This document discusses the limitations of the Millennium Development Goals (MDGs) in achieving comprehensive sexual and reproductive health and rights. It summarizes that while the 1994 International Conference on Population and Development (ICPD) took a human rights-based approach, the MDGs adopted in 2000 focused only on narrow, target-oriented technical solutions like reducing maternal mortality. For India in particular, gains made after ICPD to expand reproductive health were reduced under the MDGs to only monitoring maternal mortality and skilled birth attendance. The document calls for a post-2015 agenda that places sexual and reproductive health and rights within the social determinants of health and emphasizes economic and social justice in service delivery.

1. MDG 5 : Whither Reproductive
and Sexual Health and Rights?
Renu Khanna
Expert Group Meeting
Structural and policy constraints in achieving the
MDGs for women and girls
(UN Women – ECLAC)
Mexico City, Mexico
21-24 October 2013

2. MDGs a betrayal of comprehensive
SRHR commitments?
• ICPD – 1994
– Human Rights based
– Defined Reproductive Health – through the
woman’s life cycle
• Beijing PfA – Sexual Health and Rights
• Millennium Development Goals – 2000
– Narrowed it to target oriented approaches
– Technical solutions

3. MDG 5 - Improve Maternal Health
• Originally, Target 5a – Reduce by three quarters,
between 1990 and 2015, the maternal mortality ratio
– Proportion of births attended by skilled health personnel
• Revised in 2005 - Target 5b - Achieve, by 2015,
universal access to reproductive health
– Contraceptive prevalence rate
– Adolescent birth rate
– Antenatal care coverage (at least one visit and at least four
visits)
– Unmet need for family planning

4. In India, gains after ICPD reduced to…..
Reproductive health
MMR
Skilled birth attendant
Institutional delivery
Cash Incentive
JSY

5. Reporting on expanded list?
Government of India response…..
• decided to monitor only the MMR and proportion of
births attended by Skilled Birth Attendants.
• No explanation of why Contraceptive Prevalence
Rate, Adolescent Birth Rate, ANC and Unmet Need
for Family Planning are not actionable indicators or
considered ‘strategic’ or ‘contextually relevant’ for
India! Although we routinely collect data on these
indicators…
An accountability issue?

6. Issues around Indicators
• Skilled birth attendance, Institutional deliveries, or ‘Safe’
deliveries?
• Post Natal Care?
• Access to safe abortion services?
• Access to Emergency Obstetric Care?
• Universal access to reproductive health care – what about
–
–
–
–
–
Morbidities like fistulas, genital prolapses,
Prevention and treatment of RTIs/STIs/HIV and AIDS
Reproductive cancers
Infertility
Mental Health issues – PP depression, anxiety and depression
around proving ‘right’ kind of fertility, violence
– Comprehensive sexuality and relationship education

7. Issues around ‘Siloisation’
• MDG 1 and MDG 5 – aggregates don’t reflect
inequities, malnutrition, anaemia in women and girls a
determinant of maternal health
• MDG 3 and MDG 5 – women’s empowerment leads to
better maternal health outcomes
• MDG 6 and MDG 5 – Malaria in Pregnancy, TB in
pregnant women can have fatal outcomes. Maternal
health issues of women living with HIV?
• MDG 8 and MDG 5 – women’s access to essential
medicines?
• Verticalisation – RH (no SRH) and HIV/AIDS (only SH no
RH) !

8. POST 2015, WOMEN’S HEALTH
AGENDA

9. Principles (Langkawi Report 2010)
• Locate SRHR within macroeconomic influences on Health –
role of global capitalism, GHIs, increasing privatisation and
commodification of health
• Locate women’s health within a social determinants
perspective
• Emphasise economic and social justice perspective for
service delivery
• Emphasise strengthening of health systems to address
SRHR within primary health care
• Use General Comment 14 (Article 12 of ICESCR), UN HRC
June 2009 on preventing maternal mortality and morbidity
• Ensure participation of affected groups in agenda setting
and holding duty bearers accountable

10. ARROW - additional indicators for
MDG 5.
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•
•
•
•
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Adult lifetime risk of maternal death
Maternal deaths due to violence against women
Availability of Emergency Obstetric Care (EmOC) services
Met need for EmOC services
Legal age of marriage vs. Median age of marriage
Accessibility and quality of adolescent - and youth - friendly
SRH services
• Reasons for non-use of contraception
• Provision of informed choice
• Percentage of women of reproductive age irrespective of
marital status using a preferred contraceptive method of
their choice

11. Additional Recommendations for
Policy and Programme
• Include focus on maternal morbidity. Develop standard
definitions and mechanisms of reporting. Improve data on
incidence and prevalence of maternal morbidities through
large surveys like NFHS, DLHS, AHS. Initiate maternal
morbidity audits to obtain stronger burden of disease
estimates.
• Integrate Maternal Health, Reproductive Health, and Family
Planning. Undertake a systematic analysis to remove the
conceptual separation between these areas as well as to
work out the operational aspects of integration.
• Improve Post-partum care including provision of
contraceptive services in a rights respecting manner.

12. • Enhance male responsibility – contraceptives,
prevention of VAW. Transformatory masculinities.
• Ensure linkages between community level health
care provision and women’s groups at the
grassroots, with an aim of increasing health
literacy, organising for prevention of violence
against women, and increasing awareness of
health entitlements.
• Operationalise a rapid health care response for
women affected by violence
And most importantly
• Ensure accountability at all levels – including of
Global Health Initiatives and provision for
community monitoring, grievance redressal

13. Acknowledgements
• This presentation derives from
– MDG 5 in India: Whither reproductive and sexual rights?
Expert paper prepared by Renu Khanna (SAHAJ – Society
for Health Alternatives India). 2013.
– Breaking Through the Development Silos: Sexual and
Reproductive Health and Rights, Millennium Development
Goals and Gender Equity: Experiences from Mexico, India
and Nigeria. DAWN. 2012
– Repoliticizing sexual and reproductive health & rights: a
global meeting, Langkawi, Malaysia 3–6 August 2010.
Reproductive Health Matters and Asian-Pacific Resource &
Research Centre for Women. 2011
– Women’s Health in India Post 2015 - Policy Brief (Draft),
Renu Khanna, Dr. B SubhaSri, CommonHealth. 2013