“To end the cycle of poverty and ensure sustainable development, you have to make sure women are in control of their sexual and reproductive health and rights [SRHR],” said Mangala Namasivayam from the Asian-Pacific Resource and Research Centre for Women (ARROW). In numerous developing countries, a range of cultural and religious factors mean that many, mostly women and young girls, are unable to fully realise these rights.
Donors including the EU have long been alert to the links between SRHR and development goals such as poverty reduction, food security and climate change. As the European Parliament reminded its Member States in a 2013 motion, “investments in reproductive health and family planning are among the most cost-effective, in terms of development, and the most effective ways to promote the sustainable development of a country”.
But cultural and religious concerns – including those of some donors – have meant slow progress on the ground towards non-judgmental and non-discriminatory access to information, counselling and services. These challenges were discussed during a European Development Days panel on ‘Challenging the influence of religion in achieving universal access to sexual reproductive health and rights’.
‘SRHR for All’ in Asia Pacific
An EU-funded project in the Asia-Pacific region seeks to identify the main barriers to SRHR, and address them through a mixture of evidence-gathering and developing the capacity of local communities to advocate for SRHR at the national, regional and global levels. Now in its third year of four, ‘SRHR for ALL’is running in 15 countries. In each country, the national partner decides which issue within the identified spectrum of barriers to SRHR is most urgent to address.
“In some countries it’s child marriage, in others comprehensive sexuality education, in others it’s access to contraception,” said Namasivayam, Senior Project Officer at ARROW, a regional non-profit organization. “In others – such as Bangladesh and the Philippines – the influence of religion is increasingly becoming a major barrier.”
Breaking the Silence in Bangladesh
For Nure Maksurat, Assistant Manager at Naripokkho, a national partner working on the project in Bangaladesh, the first obstacle is the culture of silence around sex. “Almost 99% of the country is Muslim, and we are not conservative, but we are not progressive either,” said Maksurat. “So at the back of the mind we always think talking about sex and sexual health is not good and not OK.”
The lack of access to information means young people are vulnerable to sexually transmitted diseases and unwanted pregnancies. “Even parents are not easy [talking] about it with their children. They want to move the duty from their shoulder to the teacher’s shoulder,” said Maksurat.
But schools are often ill-equipped to take on this responsibility. “One of our major findings is the content in our textbooks is not comprehensive and clear, and people get confused, [and] ask their teacher to know more about it. The second finding is teachers are not comfortable to talk about this,” said Maksurat. “If teachers are not free to deliver this issue to students, then who will do it?”
Naripokkho is working with the Bangladesh government to bring information about SRHR to the nation’s youth. “We are negotiating with the government on a teacher training guidebook and to revise teacher manuals,’ said Maksurat. “The government is trying, but it has some limitations. It can’t change its policies, its structures overnight… They are working slowly.”
In the meantime, Naripokkho has completed a research programme, visiting schools to understand how SRHR information and studies are treated. Many schools were resistant to their approaches. “I sent 60 letters to schools, and only 5 schools approved,” said Maksurat. “Some said, ‘you’re talking about sexual health – no, we’re a boys’ school, it’s not about boys!’”
At the schools which did receive her, engaging was not easy when students “giggle at the word sex”, admitted Maksurat. “But we try to introduce ourselves, build rapport, start talking about side issues, and then we go to the SRHR issues. […] They are curious to know about it – the demand from students is high.”
The potential benefits of educating young people about SRHR are numerous, giving girls more control over their bodies and futures. “After piloting [this] advocacy programme, we can make it more organised and go to peripheral areas to reach every school,” said Maksurat. “But it needs time and manpower and funds, and depends on many things.”
Empowering Women in the Philippines
In the Catholic-majority Philippines, women’s SRHR are strongly influenced by the Church, which opposes ‘artificial’ birth control in favour of natural family-planning methods.
After years of legal wrangling, the Philippines passed a Reproductive Health Act in 2012. It made great strides forward for the poorest communities by guaranteeing universal access to contraception, sexual education and maternal care.
