In 1994, 179 UN member countries made a visionary commitment in Cairo at the International Conference on Population and Development (ICPD). Amidst sustained advocacy by 30,000 NGO representatives, delegates came to a negotiated consensus that individual health and wellbeing, the protection and promotion of human rights, and the advancement of sexual and reproductive health (particularly of girls and women) would form the cornerstones of population and development policies and programmes. Twenty years on, despite considerable but uneven progress in certain areas such as maternal health (globally, a 45% decline in maternal mortality ratio from 1990 to 2013), and poverty reduction, the the Cairo agenda remains unfulfilled. For example, almost half (48%) of induced abortions in 2008 were unsafe, accounting for 13% of maternal deaths; worldwide 225 million women have an unmet need for contraception; early and forced marriage continues to plague the lives of girls; and the majority of adolescents and youth do not have access to comprehensive sexuality education and youth friendly sexual and reproductive health services. Last week, at the 48th session of the Commission on Population and Development (CPD) at the UN headquarters in New York, youth and women’s rights activists reminded delegates once again that gender equality and a rights based approach to sexual and reproductive health are central to any agenda that aims for sustainable development.

The current draft of the Open Working Group’s Sustainable Development Goals (SDGs) retains two distinct and inter-connected targets within the goals of ensuring healthy lives (3.7) and gender equality (5.6) that address SRH service provision and reproductive rights respectively. If these, and other targets that respond to the reality of girls’ and women’s’ lives (elimination of all forms of violence, elimination of harmful practices including early and forced marriage, and the recognition that girls and women do the bulk of unpaid and domestic work) remain in the final negotiated document, then there is real potential for governments to create enabling environments for girls and women to freely and fully exercise their rights.

So, what would it take for any government to uphold the sexual and reproductive health (SRH) and rights (SRHR) of its citizens? Among other things, this would necessitate:

a) Directing sufficient financial investments into all aspects of sexual and reproductive health.

b) Amending restrictive laws (such as those that criminalise abortion or consensual sexual relations) that affect SRHR to bring them in line with international human rights standards.

c) Developing healthcare policies that respond to the specific SRH needs of adolescents (especially girls) and women, and that respond and address structural barriers that lead to inequalities in access.

d) Providing an integrated package of accessible sexual and reproductive health services, including family planning, maternal healthcare, treatment of sexually transmitted infections (STIs) and reproductive tract infections (RTIs), comprehensive sexuality education for all adolescents, safe abortion, prevention and treatment of cancers of the reproductive system, and infertility.

e) Monitoring the process and pathways (for example: how is the service being delivered? Is it of adequate quality?) and the outcomes of service provision (understanding not only how many are benefitting, but which groups are left out) will help track progress, remedy gaps and reduce inequalities in access.

The 2014 Adding It Up  report by the Guttmacher Institute and the United Nations Population Fund (UNFPA ) estimates that the provision of sexual and reproductive health services to every woman in the developing world will cost 39.2 billion US dollars annually. If this seems like a lot, then consider this: the defence spending of the United States in 2013 alone was 15 times this proposed amount. Such an investment would save lives; allow girls and women to exercise their right to choose if, when and how many children to have; and reduce ill-health related to complications of pregnancy, childbirth, unsafe abortion, and STI’s and RTIs. In the larger context of development, fulfilling human rights with respect to sexual and reproductive health will facilitate greatly improved educational, economic, social and political outcomes for girls and women. If the international community is serious about re-distributing power and resources more equitably and promoting inclusive economic growth, then to begin with, all women and girls need to have autonomy over their own bodies.