Sexual and reproductive health and rights in changing health systems

Abstract

Sexual and reproductive health and rights (SRHR) are centrally important to health. However, there have been significant shortcomings in implementing SRHR to date. In the context of health systems reform and universal health coverage/care (UHC), this paper explores the following questions. What do these changes in health systems thinking mean for SRHR and gender equity in health in the context of renewed calls for increased investments in the health of women and girls? Can SRHR be integrated usefully into the call for UHC, and if so how? Can health systems reforms address the continuing sexual and reproductive ill health and violations of sexual and reproductive rights (SRR)? Conversely, can the attention to individual human rights that is intrinsic to the SRHR agenda and its continuing concerns about equality, quality and accountability provide impetus for strengthening the health system? The paper argues that achieving equity on the UHC path will require a combination of system improvements and services that benefit all, together with special attention to those whose needs are great and who are likely to fall behind in the politics of choice and voice (i.e., progressive universalism paying particular attention to gender inequalities).Keywords: sexual and reproductive health and rights; universal health coverage/care; quality of care; accountability; equity Introduction Sexual and reproductive health and rights (SRHR) are centrally important to health outcomes in all countries. Sex and reproduction define unique and specific health needs for girls and women over the entire life course. Whether, how and to what extent these health needs are met by the health system depends on the extent to which girls' and women's human rights are respected, protected and fulfilled. Throughout the life course, the sexual and reproductive rights (SRR) of girls and women -to bodily autonomy and integrity, to choice in relation to sexuality and reproduction, to freedom from coercion, discrimination and violence or fear of violence, to safety, satisfaction and pleasureprofoundly shape their physical and mental health and well-being.