Freedom to Choose
Sexual and Reproductive
Health and Rights
in Finland’s
Development Policy
MINISTRY FOR FOREIGN AFFAIRS OF FINLAND
Content
4
The Concept of Sexual and Reproductive Health
and Rights (SRHR)
6
Finland’s Efforts to Promote Sexual and
Reproductive Health and Rights
8
9
11
12
14
17
18
19
20
21
22
23
24
25
26
Population Growth and Development: Future Trends
Sexuality Education Matters
Replacement Level Fertility
Sexual and Reproductive Health and Rights (SRHR)
Maternal Health
Women’s Health Issues
Violence Against Women
HIV and AIDS
Economy and Poverty
Population Politics is Environment Politics
Gender Equality and Men
Sexual Orientation and Gender Identity
Culture and Religions
Terms
Sources
Layout: Innocorp Oy/Milla Toro • Printed by: Erweko Painotuote Oy, 2010
Introduction
Sexual and Reproductive Health and Rights (SRHR) are an important element in
Finnish human rights policy and in Finnish development policy and cooperation.
This brochure aims to answer the following questions:
●● What sexual and reproductive health and rights mean
●● Why sexual and reproductive health and rights are important and
●● How sexual and reproductive health and rights relate to other development issues,
such as poverty and climate change.
The goal of Finnish development policy is economically, socially and ecologically sustainable
development. This goal is pursued by following the guiding principles of coherence,
complementarity and effectiveness. Finnish development policy is grounded in a human
rights based approach. When population issues and sexual and reproductive health and
rights are considered, attention is paid to the two-way link between the environment,
natural resources and economic development. In the view of Finland, the links between
demographic trends and poverty are diverse; it isn’t simply a cause and effect relationship.
In its development cooperation, Finland emphasizes the right of adolescents and young
people to services and information on sexual and reproductive health and rights, education
of children – especially education of girls – and improvement of women’s opportunities
to exert influence as well as men’s participation and responsibility in matters pertaining to
sexual and reproductive health and rights. n
FREEDOM TO CHOOSE
3
The Concept of Sexual and
Reproductive Health and Rights (SRHR)
Over the years, sexual and reproductive
health and rights have developed towards
a human rights based approach. The same
approach is also the basis of Finnish development
policy. The realization of sexual and reproductive
health and rights means that everyone has the
right to health, the right to decide whether or
not, how and when to have children, and the
right to have control over and decide freely and
responsibly on matters related to their sexuality.
The right of each individual or couple to make
family planning choices has been widely
accepted and seen as valuable ever since the
United Nations Conference on Human Rights
in Teheran in 1968. Among the most significant
milestones in sexual and reproductive health
and rights are the International Conference on
Population and Development held in Cairo in
1994 and the Fourth World Conference on the
Status of Women held in Beijing in 1995. These
Conferences broadened the concept of family
planning to include the right to better sexual and
reproductive health.
At the International Conference on Population
and Development, 179 nations stated that
population and development are inextricably
linked. It was also agreed that women’s
empowerment and meeting people’s education
and health needs, including reproductive health
needs, are imperative for promoting both
individual rights and balanced development.
Moreover, the Conference in Cairo adopted
a 20-year Programme of Action focusing on
individuals’ rights and needs, known as the
Cairo Programme of Action, which
includes a number of important
population and development goals
for the international community.
The Fourth World Conference on
the Status of Women held in Beijing
dealt with such issues as poverty,
health, education, economics, human
4
FREEDOM TO CHOOSE
rights, gender-based violence, the environment
and the special status of the girl child. At
the end of the Conference, the delegations
unanimously adopted the Beijing Declaration
and Platform for Action to advance equality,
development and peace. The Conference
focused on assessing the global situation from
the perspective of women while the Platform
for Action identified twelve fields of activity, for
which strategic goals were set.
In addition to the Conferences in Cairo and
Beijing, the Millennium Development Goals
(MDGs) are also closely associated with
sexual and reproductive health and rights, as
these frameworks reinforce one another. At
the Millennium Summit held in 2000, the 189
nations then Member States of the United
Nations adopted the Millennium Declaration, on
the basis of which the Millennium Development
Goals were drafted. The Millennium Declaration
and the Millennium Development Goals together
constitute an agreement whereby the UN
Member States, UN agencies and international
financial institutions set the rules for international
cooperation. The year 2015 was specified as
the deadline for attainment of the Goals. The
Millennium Development Goal most closely
linked with sexual and reproductive health and
rights is Goal 5: Improve maternal health and its
two targets: Target 5A: Reduce by three quarters,
between 1990 and 2015, the maternal mortality
ratio; and Target 5B: Achieve, by 2015, universal
access to reproductive health. n
United Nations
Population Fund (UNFPA)
UNFPA is an operative development
organization of the UN. UNFPA’s
mandate is to support Member
States in areas of population policy
and reproductive health. The central
mandate of UNFPA is the realization of
development goals related to population
dynamics and reproductive health.
Within UNFPA’s work, Finland
prioritizes the promotion of reproductive
health – especially that of young people
– gender equality, improving men’s sense
of responsibility, eradicating violence
against women and girls, and ensuring
girls’ rights.
