Thirty years ago, the International Conference on Population and Development (ICPD), held in Cairo, Egypt, underscored the right of all individuals to achieve the highest standard of sexual and reproductive health and rights (SRHR). In 2004, WHO published a reproductive health strategy – ratified by 191 Member States at the Fifty-seventh World Health Assembly – that reinforced the centrality of SRHR to societies and economies (Resolution WHA57.12). These frameworks are grounded in gender equality and recognize the unchanging importance of sexual health in achieving health for all.
WHO researchers worked with Member States, civil society and communities across all regions to operationalize a Global Strategy to cover the five key pillars for improving SRHR:
- improving antenatal, perinatal, postpartum and newborn care
- providing family planning services
- eliminating unsafe abortion
- combatting sexually transmitted infections (STIs)
- promoting sexual health.
Resolution WHA57.12 further informed SRHR policies and guiding documents in several regions and Member States. For example, Latin America's 2013 Montevideo Consensus and Africa's Maputo Plan of Action from 2016 (building upon the original 2006 plan) both include language and ideas reinforcing and upholding SRHR.
"The global strategy is the foundational policy document that centres WHO's mandate for sexual and reproductive health to date," said Dr Pascale Allotey, Director of the UN Special Programme on Human Reproduction (HRP) and WHO's Department of Sexual and Reproductive Health. "The text remains important in contributing to guiding research priorities and working with countries to develop useful resources to ensure comprehensive SRHR across the life course."
Significant progress has been made over the last 20 years within each of the five pillars, including these examples.
- The Global strategy came about as the world was reeling from the HIV and AIDS epidemic. Today, the number of people acquiring HIV has fallen by 38% since 2010 alone, due in part to the Strategy's emphasis on eliminating STIs including HIV.
- As of March 2022, 60% of WHO Member States have included the human papillomavirus vaccine (HPV) in their routine immunization schedules, greatly advancing efforts to eliminate cervical cancer as a public health threat.
- Prioritizing family planning services and contraception access led to WHO's Family planning: a global handbook for providers reference guide, which has been disseminated over a million times. Accordingly, the proportion of women using modern contraceptive methods increased from 467 million in 1990 to 874 million in 2022, while a wider range of contraceptive options is now available.
A 2020 study found that there has been a worldwide decrease in unintended pregnancy. Furthermore, evidence-based medical abortion regimens have improved global access to abortion, and over 60 countries have liberalized abortion laws in the past 30 years in line with evidence on the importance of such efforts to ensure the health of women and adolescent girls.
Professor Kate Gilmore, co-chair of the Gender and Human Rights Advisory Panel of HRP, credited the Strategy and WHO for helping generate important scientific evidence on SRHR that has contributed to some of these shifts. "Some of the great advances that we've seen – including the way civil society has taken up the cause to argue for access to safe and legal abortion – are due to the Strategy and the systematic generation of evidence over these past two decades," she said.
Despite early gains, however, recent years have seen signs of stagnation. From 2000 to 2020, the maternal mortality rate dropped by 34% worldwide – but a 2023 report found that progress has largely stalled since. The worrisome trend was illustrated during a recent event showcasing global datasets on the evolution of SRHR since ICPD. High maternal mortality rates persist in a few countries and sexual health issues, such as endometriosis, infertility and sexual dysfunction, are often overlooked or normalized.
Dr Allotey and Dr Manjulaa Narasimhan, scientist at WHO and HRP, noted in a recent commentary in the WHO Bulletin that the SRHR agenda remains unfinished and in some instances has regressed due to geopolitical tensions, economic downturns, the global food crisis, climate change, humanitarian crises and COVID-19.
Sexual and reproductive health should never be relegated to the margins of healthcare, but recognized as critical for the overall well-being of individuals and the communities in which they live.
There are emerging opportunities to catalyse progress – for example, by enhancing human rights-based approaches in SRHR and embedding principles like non-discrimination, including in crisis situations. Improving health systems with a primary health-care approach can enhance equity and expand access to comprehensive SRHR services. New technologies and alternative service delivery approaches can improve SRHR by expanding access, choice and autonomy.
Other future-looking focus areas within SRHR include research on the transformative role of artificial intelligence and innovative contraception methods, further work on strengthening health systems, and the enduring prioritization of positive pregnancy and childbirth experiences.
At a broader level, Dr Allotey called for a continued emphasis on the foundational importance of SRHR. "Sexual and reproductive health should never be relegated to the margins of healthcare, but recognized as critical for the overall well-being of individuals and the communities in which they live," she said.
