Dialogue for Change
Reference materials in support of policy dialogue
on sexual and reproductive health and rights
Foreword
The right to decide and exercise control over one’s own
body, sexuality and reproduction is fundamental for all
people. The Swedish Government therefore prioritizes
sexual and reproductive health and rights (SRHR) as a key
issue in Sweden’s international policy for many years. All
those who represent Sweden have an important role to play
in the defence and promotion of sexual and reproductive
health and rights within their respective work mandates.
Sweden’s international SRHR policy is pursued in different
ways, using different channels. Concrete decisions and
actions that have a direct impact on women, men, young
people and children are implemented through policy
initiatives as well as bilateral and multilateral programmes
at country level. Normative dialogue that helps to develop
policy is often conducted in international fora and is just
as important in this work. This is why governments, the
UN, the World Bank, the EU, the European Council,
regional institutions and local and international NGOs are
identified as important partners.
On 29 February 2008 Minister Gunilla Carlsson sent out a
circular instruction to all heads of department at the Ministry
for Foreign Affairs and Sweden’s embassies and permanent
missions abroad to inform them of the fact that the Swedish
Government had raised its ambitions for pursuing issues
concerning sexual and reproductive health and rights in
its international work. Sweden’s representatives must be
familiar with Government priorities, policies and positions
in these issues. The instruction also highlighted a recognition of the need for support to employees in the Ministry for
Foreign Affairs and at Sweden’s embassies and missions
abroad on SRHR, including strengthening their skills and
ability to conduct effective policy dialogue on these issues.
The Swedish Association for Sexuality Education, RFSU,
was subsequently commissioned to provide background
information, and in collaboration with the Ministry for
Foreign Affairs and the Swedish International Development Cooperation Agency (Sida) produce a set of materials that would facilitate and strengthen communication
and dialogue surrounding SRHR issues, including a
number of specific themes such as sexuality education,
young people’s sexual and reproductive health and rights,
combating gender-based violence, LGBT rights, maternal
mortality, access to safe abortions, condoms and other
methods of contraception. RFSU has more than 75 years
of experience of working with issues surrounding sexual
and reproductive health and rights in Sweden and internationally, both with partner organisations and decisionmakers at various levels.
The purpose of this material is to strengthen the impact
of Sweden’s SRHR policy by increasing the focus on
communication and dialogue. Its point of departure is a
rights-based perspective and approach that emphasises
development and poverty reduction, but the material can
also be used in many different political and policy contexts where discussions on people’s circumstances and
living conditions take place.
RFSU has developed this material in close collaboration
with the Ministry for Foreign Affairs and Sida (Swedish
International Development Cooperation Agency), and by
means of a consultative process involving staff at Sweden’s
embassies and missions around the world. Other ministries
in the Government Offices of Sweden have commented on
this material, and during the process various stakeholders
in Swedish society have provided their views on its content
and structure in order to ensure that it reflects the realities
that representatives of Sweden experience when engaging
in dialogue, presenting arguments and devising strategies
to promote SRHR. Ministry officials and staff have referred
to the material during training and competence-building
sessions held during regional ambassadors’ meetings in
the Spring of 2010.
Issues surrounding sexual and reproductive health and
rights are often controversial, which means that it can be
difficult to discuss them at the highest political level. Representatives of Sweden need to help change this by being
able to demonstrate that SRHR in fact comprises a body
of quite central foreign policy issues.
This material is intended for all staff in the Government
Offices of Sweden, Sida and at all Swedish embassies and
missions abroad.
Ministry for Foreign Affairs, Stockholm, June 2010
3
Contents
Introduction
6
Conducting effective dialogue
9
Checklist for dialogue
Thematic issues
11
13
Maternal mortality and the work to achieve Millennium Development Goal 5
14
Access to safe abortions
18
Young people and SRHR
23
Sexuality education
27
Condoms and other methods of contraception
31
HIV and AIDS
35
Lesbian, Gay, Bisexual and Transgender rights (LGBT rights issues)
39
Gender-based violence
43
Annex I SRHR: Definitions, terms and concepts
47
Annex II Points of departure and mandates
for work with SRHR
52
Annex III SRHR and the EU
55
Annex IV Organisations in the SRHR area
56
Annex V Links and references
59
4
Introduction
The Swedish Government’s Policy for Global Development
(Government Bill 2002 /03:122; Government Communication 2007/08:89; Government Communication 2009 /10:129)
states that sexual and reproductive health and rights (srhr) are
particularly relevant in the work to achieve the goal of equitable
and sustainable global development. However, at the same time,
srhr is a complex and often extremely sensitive issue. There are
major differences of opinion and position in this area around
the world, with issues concerning women’s and young people’s
sexuality proving particularly controversial.
Sweden places a high priority on promoting srhr. People
working for the Government Offices of Sweden, Sida and
Sweden’s embassies and missions abroad are responsible for
promoting srhr and being able to include srhr in dialogue with
governments and other actors in partner countries.
This material has been produced to aid and support the
work to pursue an effective dialogue on srhr issues within the
framework of Sweden’s international work. It contains facts,
frequently asked questions, as well as speaking points and
advice for arguments for a number of the issues that srhr cover.
The annexes also include definitions and concepts, international
frameworks and mandates, information on srhr and the eu, as
well as links and references to important documents, and to
organisations and other actors that can also be of further support in this work.
Why is it important to work with SRHR?
srhr is essentially a political issue that has a bearing on foreign
and security policy as well as development cooperation. There
are widely varying differences of opinion and position among
countries and various interest groups in relation to srhr issues,
including sexuality education, access to safe abortions and lgbt
rights. The breadth of srhr issues means that it is essential for
there to be coherence of how they are treated and talked about
across the different areas of Swedish policy. srhr is not only a
health issue, it also encompasses a wide range of issues that
are intrinsically linked not only to poverty reduction, but also
to the promotion of gender equality and the rights and role of
women in development. If people are subjected to violence,
suffer permanent injuries as a result of pregnancy or childbirth,
6
become infected with hiv or another sexually transmitted disease, or do not have a say about if, when or how often they want
to have children, they are then also deprived of the possibility
to live a life in freedom, to study, work and to shape their own
lives and contribute to the development of their society.
SRHR and gender equality
The world’s governments have agreed in conventions and declarations that human rights apply to all people, that women and
men have the same rights and must have equal opportunities.
However, the observance of these international instruments is
faltering in many ways, particularly when it comes to srhr. The
un Convention on the Elimination of All Forms of Discrimination Against Women (cedaw) came into force in 1979 and
includes Article 12 about health and Article 16 about marriage
and family life, which are both important for women’s right to
sexual and reproductive health. Article 2(f) of cedaw obliges
states to “take all appropriate measures, including legislation, to
modify or abolish existing laws, regulations, customs and practices that constitute discrimination against women”. The Convention on the Rights of the Child also contains a requirement
for states to take action with a view to “abolishing traditional
practices prejudicial to the health of children” (Convention on
the Rights of the Child, Article 24.3).
The Declaration and Programme of Action adopted at the un
International Conference on Population and Development (icpd),
held in Cairo in 1994, points out that improving the status of
women and their ability to control their fertility is a foundation
stone for development. icpd also stresses the responsibility of
men in issues of parenthood, sexuality and reproduction.
The Declaration and Platform for Action from the un Conference on Women in Beijing in 1995 points out that women’s
rights include the right to have control over their own sexuality
and the right to freedom from all forms of coercion and violence, including sexual violence.
Norms for what is considered male and female respectively
are strongly embedded in most societies, and can limit people’s
choices, opportunities and life prospects, including the ability
to make decisions about their own body and sexuality. Resistance to equal conditions for women and men is often based
on and justified by arguments based on cultural constructs of
sex and gender. Power imbalances between the sexes leads to
women and girls suffering the most from sexual and reproductive ill-health as men often make decisions on issues related to
sexuality. This includes deciding if and when to have sex, if and
what methods of contraception to use, and how many children
a woman should have and when. In many instances women are
both economically and socially dependent on men, which often
makes it difficult or impossible for them to question decisions made by men, both in private and in public. Men and
boys as well as women and girls must be involved in the work
to strengthen sexual and reproductive health and rights and to
promote gender equality.
Social injustices, discrimination, marginalisation and inequality are some of the causes of poverty as they affect an individual’s access to, for example, information, education and health
care services, and also access to the labour market. Women
with disabilities often lack access to health care and seldom
receive information about sexual and reproductive health.
SRHR and gender equality
• In Sub-Saharan Africa, 57 percent of people living with
HIV are women.
• Every year hundreds of thousands of women die and every
minute 35 women suffer from chronic injuries as a result of
pregnancy and childbirth.
• A third of the world’s women have been forced to have sex
at some point in their lives.1
Perceptions of SRHR in different
social and cultural contexts
Perceptions of srhr varies between and within different social
and cultural contexts at both national and local levels. Cultures are comprised of collective values, knowledge, notions
of morality, customs and traditions that have emerged so that
people can understand and perceive meaning in their existence. Everyone’s behaviour is influenced by the culture in which
they are fostered, and that shapes their frames of reference and
their way of thinking. This is particularly true of perceptions
of decency and morality associated with srhr and relationships
between the sexes.
In most cultures, inequality between the sexes is widespread
and deeply rooted. Harmful customs and traditions that violate
the sexual and reproductive rights of women and girls and put
their lives and health at risk, for example child marriages and
female genital mutilation, continue to be practiced in many
countries, despite national laws and international regulations
prohibiting them.
International conventions on human rights state that these
rights are universal and indivisible. The un conventions on civil
and political rights point out that religious convictions and
cultural practices must not be used as an excuse to violate the
rights of individuals.
Despite this, there is a perception in a number of countries
outside Europe and North America that human rights are based
solely on Western ideology and therefore do not apply to their
cultures. This is particularly true of rights that are associated
with women’s sexuality, physical integrity and their ability to
make decisions about their own bodies. In dialogue on srhr,
cultural arguments are often the most difficult to address and,
just as with religion, tradition and customs are used to justify
why an action such as abortion cannot be accepted, but that an
action like genital mutilation is an important identity marker
and must be performed.
Changes in culturally-based behaviours can only take
place from within and require collective changes in attitudes
and behaviours. Knowledge of the local culture is needed to
understand the bases and reasoning behind people’s attitudes
if progress is to be made in this kind of dialogue. Strategic
partnerships must also be forged with people, organisations and
networks in local settings.
1. unifem, Progress of the world’s women 2008/2009. Who answers to women?
Gender and accountability (2008).
7
Conducting effective dialogue
Sweden, a strong voice in the world
Contexts and entry points for dialogue
Dialogue is an important political tool that plays a central role in the process to promote srhr. Dialogue involves
exchange and mutual listening and learning. In order to successfully influence and promote change, it requires frankness,
humility and an ability to convey a clear message adapted
to the specific situation. Those who represent Sweden must
be able to engage actively with a process of communication,
by acquiring relevant knowledge and establishing formal
and informal contacts with authorities, the civil society in
Sweden and in the partner country, other institutions and
partners. They must also understand the specific cultural,
social and political contexts in a country or region, in order
to convey Sweden’s message and positions in the most successful way possible.
Political dialogue is a long-term process of negotiation, which
is effective if it develops within the framework of contacts and
collaborative relationships where trust, mutual respect and
openness are built up over a long period of time. It is especially
important to prepare for dialogues and arguments, to take the
time to understand both informal and formal structures and
to identify who should be involved in a particular dialogue. As
with other controversial or sensitive development issues, srhr
issues must also be owned by the people they concern. Sweden’s
srhr dialogue must be based on Swedish policy as well as international agreements in this area.
Sweden is a respected development actor in the world and
is considered to be a leader in a number of areas, including
human rights, gender equality and srhr. Consequently, representatives of Sweden are expected to have good knowledge,
qualifications and preparedness to pursue a dialogue, even
when it comes to difficult and often controversial issues.
srhr covers a wide spectrum of dimensions and issues. It is
therefore important to focus on one or a few specific issues in
different dialogues and specific contexts, for example, access
to contraception, the training of midwives, access to safe abortion, sexuality education or lgbt rights. Some of these issues
are more difficult to pursue than others. A common feature
is that they all relate to the rights of people to make decisions
about their own body, sexuality and reproduction. Some srhr issues are less controversial than others and can
therefore be used as entry points to discussion about issues
that are more difficult or sensitive. For example, using the
national situation and local examples of hiv and aids as a starting point and way of opening the door to extending the dialogue
and be able to talk about young people’s sexuality, sexuality
education and the need for access to reproductive health care.
Gender-based violence can also be a good way to start talking
about more complex issues concerning women’s right to make
decisions about their own body, sexuality and reproduction.
Effective dialogue and success can be achieved when the parties
involved have the opportunity to meet in different ways in a more
informal setting. Informal meetings and structures are often very
conducive to dialogue, but it is also important to be aware of and
consider which stakeholders are involved in the informal dialogue
and which are not, and the consequences that this may have.
srhr and gender equality are key issues in all sectors, particularly in the fight against poverty and other work that is essential
for the development of countries. Several srhr issues obviously
have a specific place in the health sector. However, these issues
clearly extend beyond the health sector, and in order to achieve
sexual and reproductive health and rights and gender equality,
they must also be discussed and addressed within the framework
of sectors such as education, human rights, the development of
democracy, infrastructure, agriculture, employment and the
labour market. The inclusion of srhr issues in national development or action plans serves as an excellent basis for producing
strategies and indicators to achieve the desired results and impact.
Planning dialogue
A dialogue can form part of a long-term process or can be
more limited. From the very beginning of a specific dialogue,
the objective of the dialogue – determined for example with
respect to a specific problem – has to be made clear to everyone
involved.
Setting objectives for the dialogue makes it easier to measure
and present results. It is important to set both short-term and
long-term objectives for the dialogue. A short-term objective
could for example be that a meeting be held with dialogue
9
partners or that contact has been established with a key actor,
while a long-term objective could be for the dialogue to result
in the conditions being put in place to provide better access for
women to trained midwives in a specific geographic area as an
appropriation item in the partner country’s health budget or in
the sectoral budget for rural development. It is important to
work with both short-term and long-term objectives in order to
move the work forwards.
Preparing for dialogue – Questions to consider
• What is the purpose of the Swedish involvement and what
responsibility and requirements does this place on the
embassy, mission, Sida or relevant department in the Ministry?
• What do we want to achieve/accomplish (be as concrete as
possible and avoid grappling with too many issues at the same
time)?
• What guidelines and steering documents provide mandates
and a basis for our work, for example international, regional or
national commitments, including Swedish policy and positions?
• What are the national legislation and the current situation in
the country like? What are the consequences for various groups
in the country? Look for statistics and other data and factual
information to be used as arguments and link them to a specific
dialogue objective.
• What obstacles can be anticipated, and how can we prepare
ourselves to handle them?
• What are the most important and most central challenges in
the country or region, in terms of srhr?
Identifying opportunities
It takes time to change people’s attitudes and values, as well as
behaviour and social traditions. Patience is the key. It is important to set reasonable objectives and targets for different stages
in a dialogue process, and to identify the opportunities that
exist or that can emerge by creating political momentum and
building alliances with, for example, civil society organisations
and other stakeholders.
It is also essential to collaborate with like-minded stakeholders and countries. Sweden may not always be able to work with
the same configuration of like-minded stakeholders in all issues
10
or fora. Different partners can support, be involved with and
actively promote key srhr issues in different contexts, and with
regard to specific issues and topics. Sweden is an active member
in many multilateral organisations, and has been working with
international ngos for many years that are also important stakeholders and partners to collaborate with on srhr issues.
It is also important to support and promote dialogue among
various actors and stakeholders in different ways, for example
between governments, parliamentarians, multilateral organisations, civil society, as well as stakeholders in the private business sector.