Finland supports UNFPA primarily
through core funding. Finland’s
contribution has increased rapidly over
the last few years. In 2008 it was 16
million euros; it rose to 21 million euros in
2009 and in 2010 it is 25 million euros.
Since 2000, Finland has been the eighth
biggest donor. In addition to core funding,
Finland has given thematic support to
UNFPA, for example, for a project on
reproductive health for young people. n
FREEDOM TO CHOOSE
5
Finland’s Efforts to Promote Sexual
and Reproductive Health and Rights
Recognition of the interdependence
between human rights, development and
security has long been included in Finland’s
foreign and security policy. The priorities
of Finland’s human rights policy are the
advancement of women’s rights, the rights of the
child, the rights of persons with disabilities, and
the rights of sexual and gender minorities and
indigenous peoples. Sexual and reproductive
health and rights, and the recognition of these
rights as an element of human rights, are
mentioned under women’s rights because more
work needs to be done in that area, but sexual
and reproductive health and rights apply equally
to men.
Finland fully supports the goals of the Cairo
Programme of Action and considers that the
availability and good quality of reproductive
health and family planning services are pivotal
in reducing both poverty and maternal and
child mortality and in preventing HIV infections.
Finland is equally committed to the Beijing
goals and Platform for Action, and Finland’s
contribution to the advancement of women has
been significant. The broad-based view of sexual
and reproductive health and rights has gained
international recognition, thus highlighting
the long-term commitment to and
openness of these efforts.
Finland works actively to make
the Yogyakarta principles
known and to increase their
prestige. The Yogyakarta
principles, defined by a human
rights expert meeting held
in Indonesia in 2006, state
that sexual minorities, though
not explicitly mentioned in
Conventions, are unambiguously
entitled to universal human rights,
including sexual rights.
Finland especially emphasizes support
for and development of health systems.
Sexual and reproductive health services –
6
FREEDOM TO CHOOSE
including HIV services – should be part of a
country’s primary health care services. On the
basis of the country’s own experience and
expertise, for example in the development of
maternal and child clinics, Finland has much
to offer in this field. Equality, girls’ school
attendance, comprehensive sexuality education
for young people, extensive reproductive health
services, and maternal and child clinics all result
from the fact that these issues have been
considered important and worthy of investment.
Finland supports the advancement of sexual
and reproductive health and rights through
development cooperation funds allocated
primarily through the UN system. Most of
the support is directed to the United Nations
Population Fund (UNFPA). In addition to
UNFPA, Finland works with the World Health
Organization (WHO), UNICEF and the Joint
United Nations Programme on HIV/AIDS
(UNAIDS).
About a fifth of all Finnish development
cooperation funds is channeled through the
European Union. The combined share of the EU
and its Member States comprises about half of
all Official Development Assistance (ODA). The
EU has been particularly concerned about the
sexual and reproductive health of young people
in developing countries. High maternal mortality,
the lack of safe and dependable reproductive
health services, low awareness and the spread
of the HIV pandemic weaken efforts to reduce
poverty and to build a foundation for sustainable
development. Through the development
cooperation it carries out, the EU strives to find
solutions to these problems.
Many Finnish NGOs, including the Family
Federation of Finland, Fida International, Finn
Church Aid, Plan Finland, the International
Solidarity Foundation, the Finnish Red Cross
and World Vision Finland, are the Ministry’s
development cooperation partners. In addition,
with the support of the Ministry for Foreign
Affairs, the Academy of Finland has funded
sexual and reproductive health and rights
research in developing countries. n
FREEDOM TO CHOOSE
7
Population Growth and Development:
Future Trends
The UN estimates that the world population will
grow from the current 6.8 billion to about 9.3
billion by 2050. Most of this increase will take
place in developing countries. The number of
people of reproductive age and the decisions
they make about the number of children they
wish to have influence population growth.
Fertility has already started to decrease in the
developed countries but is still on the rise in
many developing nations. The fertility rate in the
42 least developed countries is more than four
children per woman.
and the fertility rate are also important. The
number of people living in urban areas exceeded
the number of people living in rural areas for the
first time in 2008. By 2050, 70% of the world’s
population will live in urban areas. n
The number of people is not the sole factor
posing challenges to development. The
demographic makeup, geographic positioning
Population Growth by region, 1950 to 2050. (in billions)
10
8
6
Other less developed countries
4
2
0
1950
Least developed countries
More developed regions
1960
1970
1980
1990
2000
2010
Source: UN Population Division. World Population Prospects: The 2008 Revision.
8
FREEDOM TO CHOOSE
2020
2030
2040
2050
Sexuality Education Matters
The current generation of young people –
people who are or will soon be of reproductive
age – is the largest that has ever lived on this
planet. The need for information on sexuality and
on the prevention of unwanted pregnancies and
sexually transmitted infections is enormous. In
addition to accurate information, the availability
of contraceptives is essential. Traditionally,
contraceptive methods have only been available
to couples but, as stated in the Millennium
Development Goals, access must be guaranteed
to all. Special emphasis should be placed on
female initiated contraceptives such as the
female condom.
consequent cuts in sexuality education given
at school are thought to be one cause of the
increases in abortions and sexually transmitted
infections observed after a long period of
decline. In 2004, health and sexuality education
was reinstated as a mandatory subject at school.