“But even if we have a reproductive law in place in the Philippines, it still cannot be implemented fully because of barriers raised against it,” said Rina Jimenez-David, columnist and board member of Likhaan, an NGO promoting health services for women, and the Philippines national partner on 'SRHR for All'. “The Church has worked to influence local government officials, national government officials and the judiciary to put up blockages to the full enjoyment of sexual and reproductive health and rights.”
After the Reproductive Health Act was passed, pro-life groups filed a Supreme Court petition questioning its constitutionality. Although the court ruled that the Act was not unconstitutional, it still struck down eight of the law’s provisions. As a result, “any adolescent seeking advice or services must present a written letter from a parent before they could talk to a doctor,” said Jimenez-David. And a ‘temporary restraining order’ was placed on contraceptive implants – which over a year later has yet to be lifted.
For women in poorer communities, who have 5.2 children on average compared to 1.7 for women in the top wealth quintile, the impact of the ban is serious. “Women liked the fact that it could be installed and they wouldn’t have to worry for three years for another pregnancy to occur,” said Jimenez-David. “And three years by the way is the ideal period that UNICEF and UNFPA recommend for spacing of pregnancies.”
Continuous child-bearing not only depletes family resources and perpetuates the cycle of poverty; it also poses health risks. “We have a high rate of maternal mortality and child mortality,” said Jimenez-David. “The toll of maternal deaths is 11-12 women a day in the Philippines.”
Lack of medical personnel and limited access to resources in poorer communities compound the difficulty of accessing SRHR. David believes that in order to push governors and mayors to action – the officials on whom the responsibility for local health services falls – a change in attitudes is needed.
“Likhaan has partnered with faith organisations, progressive Catholic clerics and nuns, other churches, protestant churches and non-faith organisations like Philippine Free Thinkers, so we present an alternative voice to the dominant voice of the Catholic Church,” said Jimenez-David. “We hold symposia to talk about the roots of these religious attitudes to reproduction.”
“Most of the work has been to engage women in dialogue about their rights and concerns, and young people have been organised into peer advice groups, to spread the word to their friends, in school and outside,” said Jimenez-David. It enables women from Manila’s poorest communities and in disaster-stricken areas outside the capital to stand up for their sexual and reproductive rights.
They may have a powerful new ally in the new President Rodrigo Duterte, who said in a June speech that the country’s high birth rate was driving many families into poverty.
This connection, though not new, still needs to be highlighted. “One of the challenges is to tell the development world that SRHR is as important as everything else,” said Namasivayam. “We want to make sure it is at the centre of the SDGs, linking it to all other development goals if we are to ensure the tagline ‘leaving no one behind’ will be realized and not stay as mere rhetoric.”
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What else is the EU doing to support SRHR?
The EU uses a wide range of external assistance modalities, such as budget support, support to civil society organisations and thematic interventions. In the period 2007-2013, the EU committed around €1.258 billion to activities targeted at improving gender equality and girls’ and women’s empowerment. EU support to the health sector in partner countries strongly focuses on strengthening national health systems and tackling inequality in access to essential services, which also covers sexual and reproductive health including family planning and appropriate sexuality education. From 2008-13, the EU provided €2.9 billion for health aid to third countries. In the same period the EU contributed €1.8 billion to programmes and projects specifically targeting maternal and new-born child health and sexual and reproductive health.* *Calculated according to the Muskoka method, the contributions include funding from other sectors such as education and food security. |
Group
Capacity Building in Public Health for Development
Further Reading
Summary of the EDDs panel by Azra Abdul Cader, ARROW
This collaborative piece was drafted with input from Marianna Lipponen from DEVCO, with support from the capacity4dev.eu Coordination Team.
Teaser image credit: 'Auxiliary midwife providing a young mother and her newborn with essential health services in Ayeyarwady Region', 3MDG/UNOPS, DEVCO image library.
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