Sensitivity and cultural competence
Understanding the political and cultural situation in which
the embassy, mission, Sida or mfa department works and in
which the dialogue will be carried out is essential to be able to
pursue a credible and effective dialogue to help promote change
from within a society. It is necessary to be respectful and to
understand the srhr issues that are important, for whom they
are important, as well as to determine which issues should be
prioritised and with whom to engage in dialogue with respect
to those issues.
It is not always possible to discuss srhr issues in the same
way and using the same terms and concepts we have become
used to using in Sweden. Advocating what other people may
regard as being an extreme and inflexible srhr policy position
could result in unmanageable conflicts resulting in counterproductive polarisation and locked positions.
By spending time to familiarise oneself with and preparing
dialogue using language that is adapted to the cultural context, unnecessary controversy can be avoided and constructive dialogue promoted. This does not mean that you should
compromise on Sweden’s positions on srhr. It is quite simply
about communicating with your counterpart. The important
thing is to choose your words carefully and ‘package’ arguments
well, based on factual knowledge and an understanding of your
counterpart’s reasoning and point of view.
Checklist for dialogue
Here is a checklist of the issues with respect to a number of
policy areas that can help when building up arguments and
knowledge. They can also serve as effective entry points for a
dialogue on sexual and reproductive health and rights.
International and regional agreements and commitments are
the main starting points for dialogue. It is important to find out
which international and regional agreements the country has
ratified, any reservations it has registered, and the content of
srhr in any of the country’s national reports to the monitoring
committees of the human rights conventions, as well as the committees’ conclusions and recommendations.
Important sources of information can, of course, also be
found in the Swedish embassies’ reports on human rights.
children’s rights? sexual crimes? regarding the rights and living
conditions of lgbt persons?
• What is the national age of majority? the legal age of sexual
consent? Is there any legislation directly addressing discrimination or laws that regulate communicable disease prevention, for
example, for people living with hiv and aids?
Gender equality
• What is the minimum age for marriage by law?
• Do women have the right to divorce?
• Do women have the right to own land? to inherit?
• Are there laws regulating men’s responsibility for their
children?
• Laws regarding violence against women?
Suggestions regarding general questions:
• What is the content of national legislation or the national
policy framework for the health sector or other relevant sectors
with regard to srhr?
• How are issues dealt with that have a bearing on maternal
health, women’s access to safe abortions or young people’s
access to contraception in these documents and frameworks?
Education
• Is sexuality education allowed in schools and if so, what is its
content?
• Can condoms be distributed in schools and other public arenas?
• What is the situation like for girls who become pregnant while
they are still in school?
Areas of national policy to
look at in relation to SRHR:
Health
• Do young people have access to contraception advice? confidential testing for sexually transmitted infections?
• Are there different kinds of contraception to choose from?
• What costs are associated with sexual and reproductive health
care?
• What is the situation like regarding access to contraceptive
supplies, for example condoms?
Human rights
• How are human rights instruments and commitments conformed with?
• How about the rights of women? men? children? lgbt people?
persons with disabilities?
Legal frameworks and access to justice
• Is the rule of law observed, i.e. are the legal rights of individuals respected?
• How are violence and other crimes against women dealt with
in the context of national legislation?
• Are there laws that regulate consensual sexual activity
between adults?
• What is the legislation like regarding abortion? the use of
contraception? maternal health?
• What legislation exists for the protection and promotion of
Public opinion, media, politicians?
• Are srhr issues discussed in the media?
• Which ministers deal with these issues and how do they do
this?
• Who officially defends these issues?
• Who opposes these issues?
• What is support in parliament like for various srhr issues?
• Is there support among stakeholders in civil society and in
local communities?
11
• What point or points of view do different key stakeholders
have nationally, regionally and locally?
• Who has formal and informal power in society?
• What role do the following play: Religious leaders?
Local community leaders? Traditional leaders? Parliament?
Media? Women’s organisations and networks? Certain individual men or women or groups? Human rights defenders and
other associations in civil society?
Attitudes and positions of international actors?
• What is support like among other EU member states?
• What attitudes do international stakeholders such as other
countries in the donor community have?
• What donors or multilateral stakeholders are active in the
health sector, education sector, in the human rights area or
other relevant sectors? What are their positions and bases for
dialogue?
• What dialogue issues have they identified?
• Considering these, are there ways in which we can strengthen
each other’s dialogue more effectively?
• Are there like-minded donors involved in contexts where
Sweden is not represented and if so, can we influence them?
12
Thematic issues
This section presents the eight thematic issues that the
Swedish Government prioritises most highly in its work to
protect and promote sexual and reproductive health and
rights. These thematic issues are extremely relevant for
srhr and development, but are also often controversial and
sensitive, and particularly tricky to handle in dialogues due
to their complexity, and the fact that they are emotionallycharged in many places in the world. These thematic issues are
also closely related in many ways, which means that dialogue
around one of the issues can often create an opening for
discussion on other srhr issues.
Each section consists of a short background based on
Sweden’s position, key message, and basic information in
the form of facts and figures, suggestions for entry points
for dialogue, as well as examples of frequently occurring
assertions and suggestions on how to address them. The
thematic sections can be used separately or in combination.
There is no inherent priority in the order in which they are
presented here. Each mfa-department, embassy, mission, Sidaofficer or other representatives of Sweden must themselves
assess the prevailing conditions and specific contexts within
which the dialogue is to place, in order to decide which issues
should be prioritised.
13
Maternal mortality and the work to achieve Millennium Development Goal 5
The link between improved maternal health and poverty reduction is very clear. Reducing maternal mortality is therefore
one of the most central development issues. un Millennium
Development Goal 5 aims directly to improve maternal health
by reducing the maternal mortality ratio by three quarters by
2015 through, inter alia universal access to reproductive health.
Why is Sweden working to improve maternal
health and reduce maternal mortality?
Most pregnant women living in poverty or in poor countries
run significant health risks in connection with pregnancy,
childbirth or post-partum care after childbirth. This situation
persists despite the existence of special international initiatives
and actions that have been carried out to safeguard women’s
health for more than 20 years. The reasons for the high maternal mortality ratio in global terms include the lack of access
to adequate obstetric care, and complications following unsafe
abortions.2 Currently Millennium Development Goal 5 is the
goal that is furthest from being achieved.
On 17 June 2009, the UN Human Rights Council adopted
the resolution, ‘Preventable maternal mortality and morbidity
and human rights’.3 This resolution points out that the high
rates of maternal mortality can be prevented and that they
represent a violation of women’s rights. Countries have not done
enough to eradicate maternal mortality and prevent injuries
resulting from pregnancy and childbirth. This resolution therefore represents an important step in establishing the extent
of the scope of political responsibility, from having regarded
maternal mortality as being first and foremost a health issue, to
recognition that it is also an issue of ensuring women’s rights.
Entry points for dialogue on
actions to reduce maternal mortality
Dialogue on improved maternal health is about demonstrating
the important links between development, women’s health and
fundamental human rights. This dialogue must also highlight
the benefits and cost-effectiveness of investing in advisory services, contraception, safe abortions, combating female genital
mutilation, trained midwives and better access to good quality
care in connection with pregnancy and childbirth.
14
• Some progress has been made in recent years but hundreds of thousands of women still die every year from
pregnancy-related causes and as many as 8.7 million women
suffer infections from childbirth every year.4 Complications
from pregnancy or childbirth are a leading cause of death for
girls between the ages of 15 and 19.
• Women who give birth to their first child after the age of
20 and have not been subjected to genital mutilation run a
much lower risk of suffering from fatal complications and
infections. This also applies to women who receive information and advisory services before childbirth, and who during
delivery have access to trained health care workers who are
equipped to handle difficult births with complications.
• 74 percent of maternal mortality can be combated through
access to trained healthcare workers, clinics with sterile and
adequate equipment, and advisory services for pregnant
women.5 According to the World Health Organisation, more
than 700,000 midwives are needed in the world to be able to
achieve Millennium Development Goal 5 for reduced maternal mortality. The important role and professional skills of
midwives must be highlighted and strengthened, and more
midwives who are equipped with sufficient competence must
be trained.6
• More than one third of all maternal mortality in the world
takes place in situations characterised by conflict, postconflict or crisis. In humanitarian crises, there is often a lack
of access to contraceptives, maternity care and emergency
obstetric and childbirth care.
• More than 70,000 women die every year and millions suffer
serious and even debilitating injuries from unsafe abortions,
placing a major burden on health care systems in many
developing countries.7 Access to safe and legal abortions is
essential for reducing these figures.
One important entry point for dialogue on this issue is a given
country’s own work on achieving un Millennium Development
Goal 5 about improving maternal health. The two sub-targets of
reducing maternal mortality by 75 percent by 2015 and universal access to reproductive health are both central in this context.
The dialogue can also be based on the un Convention on the
Elimination of All Forms of Discrimination Against Women
(cedaw) which obliges states to remove all discriminatory
Sweden’s position and key message: Reducing global maternal
mortality is essential and a prerequisite for the achievement
of several of the un’s Millennium Development Goals, such
as eradicating poverty and reducing child mortality. Sweden
believes that good maternal health is strongly linked to general
issues of gender equality and women’s empowerment and
ability to fully exercise and enjoy their human rights.
measures that can make it difficult for women to gain access to
health care, including family planning. States must also ensure
that women have access to health care during pregnancy, during
childbirth and after delivery (Article 12).
Women’s reproductive health is also protected by the un
Convention on the Rights of the Child. States need to ensure
a satisfactory level of health care for mothers both before and
after childbirth in order to safeguard the child’s right to enjoy
the highest attainable standard of health (Article 24 (2) (d)).
Issues about women’s rights with regard to health must be
integrated into all social sectors as well as in humanitarian
emergencies and crisis situations. In September 2009 the World
Health Organisation and unfpa identified the need to integrate
sexual and reproductive health into the humanitarian work
being carried out in crisis situations.8
The health system is very weak in many developing countries,
particularly in terms of infrastructure and health care workers.
Many efforts to improve these health systems are specific to certain diseases and major resources have been directed at, for example, the treatment of hiv, malaria and tuberculosis. This can have
an impact on the financing and planning of reproductive health.
Development funding is increasingly being provided through
budget support, sector support and other coordinated mechanisms. It is then particularly important that the reporting and
monitoring of efforts to reduce maternal mortality and promote
maternal health is rendered visible through the use of relevant
tools and indicators. Representatives of finance ministries can
be suitable dialogue partners in this regard. However, they
often have limited in-depth knowledge and understanding of
social sector issues. Swedish embassies and missions abroad
can play an important role in creating openings and arenas for
dialogue on budget and sector support by organising meetings
between finance ministries and the ministries responsible for,
for example, health, gender equality and youth issues. The un
Population Fund unfpa and Guttmacher Institute have produced
regular reports since 2003 about the costs and benefits of
investing in sexual and reproductive health. The most recent
report focuses on maternal health: Adding it up – The Costs
and Benefits of investing in Family Planning and Maternal
and Newborn Health (December 2009). This information can
be used as a basis for budget dialogues with finance and other
line ministers.
A number of frequently heard assertions on
women’s rights and health are presented below,
along with suggestions on how to address them:
“We cannot prioritise everything. Hunger, access to
clean water and conflict resolution are quite simply
more important than maternal health when looking
at what people need.”
There is in fact a great deal of evidence to show that investments in women leads to less hunger and fewer conflicts. The
former un Secretary-General Kofi Annan pointed out as early
as 2002 that challenges surrounding population issues and
reproductive health have to be resolved if we are to tackle the
other Millennium Development Goals, particularly the fight
against hunger and extreme poverty.9 A long succession of
experts have also pointed out the strong links between a high
number of births, a lack of respect for women’s and girls’ rights
and poor maternal health and poverty. In other words, it is
important to increase investments in maternal health in order
to achieve the Millennium Development Goals. Investing in
better maternal health also reduces a country’s health care costs
as a whole, which could allow resources to be freed up for other
important purposes.
In many cases, it is women who support their families and
who make sure that their children receive food, water and
schooling. The health and education of families are often based
on the efforts of girls and women, which is why their health is
so important.
“It does not pay to invest in women.”
According to the World Bank, family planning and childbirth
care are two of the six most cost-effective measures that lowincome and medium-income countries can take in the health
sector.10 Investing in the health and rights of young women is
particularly important, and can have major positive effects on
poverty reduction and development.
The use of contraceptives promotes economic development.
Studies from organisations such as Guttmacher Institute and
15
unfpa show clearly that investing in contraception, advisory
services and maternal health can significantly reduce public
expenditure on health care and other social services.11
It is possible to reduce maternal mortality. Many countries
have achieved this. For example, maternal mortality has fallen
considerably in countries like Cuba, Egypt, Malaysia, Sri Lanka,
Thailand and Tunisia. In all of these countries, investments have
been made to improve women’s access to reproductive health
care, skilled birth attendants and better conditions for emergency childbirth care.12
“In our culture, women should marry young.”
Work against early marriage is not work against the institution
of marriage in itself. We know that women who marry later in
life are in a better position to be educated, suffer fewer complications from pregnancy and run a lower risk of suffering from
sexually-transmitted infections and hiv and aids.13 Changing
traditions surrounding early marriage and starting a family of
one’s own therefore plays an important role in the fight against
poverty and maternal mortality.
Families can gain a lot by allowing girls to get an education
instead of being married off early, as they will be better equipped
to secure a more qualified and better paid job, which will means
they will better able to contribute to the family’s income.
2. Ministry for Foreign Affairs, Sveriges internationella politik för sexuell och
reproduktiv hälsa och rättigheter, p. 20 (2006).
3. Human rights council Eleventh session Agenda item 3, Resolution 11/8.
4. unfpa, No Woman Should Die Giving Life (2008).
5. unfpa, Giving Girls Today and Tomorrow. Breaking the cycle of adolescent
pregnancy (2007).
6. who, Fact sheet who/mps/08.11 Skilled birth attendants (2008).
7. who, Unsafe abortion, 5a. edición (2007); ippf, Death and Denial – Unsafe
Abortion and Poverty (2006).
8. unfpa, who, Granada Consensus on Sexual and reproductive health in protaracted crises and recovery (2009).
9. Bernstein, S & Juul Hansen, C, Public Choices, Private Decisions: Sexual and
Reproductive Health and the Millennium Development Goals (2006).
10. The Alan Guttmacher Institute, & unfpa, Adding it up. The benefits of
investing in sexual and reproductive health care (2003).
11. Guttmacher Institute & unfpa, In Brief Series, No.5 (2008).
12. unfpa, No woman should die giving life (2008).
13. unfpa, State of the World Population (2005).
16
Experiences from the field
Bangladesh is one of the poorest and most densely populated countries in the world. In Bangladesh there is a form of
surgical abortion, ‘menstrual regulation’, that is permitted up
to the ninth week of pregnancy. Rates of maternal mortality
has fallen as access to menstrual regulation has increased.
This provides a good basis for Sweden to further develop
the dialogue and to show the positive effects on women’s
health. Sweden’s support in Bangladesh is aimed at reducing maternal mortality, and Sida works in-country with other
stakeholders, such as the Netherlands, the United Kingdom,
WHO and UNFPA.
The dialogue in Bangladesh around abortion and maternal
mortality has been based on demonstrating the links between
women’s health and unsafe abortions, which are responsible
for a large proportion of maternal mortality. This dialogue has
proved successful because menstrual regulation is permitted
and accepted. Through its development cooperation in Bangladesh, Sweden has established itself as a recognised voice
for maternal health and SRHR. The work of the embassy
is based on the laws in Bangladesh as well as the policy
documents that have been adopted by the government. The
dialogue thus links Swedish viewpoints and positions to these
frameworks.
Access to safe abortions
One central dimension for ensuring that women are able to
enjoy their human rights is the extent to which they can make
decisions about their own body, sexuality and childbearing.
All human rights and fundamental freedoms apply to women
as they do to men. Women’s right – on a basis of equality of
men and women – to decide when they want to have children is
ensured through the un Convention on the Elimination of All
Forms of Discrimination Against Women (cedaw). Women’s
possibilities to claim and exercise this right is linked to and
requires access to contraception in order to avoid unwanted
pregnancies and prevent abortions.