The right to privacy is extremely important
when it comes to sexual health services. This
consideration applies especially to young people,
who expect health care professionals to provide
All too often, young people still remain without
the information, services and methods
needed in order to make responsible
decisions regarding sexual and
reproductive health and whether or not
to have children. Political commitment
to taking the needs of young people
into account is a crucial factor.
Investing in young women and girls
is one of the most cost-effective
and influential ways to promote
global development goals.
In Finland, sexuality education
was intensified in the 1970s and
1980s. As a result, the sexual health
knowledge of young people improved,
which decreased the number of abortions.
National guidance on sexuality education was
reduced after the recession in the 1990s. The
FREEDOM TO CHOOSE
9
...Sexuality Education Matters
services and support for independent decisionmaking in a confidential manner. One way to
reach young people is through websites that
have information on sexuality related issues. In
Finland, the Family Federation of Finland, among
others, maintains a website where questions
can be asked anonymously and visitors can chat
with experts live. This model could be applied
elsewhere, too.
The number of young people is huge and
therefore their health, their level of knowledge
and their choice of occupation and family
are of crucial importance. These choices are
pivotal both to the world’s economic and social
development and for the future of population
growth. n
10
FREEDOM TO CHOOSE
Information in Nicaragua
In Nicaragua, Finland supports a sexual
and reproductive health project that is
targeted especially at young people.
The project advances reproductive
health related rights and equality
throughout the country and creates
an atmosphere favorable to them.
The project enhances young people’s
knowledge of reproductive health,
improves the possibilities for youth
participation and develops youth services.
Communication plays a central role in
achieving these goals.
The partners include the Ministry
of Health of Nicaragua, the Institute
responsible for gender work, the police
and the army. The Catholic Church and
other churches as well as human rights
and other NGOs are collaborators.
In addition to funding from Finland,
the project receives funds from The
Netherlands, Denmark and the United
Nations Population Fund (UNFPA).
UNFPA is responsible for implementation
of the project. n
Replacement Level Fertility
The total fertility rate of the world
population in 2008 was 2.5. This means
that, on average, a woman will have two and
a half children in her lifetime. In industrialized
countries the average number of children is 1.6
(1.8 in Finland), while in developing countries
it is 2.7. In the least developed countries, the
figure can be as high as 4.6. Variation can be
great both between and within countries. In all
countries, poor women have more children than
richer ones.
It is estimated that we will soon reach
the replacement level fertility milestone.
Replacement level fertility means that the
number of people remains the same. This will
be one of the most noteworthy changes in
population growth. If the current pace continues,
the UN estimates that population growth will
stabilize after 2050.
All countries are shifting from high mortality and
fertility to low mortality and declining fertility, but
countries are in different phases of this shift.
Fertility has dropped below the replacement
level in 86 countries. Total fertility rate will
continue to drop in developing countries as well
if we manage to expand the availability of family
planning services. n
Average number of children
per woman
7
6
5
6.1
5.1
4
4.0
3
3.0
2.8
2
2.3
1
0
Sub-Saharan
Africa
South-Central
Asia
1990–1995
Latin America/
Caribbean
2005–2010
Source: UN Population Division. World Population
Prospects: The 2008 Revision.
A decline in fertility has various effects:
●● Declining fertility changes the population’s age structure, thereby increasing the number
of working people in relation to children and elderly people
●● Declining fertility makes it easier for women to work and this increases the workforce
●● Households are economically better off as there are fewer dependents, i.e. children and
elderly people
●● Low fertility enables faster accumulation of personalPyöristys
capital
2 mm
FREEDOM TO CHOOSE
11
Sexual and Reproductive
Health and Rights (SRHR)
It is important to use the terms sexual
health and sexual rights. This emphasizes
that sexuality isn’t limited only to reproduction.
The two dimensions – sexuality and reproduction
– are so closely linked that they should be
considered together. The term sexual and
reproductive health and rights covers both
dimensions.
Sexual and reproductive health includes all
health issues pertaining to sexuality, such as the
possibility to use modern, reliable contraceptive
methods, the prevention of and care for
sexually transmitted infections, monitoring
and care during pregnancy and childbirth and,
when needed, the option for safe abortion.
Reduction of violence and harmful practices is
12
FREEDOM TO CHOOSE
also a fundamental part of sexual health. Many
factors influence sexual health, ranging from
sexual behavior, attitudes, and societal factors
to biological risks and genetic vulnerabilities.
Sexual health encompasses the problems of
HIV, AIDS and sexually transmitted infections,
unwanted pregnancies and abortion, infertility,
cancers and sexual dysfunctions. Sexual
health necessitates a positive and respectful
attitude towards sexuality and sexual relations.
Sexual health also means that people have
the opportunity to have a safe and satisfying
sex life. Sexual health is “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”.
(Cairo Programme of Action, 7.2.)
