ABSTRACT
It was the second part of this definition that was slightly amended for inclusion in the eventual ICPD Programme (United Nations 1994). Considering the importance now being attached to sexuality and sexual health, it is striking that, apparently, no further elaboration of the definition of sexual health took place in the 20-year period between the publication of the Technical Report and the ICPD Programme. And despite the fact that the ICPD Programme included sexual health in reproductive health, by far the lion’s share of attention in policies and programmes following ICPD – at least in the developing world – continued to be given to the aspects of reproductive health that had been historically accepted: maternal and child health and family planning. At the level of international development assistance, sexual health as just defined has not been a target of support per se. Why was this? There are several lines of argument that I will explore here. The first relates to the international political environment that influenced the entire casting of the ICPD Programme of Action. Growing concerns during the 1960s about the population explosion described in best-selling publications such as Paul Ehrlich’s The Population Bomb (1968) and the Club of Rome’s Limits to Growth (Meadows et al. 1972), led to an unprecedented investment during the end of the 1960s and the 1970s in population control through support to family planning
programmes (Dixon-Mueller 1987). It was assumed that the substantial distribution of contraceptives to women in developing countries would inevitably have an impact on population growth. Large campaigns were often undertaken to sterilise women in some Latin American countries and both men and women in India, or to bring implantable contraceptives to women in Indonesia through ‘safaris’ in which buses were driven out to the rural areas and women rounded up for the insertions (Isis 1984). That these campaigns were often coercive started to be documented by the emerging international women’s health movement (Hartmann 1987; GarciaMoreno and Claro 1994), which led to a serious questioning of the impact of ‘international development’ on women’s health and rights. Women’s health advocates argued that women needed ways of regulating their fertility, yes, but this would only become acceptable when they knew they could go through pregnancy and childbirth safely, and have their children survive. Women’s health and lives could not be reduced to stopping pregnancy occurring. At about the same time, the first global estimates of maternal mortality appeared (AbouZahr and Royston 1991) showing that more than 500,000 women died each year in pregnancy. This hitherto unnamed scandal – women dying, not from a disease but in the act of producing life – was placed high on the international agenda of both the women’s movement and the international development community. Thus, the ICPD Programme was seen as an essential platform for creating a major paradigm shift: from population control to reproductive health. The latter was formulated to be ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes’ (United Nations 1994: paragraph 7.2). The definition goes on to state that reproductive health:
[T]herefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate healthcare services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.