Why will Sweden persevere in this work and actively
defend women’s access to safe and legal abortions?
Unsafe abortions are carried out because of the lack of opportunities to prevent unwanted pregnancies. Of the 46 million
abortions that are carried out every year, 78 percent are in
developing countries.14 Many of them are performed on girls
and young women and in situations where access to sexuality
education, advisory services and contraception is limited. An
unwanted pregnancy often leads to a young girl being expelled
from school, losing the opportunity for education and work, and
running the risk of being socially stigmatised. In desperation,
many young girls choose to undergo an unsafe abortion, which
can cost them their lives or seriously injure them. Unsafe abortions are mainly carried out in countries where access to safe
abortions is limited by legislation or other factors.
Entry points for dialogue on safe abortion
Maternal mortality rates among women and girls linked to
pregnancy and childbirth are so high in some countries that
they can be classified as constituting a public health problem.
The right to abortion is not explicitly set out in any of the
un conventions on human rights. However, the committees
that monitor the application of these conventions have often
found that several of women’s rights are threatened when
their access to safe and legal abortion is restricted. States
have therefore been recommended to review and amend
their legislation to increase the opportunities for women to
have access to safe abortions and to ensure that women who
18
undergo an illegal abortion do not risk legal repercussions,
including prison sentences.
The Human Rights Committee and the cedaw Committee
have made a connection between unsafe and illegal abortions
and the right to life. The Committee on Economic, Social and
Cultural Rights has also pointed out on many occasions that the
right to health is also threatened when restrictions are placed
on access to abortion and/or where abortions are unsafe.
The Programme of Action from icpd does not contain any reference to the right to abortion. It states that abortion should not
be promoted as a method of family planning, and that prevention of unwanted pregnancies to eliminate the need for abortion must be given the highest priority. It also states that when
abortion is legal, it must be safe and women must always have
access to the services that are needed to treat complications that
can arise following an abortion (PoA 8.25). The five-year review
of icpd stresses that unsafe abortions represent a public health
problem. The Platform for Action from the Fourth Conference
on Women in Beijing also encourages states to re-examine laws
that punish women who have an abortion (106 (k)).
Regional instruments can be an important starting point
for dialogue on safe abortion. In July 2003 the African Union
adopted ‘The Protocol to the African Charter on Human and
Peoples’ Rights on the Rights of Women in Africa’. This regional
instrument sets out the African states’ obligation to provide
legal and safe abortion when a pregnancy is a result of a sexual
assault, where the mental or physical health of the woman is
threatened or when the woman’s or foetus’s life is in danger
(Article 14 (2) (c)).
The au’s Africa Health Strategy 2007–2015 was adopted in
Johannesburg in April 2007, and stresses the importance of a
holistic approach to important issues, such as maternal mortality, including as a result of unsafe abortions.
Sweden’s position on access to abortion is considered to be
an extreme standpoint by several other countries, so it can be
strategic and fruitful to initiate discussions about abortion
using arguments that are based on health, gender equality and
the work of countries to achieve the un Millennium Development Goals, particularly goals 3, 4 and 5.
In most countries, entry points can perhaps be created
Sweden’s position and key message: Access to safe and legal
abortion falls within the framework of human rights, is
important to reduce maternal mortality and is a part of the
work to fulfil commitments to realise the right to health.
• Maternal mortality remains high in developing countries.
Of the women who die every year as because of complications relating to pregnancy and childbirth, approximately
13 percent die as a result of unsafe and illegal abortions. In
addition almost five million women are seriously injured as a
result of unsafe abortions every year.15
• 90 percent of these deaths and injuries can be prevented
by simply increasing access to contraception.16 Between
1995 and 2003 the number of safe abortions fell from 25.6
million to 21.9 million, while the number of unsafe abortions
only fell from 19.9 million to 19.7 million.17
• In some countries women who have had abortions are
criminalised. This contributes to great suffering among
women, many of whom are often very young, who incur complications resulting from an unsafe abortion. Unsafe abortions are also a major economic problem for national health
budgets, and often burden the local health sector by taking
up a large proportion of health care resources.18
• There are only a handful of countries in the world in which
abortions are totally prohibited and not permitted no matter
what the reason.19
in connection with discussions on the connections between
abortion legislation, women’s access to and knowledge about
safe abortions and improved public health. It is also important
to know as much as you can about the legislation regarding
abortion in a given country, as well as how it is enforced and
whether or not ordinary people are aware of it. It might then
be possible to discover ways to strengthen progressive forces
within the health system and civil society that want to increase
accessibility, or strengthen organisations that work with providing information about the law and/or that make demands on
authorities to provide the services that they are bound by law
to make available.
Demonstrating the links between maternal mortality and
unsafe abortions is an important entry point to dialogue on
abortion. Most countries want to reduce the high number of
women and girls who die as a result of complications in connection with pregnancy and childbirth. Unsafe abortions represent around 13 percent of maternal mortality globally, but
in many countries in Sub-Saharan Africa this figure is as high
as 30–40 percent.20 Providing access to safe abortion is therefore an essential part of the work to reduce maternal mortality.
Supporting women’s access to safe abortion reduces health
care costs and represents an important factor in the work to
realise the right to health for everyone. Studies show that costs
of maternal ill-health for hospital beds, blood banks, surgical
procedures, antibiotics and other medicines, as well as doctors
and other health care workers far exceed the costs of providing safe abortion. Adolescents, and poor and young women
are those who mainly have no other recourse than to undergo
unsafe abortions. Women from other social classes may often
be able to seek out and pay for a safe abortion. This means
that the consequences of unsafe abortions mostly affect poor
women, which means that the issue of abortion is also an issue
of poverty, justice and social equality.
Experiences from Sweden’s embassies and missions abroad
show that abortion is an extremely sensitive issue that must
be dealt with in a strategic manner. One important entry point
for dialogue can be to begin by discussing it with like-minded
bodies, and by carefully highlighting experiences from Sweden’s
own development, where so much has changed since the middle
of the 20th century. This dialogue should highlight the links
between access to safe abortion and access to contraceptives to
prevent unwanted pregnancies, and the positive consequences
this has on public health.
A number of frequently heard assertions
on abortion are presented below, along with
suggestions on how to address them:
“Women suffer psychological
damage as a result of having an abortion.”
Studies show that having an abortion is not a simple decision for women who decide to terminate a pregnancy. Most
women who become pregnant at a difficult stage in their lives
can feel desperation, grief or anxiety. When abortions are
legal, women are able to process their feelings with the help of
counselling services.
The criminalisation of abortion leads to feelings of shame,
fear and anxiety. It also makes it difficult for women to
seek counselling in order to process their feelings, and to
19
seek hospital care if complications do arise as a result of an
illegal abortion.
“Abortion is murder, a sin and immoral.”
Using arguments such as that it is the woman herself who has
the right to decide about her own body and therefore to have
an abortion (which is in line with the Swedish model) can be
counterproductive in a discussion with someone who thinks
that abortion is murder and should be penalized. It can be
more fruitful to discuss whether it is reasonable and acceptable that women die of unsafe abortions, and that they are
considered to be criminals because they have had an abortion.
One of the serious health consequences of denying women
abortions is the fact that women instead use life-threatening
methods, including taking hazardous substances, in order to
provoke a spontaneous abortion or miscarriage, thereby risking
premature death or disability.
“Abortion not only affects the woman,
but also society as a whole.”
Yes, since women in most societies are the ones who look after
and bring up children, it is often they who make the everyday
decisions that affect their family’s health. It should be the
woman herself who decides whether she wants to proceed with
the pregnancy. Women are also very well aware of how their
reproductive choices affect their family and whether, for example, how having more children will affect the family.
The consequences of illegal and unsafe abortion are reflected
in high levels of maternal deaths and suffering, and costs in
terms of health care resources and lower rates of economic
growth at both local and national level than would otherwise be
the case.
“Introducing free abortion is
a Western idea, new colonialism.”
Women throughout history and in all regions have chosen to
terminate pregnancies when they have felt compelled to do so,
irrespective of whether it has been illegal or legal. The vast
majority of all injuries and deaths which occur as a result of
unsafe abortions are not carried out in the West, but in devel20
oping countries where abortion is strictly regulated by law or is
illegal, or where there is poor access to safe abortions. In such
countries there tends also to be a high unmet need for contraceptives and family planning, especially among the poorest
people, adolescents and young women. It is important to note
that in order to effectively address statements and arguments
such as this one, it is important to have a good understanding
about the country’s abortion legislation in order to determine
what possible entry points exist and can be used to open up
discussion in this area.
“Abortion leads to social decline and destruction of society.”
The decision to have an abortion, irrespective of how safe and
legal it is, is not a decision that a woman makes lightly; it is a
decision she takes when she feels it is necessary or feels that she
does not have any other choice. If unwanted pregnancies are to
be prevented, the most effective way is to ensure that women
have access to information about sexual and reproductive
health, contraception and family planning, and that they have
the opportunity to make decisions about their own sexuality.
Prevention of unwanted pregnancies also requires that men
must be encouraged to assume their responsibility.
A common argument used to attack those who defend access
to legal and safe abortions is to accuse them of being active
abortionists or of advocating that abortions be used as contraception and method of family planning. Rather than call oneself
an advocate for abortion, it is better to present oneself as a
supporter of women’s right to choose and to work to ensure
that those who want and need to are ensure of access to safe
abortion services and care in case of complications.
“Men should also have a say when it comes to abortion.”
The woman is the person who becomes pregnant and is normally the one who has the primary responsibility of looking
after the child, irrespective of the circumstances under which
she became pregnant, her living conditions, or her capacity and
ability to take care of a child. She should therefore be able to
decide herself whether she wants to go through with a pregnancy or not. Of course, the man in question has the right to
give his opinion (if he is known and this is possible), but in the
end, the decision is one that must be taken by the woman herself based on her assessment of her situation and her options.
Experiences from the field
Zambia has relatively liberal abortion legislation, but one of
the main problems is the fact that people do not know about
this legislation, not even health care workers. Meetings with a
large number of stakeholders who work with this issue have
been important to make multilaterals in particular aware
of the fact that there is a legal basis for working with safe
abortions.
In Uganda abortions are prohibited, but the officer there
has brought the issue up in discussions with other likeminded stakeholders. In so doing however, they stress the
importance of caution, due to political sensitivity and the risk
of a backlash.
SRHR issues have been very topical, but also extremely
difficult to pursue within the framework of sector support
in Central America. The issue of abortion has been particularly difficult and, according to an officer at the embassy in
Nicaragua, there is more to be gained by simply not highlighting the abortion issue as an separate issue, but to put it
into a context, e.g. by linking it to long-term prevention work
and sexuality education at school, as well as to show the
economic consequences for a society that does not invest in
SRHR.
14. ippf, Death and denial (2006).
15. who, Unsafe abortion, Fifth edition (2007).
16. unfpa, No Woman Should Die Giving Life (2008).
17. Guttmacher Institute, Abortion worldwide. A decade of uneven progress (2009).
18. rfsu, Breaking Through. A guide to sexual and reproductive health and rights
(2004).
19. E.g. Chile, El Salvador, Malta and Nicaragua.
20. unfpa, Healthy expectations. Celebrating achievements of the Cairo
Consensus and highlighting the urgency for action (2009).
21
Young people and SRHR More than half of the world’s population is under 25, and in
several developing countries, young people make up between
50 percent and 60 percent of the population. Half of them live
in poverty or extreme poverty. A record high generation of
young people find themselves at a time in their lives when they
are shaping their existence, planning their futures, learning
to stand on their own two feet, and becoming sexually active.
However, in many countries the practice of transferring positive
traditional knowledge of sexuality has been lost. Consequently
many young people lack access to correct information, the
knowledge and the means to protect themselves against sexually
transmitted diseases including hiv, and unintended pregnancies.
Why is Sweden working to promote young people’s
sexual and reproductive health and rights?
Young women and men are not only recipients of health care
and information, they are also active stakeholders in society who
have the right and ability to be involved in decisions that affect
their lives. Focusing on young women and men is also important
for the promotion of gender equality.21
If young women and men are to be able to make informed
decisions about their lives, they must have access to knowledge and information both about their sexuality as well as
methods of avoiding risky behaviour such as unsafe sex. In all
countries, social norms and values determine what attitudes
to young people’s sexuality and gender identity prevail in the
society. These norms have consequences for young people’s
room to manoeuvre and ability to act and when it comes to
the possibilities at their disposal to express their sexuality,
and to protect themselves from sexually transmitted diseases
and unwanted pregnancies.
Entry points for dialogue on young people and SRHR
Work to promote young women’s and men’s sexual and reproductive health and rights cannot be seen as an isolated issue.
It is closely interrelated with young people’s living conditions,
life prospects and position in society in general. As previously
mentioned, a very large proportion, often close to half, of the
total population in many developing countries is under 25
years old. At the same time, their de facto social and politi-
cal position in society are often weak. Young people often do
not have a say or any influence in society and its development.
This is particularly true for young people living in conditions
of poverty and deprivation. It is therefore important to involve
both young people and adults in an intergenerational dialogue
in order to reach a common understanding of each other’s
needs, challenges and potential.
There is a great deal of resistance to the idea of young people
making independent decisions about their bodies, sexuality
and reproduction, and when it comes to their being sexually
active outside the socially recognised forms of marital union
that exist in various societies. In many societies, leaders and
decision-makers advocate sexual abstinence and fidelity in marriage as the only alternative for sexual expression, particularly
for women. They therefore believe that information on sexuality
and access to condoms and contraception are unnecessary and a
threat to public order.
• Early marriage for girls is regarded in many societies as
a way of achieving better social and financial life circumstances. However, early marriage is itself actually closely
related to poverty. Postponing marriage to later in life
increases young women’s opportunities for education and
work.22 Pregnancy at a young age is also associated with serious health risks and contributes to the cycle of maternal and
childhood mortality. Some progress has been made, but the
UN calculates that in the next decade 100 million girls will be
married off before they reach the age of 18 years.23
• 45 percent of people over the age of 15 who are infected
with HIV are currently between 15 and 24 years old and the
vast majority live in developing countries.24 Young women are
particularly affected.
• Adolescent girls aged 15 –19 account for an estimated 14%
of all unsafe abortions in the developing world, and 25% of
all unsafe abortions in Sub-Saharan African countries.25
Children and young people up to the age of 18 are covered
by the Convention on the Rights of the Child. Article 24 of
the Convention on the Rights of the Child deals with the
child’s right to enjoy the highest attainable standard of health
and the right to health care services and rehabilitation. One of
the areas that is highlighted in particular is states’ obligation
23
to work to develop preventive health care, parental guidance,
as well as education on and help with family planning and
other reproductive choices (Article 24.2 (f)).
The Committee on the Rights of the Child monitors states’
adherence to the convention and interprets its content. In a general comment on the health and development of young people26
the Committee states that young people may not be discriminated against in the enjoyment of their rights as a result of their
sexual orientation or their health status (which includes hiv
and aids) and that a minimum age for sexual self-determination
and medical treatment without the parents’ consent should be
introduced into law. The recommended minimum age for marriage is 18 years.
The Committee on the Rights of the Child also maintains
that states, based on the principle of the child’s best interest, his or her right to access to information and his or her
right to health, must provide young people with information
about sexuality and reproduction, including contraception, hiv
prevention and how to avoid being infected with other sexually transmitted infections. States are encouraged to allow
young people to play an active role themselves in producing
and spreading information. It is also recommended that states
develop programmes to provide access to sexual and reproductive health care services, including contraception and to safe
abortion where this is legal (see the thematic sheet on access to
safe abortion).
