Reproductive Health: A Matter of Social Justice

The following is extracted from an address given by the WHO Director-General Dr Gro Harlem Brundtland at the ICPD+5 Forum in The Hague, Netherlands, 8–12 February 1999. ICPD+5 was held to assess progress in reaching the goals of the International Conference on Population and Development held in Cairo, Egypt, in 1994.

"Today, a broader understanding of reproductive health is gaining ground. Reproductive health deals with intimate and highly valued aspects of our lives. It reflects health in childhood and adolescence. It sets the stage for health beyond the reproductive years for both men and women.

"When we take stock of progress since 1994, there are positive changes—such as the paradigm shift from population control to reproductive health and rights. There are negative trends—such as a failing will to implement the Plan of Action and, not least, the tragic lack of resources. And there are still needs crying out for urgent attention—such as the challenge of adolescent sexuality and the tragedy of maternal mortality.

"Failure to address people's reproductive health needs is a matter of human rights and social justice. People have a right to make free and informed decisions about their reproductive lives. They have a right to information and care that will enable them to protect their health and that of their loved ones. They have a right to benefit from scientific progress in health care.

"We must never forget the right to equality and nondiscrimination on grounds such as sex, marital status, race, age and class. People have a right to privacy and to freedom from sexual violence and coercion. Defining reproductive ill-health as not only a health issue but as a matter of social justice provides a legal and political basis for governments to act.

"We know what happens when they do not act—when people's sexual and reproductive rights are denied. Every year, at least 120 million women who do not want to become pregnant do not have the means to prevent it. Every year, 20 million women put their health and lives at risk because they seek unsafe abortions. Every year, there are more than 330 million new cases of curable sexually transmitted diseases and one in 20 adolescents becomes infected. Every year, the HIV virus infects 5.2 million people, over half of them young people below 24 years old. Every year, there are 450 000 new cases of cancer of the cervix.

"Governments and civil society need to develop a public health approach to reproductive health that is cost-effective and has the maximum impact. There are lessons to be learned from 20 years of experience with primary health care, looking beyond the customary boundaries of curative and preventive medicine and addressing the underlying social causes of poverty, hunger and ill-health.

"It is not a job for the traditional health sector alone. The agenda is as much about social justice as it is about health care. We need to clarify concepts and to define the division of labour among sectors and professions.

"Needless suffering and death are sufficient cause for action in themselves, but there are also significant social and economic considerations. Reproductive ill-health affects young people with family responsibilities, women and men in the prime of their lives.

"Just imagine the costs, to the individual and to society, of the 600 000 women dying every year due to maternal causes, and the 7.6 million perinatal deaths. Not to mention the 2 million little girls subjected to female genital mutilation. Think of the costs of failing to ensure that young people—our common future—have the knowledge, skills and services they need to help them make healthy choices in their sexual and reproductive lives. Investment in reproductive health is an investment in future health and development."

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