One of the most significant achievements of the
Beijing Conference was the fact that the Platform
for Action guarantees everyone the right to free
command of their own sexuality. “The human
rights of women include their right to have
control over and decide freely and responsibly
on matters related to their sexuality, including
sexual and reproductive health, free of coercion,
discrimination and violence”. (Beijing Platform
for Action, point 96.)
The term sexual rights commonly refers to
the Declaration issued by the International
Planned Parenthood Federation in 2008 (Sexual
Rights: an IPPF Declaration). The sexual rights
named in the Declaration are based on the UN
Universal Declaration of Human Rights and
other international conventions. Sexual rights are
seen as belonging to everyone. Both individuals
and couples have the right to make conscious
and responsible decisions on matters regarding
their own sexuality, including the choice to enter
into an intimate relationship, having a family and
preventing sexually transmitted infections and
unwanted pregnancies. These rights must not
be restricted through pressure, discrimination or
coercion. n
Sexual Rights
Article 1 The right to equality, equal
protection of the law and freedom from
all forms of discrimination based on sex,
sexuality or gender
Article 2 The right to participation for all
persons, regardless of sex, sexuality or
gender
Article 3 The rights to life, liberty, security
of the person and bodily integrity
Article 4 The right to privacy
Article 5 The right to personal autonomy
and recognition before the law
Article 6 The right to freedom of thought,
opinion and expression; right to association
Article 7 The right to health and to the
benefits of scientific progress
Article 8 The right to education and
information
Article 9 The right to choose whether or
not to marry and to found and plan a family,
and to decide whether or not, how and
when, to have children
Article 10 The right to accountability
and redress
FREEDOM TO CHOOSE
13
Maternal Health
Every minute, a woman dies of preventable
pregnancy and childbirth related causes. This
adds up to half a million women per year. Even
more women are disabled by complications
during delivery and unsafe abortions. Pregnancy
and childbirth continue to pose a major risk
for women, especially in developing countries.
Pregnancy-related problems are still the number
one cause of death among 15 to 19 year-old
women. Monitoring the health of a pregnant
woman is one the best ways to avoid pregnancyrelated complications, as it is difficult to predict
the occurrence of problems during pregnancy
and delivery.
Up to 40% of women’s health problems in
developing countries are associated with sexual
health. Maternal clinics and the services they
provide hold the key to reducing this number.
The low maternal mortality rates of Finland
Where is our attention?
500,000
women per year =
3 jumbo jets full of
women crashing
every day
14
FREEDOM TO CHOOSE
and many other countries are proof that easily
available services with good coverage lead
to low maternal mortality rates. The creation
of maternal and child clinics has had a huge
impact in Finland. In 1944, when the law on free
maternal and child clinics was passed, the child
mortality rate in Finland was 6.8%. In ten years
it had dropped to less than half, and was 3% in
1954. Since then it has been declining steadily
and in 2008 it was 0.26 % – one of the lowest
in the world.
Maternal deaths per 100,000
live births, 1990 and 2005
Sub-Saharan Africa
Southern Asia
620
490
Oceania
550
430
South-Eastern Asia
The possibility to choose the timing and spacing
of children also affects women’s health and
the safety during pregnancies, since overly
frequent deliveries can endanger a woman’s
health. Women cannot always decide the timing
and spacing of children; decisions are made,
for example, by the spouse or the in-laws. The
need for modern contraceptives is estimated to
rise by 50 to 70% by 2020. At present, there
are still about 200 million women in the world
who would like to use contraception and decide
on the timing of children but do not have the
opportunity to do so. The reason for this may be
lack of knowledge or the low quality and poor
availability of services and/or contraceptives.
The price of contraceptives and/or services, too,
can be an obstacle; poor families do not have
the resources to prevent unwanted pregnancies.
920
900
300
450
Western Asia
190
160
Nothern Africa
160
250
Latin America & the Caribbean
180
130
CIS
58
51
Eastem Asia
50
95
Developed regions
11
9
Developing regions
0
100 200 300 400 500 600 700 800 900 1000
1990
2005
2015 target
1990
Source: The Millennium Development Goals Report 2009
2005
2015 target
FREEDOM TO CHOOSE
15
...Maternal Health
It is important to care for women’s health during
and after conflict or humanitarian crises. There
are tens of millions of refugees and internally
displaced people in the world; three quarters of
them are women and girls, of whom about one in
five is pregnant. Overlooking reproductive health
in crisis situations has severe repercussions,
such as unplanned pregnancies, rape, the spread
of sexually transmitted infections and permanent
disabilities or deaths due to unsafe abortions or
unsafe deliveries. Despite these facts, delivery
services are rarely taken into account when
reacting to crises. Provision for sexual health
service needs in refugee camps, during conflicts,
after natural disasters or in post-conflict
countries is either poor or nonexistent. Lack of
health services or the proper instruments means
a much greater risk that the woman may die or
be disabled during delivery. n
16
FREEDOM TO CHOOSE
Mother-Child Health Care
in Afghanistan
Finland has supported an integrated
reproductive health/mother–child health
care project in Afghanistan through Marie
Stopes International (MSI) since 2002.
Maternal mortality in Afghanistan is
the second highest in the world; about
17,000 women die every year due to
complications of pregnancy. Nine out
of ten deliveries take place at home,
usually assisted by traditional midwifes
or family members. NGOs play a central
role in health care, as over 80% of all
health care in Afghanistan operates with
assistance from NGOs.