The icpd’s Programme of Action contains several formulations that highlight the link between young people and srhr. It
stresses that young people must be involved in the planning,
implementation and assessment of activities that relate to
sexual and reproductive health (PoA 6.15). It also maintains
that states must work to ensure that young people’s access to
services and information is not constrained, and that governments must protect and promote young people’s right to
sexuality education, information and health services (PoA
7.45–46). The follow-up document, ‘Key Actions’, emphasises
the fact that these services (which also include counselling)
must protect young people’s rights to privacy, discretion and
informed consent (icpd + 5 73 (a)).
The Beijing Platform for Action (1995) encourages govern24
Experiences from the field
According to a programme officer at the embassy in Lusaka,
to give more weight to argumentation in dialogue on young
people and SRHR, there is much to be gained by using
materials and statistics from, for example, UNFPA and WHO.
Information from UN bodies or research can provide more
credibility than referring only to Sweden’s experiences and
position.
An official at the embassy in Maputo, where Sweden has
supported a UNFPA-led project on the sexual and reproductive health of young people, confirms the importance of
the choice of dialogue channel. This project also proved to
be a good forum for dialogue on sexuality education, family planning, abortion, HIV and young people. According to
this official, UN bodies are considered to have better local
support than the development cooperation offices bodies of
individual donor countries.
ments to meet young people’s needs to ensure that they can
deal with their sexuality in a positive and responsible way
(Beijing Platform for Action 108 (k)). It also includes as a
strategic action, that all barriers to access to formal education
for pregnant adolescents and young mothers should be removed
(Beijing Platform for Action 83 (s)).
The health of young people and their access to education
and information are also a focus for international processes
and initiatives designed for the prevention, care, support and
treatment of hiv/aids such as ungass, and regional instruments
such as the Mexico City Declaration on Sex Education in Latin
America and the Caribbean (2008).
A number of frequently heard assertions on
young people and SRHR are presented below, along
with suggestions on how to address them:
“Sex should only take place within marriage.”
No matter what people think about sexual activity among
young people or outside marriage, it is a fact that young people search for intimacy and love, and that most of them will
experiment with sex sooner or later. It is therefore important
for young people to be informed about what sexual activity,
what it involves and what emotional or direct consequences it
Sweden’s position and key message: Young people must
be guaranteed the right to make decisions about their own
sexuality and given the opportunity to have a responsible,
satisfying and safe sex life, without coercion, violence,
discrimination or the risk of becoming involuntarily
pregnant or being infected with hiv and other sexually
transmitted infections.
can have, in order to allow them to live fulfilling lives and to
be able to make well-informed decisions on marriage and family formation. If young people know about the various consequences of being sexually active, it may also strengthen their
ability to protect themselves by saying no to sex when they do
not want it.
“Parents are those who are responsible
for their children, and they know best.”
A young woman cannot make decisions about her education
or gainful employment if she is being subjected to violence or
for other reasons is not given the opportunity to make decisions about her own sexuality and reproduction. In concrete
terms, it means that young women must be given the opportunity themselves to decide when they are ready to marry,
have children and the number of children they want to have, as
their decisions also affect their opportunities to continue their
schooling or look after themselves and their families. However,
it is important to acknowledge the fact that granting someone
else this kind of power – in this case a female child, means that
parents lose a measure of their own power and control over her.
It is therefore a good idea to link arguments and suggestions
to something that can be positive for the parents, even though
they lose power over their children. For example, if daughters
are educated instead of marrying early, they can have a profession and will be better able to contribute to their own and their
family’s well-being.
“We cannot prioritise srhr for young people. Unemployment, education and water supplies are more important.”
The consequences of not investing in young people’s sexual and
reproductive health and rights also lead to a depletion of valuable human resources, as well as high costs of health care due
to injuries during childbirth, injuries from unsafe abortions and
the treatment of sexually transmitted diseases, as well as antiretroviral drugs for young people living with hiv. This also leads
to the society having a lower educated, less qualified workforce,
and an increase in the financial dependency of young people on
their parents and relatives.27
21. Ministry for Foreign Affairs, Sveriges internationella politik för sexuell och
reproduktiv hälsa och rättigheter (2006), p. 15.
22. undesa, The Millennium Development Goals Report (2008).
23. unfpa, State of the World Population (2005).
24. unaids, 08 Report in the Global Aids Epidemic (2008).
25. Guttmacher Institute, Adding it up – The Costs and Benefits of Investing in
Family Planning and Maternal and Newborn Health (2009).
26. Committee on the Rights of the Child, General comment No. 4, Adolescent
health and development in the context of the Convention on the Rights of the
Child, crc/gc/2003/4, 1 July 2003 (2003).
27. unfpa, Giving girls today and tomorrow. Breaking the cycle of adolescent
pregnancy (2007).
25
Sexuality education
Despite the importance of sexuality education for people’s health
and enjoyment of human rights, it is a controversial topic in many
countries. Public discussions about sexuality, particular in relation to women’s and young people’s sexuality, are often characterised by conceptions and norms about perceptions of morality
rather than factual knowledge. Resistance will of course vary
depending on the specific situation, so it is therefore important to
begin by understanding the relevant political and social context.
Why is Sweden working to promote
sexuality education internationally?
Sweden’s point of departure is that sexual and reproductive
ill-health, such as sexually transmitted infections, including hiv
and aids, unwanted pregnancies and unsafe abortions, are due
primarily to the fact that people have limited knowledge and
information about their own bodies, sexuality, sexual intercourse, relationships and reproduction. Sexuality education is
therefore important to reduce people’s vulnerability in these
respects. Young people are obviously a primary target group for
this work, but it is also important to provide adults with support and education, and to highlight vulnerable groups that may
have fallen outside of the formal education system.28
Most children go to school for at least a few years in their
lives and so there is great potential for sexuality education
within the framework of the regular education system. Sexuality education in schools should be introduced at an early stage,
partly to ensure that as many young people as possible are
reached, and partly because it is more effective if it is given
before young people become sexually active.29
However, 73 million children in the world do not attend
school, and in developing countries as many as 50 percent do
not receive an equivalent of secondary-school education.30
Neither have a very high proportion of adults ever received any
sexuality education. Sexuality education is therefore not only a
challenge in terms of improving knowledge among teachers, but
also in terms of the development of educational programmes
that reach out to those outside the formal education system.
Civil society organisations often have a broad contact network as well as great deal of knowledge and experience in this
respect that could be helpful.
What is sexuality education?
The purpose of sexuality education is to ensure that people,
and in particular young people, can better understand themselves so that they can make informed choices about sex and
relationships, as well as to counteract myths and false perceptions about sexuality. Sexuality education also aims to prevent
sexual harassment, sexual violence, and the discrimination of
lgbt people and people living with hiv and aids. Good quality
sexuality education improves public health by providing information that is adapted to people’s ages and specific contexts,
and that looks at relevant, real-life issues related to sex and
relationships for young people. This kind of sexuality education is supportive of people’s ability to make their own choices
and respect other people’s choices in terms of intimacy and
sex. The most important components in good quality sexuality
education are that it provides correct and factual information
about the human body and sexuality, that it develops skills such
as critical thinking, communication and negotiation methods,
self-esteem and respect for others, and finally that it encourages self-respect and a non-judgemental and non-discriminatory
attitude.31 Discussions about feelings, love, relationships, masturbation, sexual pleasure, gender equality, gender roles, sexual
orientation and gender identity, as well as methods for protecting against unwanted pregnancies and sexually transmitted
diseases provide knowledge, make people feel more confident
and facilitate safer sex.
Relevant sexuality education requires competent and knowledgeable teachers. Those who teach sexuality education must
have the trust of the pupils. Pupils should be able to rely on
teachers’ respect for their thoughts, ideas and questions without judgemental accusations or ridicule, and on the teachers’
willingness and ability to answer their questions with correct
and unprejudiced information. Good sexuality education places
high demands on teachers.
Entry points for dialogue on sexuality education
‘Sexuality education’ are two words that are charged with layers
of meaning, and their content and meanings associated with
them can be very different in various parts of the world. It is
important that sexuality education be discussed in the context
27
of its role in the development and maturation of children and
young people, its potential as an element in the fight against
poverty, and its role in promoting public health through the
provision of important life skills.
Young people are curious and do not normally hesitate to
ask questions about their feelings or to seek information on
their own or from peers if they find it difficult to talk to their
parents or other adults. Studies show that many young people
in both developing countries and industrial countries currently
receive this information primarily from each other or from
other sources, such as publications or the Internet, and that
this information is often far from being factually correct. If
young people receive the correct information, it is easier for
them to take responsibility for their own sexual behaviour.
Knowledge about relationships and sexuality leads to better
communication with a partner. Schools can refer young people
to clinics and also in other ways increase their awareness of
the importance of seeking health services when they need to.
This knowledge leads to demystifying myths about how hiv and
sexually transmitted diseases are spread, and also how harmful
traditions that are practiced in some countries and regions can
be avoided.
A useful tip
A number of UN bodies, UNESCO, UNAIDS, UNFPA,
UNICEF and WHO, worked together to produce a manual
“International Technical Guidance on Sexuality Education”,
the purpose of which is to provide useful data and guidelines for sexuality education in schools. This guide is divided
into a section that contains arguments for sexuality education, which can be used in dialogues with governments and
in particular health and education ministries, as well as a
section that focuses on how a good and effective sexuality
education programme can be designed
The icpd Programme of Action highlights universal access
to sexuality education as being essential for people to be able
to enjoy their sexual and reproductive rights, and further,
that sexuality education should be provided as part of basic
education curricula as well as in other kinds of formal and nonformal education.
28
The Human Rights Committee, the Committee on the
Elimination of All Forms of Discrimination against Women and
the Committee on the Rights of the Child have linked access to
sexuality education at school to the right to life, health, education and information.
Regional frameworks can be important instruments. One
example of this kind of framework is the ‘Mexico City Declaration on Sex Education in Latin America and the Caribbean’.
Another is the ‘Maputo Plan of Action’ for the African region.
In Europe, the European Committee of Social Rights, which
is the monitoring body for the European Social Charter, has
presented a line of argument based on principles that sexuality
education must be objective, based on scientific fact and contain correct information about contraception and other issues.
Sexuality education must not be discriminatory by excluding
children from such education or by strengthening disparaging
stereotypes and prejudices.32
A number of frequently heard assertions on
sexuality education are presented below, along
with suggestions on how to address them:
“Sexuality education increases sexual activity and promiscuity among young people.”
This is incorrect, since studies show the opposite to be true:
that with more information and knowledge, a person’s sexual
debut takes place later in life and that young people who have
received sexuality education can and do protect themselves
better against sexually transmitted infections and unwanted
pregnancies.33
If sexuality education is going to be effective, it not only
requires adequate actions that increase people’s knowledge and
ability to discuss sexuality with their partners. It must also be
supplemented with access to counselling, contraceptive methods and health care services.
“Sexuality education is not necessary –
young people should not be having sex anyway.”
The school’s role is to disseminate objective and all-round
knowledge to ensure that young people can make their own
informed choices based on their own circumstances and reality.
Sweden’s position and key message: Knowledge and
information about the human body, sexuality, reproduction
and relationships are fundamental to ensure that people’s
sexual and reproductive health and rights are met.
Knowledge about the human body, sexuality and contraception
provides young people with an opportunity to take responsibility for their lives and their sexuality. Sexuality education is an
effective way of increasing knowledge, and evidence shows that
the sexual debut does not take place earlier among children
who receive such education.34 One-sided campaigns for young
people to abstain from sex have not shown positive results.35
Most young people have sex sooner or later. In countries where
neither an open discussion nor any sexuality education is
allowed, young people often feel confusion, shame and guilt
over their sexuality, girls are forced to finish school because
they become pregnant, and people become infected with sexually transmitted diseases and hiv because they know too little
about how their bodies work, about how to protect themselves
and how to obtain condoms and other contraceptives. Young
people have the same thoughts and questions about sexuality
around the world, but they receive different answers depending
on where they live.
Young people must be able to protect themselves. Sexuality education increases the ability for them to do this. Lack of
information makes them more vulnerable.
“Teachers lose children’s respect
if they have to talk about sex.”
Young people’s sexuality is certainly controversial, but teachers who have received training and support in their role as
sexuality educators report that it is indeed possible to include
sexuality in instruction, and that they actually become
popular among the pupils because they are perceived as taking
the pupils seriously. In terms of the relationships between
teachers and pupils, one can point out that successful sexuality education actually works as a way of increasing trust in
the teacher as well as their status. A teacher or another adult
who can provide good quality sexuality education gains the
respect of young people.
Effective sexuality education is something that is clearly
useful and applicable in people’s real, everyday lives. It should
be a part of discussions about e.g. social relations between
the sexes, intimate relationships, gender equality and sexual
harassment. These discussions are extremely important as they
strengthen young people’s self-esteem and self-confidence, as
well as their ability to take responsibility for their behaviour
and their future.
Experiences from the field
At the embassy in Tanzania, the ambassador has discussed
SRHR with teachers, local politicians and ministers. He has
particularly pursued the importance of pregnant girls being
allowed to remain in school. The issue of sexuality education does not meet with a lot of overt resistance in the public
debate, but neither is it a prioritised issue. On the other hand,
the arguments about preventing teenage pregnancies and
allowing pregnant girls to remain at school have had a positive impact as a result of the debate. One important discovery
has been that an effective way to make progress on such
issues can be to use measures to influence public opinion
such as e.g. press releases and newspaper articles, in combination with the forging of alliances with local organisations
and decision-makers.
28. Ministry for Foreign Affairs , Sveriges internationella politik för sexuell och
reproduktiv hälsa och rättigheter (2006), p.23.
29. Guttmacher Institute, Protecting the Next Generation in Sub-Saharan
Africa (2007).
30. undpi, Goal 2: Achieve Universal Primary Education (2008).
31. ippf, Reference guide to policies and practice. Sexuality education in Europe
(2006).
32. European Committee on Social Rights interights v. Croatia (Complaint
No. 45/2007).
33. Guttmacher Institute, Protecting the Next Generation in Sub-Saharan
Africa (2007).
34. Guttmacher Institute, Protecting the Next Generation in Sub-Saharan
Africa (2007).
35. Human rights Watch, The less they know, the better Abstinence-Only
Hiv/Aids Programs in Uganda (2005).
29
Condoms and other methods of contraception
Access to contraception, medicines and health care equipment
and materials for sexual and reproductive health is a central
feature of the goals from the Programme of Action from the
International Conference on Population and Development (icpd)
in Cairo in 1994, and is important for the achievement of several of the UN Millennium Development Goals.
Why is Sweden working to promote access
to condoms and other contraceptives?
Access to contraceptives such as condoms, and information and
counselling on different methods of contraception are fundamental for women’s, men’s and young people’s prospects of having a safe sex life, and of being able to decide if and when they
want to have children.
People’s general health status, capacity and possibility to
study and work are improved considerably when they are guaranteed access to adequate and affordable sexual and reproductive
health care services. Women’s and young people’s opportunities to be able to make decisions about their own lives and play
an active role in society are particularly improved by access to
such health services, including to contraceptive methods such
as condoms. Women who are able to plan their pregnancies and
protect themselves against sexually transmitted infections are
also better educated and are in a better position to look after
their children than those that are not. Strengthening sexual and
reproductive health and rights also means that more people are
able to work and therefore to contribute to the national economy
and increased productivity, and that costs for health care for
families as well as for nations will decrease. Guaranteeing access
to condoms and other forms of contraception is considerably
more cost-effective than having to provide care after unsafe
abortions and complications in connection with pregnancy and
birth, or after people have become infected with hiv.
Entry points for dialogue on condoms,
contraceptives and other health care supplies
for sexual and reproductive health
The importance of having access to condoms, contraceptives,
medicines and health care supplies to ensure sexual and reproductive health can be linked to people’s fundamental right to
the highest attainable standard of health and to being able to
live a life in dignity, which is set out in several un conventions
on human rights.
