Addressing barriers to accelerate

progress on SRHR in Asia Pacific

Professor Caroline Homer

@Caroline.homer
What we know

• Sexual and reproductive health and rights (SRHR)

are essential for sustainable development because
of:
o links to gender equality and women's wellbeing
o impact on maternal, newborn, child, and adolescent health
o roles in shaping future economic development and
environmental sustainability.
• Everyone has a right to make decisions that govern
their bodies, free of stigma, discrimination, and
coercion
o decisions include those related to sexuality, reproduction,
and the use of sexual and reproductive health services

Starrs et al. Guttmacher–Lancet Commission. Lancet 2018; 391: 2642–92

Photo by Mentatdgt
Is there still a problem?

• Each year in LMIC regions:

o >30 million women do not give birth in a health facility
o >45 million have inadequate or no antenatal care
o >200 million women want to avoid pregnancy but are not
using modern contraception

• Each year worldwide

o 25 million unsafe abortions take place
o >350 million men and women need treatment for one of
the four curable STIs
o nearly 2 million people become newly infected with HIV
o nearly one in three women experience intimate partner
violence or non-partner sexual violence
Starrs et al. Guttmacher–Lancet Commission. Lancet 2018; 391: 2642–92
Photo credit: Burnet Institute
• Between 49 million and 180 million couples worldwide are
affected by infertility, for which services are mainly available
only to the wealthy

• An estimated 266 000 women die annually from cervical

cancer even though it is almost entirely preventable

• Men also suffer from conditions, such as STIs and prostate

cancer, that go undetected and untreated because of social
stigma and norms about masculinity that discourage them
from seeking health care

Starrs et al. Guttmacher–Lancet Commission. Lancet 2018; 391: 2642–92

 … the last few months has been challenging

• Bushfire emergency

• COVID-19 response

• Black Lives Matter movement

• What does this time mean in maternity/perinatal/newborn

care?

• What has it meant and does it mean to be pregnant in 2020?

Blow and Wilson – MJA https://insightplus.mja.com.au/2020/24/in-this-
together-time-for-doctors-to-strive-for-social-justice/

Photo credit: Caroline Homer

Source: https://www.thelancet.com/action/showPdf?pii=S0140-
6736%2818%2930293-9
Source: https://www.rutgers.international/sites/rutgersorg/files/PDF/web-
Rutgers_ICPD%2B25%20report%2024.3.19.pdf
Barriers - inequalities and inequities
• Lack of
• access
• availability
• affordability
• acceptability
• Poor quality
• Limited opportunities

• Power imbalances and family violence adds to all

barriers

• COVID-19 has exacerbated all the barriers ….

SRHR during COVID-time

• “All countries must strike a fine balance between protecting

health, minimizing economic and social disruption, and
respecting human rights” (DG WHO, Dr Tedros)

• When health systems are overwhelmed, countries need to

make difficult decisions to balance the demands of responding
directly to COVID-19, while simultaneously engaging in
strategic planning and coordinated action to maintain
essential health service delivery
• The provision of many services will become more challenging
• Women’s choices and rights to sexual and reproductive
health care, however, should be respected regardless
of COVID-19 status

https://www.who.int/reproductivehealth/publi
cations/emergencies/COVID-19-SRH/en/
There is a lot of guidance – we
need to make sure it is getting
into practice
Principles during COVID-19 response

• Prioritize essential health services and adapt to changing

contexts and needs
• Optimize service delivery settings and platforms
• Establish safe and effective patient flow at all levels
• Rapidly optimize health workforce capacity
• Maintain the availability of essential medications, equipment
and supplies
• Fund public health and remove financial barriers to access
• Strengthen communication strategies to support the
appropriate use of essential services
• Strengthen the monitoring of essential health services
• Use digital platforms to support essential health service
delivery
WHO 2020
https://www.who.int/publications/
i/item/10665-332240
More generally

• Countries should incorporate the essential services

into universal health coverage, paying special
attention to the poorest and most vulnerable
people.
• Countries must also take actions beyond the health
sector to change social norms, laws, and policies to
uphold human rights.
• The most crucial reforms are those that promote
gender equality and give women greater control
over their bodies and lives.

Starrs et al. Guttmacher–Lancet Commission. Lancet 2018; 391: 2642–92

• Progress in SRHR requires confrontation of the
barriers embedded in laws, policies, the economy,
and in social norms and values—especially gender
inequality—that prevent people from achieving
sexual and reproductive health

• Improvement of people's wellbeing depends on

individuals' being able to make decisions about
their own sexual and reproductive lives and
respecting the decisions of others

Starrs et al. Guttmacher–Lancet Commission. Lancet 2018; 391: 2642–92

What can we do?

• Keep SRHR at the centre of focus

• Activate political will
• Promote, facilitate and enable advocacy
• Make the problem visible
• Collect and use data and evidence
• Focus on the most vulnerable and the most poor
• Promote, support and grow the health workforce
• Take opportunities – use COVID-19 as an
opportunity for reform and change
Thank you