In spite of the difficult environment,
MSI has been able to expand its
operations in Afghanistan. In 2009 MSI
Afghanistan prevented about 1,600
maternal and 23,000 child deaths.
MSI emphasizes an extensive range of
different contraceptives, children’s health
care and sexual and reproductive health
care services. MSI’s work highlights the
promotion of women’s rights. The project
aims to strengthen Afghanistan’s own
health care services. Services provided
by MSI are therefore a component of the
national primary health care. n
Women’s Health Issues
Fistula
A fistula develops most often as a result of
prolonged childbirth, when the head of the fetus
presses against the birth canal, causing an
opening between the vagina and the bladder
and/or the rectum. This can lead to loss of
urinary or fecal continence. Unless surgery is
performed for the fistula, it will lead to chronic
ailments and even social isolation of the woman.
Fistula is most common among women and girls
living in rural areas.
About 2 million women in the world have a
fistula. Some 50,000–100,000 new cases occur
every year. This injury can easily be prevented by
means of deliveries where skilled personnel are
in assistance and by the provision of care should
complications arise.
Unsafe Abortion
More than half of the 80 million unplanned
pregnancies end in abortion every year. This adds
up to roughly every fifth pregnancy worldwide.
Unwanted pregnancies are often solved by
having an illegal abortion; these often lead to
complications causing disability or even death.
Illegal abortions leading to death are a major
cause of maternal mortality – 14%, or 70,000
deaths per year. In some countries, mortality due
to unsafe abortion can account for as much as
30–50% of all maternal mortality. Estimates on
the number of illegal abortions vary, but the figure
may be as high as 20 million per year.
The abortion statistics are lowest in countries
where everyone has access to safe and legal
abortions. A law that allows abortion for social
reasons as well was adopted in Finland in 1970.
For the first few years after the law entered into
force, an increase occurred in the number of
abortions, but the figure began to decline again
soon thereafter. There is no longer any need for
illegal abortions. n
A Hairdresser’s Visit and
Information on Responsible
Sexual Behavior
The organization Lääkärin sosiaalinen
vastuu (Physiscian’s Social Responsibility
PSR) works together with hairdressers
to promote reproductive health in Ibadan,
Nigeria. The goal is to reduce sexual risk
behavior, sexually transmitted infections
and unwanted pregnancies. This goal is
pursued by means of education, seminars
and talks. Information is also distributed
though films, banners and flyers. The
project is targeted at hairdressers and
their customers. n
FREEDOM TO CHOOSE
17
Violence Against Women
One of the most common human rights
abuses is violence against women. Violence
against women may include physical, sexual or
economic abuse or exploitation. One in every
three women suffers from violence during her
lifetime. Violence against women exists in all age
groups, all economic classes, and all cultures
everywhere in the world. It can happen at home,
on the street, at school, at work, in the fields, in
refugee camps and during conflict and crises.
What is remarkable about violence against
women is its diversity. Violence against women
often relates to sexuality. In addition to mental
and physical injuries, violence can cause the
spread of sexually transmitted infections or an
unwanted pregnancy, which in turn may lead to
an illegal abortion.
Gender-based violence both reflects and
reinforces the unequal position of women.
Violence against women is the number one
cause of death among women 15 to 44 years
of age. According to a World Bank study done in
1994, a woman is more likely to be raped or the
victim of abuse by an intimate partner than to be
in a car accident, contract malaria, get cancer or
to experience war. Research also shows a clear
link between violence against women and HIV
infections.
Violence against women also has economic
implications. In the United States, the Center
for Disease Control and Prevention estimates
in its report for 2003 that the cost of violence
in intimate relationships comes to over 5.8
billion dollars a year. Of this sum, 4.1 billion
dollars is spent for medical expenses alone;
lost productivity accounts for the remaining
1.7 billion dollars. Throughout the world,
violence against women creates costs at many
levels: to the individual, the family, society and
the nation. n
Violence against women takes many forms, including:
Sexual, physical and psychological abuse by an intimate partner
Physical, psychological or sexual abuse by a family member or relative
Sexual harassment or abuse by figures of authority, e.g. a police officer, teacher, or employer
Trafficking in human beings, including trafficking in children
Forced sex
Harmful practices such as female genital mutilation and cutting, child marriages,
dowry related murders and honor killings
●● Systematic sexual abuse during conflict and rape as a weapon of war
●● Other forms of violence
●●
●●
●●
●●
●●
●●
18
FREEDOM TO CHOOSE
HIV and AIDS
One of the greatest development
challenges is halting the spread of the human
immunodeficiency virus (HIV). At present, 33
million people in the world live with HIV, 97% of
them in low-income countries. There were 2.7
million new infections in 2008 (UNAIDS). In
its development policy, Finland views HIV and
acquired immune deficiency syndrome (AIDS)
not only as a health issue but as a human
development challenge that touches society
as a whole. In its AIDS work, Finland stresses
a comprehensive approach and preventative
action, and focuses on the realization of human
rights.