The un Convention on the Elimination of All Forms of
Discrimination Against Women (cedaw) includes the right of
women to decide freely and responsibly about the number and
spacing of their children and the right to access sexual information, education and the means to enable them to exercise
these rights (Article 16(1)(e)). The cedaw Committee that
monitors adherence to this convention has also stressed the
fact that women cannot make well-informed decisions about
the use of safe and reliable contraception if they have not
received adequate information and do not have access to advisory servicers on contraception.36
Experiences from the field
Dialogue on sexuality and gender equality with young men
and local leaders in the RFSU project, “Young Men As
Equal Partners” in Tanzania, Zambia, Uganda and Kenya
2006 –2009, resulted in an increased demand for sexuality education and sexual and reproductive health services.
Condom use increased as well as the number of visits to
reproductive health clinics, which contributed to a decrease
in STIs and teenage pregnancies in the project areas.
Other un human rights monitoring committees have recommended that states improve access to safe and affordable
contraceptives. States have also been specifically encouraged
to ensure that women, men and young people have access to
condoms, and that information about the use of condoms is
disseminated in the context of hiv prevention programmes.
Development cooperation funding for family planning has
decreased.37 Studies indicate that investments for actions to
combat hiv and aids are those that currently receive the major
part of international financial support in the area of srhr.
Although work to prevent and combat hiv and aids can successfully be integrated into and create synergies with other srhr
work, it is important not to neglect the need for funding for
other srhr issues. Although some progress has been seen in, for
example, maternal mortality, in some countries maternal health
and access to condoms and other methods of contraception glo31
bally must be significantly improved if un Millennium Development Goals 4, 5 and 6 are to be achieved by 2015.
Dialogue on national budgets in connection with the followup of national strategies for poverty reduction, health sector
support or actions plans for the strengthening of health systems
can be key entry points for raising the issue of sexual and reproductive health care services. Dialogue in such contexts could
for example include working actively to ensure that adequate
resources are allocated and clearly designated in the budget
for inter alia contraceptives, condoms, testing, advisory and
counselling services, midwives, emergency contraception pills,
care after unsafe abortions, maternal health care, hiv testing
and anti-retroviral drugs in national budgets.
The use of contraceptives promotes development at all
levels, i.e. for individuals, families and local communities as
well as for nations. Investments in sexual and reproductive
health and contraception strengthen the ability of families to
support themselves, and can reduce public expenditure for
health care and other social services. Increasing the availability of condoms and contraception is thus a cost-effective way
of promoting poverty reduction. In addition, several of the
un Millennium Development Goals could be achieved if more
resources were invested in sexual and reproductive health,
including to increase the availability of and access to condoms
and other contraceptives.
A number of frequently occurring assertions
regarding condoms and other methods of
contraception are presented below, along with
suggestions on how to address them.
“Information on contraception and
condoms leads to an increase in sexual activity.”
No research or analytical studies suggest that information
about condoms or contraception results in an increase in
sexual activity. However, there are studies that do show that
ignorance leads to an increase in risky sexual behaviour.38
The use of condoms is in many places a moral issue,
whereby condoms are seen as symbolising infidelity, promiscuity and sex before marriage. However, one’s own personal
religious or moral convictions should not affect other people’s
32
ability to choose for themselves whether or not they want to
use condoms. When used correctly, condoms – both male and
female – are currently the only proven and effective means of
prevention against the transfer of hiv and other sexually transmitted infections for individuals who are sexually active.
“It does not pay to invest in contraception and condoms.
Most people still want to have large families.”
Most families actually want to have the number of children and
a family size that they can provide adequately for. More than
200 million women who want to postpone or limit their childbearing do not have access to modern contraceptives. In 2009,
up to 50 percent of all pregnancies globally were unplanned and
25 percent were unwanted.
Studies also show that women who can plan their childbearing benefit significantly, both in terms of personal prospects
and financially. In the Philippines the average income growth
for women was twice as high if they had had three pregnancies
compared to if they had had more than seven pregnancies.39
• Maternal mortality could be reduced by one-third simply by
improving women’s access to effective contraception.
• 200 million women lack access to contraception, even
though they express a need for it.
• The total demand for contraception is expected to increase
by 40 percent in the next 15 years.40 This is partly, but not
entirely, due to a lack of financial investment in reproductive
health supplies, as well as to an urgent need to reprioritise
among current measures and investments.
• Maternal mortality could be reduced by half and costs for
health care considerably decreased if more investments were
made to improve the accessibility of condoms and other
methods of contraception.41 A lack of infrastructure, such as
transport options and logistics problems, also result in contraception, medicines and health care supplies for sexual and
reproductive health not reaching everyone who needs them.
• In Thailand, local authorities invested in a campaign for
“100-percent” condom use in brothels in the 1990s. This
resulted in condom use increasing from 14 to 95 percent
over five years, and sexually transmitted diseases falling from
400,000 to 30,000 cases per year in the same period.42
Sweden’s position and key message: Access to condoms
and other contraception is an important way to avoid
unwanted pregnancies. The use of condoms is also essential
for effective prevention work against the spread of hiv and
other sexually transmitted infections.
36. Convention on the Elimination of Discrimination against Women,
General Recommendation No. 21, Equality in marriage and family relations,
(13th session, 1994).
37. Eurongos, dsw, epf Euromapping, Mapping European development aid and
population assistance (2008).
38. Guttmacher Institute, unfpa, Adding it Up – The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health (2009).
39. unfpa, State of the world population (2005).
40. unfpa, No Woman Should Die Giving Life (2008).
41. Guttmacher Institute, unfpa, Adding it Up – Costs and Benefits of Family
Planning and Maternal and Newborn Health Services (2009).
42. who, Regional office for the Western Pacific, Fact sheet: Condom facts and
figures (2003).
33
HIV and AIDS
Combating hiv and aids requires active involvement, responsible
leadership and forceful actions and measures from many different stakeholders. hiv and aids represent a complex challenge,
and is one of the greatest global threats to poverty reduction
and the achievement of equitable and sustainable development.
However, there are positive trends: the spread of hiv seems to
have stabilised in many parts of the world, and international
investments and the work of different countries have meant
that currently more than 4 million people living with hiv and
aids in low-income and middle-income countries have access to
condoms and anti-retroviral drugs.43
Why is Sweden working to combat
HIV and AIDS in the context of SRHR?
In 2008 the Swedish Government adopted a policy for Sweden’s
International hiv and aids work; The Right to a Future. This
policy stresses that human rights, work to promote gender
equality and the fight against hiv and aids are closely interlinked. Individuals and groups of people become more vulnerable to hiv infection when their human rights, in particular
their sexual and reproductive rights, are not respected. Consequently, respect for human rights must be strengthened, and
equality between women and men must increase in order to
fight hiv and aids effectively. In this policy, Sweden highlights
two central areas in its hiv and aids work: to prevent the spread
of hiv, and to alleviate the long-term effects of hiv and aids for
individuals and societies.44
The strong stigma which currently surrounds hiv means that
people living with the infection are marginalised and denied
equal treatment. They and their families are often forced to live
in social exclusion, and sometimes subjected to violence and
harassment. This also results in many people not getting tested
in order to avoid stigma and discrimination.
People living with hiv must be able to enjoy the same rights
as others, and to have equitable access to health care services,
education, information, srhr counselling and methods of contraception such as condoms. They also have the right to avoid
being subjected to violence and should be given the opportunity to play an active role in formulating and implementing hiv
policies and programmes.
Entry points for dialogue on HIV and AIDS
hiv prevention is a prioritised Swedish issue and must be
emphasised in dialogue. This can be done mainly by working to
integrate a human rights perspective and a gender equality perspective in interventions, as well as by influencing and pursuing dialogue on the implementation and monitoring of existing
policies, actions plans, guidelines and budgets.
Discussions on hiv and aids touch upon a number of human
rights, for example the right to health and to access medicines,
and the right not to be discriminated against. The un Human
Rights Committee has encouraged states under the heading
‘Right to life’ to supply anti-retroviral drugs to people living
with hiv and aids.
• The poorest areas of the world have been hit hardest by
HIV and AIDS. Currently there are 33 million people living
with HIV, and 2.7 million more people are infected every year.
Of these, 45 percent are young people between the ages
of 15 and 24, the majority of whom live in poor countries.45
Poverty, lack of gender equality and sexual violence result in
women and girls, in particular in Sub-Saharan Africa, being
more likely to be living with HIV and AIDS than men.
• HIV and AIDS cause not only personal tragedies, but also
create major problems for society as a whole. The consequences of the HIV pandemic include everything from a
lower GNP to a decimated teacher and civil servant corps.
Most people living with HIV have been infected through
sexual contact. Efforts to tackle the HIV epidemic must
therefore have a focus on sexuality and on rights dimensions.
In specific terms, this means that the work to prevent the
spread of HIV must include sexuality education, the use of
condoms and attention to the promotion of gender equality.
Article 12 (2) (c) of the Covenant on Economic, Social and
Cultural Rights is about the prevention, treatment and control of
epidemic diseases, and implies that governments need to establish
prevention and education programmes for public health problems
such as sexually transmitted infections, including hiv and aids.46
In the Declaration from the un General Assembly’s special
session on hiv and aids (hiv-ungass) in 2001, all un member
states pledged to set up time-bound targets and regularly follow
up the work on the pandemic. At the follow-up session of 2006
35
a new declaration was signed with explicit text concerning
general access to prevention measures, medicines and health
care by 2010.
hiv epidemics are very different in different parts of the
world. It is therefore important to analyze and have an adequate
understanding of what the epidemic is like and what factors
drive the spread of hiv in a particular place, in order to identify suitable ways of opening doors for dialogue and carrying
out relevant, context-specific measures. In some countries the
epidemic is concentrated to specific groups, while in other countries it affects the general population to a greater extent. In SubSaharan Africa, 60 percent of people living with hiv are women.
Many of them are infected within marriage. In other regions it
is also primarily women and girls who are becoming infected to
a greater extent than men and boys. Work to promote gender
equality and women’s rights and to counteract the increasing
feminisation of the hiv epidemic is therefore important.
Experiences from the field
Experience at the embassy in Pretoria has shown that good
opportunities to conduct dialogues about various SRHR
issues have arisen within the context of HIV and AIDS work.
South Africa has relatively progressive legislation in terms
of human rights, which was partly developed within the
framework of national HIV and AIDS work. This has led to
the work to fight stigma and discrimination of HIV-positive
people becoming clearly linked to human rights issues. Due
to the clearly discernible consequences of HIV and AIDS
prevalence in South African society, a greater degree of
openness has developed in the country around controversial issues such as sexuality education, contraception, and
women’s and LGBT rights, thus providing a good foundation
for continued SRHR dialogue.
Men who have sex with men, women and men in prostitution,
as well as injecting drugs users are often left out of hiv interventions, thereby further increasing the vulnerability and isolation
of these groups. These key populations at risk must be targeted
by context-specific efforts and also be given the opportunity to
take active part in the design of prevention programmes.
Young people’s sexuality and rights are seen as being sensitive
issues and are difficult to talk about in many societies. How36
ever, it is impossible to fight poverty sustainably and achieve
the un’s development goals without investing in health and
rights for the large group of people that young men and women
represent. Young people must receive information about how
their bodies work and about sex and relationships. They also
need to be given access to health care that is not judgemental or
discriminatory so that they can be tested, receive counselling
and gain access to contraception.
When people are discriminated against because of their sex,
sexual orientation or other factors, their vulnerability and risk
of being infected with hiv is increased. Traditional gender roles
must be challenged in order to prevent the spread of hiv. Finding ways of involving men in this work is an important part of
Sweden’s work and dialogue to combat hiv and aids. For example,
men and boys must be able to take responsibility for their own
sexuality by respecting the human rights of women and girls, and
to question their own sexual behaviour, by, for example, using
condoms and by repudiating and disassociating themselves from
all forms of gender-based violence towards women and girls.
Women’s subordinate position and their lack of sexual
bargaining power mean that the female condom is extremely
important. The female condom gives women the option of controlling the use of condoms themselves and should be marketed
and distributed to a much greater extent than today. At the
same time, investing in producing new prevention methods, such
as microbicides and vaccines should continue to be financed.
However, research into them is currently still underway and it
will take time before effective methods are publicly available.
The major global initiatives that have been set up to stop the
spread of hiv have not always included srhr, despite the obvious
links between sexuality, gender equality, power and the spread
of hiv. Sweden has, for example, in the Global Fund to Fight
aids, Tuberculosis and Malaria47, worked actively with other
stakeholders to ensure that organisations that work with srhr
issues can access the Global Fund’s programmes and resources,
and that policies and guidelines for how the funds that are
distributed also ensure their availability to initiatives that have
a focus on srhr. Monitoring how this work is being carried out
at country and regional level is an important entry point for
actions and dialogue for representatives of Sweden. It is impor-
Sweden’s position and key message: Sweden’s international
work in the area of hiv and aids must be seen in the
context of sexual and reproductive health and rights (srhr)
and be characterised by the obligation to strengthen respect
for human rights and increase gender equality. The effects
of hiv and aids do not only concern the health sector but are
also manifested in other sectors and areas in society.
tant to find out what stakeholders and other actors receive
funding from the major global initiatives, and to require that
they recognize the importance of gender equality and human
rights dimensions, and that organisations, programmes and
projects working with lgbt rights and young people’s rights also
are given access to funding.
Support for civil society organisations that work with an integrated perspective of srhr and hiv should form an important element in the design of guidelines and policies at both national and
local levels. It is therefore important to influence the processes
in for example the Global Fund’s Country Coordinating Mechanisms (ccm) to ensure a broad and firmly established approach
to hiv prevention work that includes the use of condoms,
sexuality education, gender equality and a focus on women,
young people, vulnerable groups and key populations at risk.
In many countries, dialogue and collaboration with progressive, pragmatic religious leaders can be extremely important.
These leaders can, for example, be key figures and contacts in
dialogues about girls’ rights to education and violence against
women, and for involving men in the work to prevent the spread
of hiv, and to promote sexual and reproductive health in general.
A number of frequently occurring assertions
on HIV and AIDS are presented below, along with
suggestions on how to address them:
“Condoms do not protect against hiv and aids.”
It is not true that condoms do not protect against hiv and
aids. An unbroken condom used correctly is currently the
only means of prevention that effectively protects against hiv
transmission. The condom is a cheap and simple way to ensure
the health of the population. There is a high level of opposition
to the use of condoms on religious and political grounds in
many parts of the world. This is reflected in both messages and
campaigns in some countries as well as in the personal attitudes
and positions of political and religious representatives.
“Abstinence is the only way of avoiding hiv and aids.”
Not having sex at all means that the risk of hiv transmission
through sexual contact is eliminated. However, this is not a
long-term or realistic alternative for most people. People have
sex because they are looking for intimacy and they want to have
sex, but sometimes and unfortunately because it is forced upon
them. Since the reality is that people do have sex, they need to
know about how to protect themselves against hiv and other
sexually transmitted infections.
“It does not pay to invest in hiv prevention work.”
This assertion could not be further from the truth. Prevention
is crucial. Studies show that hiv prevention work is up to 28
times more cost-effective than provision of hiv treatment and
health care services. Everyone who is infected must be given
access to treatment, but due to the large number of people
being infected with hiv every day (7,400), major resources have
to be placed on prevention work in order to effectively stop the
spread.48 For every two people who gain access to anti-retroviral drugs, there are five people who become newly infected
with hiv. In other words, the number of people who are newly
infected exceeds the number of people who start hiv medication.49 Investing in prevention work is therefore absolutely
essential to turn this situation around. In countries where hiv
prevalence is widespread in the general population, there are
huge losses of human capital and institutional memory in terms
of teachers, health care workers and other important social
functions. This in turn leads to the education and health systems in those countries, which are already stretched, being hit
even harder and puts them at risk of deteriorating completely.
43. who, Towards universal access: scaling up priority hiv/aids interventions in the
health sector. Progress report (2009).
