The right to adequate health care, and sexual and reproductive health, is a basic human right and is acknowledged as such in the Beijing Platform for Action.
It is important to clarify what is meant by a rights-based approach in relation to health. Among other things, it includes the availability, accessibility and affordability of services to meet people's needs; access to information provided in a confidential setting, and appropriate technologies and resources necessary for women to make their own decisions and choices regarding their health throughout their lifetimes. Services and education must be based on the right to dignity, respect and self-determination.
Despite the fact that national plans of action in the post-Beijing period place health policy and resource allocation high on their agenda, countries in the region have not succeeded in making a breakthrough in providing adequate access to comprehensive health care for all women. In part, this is a result of the globalization of economies and national financial and political crises, which have contributed to worsening feminization of poverty. Declines in public health spending have cut health coverage for poor women, home-based/informal sector women workers, women farmers and women heads of household, especially where individuals/employers are expected to bear the health costs. Government health budgets are decreasing to well below the WHO recommendations of at least five per cent of GNP.
For the above reasons, I wish to highlight and expand upon the critical health issues and recommendations in relation to rights that emerged from the report of the Asia-Pacific NGO Symposium held August 31st to September 4th in Bangkok.
Recommendations
Governments must reassess their viewpoints and acknowledge the benefits of a rights-based approach to the health status of women, young and old alike. More dialogue between governments, NGOs, health professionals, and UN agencies on human rights, women's rights and health, has to be initiated, particularly at a regional level, which will help expand national perspectives and build technical capacities to implement a rights-based approach.
Health professionals and their respective associations must continue to work on incorporating women's rights in the ethics or charters of their health practices, on improving their interaction with women clients and women's access to health information and gender-sensitive services, and on advocacy regarding the rights approach to health with government.
Governments must redouble their efforts to provide health care to women with special health needs, including adolescents and young women, older women, women with disabilities, migrant workers, refugees, other displaced women in need of international protection, and internally displaced women.
There is a need for global and national policies to take on more balanced approaches to globalization within the framework of health as a human right. These must ensure (1) that a good balance between promotive, preventive and curative services and between primary, secondary and tertiary care exists/persists; (2) equitable access to a well-functioning health care system; (3) efficiency in providing services at reasonable cost; and (4) financial viability in generating revenues through a mix of different approaches.
Reproductive health services need to be expanded from a primary focus on family planning to the right to reproductive and sexual health services and other key areas of women's health. These include nutrition, the prevention and treatment of communicable diseases including HIV/AIDS and other STDs, reproductive cancer screening and treatment, treatment of spontaneous and unsafe abortion, morbidity due to pregnancy and childbirth, sexual violence, mental health and other necessary but neglected areas.
In order to reduce the high number of maternal deaths due to unsafe abortions in the Asia-Pacific region, women must have informed access to a wide range of contraceptive methods. In unfortunate cases where abortion is necessary, it should be available and safe for all women and well linked to other reproductive health services. In expanding the focus on reproductive health, a cost-effective, rights-based public health approach must be taken. The rational use of safe, affordable and effective medicines must be ensured based on an essential drug policy as recommended by the WHO. Furthermore, services which presently focus on women of reproductive age need to be extended to older and younger women whose needs are just as great and often, much more neglected.
Young people's right to reproductive health services and sexuality education needs to be recognized as part of human rights. Young people in the ICPD Youth Forum in The Hague emphasized that the rights of young people are no different from those of adults and that young people have the right to be listened to, their needs for services/education met, and to be involved in the planning, implementation and evaluation of reproductive health services.