HIV and AIDS are an extensive challenge that
has economic, social, security and cultural
effects. The HIV pandemic has a significant
debilitating effect on communities, especially in
high prevalence areas such as Southern Africa.
In these countries, the pandemic has notably
lowered life expectancy and influenced the
demographic structure and population growth.
About half (48%) of newly infected people are
women and 40% of new infections are among
young people (15 to 24 years old). Gender
inequality is one of the major reasons for the
rapid spread of the virus. In many cases, women
and girls do not have the opportunity to say
no to sex, to demand that their partner use a
condom or to do so themselves. It is therefore
extremely important that sexual rights are seen
as an element of human rights and that their
realization is guaranteed.
The international
community is committed
to the provision of HIV
prevention, treatment,
care and support for all
who need it. HIV drugs
are now more widely
available than in the
past, but there is still no cure for the human
immunodeficiency virus itself. For this reason,
prevention of infections is still a vital aspect of
comprehensive and cost-effective health care.
AIDS-related illnesses have become the number
one cause of death among 15 to 49 year-olds
worldwide. The epicenter of the HIV pandemic
is in sub-Saharan Africa, but the pandemic is
growing fastest in Eastern Europe, Central Asia
and elsewhere in Asia. n
AIDS Work of the Angolan
Lutheran Church
The Finnish Evangelical Lutheran Mission
works together with the Lutheran church
in Angola. This project provides HIV
and AIDS testing as well as support for
infected people and their families. The
project intervenes in stigmatization and
social isolation. Support is also given to
medical care in health centers. n
FREEDOM TO CHOOSE
19
Economy and Poverty
Poverty is both a cause and a
consequence of population dynamics.
Poverty has an effect on population growth, age
structure and urbanization, and high birth rates
can worsen poverty. Traditionally it is thought
that economic growth leads to welfare, lower
birth rates and children’s better health and
education. However, the relationship between
the economy, welfare and population dynamics
is more complex than this.
High fertility, poverty, low education and the
poor health of mothers and newborns form
a vicious cycle. Investment in better health,
including sexual health, is central not only for
the safety of the individual but also for efforts
to decrease morbidity and mortality. Better
sexual and reproductive health helps individual,
families, communities and countries rise from
the poverty gap.
20
FREEDOM TO CHOOSE
Empowerment of women and men through
education, equal opportunities and extensive
sexual and reproductive health services
advances social and economic development.
Educating women has been found to be
effective in breaking the poverty cycle. Educated
women marry later, have fewer and healthier
children, are healthier themselves and educate
their children better.
Currently, 15 billion dollars in productivity is lost
per year because of insufficient maternal health
services that result in the death of women and
children. An annual investment of about 6 billion
dollars would provide satisfactory maternal
health services worldwide. n
Population Politics is
Environment Politics
There are many visions for the future of
climate change, but one factor they share is
that they all involve human beings and the
consequences of their actions. It is therefore
fundamental how many we are, how we make
a living, how we spend our free time, what
technology we use and what our consumption
habits are. It has been calculated that a
population increase of 1% leads to a 1%
increase in carbon dioxide emissions. Hence,
population policy is also environment policy.
A growing population increases the pressure
not only on food production but also on the
production of consumer goods. As developing
nations become wealthier, meeting the needs
of growing populations requires considerable
amounts of energy and natural resources.
Climate change causes certain phenomena,
such as drought and desertification, to become
more frequent and prevalent. These phenomena
worsen as people overgraze land and cut down
forests in order to secure their living.
From the viewpoint of natural resources alone,
the situation in Africa is such that the growing
population will consume more than the continent
can produce. This makes the rise out of poverty
even harder. Relatively fewer children are born
everywhere except for most of sub-Saharan
Africa. In this region, poor health, high fertility
rates, high mortality, low economic growth and
worsening poverty go hand in hand.
Balanced population growth is central to
communities and to the well-being of the
environment. It can only be achieved if people’s
sexual and reproductive rights are realized.
This means that everyone should have the
opportunity to make independent decisions
regarding their own reproduction and sexuality.
This, in turn, requires that people have the
knowledge and the means for planning their
reproduction. n
FREEDOM TO CHOOSE
21
Gender Equality and Men
Gender equality is crucially important
for the promotion of sexual and reproductive
health and rights. Gender equality exists in
a society where both women and men enjoy
equal opportunities, rights and obligations
in all areas of life. Equality is realized
when both sexes equally share
power and influence, both have
equal opportunities of economic
independence through work or
entrepreneurship, and both have
equal access to education and
the opportunity for personal
development.
For actions to be effective, the
dependence of gender identity and
power relations on the social context
has to be acknowledged. Cultural,
religious, economic, political and social
conditions, and the interrelationships between
these, are all intertwined in the social context.
Equal partnership requires changes in women’s
and men’s knowledge, attitudes and behavior.
Alongside empowerment of women, it is
imperative that men and boys also work actively
to remove gender stereotypes and change
perceptions of masculinity and sexuality. This
is because in many societies, men hold much
power, which makes their participation vital. The
goal is joint decision-making. n
22
FREEDOM TO CHOOSE
Sexual Health in
Lungwena, Malawi
The Family Federation of Finland together
with the University of Malawi and local
officials have a project in the countryside
of southern Malawi that aims to improve
existing sexual health services and their
availability by means of a volunteer
network. The project will enhance
people’s knowledge of sexual health,
sexually transmitted infections, use of
contraceptives and safe motherhood. Men
are also included in targeted campaigns.