44. Government Offices of Sweden, Rätten till en framtid Policy för Sveriges
internationella hiv- och aidsarbete (2008), p. 6.
45. unaids, 08 Report on the Global Aids Epidemic (2009).
46. Committee on Economic, Social and Cultural Rights, General Comment
No. 14: The right to the highest attainable standard of health, e/c.12/2000/4 (2000).
47. Read more about the Global Fund’s work at: www.theglobalfund.org
48. Fact sheet for the High level event on the Millennium development goals,
United Nations headquarters, New York, September 2008.
49. un General Assembly, Sixty-fourth session, Agenda item 44, ‘Implementation of the Declaration of Commitment on Hiv/Aids and the Political Declaration
on hiv/aids’, Progress made in the implementation of the Declaration of Commitment on hiv/aids and the Political Declaration on hiv/aids Report of the SecretaryGeneral (2010).
37
Lesbian, Gay, Bisexual and Transgender rights (LGBT rights issues) ­
Why is Sweden working to
promote LGBT people’s rights?
In many parts of the world lesbian, gay, bisexual and transgender people (lgbt) are subjected to discrimination, persecution,
social marginalisation and violence, including sexual assault. In
some countries any manifestation of sexual orientation, gender
identity or gender expression that differs from the heterosexual
norm is punishable by a prison sentence, torture or execution.
In order for the human rights of lgbt people to be adequately
protected and respected so that they can contribute to the
development of their society on the basis of equality with other
people, it is important that their situation and vulnerability be
made visible.50
Discrimination of lgbt people and violations of their rights
occur throughout the world. Combating, for example, discriminatory legislation for lgbt rights is an important dialogue issue
in bilateral cooperation, within eu collaboration and in international and global contexts.
Discrimination and stigmatisation mean that lgbt people
often live in social and financial exclusion as it can be difficult
for them to find or maintain a job. Many lgbt people are forced
to create and/or find social networks on the sidelines of established society, where they are often marginalised and isolated
from family, friends, associations and other communities.51
Everyone is entitled to information, health care services and
protection from being infected with sexually transmitted infections. Society’s exclusion of lgbt people means that they risk not
• In more than 85 countries in the world, sexual acts
between adults of the same sex are forbidden by law.52
• In eight countries, homosexuality is punishable by death.53
• The lack of adequate legal protection for LGBT people is
also common in states where there is no capital or corporal
punishment for LGBT people.
• Harassment from police is common, as well as impunity for
perpetrators.
• In some parts of the world, women who do not fit the heterosexual norm risk being subjected to curative rapes, where
the perpetrators’ express intent is to ‘cure’ the woman of her
sexual orientation.54
being reached by information about sexual and reproductive
health and rights, including safer sex and health care as well as
hiv prevention. In addition, lgbt people who seek health services
risk being denied care and support because of their sexual orientation or gender identity. Transgender people experience major
social oppression and are seldom recognised as an important
interest group in discussions about hiv prevention and sexuality.
Entry points for dialogue on LGBT
persons’ enjoyment of human rights
Discrimination on grounds of sexual orientation or gender identity
goes against the fundamental principle of everyone’s equal value
and rights. Sexual orientation is not expressly set out among the
forms of discrimination in un conventions. However, the committees that monitor adherence to the un’s two central conventions
for human rights (iccpr and icescr) have established that the
grounds for prohibiting discrimination cited in the conventions also
pertain to sexual orientation, as has the European Court in reference to the ban on discrimination in Article 14 of the European
Convention.55
In 2006, a number of human rights experts developed the
Yogyakarta principles that show how fundamental human rights
can be applied to sexual orientation and gender identity. The
Yogyakarta principles include inter alia the right to life, freedom, privacy, access to justice, as well as freedom from violence, torture and arbitrary arrests.56
In December 2008, a Declaration on Decriminalising Homosexuality was launched at the un General Assembly. This declaration has so far been signed by nearly 70 countries, including
the usa and all of the eu member states.
States are responsible for ensuring that individuals are
not discriminated against. lgbt people and their families are
confronted with many risks and subjected to discrimination
and violence in many countries. The justice system is undermined as impunity is common for those who perpetrate crimes
of violence against lgbt people. In addition to causing a great
amount of suffering for the individuals concerned, society as
a whole is affected since social insecurity and social tensions
increase in situations in which such violence is tolerated. Even
where homosexual acts and/or manifestations of transgen39
der identities are not criminal offenses according to national
legislation, such sexual or gender expressions may be seen as
behaviour that goes against prevailing cultural values and local
perceptions of morality.
LGBT rights – a luxury problem?
lgbt issues are essentially a matter of human rights that concerns health, safety, well-being and poverty reduction, as well
as countries’ prospects for achieving the goal of equitable and
sustainable global development. In addition to relevant information about and a good understanding of the local context,
it is helpful to be aware of and be able to refer to experiences
and developments in Sweden with regard to how the situation concerning lgbt rights has changed dramatically over the
years. Nowadays, negative behaviour and attitudes toward lgbt
people, which used to be considered as morally correct and
justified by many in Sweden, are now usually considered to be
out-of-date and reactionary. Many other societies and countries
in the world have undergone or are currently undergoing similar
processes of changing their norms and attitudes.
Experiences from the field
It is difficult to work with LGBT people’s rights in Vietnam.
According to the embassy in Hanoi, these issues receive very
little attention if any at all. In the dialogue on HIV and AIDS,
the issue of men who have sex with men has partly been
highlighted to some extent.
Since 2008, the embassy has been working with a Vietnamese NGO that works for LGBT rights. Sweden is the first
country to support an organisation that works openly with
lesbian women’s rights in Vietnam.
“As a result of Sweden’s support, there is now a 15-minute
slot on Radio FM live every Sunday in Vietnam that offers
counselling and advice for lesbian women. The programme
is a hotline for lesbians, and they can phone in directly to
receive information and support.”
Civil servant at the Swedish embassy in Hanoi
It is important to exercise caution when collaborating with
organisations in the civil society that work with lgbt rights. In
countries where homosexuality is criminalised or not socially
accepted, lgbt people’s very lives can be in danger if they come
40
forward or are exposed by other people. Locally-employed
staff who work with these issues at Swedish embassies can
also be at risk of being subjected to threats and harassment.
Working to change legislation and to provide support to human
rights defenders through diplomacy and dialogue is therefore
extremely important in these kinds of situations.
In countries in which there is good legal protection, work
with lgbt rights should primarily focus on convincing those in
power about the importance of ensuring that laws are observed
and enforced, and that different institutions in society do not
discriminate against lgbt people.
Dialogue on lgbt rights requires a preparedness to deal with
both opinions based on what are clearly misconceptions or misrepresentations of facts, as well as on emotional arguments.
A number of frequently occurring assertions
about LGBT people are presented below, along with
suggestions on how to address them:
“Recognizing lgbt rights is
the same as approving paedophilia.”
There is a clear distinction between sexual acts between consenting adults that are an expression of reciprocal and mutual
satisfaction on the one hand, and on the other hand criminal
acts of assault that violate and exploit other people (such as
paedophilia and other assaults on children, or rape).
“Recognizing lgbt rights leads to
an increase in the spread of hiv.”
lgbt people run a higher risk of suffering from hiv and aids
because they are discriminated against and stigmatised, and
because general health care and hiv prevention measures do
not reach them. Due to their vulnerability to ill-treatment,
threats and violence, they may also be afraid to seek health care
services. So to the contrary, openness surrounding these issues
therefore has the potential to reduce the spread of hiv.
“Recognizing lgbt rights undermines
the existence of traditional heterosexual marriage.”
Human rights apply to all people, including lgbt people. The
issue is not about giving special rights to one particular group
Sweden’s position and key message: Everyone has the
right to exercise their sexual and reproductive rights
and to have these rights realised. The fundamental
feature of the work to promote lgbt people’s living
conditions and opportunities is the general principle
of non-discrimination, as well as every person’s equal
value and right to equal treatment.
at the expense of another. Increasing civic and social rights has
led to more stable societies throughout history, with stronger
development and less poverty. Neither does recognising or
strengthening lgbt people’s exercise of their human rights mean
that other people’s rights or opportunities for love or marriage
will be restricted.
“Homosexuality is unnatural, immoral and wrong.
Homosexuals should not be allowed to exist.”
Human rights apply to all people irrespective of their sexual
orientation or the opinions of states and others about the
life choices of individuals. In these issues, it is therefore not
necessary to go into an argument about whether homosexuality is right or wrong, natural or unnatural. No matter what
personal opinions people have about other people’s individual
choice of whom they love have chosen as a life partner, there is
always scope to argue that no one’s human rights can or should
violated, otherwise we are all in danger of having our rights
infringed upon.
Prescriptive ideas about morality over time in a given society
as well as within societies are changeable, just like other cultural perceptions, traditions and expressions.
“Homosexuality is a Western invention,
it does not exist in our culture.”
lgbt people live in all countries. One reason why people might
think there are more lgbt people in, for example, Europe and
the usa, is because they usually have considerable protection in
the law in these regions, as well as the possibility and choice of
living openly with their sexual identity.
50. Ministry for Foreign Affairs, Sweden’s International Policy on Sexual and
Reproductive Health and Rights (2006), p. 17.
51. rfsl, hbt i utveckling [lgbt in Development] (2008).
52. rfsl, hbt i utveckling [lgbt in Development] (2008).
53. United Arab Emirates, Iran, Yemen, Mauritius, Nigeria, Saudi Arabia,
Somalia and Sudan.
54. rfsl, hbt i utveckling [lgbt in Development] (2008).
55. Mänskliga rättigheter i svensk utrikespolitik [Human Rights in Swedish
Foreign Policy]. Regeringens skrivelse [Swedish Government Communication]
2007/2008, p. 25.
56. Yogyakartaprinciples.org
41
Gender-based violence
Why will Sweden continue to work
actively to combat gender-based violence?
Gender-based violence occurs throughout the world and is
different from other kinds of violence as it affects individuals due to their sex or gender expression, and because of
the expectations that are linked to cultural perceptions of
what is male and female respectively. It is primarily men and
boys who subject girls and women to gender-based violence,
something that is closely related to perceptions of gender
relations whereby women and girls are considered generally to
be in a subordinate position compared to men and boys. Men
who do not meet the norms of how a man in a given society
should be or behave can also be subjected to violence by other
men. Gender-based violence can be linked to violence in the
name of honour and to violence against lgbt people, forms of
gender-based violence that are often based on cultural values
and attitudes.
Much of the gender-based violence related to sexual and
reproductive health and rights is invisible, for example sexual
assaults in the home and rape within marriage. Gender-based
violence is often deeply rooted in cultural customs and traditions. Harmful traditions and customary practices, including
female genital mutilation, forced marriage and child marriage,
• 20 percent of the world’s women will be subjected to a
rape or attempted rape at some point in their lives.
• 33 percent will be subjected to violence, harassment or
assault in a close relationship.
• Of these sexual assaults, 50 percent are committed
against girls under the age of 15, often within forced marriage. Sexual violence contributes to the spread of sexually
transmitted infections, including HIV. Violence and rape
within marriage are not considered to be criminal offences in
many countries. Studies also show that many women accept
violence within marriage. Violence against women causes
just as many deaths and serious injuries as cancer diseases
among women between the ages of 15 and 44 years old.58
• In some countries, the costs of gender-based violence
represent a considerable proportion of the total GNP, and
not only include high costs of hospital care and other social
services, but also lost productivity.
restrict the right of girls and women to make decisions about
their own bodies. The un defines these actions as forms of
gender-based violence, and states that they cannot be defended
or excused by references to culture or religion. Dialogue on
these kinds of gender-based violence can be conducted within
the framework of the states’ commitments to conform to and
implement international, regional and national laws and agreements that prohibit harmful traditions and customs.57
Gender-based violence, rape and sexual assault cause physical and psychological trauma. In addition to physical injuries,
anxiety and fear, violence limits the opportunities of women
and girls to acquire an education, remunerable work and to
contribute to development. Women and girls who have been
subjected to sexual violence are often stigmatised and excluded
from families, which can leave them completely outside of
and unable to access their normal social protection networks.
Since women are responsible in most societies for the care of
children, the sick and the elderly, violence against women risks
having a negative impact on the rest of the family, particularly
for children who are born as a result of rape. It is necessary to
provide support, counselling and outreach work for the women
and girls affected, as well as to men, families and local communities to ensure that those who are subjected to violence will be
able to receive effective help. Local women’s organisations and
networks can provide a great deal of knowledge and information
in this regard.
Gender-based violence includes
many different kinds of violence
An estimated 3 million girls undergo genital mutilation every
year.59 Several kinds of genital mutilation are very dangerous
to the health of girls, resulting in bleeding, severe infections
and far too often in permanent damage, disability or death,
for example during pregnancy and childbirth later in their
lives. Genital mutilation is often linked to a girl’s future
cultural identity as being a ‘real’ and adult woman and her
prospects of marrying.
Gender-based violence tends to increase in crisis situations,
and rape and other kinds of sexual violence are often used as a
conscious tactic and a weapon in war and armed conflicts. The
43
opposing parties in wars and armed conflicts often use sexual
violence in order to humiliate and degrade their victims, and to
destroy social relations and the social fabric of local communities.
Under international law, conflict-related sexual violence can be
classified as a war crime or a crime against humanity. However, the level of impunity is high and it can be very difficult to
prosecute and punish people who commit these criminal offences.
Sexual violence in conflict and post-conflict situations is mainly
committed against women and girls, but also men and boys.
Women and girls who have psychological or physical disabilities can be especially vulnerable to gender-based violence. They
are often dependent on their families, their partner or institutional staff, and often do not dare report violence and assaults.
They often have low or no self-esteem, which can also increase
their vulnerability to violence. The rights of women and girls
with disabilities must be protected and promoted, including by
strengthening their access to sexual and reproductive health.
The most common form of gender-based violence is the violence that women are subjected to at the hands of their own
partner, father, brothers or other male relatives. This kind of
violence is considered to be a private matter in most societies.
This prevents many women from seeking the help they need,
both legal and medical (for example maternal health care),
and such violence can therefore have serious consequences on
their sexual and reproductive health. In some cases, women
are threatened with violence if they ask their partners to use
a condom or have a hiv test. In such situations, women probably avoid such negotiations, therefore exposing themselves
Experiences from the field
In Ethiopia there is a strong link between the level of education for women on the one hand, and on the other hand
maternal and infant mortality and a high level of acceptance
of violence against women. At the embassy in Addis Ababa,
the dialogue has been linked to the education sector, with
gender equality and gender-based violence as important
issues. This has allowed connections between the issues to
be highlighted, thereby expanding scope for the dialogue
to also focus on gender equality, human rights, democracy
and health.
44
to greater health risks and/or an unwanted pregnancy.
Violence, oppression and murder in the name of honour
are forms of violence that are defended on cultural grounds
because a woman or girl is considered to have brought shame on
the family through behaviour linked to sexuality. This form of
oppression and violence not only affects women and girls, but
also young men who do not conform to the norm within the
family and local norms.
As it is usually men who subject women to gender-based
violence, major efforts must be made to direct measures for
promoting changes in the behaviour and attitudes of men and
boys. Men need to understand the damage they cause when
using violence against women, both physically and psychologically, and how children and the rest of the family are affected.
Although the problems of gender-based violence are very
widespread and generally acknowledged, both donor countries
and partner countries need to do a lot more in terms of carrying out effective measures to combat such violence.
Entry points for dialogue on gender-based violence
Gender-based violence, and sexual violence in particular, that
is carried out by men against women and girls increases the
spread of hiv, the numbers of unsafe abortions and maternal
mortality, and restricts women’s freedom of movement and
impacts negatively on their possibilities for education, work,
and ability to participate in and influence public life and
political processes.
Violence against women is a problem not only for individuals
but for society as a whole, and has negative effects on a number
of important social areas. The costs can be significant, not only
economically but also in terms of suffering for the woman, her
family and society as a whole.
