A year ago the Nairobi Summit marked the 25th anniversary of the International Conference on Population and Development (ICPD+25) in Cairo, where 179 governments adopted a landmark Programme of Action to ‘empower women and girls for their own sake and that of their families, communities and nations’.
We have made important gains since then. As The Lancet highlights, maternal mortality has decreased by around 40%, but it falls short of the 75% target set in Cairo. Use of modern contraception by women in a relationship and wanting to avoid pregnancy has increased from 15% in 1994 to 37% today, but around 200 million women worldwide still have unmet contraceptive needs. The prevalence of female genital mutilation among girls in countries where the practice is common has decreased in the past 25 years, as has the proportion of girls who are child brides.
The backlash against women’s rights
Despite these gains, numbers remain too high. The Programme of Action’s goals haven’t been met in too many countries. Young people, particularly girls, still lack agency, education and access to critical health services.
More worryingly, we are witnessing increasing contestation and backsliding in hard won rights for women. Take the unprecedented expansion of the Global Gag Rule to severely restrict critical US support to sexual and reproductive health and rights (SRHR) around the world, or the national-level backlash against abortion rights in places like Poland. Recent UN Security Council (UNSC) resolutions, like UNSC Resolution 2467 (PDF) on survivor-centred approaches to wartime sexual violence, have also been watered down to exclude SRHR after the US threatened them.
I am honoured to have been asked to serve on the High-Level Commission which was established to monitor and report on progress towards fulfilling the 12 commitments to women’s health and rights enshrined by the Nairobi Summit. The importance of making progress on these commitments cannot be overstated. ODI’s own research – on youth, economic justice, education, humanitarian response and countless other areas – all speaks to the fundamental nature of bodily autonomy, reproductive justice and choice. None of these are possible without the others.
Investment in adolescent girls must be prioritised
Patriarchy, colonial histories, profound economic inequalities and heteronormativity all play a role in creating the structural barriers and social norms that shape people’s lives. These include the laws, economic models and political institutions that condition what is possible. This is particularly true for adolescent girls and their ability to realise their full potential.
Despite progress, more than 16 million adolescent girls become mothers each year, nearly all of whom live in poorer countries and are married at a young age. The social and economic costs of child motherhood are immense, from premature school dropouts and limited life opportunities, to heightened risk of maternal and infant illness and death. In line with commitment four of the ICPD 25, the global response to family planning must put adolescent girls at its centre, with investment urgently needed to accelerate progress.
Women and girls caught in crises can no longer be ignored
The Nairobi Summit also helped draw attention to an issue close to my heart, as a long-time researcher and former practitioner, which is the rights of women and girls caught in crises. SRHR are so often sidelined in crisis settings, as the most marginalised and disadvantaged slip through the net of existing services and face dire outcomes as a result.
How we engage in the most difficult contexts – conflict, displacement, disaster (see commitment 12) – is a key indicator of our overall commitment. We must work relentlessly to ensure that women and girls in crisis situations have universal access to the minimum initial services package (MISP) for reproductive health. This package of measures is meant to support them from the very onset of a crisis, with everything from everyday contraceptive access to mitigating the effects of widespread sexual violence.
But we must also shine a light on the worst abuses. SRHR in conflict and post-conflict settings are not just about access to supportive services. They are also about confronting the use of forced abortion, contraception and sterilisation against marginalised groups.
These tactics tend to be used disproportionately against marginalised groups, for example in Colombia and China, including people with disabilities, poor and racialised women, and indigenous or colonised populations. An intersectional approach is needed to capture the compounding nature of multiple exclusions. An awareness of the histories that underpin this marginalisation is also important, to see how it fits into a wider schema of structural power and control.
Staying on track during Covid-19
This is a critical moment, particularly in the context of Covid-19 and a global backlash against women’s rights and autonomy. SRHR must not be forgotten.
We have seen what can happen with other health crises, like Ebola. Access to critical sexual and reproductive health services including abortion and contraception have been restricted during the pandemic, as funds and capacity are diverted. There is a risk such services are deemed ‘non-essential’ amid lockdowns and Covid-19 containment measures. It is incumbent for the High-Level Commission to learn from the evidence as we move forward, so as not to find ourselves back where we started in another 25 years.
We have in front of us 12 urgent, important, challenging (and overdue) commitments. As Executive Director of the United Nations Population Fund Natalia Kanem wrote, good is no longer good enough – let’s dig deeper. Let’s be ambitious, let’s be brave and let’s seize this opportunity to work for women and girls around the world.