Education of staff, especially in sexual
health related issues, attention to the
special needs of young people, and to
service situations all improve the quality
of services. n
Sexual Orientation and
Gender Identity
Equality isn’t only equality for women
or men but equality for all. Sexual rights
and their realization and access to services are
major questions when it comes to sexual and
gender minorities (Lesbian, Gay, Bisexual
and Transgender people, LGBT). The
rights guaranteed in international
conventions apply to all.
Homosexuality is still a criminal
offense in over 80 countries.
The strictest attitudes towards
homosexuality are found in
Arab countries, where the
death penalty is applied.
Most of Africa criminalizes
homosexuality, whereas in Asia
the attitude is less absolute
although the topic is taboo. In Latin
America, there are countries with
stricter attitudes and others with more
open views. A negative stance to sexual
and gender minorities, expressed in the form of
laws and attitudes, affects how gender minority
specific questions are taken into account,
for example in sexuality education and the
prevention of HIV infection. n
FREEDOM TO CHOOSE
23
Culture and Religions
Every human being grows up to be part of
the culture around him or her, and the culture so
acquired influences beliefs and behavior. Hence
culture also affects equality, maternal health
and reproduction. Sexuality – including sexual
rights and sexual and reproductive health – is
regarded differently in different cultures and
religions. This is the reason why it
has sometimes been difficult
to reach a consensus on
common international
principles, goals and
practices.
Sexual and
reproductive
health and rights
still encounter
resistance in
international fora.
The underlying
reasons involve views
about women’s social
status and unwillingness
to recognize women’s right to
decide about their own sexuality
and reproduction. Sexual orientation and
gender identity have also been sensitive issues.
In discussions on sexuality, it is necessary to
go beyond sexual behavior and the number of
partners to the level of societal, economic and
cultural factors. It is important to understand
how power relationships between women and
24
FREEDOM TO CHOOSE
men affect sexual health and rights. Decisions
about the number and timing of children are
always made within the context of a culture.
Perceptions are hard to change from the
outside; therefore change is achieved easier
from within the culture. The context – i.e. the
prevailing culture and religion – cannot be
overridden; it has to be considered.
Religious reasoning should not
be downplayed; instead,
a way to work with it
should be found. These
considerations are
pursued with a
culture-sensitive
approach: human
reality and culture
are the basis
of policy. If this
approach is followed,
decisions are not
detached from reality.
Changing attitudes,
behavior and laws, especially
regarding sexual and reproductive
health and rights, has proved to be a
complicated and lengthy task. Changing ways of
thinking is even harder than providing services
in places where life is bound by traditions
centuries old and complex social constructions.
Change requires understanding of a society’s
cultural dynamics and awareness of its positive
and negative aspects. n
Terms
AIDS
Acquired Immune Deficiency
Syndrome, the last phase of an HIV
infection.
Culture
Sensitivity
An approach that takes into account
the differences between cultures
(values, norms), for instance, in
development cooperation.
Empowerment This term is used to refer to gender
equality, especially of women. It means
striving to ensure more power and
influence for women as individuals
and members of society with regard to
legal, social and economic issues and
also within the family.
Fistula
A (obstetric) fistula is the result of by
prolonged delivery when the child’s
head presses against the birth canal,
causing a tear or tears in the canal. It
leads to incontinence.
Gender
This is a social construct whereas sex
is biological. It means that women
and men in different cultures and
at different periods have varying
obligations and rights. Feminine
or masculine identity is formed in
interaction with the surrounding
culture and its members.
Gender
Identity
The personal internal experience and
awareness of one’s gender.
Gender Role
Expresses social behavior that is
traditionally expected on the basis of
the person’s biological sex.
HIV
Human Immunodeficiency Virus.
Human
Rights Based
Approach
This concept means that development
processes are anchored in a rights
system that complies with international
law and the rights and obligations
stated therein. In practice, development
is then normatively based on
international human rights standards
and is operationally guided towards
promoting and securing human rights.
Infant
Mortality
The number of children that die during
the first year per 1000 live births.
Maternal
Mortality
The number of women that die due to
pregnancy per 100,000 births.
Total
Fertility
The average number of children that
would be born to a woman over her
lifetime if she were to experience the
exact current age-specific fertility rates
through her lifetime. Also referred to
as the fertility rate.
Reproductive
Age
15 to 49
Sexuality
Sexuality includes sexual development,
biological sex, sexual orientation, social
gender identity and the resulting role
and reproduction. Sexuality can be
experienced in many ways through
attitudes, values, and beliefs or in
relations to others and to the self.
Psychological, biological, cultural,
social, political, historical, religious,
economic and mental factors all
influence sexuality and its expression.
Sexuality is an inherent capability
to react mentally and physically to
sensations by experiencing pleasure
and the readiness to seek these
experiences.
Sexual
Orientation
One’s personal sexual interest.