Gender-based violence is a public health problem and a
security issue. It is also the issue that many multilateral bodies
and women’s rights organisations around the world currently
consider to be the most serious threat to women’s rights,
lives, health and well-being. Several important social institutions need to work together to map the situation in specific
countries and formulate effective strategies for what should be
done. Research, data collection, legislation and skilled health
Sweden’s position and key message: Gender-based
violence is a major global problem. Violence restricts
the opportunities for people to enjoy their human
rights, undermines security and the principles of the
rule of law, and leads to major economic costs for society.
care workers are needed. The planning and implementation of
interventions should be carried out in collaboration with local
authorities and with voluntary civil society organisations, that
have broad experience and knowledge of the issues and can
inspire more trust than state institutions among women and
girls that have been subjected to violence. It is also important
to work with trade and industry and other stakeholders and
actors in the private sector.
In 2000, the un Security Council adopted resolution 1325
on Women, Peace and Security. This resolution was accompanied by resolution 1820 (2008), and resolutions 1888 and
1889 (2009), which strengthen the states’ commitments and
responsibility to fight conflict-related sexual violence. These
resolutions are important tools and bases for working with
issues concerning women’s rights in crisis, conflict and postconflict situations.
Measures to combat and prevent gender-based violence are
needed at different levels and in many different areas. Political
will and initiative are required first and foremost. Legislation,
effective police authorities, an well-functioning judicial system
and a system for health care and other social services are also
needed. Gender-based violence is accepted in many places or is
considered to be a private and not a public matter. This means
that violence is not prioritised highly enough by decision-makers
and legislators in many countries.
A number of frequently occurring assertions on
gender-based violence are presented below, along
with suggestions on how to address them:
“Violence in the home is accepted by both
women and men in our society. It is a private matter
and something that belongs at home in the family.”
Irrespective of the cultural, religious or traditional arguments
used to defend violence against girls and women, violence
is forbidden by law in most countries and is a violation of
people’s human rights. An important part of the fight against
gender-based violence is legislation against all forms of sexual
violence including domestic violence and customary practices such as female gender mutilation., as well as a state that
observes the rule of law and ensures that laws are observed.
“Gender-based violence is a marginal
issue in the fight against poverty.”
Gender-based violence has far-reaching consequences on
women’s lives and health, and subsequently for families and
society as a whole. In addition to the physical and psychological
injuries arising from the violence itself, gender-based violence
also leads to impaired reproductive health, often resulting
in injuries or death during pregnancy or childbirth. Genderbased violence also means that women and girls in particular
are more vulnerable to sexually transmitted infections and hiv
infection. The deterioration in women’s health as a result of
gender-based violence means that their productivity falls, as
does their ability to look after their families. It is negative for
social development and therefore also a country’s prospects of
effectively combating poverty.
57. Ministry for Foreign Affairs, Sweden’s International Policy on Sexual and
Reproductive Health and Rights (2006), p. 17.
58. unfpa, State of the World Population report (2005); who, Multi-country study
on Women’s Health and Domestic Violence against Women (2005); un, Ending
Violence against women: from words to action. Study of the Secretary-General
(2006).
59. unfpa, A Holistic Approach to the Abandonment of Female Genital Mutilation /
Cutting (2007).
45
Annex I SRHR: Definitions, terms and concepts
When srhr issues are being discussed and negotiated at the
international and global level, there is always a certain amount
of opposition based on religious, traditional and political
grounds. There are certain concepts and topics that are particularly questioned. It is important to be familiar with srhr concepts, including those that cause a great deal of debate internationally, even if they do not apply to all political contexts and
even though different words may have different meanings in different places. This knowledge can be helpful when identifying
entry points to introduce discussion on srhr issues and bringing
them up in a dialogue process. For example, the concept of srhr
itself is not accepted in many contexts.
sexuality and the fact that it can increase people’s quality of
life are usually ignored. Sweden wants instead to highlight the
fact that the purpose of good sexual health is to provide people
with the same opportunities, rights and conditions to enable
them to accept their sexuality and make informed decisions
about their own bodies.
Reproductive health
Good reproductive health requires, for example, good maternal
health care, i.e. services for maternity and childbirth care; this
includes emergency obstetric care and knowledge of sexuality and
reproduction, as well as access to contraception and safe abortion.
What is SRHR?
Reproductive rights
Sexual and reproductive health is defined in the Programme
of Action from the un Conference on Population and Development (icpd Programme of Action, PoA) in Cairo in 1994. In this
definition, sexual health is included in the concept of reproductive health.
“a state of complete physical, mental and social wellbeing
and not merely the absence of disease or infirmity, in all matters
relating to the reproductive system and to its functions and
processes. Reproductive health therefore implies that people are
able to have a satisfying and safe sex life and that they have the
capacity 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 health-care services that will
enable women to go safely through pregnancy and childbirth
and provide couples with the best chance of having a healthy
infant.”(icpd PoA 7.2)
For Sweden, it is important to stress the fact that sexuality refers not only to reproduction, which is why Sweden uses
both concepts of ‘sexual’ and ‘reproductive’ health. When issues
surrounding people’s sexuality are referred to and discussed in
international contexts, the debate often focuses on problems
and negative dimensions. The positive aspects and functions of
According to icpd, reproductive rights are defined as the right
to freely decide the number, spacing and timing of children and
to have the information and education, as well as the means
required to be able to exercise this right.
Reproductive rights are often debated and are the subject
of controversy, because they also include the right to limit the
number of children people have and therefore indirectly the
right to contraception and to abortion. Although abortion is
not included explicitly in references to reproductive rights in
international human rights conventions, Sweden sees this as an
important issue within the framework of, for example, women’s
right to health and the right to make decisions about their own
childbearing as set out in Articles 12 and 16 of the un Convention on the Elimination of All Forms of Discrimination Against
Women (cedaw).
Sexual rights
So far, sexual rights have not been defined in international
agreements. This is because issues surrounding human rights
relating to sexuality are considered to be too controversial by
some states.
Sweden’s position is that sexual rights are part of the human
rights as defined in the international framework which is comprised of the un conventions. This means that people, irrespective of sex, ethnic background, disabilities, gender identity or
sexual orientation, are entitled to make decisions about their
47
own body and sexuality, and should not be subjected to discrimination, harassment or violence. This includes, inter alia,
the right to choose their own partner, to say yes or no to sex,
and to decide if and when they want to have children.
In a report from 2002, the World Health Organisation
defines sexual rights as follows:
Sexual rights embrace human rights that are already recognized in national laws, international human rights documents
and other consensus statements. They include the right of all
persons, free of coercion, discrimination and violence, to:
• the highest attainable standard of sexual health, including
access to sexual and reproductive health care services;
• seek, receive and impart information related to sexuality;
• sexuality education;
• respect for bodily integrity;
• choose their partner;
• decide to be sexually active or not;
• consensual sexual relations;
• consensual marriage;
• decide whether or not, and when, to have children; and
• pursue a satisfying, safe and pleasurable sexual life.61
The International Planned Parenthood Federation, ippf, is
an umbrella organisation that includes srhr member organisations from around the world. It has produced a declaration that
presents sexual rights as human rights. The ippf declaration is
based on human rights and shows how they are linked to sexuality and physical integrity.62
LGBT, sexual orientation and same-sex relationships
In many countries, consensual sexual acts between two
people of the same sex are criminalised and same-sex love
relationships and family formations are illegal. This is basically a matter that relates to the non-discrimination principle
and everyone’s equal value, human rights and the ability to
take responsibility for and make decisions about their own
body. It is also a democratic issue, whereby individuals on the
basis of shared group identities, interests and struggles are
able to work together with others to contribute to common,
democratic work and discussions, without being subjected to
violence or discrimination.
48
Culture
Culture includes collective values, knowledge, concepts,
customs and traditions which are created and used by people
to understand the world and interpret their surroundings and
circumstances, and to give meaning to their existence. All
people belong to and are influenced by a cultural sphere that
influences their behaviour, norms and actions. Although culture
affects how people think, it does not give rise to people who
all think in exactly the same way. Cultural background is one
of the most important identity markers for how people orient
and define themselves in life. Cultures are in no way static,
but are in a continual state of change. They influence and are
influenced by both internal and external events and processes.
Different cultures meet and interact, leading to changes in
cultural patterns, traditions and values. These processes can be
both enriching and frightening. Questioning your own culture
and what your culture consists of can also lead to a feeling of
insecurity and exclusion.
References to culture and religion are often used as a way of
restricting people’s rights, and this is particularly true of sexual
and reproductive rights. Cultural or religious arguments are
often used to counteract work towards gender equality and
women’s enjoyment of their human rights.
Abortion
Legal and safe abortion is one of the most controversial issues,
and there are no binding international agreements that portray
this as a rights issue. The un Conference on Population and
Development (icpd) stated that abortions must be safe where
they are legal; this is as far as people have come in international
negotiations. Abortions are included in negotiation texts in relation to unsafe abortions, i.e. as a health issue and not a human
rights issue.
Abstinence
Sexual abstinence and fidelity in a heterosexual relationship are
portrayed by some people as the best and only way of preventing hiv and unwanted pregnancies. However, for most people,
abstinence is not a realistic alternative over a long period of
time or over a lifetime.
One-sided messages and campaigns for abstinence have not
shown positive results and cannot stop unwanted pregnancies
or the spread of hiv. Most women and men have sex sooner or
later in their lives. Studies have shown that if people have more
knowledge, their sexual debut takes place later in life, and that
people who receive sexuality education and access to contraception protect themselves better against sexually transmitted
infections and unwanted pregnancies.
Family/Families
There is currently not a uniform definition of family, even
though this concept has been an important and controversial
concept for a long time. In Western contexts, family is defined
traditionally as the nuclear family – mother, father, child. The
expression advocated by Sweden “families or various forms
of the family, different types of families or other unions” is
interpreted by some people as meaning same-sex relationships,
which they do not accept. In many parts of the world, extended
families are common and much more complex than simply the
nuclear family, so it is important to talk about families and different kinds of family and not simply the nuclear family that is
often presented as standard.
health of young people. The population conference in Cairo in
1994 included a great deal of discussion about young people’s
rights. The final document was a compromise, where parents’
rights and obligations to provide young people with health
information were included, but the document also recognised
the right of young people to education, information and health
care in order to enable them to make their own informed
decisions. The obstacles that exist for young people to gain
access to information based on facts, and contraception, condoms, health care and counselling must be overcome.
Couples, individuals and groups
It is an individual’s right to have access to sexual and reproductive
health care services. In many societies, individuals are considered
to be inseparable members of a group and a context, defined
in terms of specific social and cultural parameters. This means
that people’s sexuality and reproduction are considered to be a
collective and not a private matter. This view forms the basis for
denying in particular unmarried people, women and young people
the right to control over their own sex life and to the sexual and
reproductive health care and services associated with this.
Sexual orientation and gender identity
Family planning
Family planning is a concept that might not appear to be very
controversial at first sight, but just as is the case with the concept
of family in the discussion above, family planning can exclude
people that do not belong to a traditional family formation. Family planning includes providing information, advice, methods,
services and the means to allow people to plan the number of
children they want and when to have them. Family planning as a
concept consequently excludes people who are not married or
planning a family. It is important for all people who need reproductive health services to be included regardless of their marital
status, and it is also important to integrate this dimension into
the prevention of sexually transmitted infections, including hiv.
Rights of adults versus the rights of young people
Opponents of srhr believe that parents or other adults have
the right to make decisions about the sexual and reproductive
There is still no binding international consensus document
which explicitly names sexual orientation as a form of discrimination, even though documents do exist that would
easily make this interpretation possible. In the un General
Assembly in December 2008, a declaration on lgbt people’s
rights was presented for the first time. This declaration was
produced by a inter-regional group of un Member States, and
has so far been signed by nearly 70 states, including all eu
member states and the usa.
Sexuality
Sexuality is an important aspect of people’s lives. It includes
sex, desire, gender identity and gender roles, sexual orientation, enjoyment, intimacy and reproduction. Sexuality is also
closely linked to power, and sexuality and has been controlled
in different ways throughout history. Women’s sexuality in
particular has been, and often still is, controlled by traditions
49
and customs. Sexuality is far more than just the act of sexual
intercourse, according to the definition given by who.63 Sexuality is a part of being a human being, but this does not mean
it is something determined by nature. Sexuality is shaped and
changed by religion, legislation and the historical, economic,
social and culture context in which a person lives and has her or
his being.
60. Ministry for Foreign Affairs, Sweden’s International Policy of Sexual and
Reproductive Health and Rights, p.23 (2006).
61. who, Defining sexual health. Report of a technical consultation on sexual
health. 28–31 January 2002, Geneva (2002).
62. ippf, Sexual Rights: an ippf Declaration (2008).
63. who, Defining sexual health. Report of a technical consultation on sexual
health. 28 –31 January 2002, Geneva (2002).
50
Annex II Points of departure and Mandates for work with SRHR
The mandate and points of departure for work on sexual and
reproductive health and rights can be found in several Swedish
national steering documents, as well as in international frameworks and Sweden’s commitments with respect to these.
Sweden was the first country in the world to adopt a specific
srhr policy, Sweden’s International Policy for Sexual and Reproductive Health and Rights in 2006. This policy aims to provide
the foundation for Sweden’s international bilateral, multilateral, operational and normative work in the area of sexual and
reproductive health and rights. The policy sets out a number
of strategic areas for Sweden’s international srhr work. They
include working to strengthen women’s sexual and reproductive
health and rights, young people’s health and rights, the role and
responsibility of men in gender equality work, lgbt rights, safe
abortions, access to contraception and sexuality education, as
well as combating gender-based violence and violence against
women and girls. This srhr policy is based on international
agreements on human rights.
Sweden’s Policy for Global Development, pgd, the aim of
which is to contribute to equitable and sustainable global development. It is characterised by policy coherence across all areas
of policy and political action, and forms the main basis for the
Swedish Government’s development policy and for international
development cooperation. The goal for development cooperation
in pgd is to contribute to an environment supportive of poor
people’s own efforts to improve their quality of life. Two fundamental perspectives permeate this policy: a rights perspective
and the perspectives of poor people on development. The pgd
states that all people, irrespective of sex, age, disability, ethnic
background or sexual orientation should be able to exercise and
enjoy their human rights, including their sexual and reproductive health and rights (srhr). In the Government’s pgd Communication to the Riksdag (Swedish Parliament) 2007/08:89 and
2009 /10:129, srhr is included as a special focus area within the
global challenges of ‘Oppression’, and essential to achieving the
target of equitable and sustainable global development.
The Right to a Future – Policy for Sweden’s International hiv
and aids work was adopted in 2008. It states that Sweden must
prioritise in particular hiv prevention work and the alleviation
of long-term effects. This work must be based on the require52
ment for strong respect for human rights and greater gender
equality. The work must mainly be aimed at promoting better
conditions and opportunities for women and girls, young people
and groups that run a high risk of being infected with hiv and
dying prematurely of aids.
UN Conventions and SRHR
The un Universal Declaration of Human Rights and the subsequent central conventions on human rights stress the principles
of non-discrimination and the equal value of every person. The
Universal Declaration provided the international community
with a common set of values on the relationship between the
state and the individual, and set a standard for human rights
which is superordinate to political, economic, social, cultural
and religious differences. The conventions and the recommendations that have been produced in the un convention committees are important tools and bases for dialogue and collaboration, and for following up the obligations contained in the
conventions.
UN conferences on population
and on women in the 1990s
International agreements concerning srhr issues were more
specifically achieved in the middle of the 1990s at two major
and important un meetings: the International Conference on
Population and Development icpd in Cairo in 1994 and the
Fourth World Conference on Women in Beijing in 1995. icpd
dealt with the individual’s possibilities of achieving the highest
attainable standard of sexual and reproductive health, and
inter alia stated that abortions must be safe where they are
legal. The Programme of Action stated the need to invest in
maternal health, sexual information, access to contraception
and gender equality.
