enough evidence to show that investments in preventive and primary care which is where a bulk of SRHR services can be delivered, is a good return on investment. 

Shrirupa: I think we all need to remember that SRHR is cost effective from all angles - be it the financial costs, productive costs, time costs, emotional costs. As you know, the Nairobi Summit opened with the release of new research showing the price tag to achieve “three transformative results” -- zero maternal deaths, zero unmet need for family planning, and zero gender-based violence and harmful practices -- within the next decade. The total cost to the world would be $264 billion, according to the analysis by UNFPA and the Johns Hopkins University, in collaboration with Victoria University, the University of Washington and Avenir Health. The cost of inaction is obviously much higher. In your opinion not only as leaders in your field and partners in SRHR but also as women and mothers, who should invest in SRHR?

Shama: Other than the obvious government investment in SRHR, markets and society will need to be investing in SRHR. You see, investment is not about money alone; it is time and effort in policy re-design, systems integration and ensuring quality delivery. Markets under-estimate their role or it gets pegged only for delivery of services. The private sector plays a role in protecting or undermining rights, enforcing or creating norms,  or designing services and products. Unequal pay for equal work is a tragedy of our times - just shows how our mindsets have not kept pace with the times.

As a society, we will need to look carefully at the institutions that represent us to see if they are truly fulfilling the mandate. 

Angela:

We often forget that SRHR is EVERYONE’s business.

To me besides what you mentioned Shama, I want to add the communities and families, our educational system our health care systems, our societies need to invest. 

They, rather, we need to invest in actively fighting negative and harmful social norm, and make it such that women, children and adolescents are able to exercise their rights to achieve their full potential without fear of harm, exploitation, abuse and that they have the opportunity to seek whatever they need, whenever they need and how they want it. 

Shrirupa: Indeed  “SRHR is EVERYONE’s business”. Thank you so much for your time and I cannot wait to share this conversation with everyone ahead and see what they have to say too. Your parting thoughts:

Shama: We put rockets into space in the 50s and 60s! We must apply ourselves to solve real human problems here. Definitely, time for action and most of it is NOT rocket science.  

Angela: Time to move beyond commitments and into action. Lives are being lost, harassed, abused while we coin and wordsmith slogans and campaigns. Let’s get stuff done! 

Shrirupa: Absolutely! Thank you once again and this chat was brought to you from Swasti Cafe. To join the conversation write to me at [email protected]

Editor's Note: Shama & Angela’s sentiments are not isolated. We are happy to note that several Governments including Austria, Canada, Denmark, Finland, France, Germany, Iceland, Italy, Netherlands, Norway, Sweden and the United Kingdom, together with the European Commission, committed around $1 billion in support towards the ICPD goals. 

Like Shama was talking about markets and private sector organizations also needing to do their bit, the private sector also stepped in: Children’s Investment Fund (CIF), The Ford Foundation, Johnson & Johnson, Philips, World Vision and many other organizations announced that they will mobilize some $8 billion in combined new pledges.

And like Angela said in her parting thoughts, we bumped across this invigorating quote from Ambassador Ib Petersen, Denmark’s Special Envoy for ICPD25: 

“There will be no ICPD50. Women and girls around the world have waited long enough to have rights and choices...Looking towards 2030, we now enter a decade of delivery during which we will walk the talk and hold all of us to account for the commitments we made in Nairobi.”