In 1995, the 4th World Conference on Women (Beijing) for the first time recognised the right of women « to have control over their sexuality»[SI1] . Twenty years later, every woman should be able to make her own choices regarding her life, her body and her health. She should therefore have access to information and high quality services throughout her life as a teenager, as a woman and potentially as a mother. Every woman should be able to choose if and when she marries, whether or not she has children, how many she has and the space between them.
Every year, 47,000 women die as a result of unsafe abortions.
Although progress certainly has been made, notably with a 45% decrease in maternal mortality between 1990 and 2015, commitments on rights to sexual and reproductive health (SRHR) fall remarkably short worldwide: even this year, 225 million women who would like to delay or avoid pregnancy have no access to safe and reliable contraception. 287,000 women will die as a result of pregnancy related complications and 47,000 following an unsafe abortion.
Respect for human rights regarding sexuality and reproduction is fundamental in order to allow each individual, particularly women and girls, to have an active role in their own health, to have access to education and to fully participate in social and economic life.
The SRHR , the most intimate of human rights, are also a vital component of progress towards gender equality. While states have adopted a new international development programme for the next 15 years, the SRHR must be upheld and strengthened as keystone of sustainable development.
Sexual and reproductive health (SRH) is an all-encompassing concept, which includes sexual health and reproduction as well as maternal and neonatal health. It includes respect for the sexual and reproductive rights of each and every person: the right to have an enjoyable, safe and freely chosen sex life; the right of access to comprehensive family planning services; or the right to be free from sexual violence and physical harm.
Our framework of intervention
With regard to the difficulties individuals met in exercising their sexual and reproductive rights and the impact on public health, we took the decision to commit ourselves to the fight for universal access to SRH services. For this we are strengthening the continuum of care in SRH, in good quality community care structures and throughout the lives of the service users.
The implementation of these commitments is based on two types of complimentary actions: the provision of accessible, good quality holistic care and advocacy to promote the fulfilment of the sexual and reproductive rights of each and every person.
We pay particular attention to:
Promoting the prevention and management of unwanted pregnancies
Guaranteeing the response to SRH needs in emergency situations and in particular preventing and providing support in cases of gender based violence.
Promoting the prevention of cervical cancer.
CONTRACEPTION & ABORTION
Access to contraception
Too many young girls and women, especially in developing countries or amongst people in vulnerable situations have no control over their own sex lives: they have no access to contraception and, consequently, have no means of preventing an unwanted pregnancy. Doctors of the World actively supports the right of all women to be able to obtain safe and effective contraception (including emergency contraception) to avoid an unwanted pregnancy and to have access to a legal and safe abortion (IVG).
In all regions of the world, countries have tried or still try to limit access to abortion by adopting restrictive or repressive legislation. But this ban doesn’t reduce the number of elective abortions. On the contrary, it has the result of driving abortions underground and exposing the women who resort to them to serious to their health and their lives.
Our mobilisation translates into the strengthening of local health services and advocacy for sustainable progress in the rights of women and teenagers, and this in all the countries where we work including France. Doctors of the World is especially active with women in vulnerable situations. We work alongside actors from civil society and health professionals to enable the lifting of barriers which hinder access to sex education, safe and effective contraception and the management of unwanted pregnancies.
Emergency situations destabilise health systems. But they also exacerbate gender inequalities, and hence the vulnerability of women and young girls, who find it even more difficult to access healthcare which meets their needs and especially regarding sexual and reproductive health.
Gender related violence
Isolation, repeated forced displacement, or heavy casualties, promiscuity, the loss of livelihoods are all factors that can lead to an increase in disease, maternal and neonatal death, transmission of STI and HIV, unwanted pregnancies or gender related violence. A feeling of impunity amongst the aggressors is also an important factor which could explain an increase in violence.
As a medical player, Doctors of the World is committed to supporting SRH needs and denouncing violence experienced by people in emergency situations. We, along with other actors present bring a global and multidisciplinary response. We intervene both in conflict zones (notably in Syria, CAR, DRC, Colombia) and in natural disasters (as in Nepal).
As part of these interventions, right at the start of the humanitarian response, we work towards better integration of minimum SRH services and we alert policymakers to cases of obstruction of basic human rights (such as the right to physical integrity, safety, health…).
PREVENTION OF CERVICAL CANCER
Every year over 270, 000 women die from cervical cancer, a disease which could be avoided in the majority of cases, with appropriate testing. Over 85 % of these deaths occur in poor and developing countries with inadequate access to testing and treatment. Prevention, detection of precancerous lesions, followed by appropriate treatment when necessary are essential for the prevention of the 530,000 new cases of cervical cancer diagnosed each year and those which are not.
In France, we promote access to smear tests for women suffering social exclusion or vulnerability. In 2016, we will develop operational research during which information and prevention sessions on sexual health and cervical cancer will be provided. Following these sessions, an HPV (the virus responsible for the development of cervical cancer) self- sampling kit may be handed out. The objective of this approach is to provide the tools facilitating access to information and to first-line testing.
This issue will be further embedded in our international projects over the coming months.