FREEDOM TO CHOOSE
25
Sources
Adding it Up, The Benefits of Investing in
Sexual and Reproductive Health Care.
UNFPA and The Alan Gutmacher Institute,
2003.
Heise, Lori, Jacqueline Pitanguy, and Adrienne
Germain: Violence against Women: The Hidden
Health Burden. World Bank Discussion Paper
#255. World Bank: Washington, D.C., 1994.
Breaking Through. A Guide to Sexual and
Reproductive Health and Rights. ICPD – the
Foundation for the Millennium Development
Goals, 2004.
HIV/Aids as a Development Issue. Foreign
Ministry Policy 2004. Ministry for Foreign Affairs
of Finland.
Development Policy Programme 2007.
Towards a Sustainable and Just Humanity Policy.
Government Decision-in-Principle, Ministry for
Foreign Affairs of Finland, 2007.
Finnish Development Policy Guidelines for the
Health Sector. Ministry for Foreign Affairs of
Finland, 2004.
ICPD Programme of Action, 2007.
Family Planning and Poverty Reduction,
Benefits for Families and Nations.
UNFPA, 2007.
Kansainvälinen väestö- ja kehityskonferenssi
Kairossa 5.–13.9.1994. Suomen valtuuskunnan
raportti. Ulkoasianministeriön julkaisuja 5/1995.
Focus on 5. Women’s Health and the MDGs.
Women Deliver, 2009.
Kaupungeissa kasvaa mahdollisuus. Tiivistelmä
YK:n väestörahaston vuosiraportista State of the
World Population 2007. Väestöliitto, 2007.
Go forth and multiply a lot less. The Economist,
October 31st 2009.
Government report to Parliament on the
human rights policy of Finland 2009,
publications of the Ministry for Foreign
Affairs 7/2009.
Healthy Expectations, Celebrating Achievements
of the Cairo Consensus and Highlighting the
Urgency for Action. UNFPA and the Population
Reference Bureau, 2009.
26
FREEDOM TO CHOOSE
Kohti muuttuvaa maailmaa – Naiset, väestö
ja ilmasto. Tiivistelmä YK:n väestörahaston
vuosiraportista State of the World Population
2009. Väestöliitto, 2009.
Korhonen Elina & Lipsanen Laura (toim.):
Köyhyyden jalanjälki. Väestötietosarja 17,
Väestöliitto, 2008.
Korhonen Elina, Lipsanen Laura & Yli-Räisänen
Heli: Seksuaalioikeudet kuuluvat kaikille.
Väestöliitto, väestötietosarja 18, 2009.
Korhonen Elina: Terve talous – hyvinvoiva väestö
talouskasvun perustana. Toim. Laura Lipsanen.
Väestötietosarja 16, Väestöliitto, 2008.
Korhonen Elina, Lipsanen Laura & Salin
Marja-Leena (toim.): Terve tulevaisuus! YK:n
vuosituhattavoitteet ja terveys. Väestöliitto, 2007.
Seksuaali- ja lisääntymisterveys, keino
köyhyyden voittamiseksi. Tiivistelmä YK:n
väestörahaston vuosiraportista State of the
World Population 2002. Väestöliitto, 2002.
Seksuaalioikeudet osana ihmisoikeuksia.
Väestötietosarja 11, Väestöliitto 2002.
Kulttuurintuntemus kehityksen avaimena –
Kulttuurit, tasa-arvo ja ihmisoikeudet. Tiivistelmä
YK:n väestörahaston vuosiraportista 2008.
Väestöliitto, 2008.
Sexual Rights: an IPPF declaration. International
Planned Parenthood Federation, 2008.
La religión en la vida cotidiana. Uskonto
arjessa – katsaus Nicaraguaan. Anna
Huovila: Uskonnon vaikutus seksuaali- ja
lisääntymisterveyteen. Suomi-Nicaragua-seura
ry, 2009.
Tasa-arvon ja lisääntymisterveyden edistämisellä
kohti vuosituhattavoitteita. Tiivistelmä YK:n
väestörahaston vuosiraportista State of the
World Population 2005. Väestöliitto, 2005.
Reducing Poverty and Achieving The Millennium
Development Goals: Arguments for Investing in
Reproductive Health & Rights. UNFPA, 2005.
Report of the UN Secretary-General on world
demographic trends, E/CN.9/2009/6.
Reproductive Health in Emergencies:
Briefing Pack. Raise.
Respect Choice. Safe Abortion a Prerequisite
for Safe Motherhood. ICPD – the Foundation for
the Millennium Development Goals, 2004.
SETA, secretary general Aija Salo.
UNFPA Statement. Population and Climate
Change, Framework of UNFPA’s Agenda.
February 2008.
www.un.org
www.unfpa.org
www.unicef.org
www.unifem.org
www.who.int
www.ilga.org
www.cdc.gov/ViolencePrevention/
intimatepartnerviolence/index.html
FREEDOM TO CHOOSE
27
Development Communication
PO BOX 456
FI-00023 GOVERNMENT, FINLAND
Telephone: +358 9 1605 6370
Telefax: +358 9 1605 6375
Internet: http://formin.finland.fi
E-mail:[email protected]