The Conference on Women in Beijing confirmed the decisions
taken at icpd and the importance of work for gender equality and
women’s empowerment, education, work, political participation
and freedom from violence. The 1995 Conference on Women
also stated that women’s power and ability to decide over their
own sexuality and reproduction is an important step to ensure
that they can fully exercise and enjoy their human rights.
Sweden´s Strategic Areas for International SRHR
Safe and
Legal
Abortion
Adolescent
Health and
Rights
Empowering
Women and
Girls
Hiv/Aids
and
STIs
Neonatel
Care
Maternity
Care
Sexual and
Reproductive
Health and
Rights
Role of
Men and
Boys
Contraceptives
Prostitution/
Human
Trafficking
LGBT
Persons
Genderbased
Violence
UN General Assembly Special Session on HIV and AIDS
In 2001 the world’s leaders gathered together for a summit on
hiv and aids, the un General Assembly Special Session on hiv and
aids, hiv-ungass. The Declaration from hiv-ungass 2001 points
out the importance of gender equality and women’s empowerment for stopping the spread of the hiv epidemic. hiv-ungass
was followed up in 2006, where it was established that all people
must have access to broad prevention measures as well as health
care services and treatment by 2010. The declaration also
included substantial attention to the need for young people to
have access to contraception and information about hiv.
The Millennium Declaration
and Millennium Development Goals
At the un Summit in 2000, all member states adopted the Millennium Declaration. This is an agreement on global collaboration, a common agenda for global development operationalised
through eight measurable and time-bound millennium goals.
srhr is not included as a goal in itself but are rather largely
restricted to Millennium Development Goal 5 on improving
maternal health. However, srhr is of vital importance for achieving all the Millennium Development Goals, particularly the
health targets for reducing child mortality (goal 4), maternal
morality (goal 5) and stopping the spread of hiv/aids (goal 6).
In 2002 the then un Secretary-General, Kofi Annan, commissioned a group of experts to produce a programme of action
to achieve the Millennium Development Goals. Their analysis
highlighted the fact that sexual reproductive health was essential to achieve the Millennium Development Goals.64 In 2006 an
important new target was added to Millennium Development
Goal 5, Universal access to reproductive health.
Capacitybuilding
Sexuality
Education
The partner countries themselves must be able to manage the
funds they receive based on national priorities. Sector support
has many advantages and incredible potential, but some issues
risk being left in the shade or disappearing completely, unless
there is the knowledge, capacity and willingness to prioritise
them in the partner country. Dialogue on policy is one of the
most important instruments for being able to influence how aid
is used.
Millennium goal 5: Improve Maternal Health
Target 5.A: Reduce by three quarters, between 1990
and 2015, the maternal mortality ratio
Indicators
5.1 Maternal mortality ratio
5.2 Proportion of births attended by skilled health personnel
Target 5.B: Achieve, by 2015, universal access to
reproductive health
Indicators
5.3 Contraceptive prevalence rate
5.4 Adolescent birth rate
5.5 Antenatal care coverage (at least one visit and at least
four visits)
5.6 Unmet need for family planning
www.mdgmonitor.org/goal5.cfm
Paris Declaration on Aid Effectiveness
The Paris Declaration from 2005 set new guidelines for delivering and following up development aid flows, and stressed the
importance of coordination between donors within the framework of the partner country’s active ownership and leadership.
The principles contained in the Paris Agenda have led to more
investments in programme support and sector support, rather
than investments in small-scale projects with a limited impact.
64. Bernstein, S & Juul Hansen, C, Public Choices, Private Decisions: Sexual and
Reproductive Health and the Millennium Development Goals (2006).
53
Annex III
SRHR and the EU
The protection of human rights is a core value and central
principle in the eu. The eu Charter of Fundamental Rights
supplements and clarifies this principle. All eu member states
are bound by human rights treaties such as the European
Convention, the Convention on the Rights of the Child and the
Convention on the Elimination of All Forms of Discrimination
Against Women. All eu member states are also united around
the programmes of action from Cairo and Beijing.65 All these
instruments guarantee sexual and reproductive rights to some
extent. Here are a number of examples of Council Conclusions
adopted by the eu:
At a gaerc (Ministerial) meeting in November 2004, policy
decisions in the form of Council Conclusions were adopted for
a renewed commitment to icpd and the Millennium Development Goals.
“The council recognises that additional resources are needed
to enable a prompt implementation of the icpd agenda by focusing in particular on sexual and reproductive health and rights,
and encourages ec and Member States to provide financing
through geographical and thematic instruments, multi sector support and/or budget support and through additional
resources from the un and other international development
agencies.”
In addition to this, there are the Council Conclusions
adopted at gaerc April 2007 on ‘Recently emerging issues
regarding hiv/aids’, which focus on the feminisation of the hiv
epidemic and the needs of young people. They also point out
the importance of integrating hiv/aids into national development plans and aid programmes. During this meeting, Council
Conclusions were also adopted on gender equality and women’s
empowerment in development cooperation. The Council
Conclusions refer to icpd, cedaw, Beijing and the Millennium
Development Goals.
The joint eu statement before the un General Assembly
Commemoration of the 15th Anniversary of icpd on 12 October
2009 stressed the importance of investing in srhr and women’s
rights.
“The eu recognises that the right to attain the highest
standard of health, including sexual and reproductive health,
is a basis for action. The incorporation of the icpd agenda into
national development strategies – especially in national health
policies, strategies, programmes and budgets – is a prerequisite
for achieving the Millennium Development Goals.”
Joakim Stymne, State Secretary, International Development
Cooperation at the Swedish Ministry for Foreign Affairs.
When new members join the eu, there is certain opposition
to srhr, particularly with regard to the issue of abortion. Formulations that, for example, include the word ‘services’ in relation to sexual and reproductive health and rights are difficult to
get accepted due to suspicions that they could represent covert
language for abortions. In the eu, abortion is only completely
illegal in Malta. Some other member states have restrictions on
abortion, for example Poland and Ireland.
Sweden has been working with other like-minded member
states in the eu to actively pursue a line of action that safeguards srhr issues, defends the eu’s policy, work and acquis, and
shows leadership towards and through support to non-member
countries. srhr has tended to divide the eu into three groups:
one group that thinks along the lines of Sweden; a group that
prefers a joint eu position and is very flexible when it comes
to concrete formulations about srhr; and a group that opposes
texts on sexual rights or reproductive and sexual health care
services because they may provide an opening to abortion.
65. Malta registered a reservation in writing against the use of terms such as
‘reproductive rights’ in icpd.
55
Annex IV
Organisations in the SRHR area
Where can you find relevant
information about SRHR?
Information about Sweden’s srhr work can be found at the Ministry for Foreign Affairs and Sida.
For countries that Sweden collaborates with in different
ways, the best and most up-to-date information about the srhr
situation and needs can be obtained from local stakeholders and
other actors. There are also a number of national, regional and
international organisations that work with policy development,
methodology development and advocacy work which can provide more access to knowledge, arguments and networks. In this
annex, there is information about a number of organisations and
stakeholders that can provide in-depth knowledge about srhr
both in Sweden and around the world.
RFSU
(Swedish Association for Sexuality Education) is a Swedish nonprofit organisation that works with sexual and reproductive
health and rights both in Sweden and abroad through information, advocacy work and partnerships in the Global South.
www.rfsu.se
RFSL
(Swedish Federation for Lesbian, Gay, Bisexual and Transgender
Rights) is a national Swedish organisation that has been working for lesbian, gay, bisexual and transgender rights since 1950
by informing, influencing and implementing change work in
Sweden and around the world.
www.rfsl.se
ilga
rfsl is a member of the International Lesbian, Gay, Bisexual,
Trans and Intersex Association, ilga, which is an umbrella organisation for lgbt rights in the world. ilga has member organisations
throughout the world and a number of regional offices.
www.ilga.org
ippf
International Planned Parenthood Federation, ippf is an umbrella
organisation that includes srhr member organisations all over the
56
world, with rfsu being the Swedish member. ippf is found in more
than 150 countries and works with information, outreach work,
clinic activities, advocacy work and advice in the area of srhr.
ippf has its head office in London with regional offices in Nairobi
(for Africa), Tunis (for the Arab world), Brussels (for Europe),
New Delhi (for South Asia), Kuala Lumpur (for East Asia and
Oceania) and New York (for the Western Hemisphere).
www.ippf.org
There are a number of un bodies that work with srhr in various
ways:
unfpa
unfpa is the un Population Fund that works with monitoring and
implementing the Programme of Action from icpd. This organisation has relevant documents relating to srhr, as well as facts
and statistics on reproductive health, young people and maternal health in particular.
www.unfpa.org
unaids
unaids works with hiv and aids and has information about policy
development in this area, facts and statistics, as well as material
and methodology development.
www.unaids.org
unicef
Unicef works with children and young people and has many
statistics and facts about young people’s living conditions, hiv
and srhr.
www.unicef.org
who
who works broadly with health and health promotion work, but
also with srhr and related issues.
www.who.int
In September 2009 the UN General Assembly adopted a
resolution to improve the cohesion work on gender equality and
women’s rights within the un system. Four existing un bodies
(unifem, Division for the Advancement of Women, Office of the
Special Adviser on Gender Issues and un-instraw) will merge to
become one, headed by an Under Secretary-General. The new
entity, ‘un Women’ headed by usg Michelle Bachelet will become
operational in January of 2011.
A number of stakeholders in civil society work with srhr in
different ways. They can be a good source of facts, arguments,
information about new projects, methodology development and
advocacy material:
guttmacher institute
Guttmacher Institute, is a research organisation that produces
research reports on srhr, young people and sexuality in the usa
and in developing countries. They have interesting information
and research on sexuality education, contraception, abortion
and teenage pregnancies.
www.guttmacher.org
raise
raise, is a campaign that works to raise awareness of the need
for srhr in humanitarian situations. It has facts, statistics and
arguments for including srhr in humanitarian aid.
www.raiseinitiative.org
and work to ensure that states protect, respect and fulfil their
obligations in terms of reproductive rights. The Center for
Reproductive Rights works with advocacy and change work in
Africa, Asia, Europe, Latin America and the Caribbean, as well
as in the USA.
www.reproductiverights.org
Population Action International
Population Action International, pai, is an American organisation that works throughout the world to secure access to
sexual and reproductive health and rights. pai works with
policy development in srhr and development aid and focuses on
ensuring access to contraception, condoms and other healthcare
equipment.
www.populationaction.org
International Women’s Health Coalition
International Women’s Health Coalition, iwhc, is an American
organisation that works with women’s rights and sexual and
reproductive health and rights around the world. iwhc works
with policy development and capacity building through the un
system and by financing and developing advocacy work in different parts of the world.
www.iwhc.org
ipas
ipas is an organisation that works with women’s sexual and
reproductive rights and in particular with reducing abortionrelated deaths and injuries.
www.ipas.org
Catholics for Choice
Catholics for Choice is an American organisation that works to
influence legislation and attitudes regarding sexuality, contraception and abortion using a Catholic perspective. They are
based in the usa, Europe and Latin America.
www.catholicsforchoice.org
Center for Reproductive Rights
Center for Reproductive Rights is an organisation that uses
the law to pursue reproductive rights, such as human rights,
Sexuality Information and
Education Council of the United States
Sexuality Information and Education Council of the United
States, siecus, is an American organisation that works with disseminating information about sexuality and sexual and reproductive health. siecus works with education, advocacy work
and information to create support for comprehensive sexuality
education.
www.siecus.org
Marie Stopes International
Marie Stopes International, msi, is a non-profit organisation that
works on improving sexual and reproductive health and rights.
They are represented in 43 countries around the world and they
have a large number of clinics with contraception advice, safe
57
abortions, maternal and child health, as well as hiv testing and
services. They also carry out policy and advocacy work at both
a global and national level.
www.mariestopes.org
Association for Women’s Rights in Development
Association for Women’s Rights in Development, awid, is an
organisation that works for women’s human rights in development. awid develops and produces reports and materials to
strengthen policy and work for women.
www.awid.org
Reproductive Health Supplies Coalition
Reproductive Health Supplies Coalition is a network of state,
private and non-profit organisations which aims to provide
people in low- and middle-income countries with access to
contraception, condoms, healthcare equipment and medicines
in order to ensure reproductive health. Reproductive Health
Supplies Coalition works with advocacy work, capacity building, advice and technical support around the world.
www.rhsupplies.org
The International Gay and
Lesbian Human Rights Commission
The International Gay and Lesbian Human Rights Commission,
iglhrc is an advocacy organisation that works to make people
aware of and fight discrimination of lgbt people around the
world.
www.iglhrc.org
Knowledge-support and consultancy companies
Knowledge-support and consultancy companies, such as the
Stockholm-based InDevelop-ipm Consortium, work with studies
and advisory services on gender equality and srhr issues on a
commercial basis.
www.indevelop-ipm.se
58
Annex V
Links and references
Policies
Sweden’s Policy for Global Development (pgd)
Sweden’s International Policy for Sexual and Reproductive
Health and Rights (2006)
Mänskliga rättigheter i svensk utrikespolitik [Human Rights
in Swedish Foreign Policy]
The Right to a Future – Policy for Sweden’s International hiv
and aids work (2009)
Pluralism – Policy for Sweden’s Support to Civil Society in
Developing Countries in Swedish Development Cooperation
(2009)
Change for Freedom – Policy for Democratic Development and
Human Rights within Swedish Development Collaboration
2010–2014
On Equal footing – Policy on gender equality and the rights
and role of women in Sweden’s international development
cooperation 2010–2015
Programmes of Action
Plan of Action for Sida’s Work on Gender-Based Violence
2008–2010
Plan of Action for Concretising Sida’s work with lbgt-issues
in Development Cooperation 2007–2009.
Conventions
European Convention for the Protection of Human Rights and
Fundamental Freedoms (European Convention) (1950)
un, Covenant on Civil and Political Rights (iccpr) (1966)
un, International Covenant on Economic, Social and Cultural
Rights (icescr) (1966)
un, Convention on the Elimination of All Forms of
Discriminationof Women (cedaw) (1979)
un, Convention on the Rights of the Child (1989)
un General Assembly
Key Actions for the Further Implementation of the Programme
of Action of the icpd – icpd+5 (a/res /s-21/2) (1999)
Follow-up to the Programme of Action of the International
Conference on Population and Development – icpd+10
(e/cn.9 / 2004 / 9) (2004)
United Nations General Assembly Declaration of Commitment
on HIV/AIDS (Resolution s-26 /2) (– hiv ungass 2001)
Political Declaration on hiv/aids (a/res/60/262)
(– hiv ungass 2006)
United Nations. Millennium Declaration (A/RES/55/2) (2000)
oecd Paris Declaration on Aid Effectiveness 2005
un Security Council
Resolution 11325 on Women Peace and Security
(s / res /1325 (2000))
Resolution 1820 on Women Peace and Security
(s / res /1820 (2008)).
Resolution 1888 on Women Peace and Security
(s / res /1888 (2009))
Resolution 1889 on Women, Peace and Security
(s / res /1889 (2009))
un Human Rights Council
Resolution 11/8 (2009), Preventable maternal mortality and
morbidity and human rights
Regional Agreements
african union
The Protocol to the African Charter on Human and Peoples’
Rights on the Rights of Women in Africa, 2003
Africa Health Strategy 2007–2015
Plan of action on sexual and reproductive health and rights
(Maputo Plan of Action), 2006
Declarations and resolutions
World Conferences
Programme of Action of Adopted at the International
Conference on Population and Development (icpd) (1994)
Beijing Declaration and Platform for Action (1995)
european union
Council Conclusions on the Cairo Agenda about Population
and Development adopted on 23 November 2004 (15157/04)
Council Conclusions on hiv /aids adopted on 23 April 2007
(7225 /07)
59
latin america and the caribbean
Mexico City Declaration on Sex Education in Latin America
and the Caribbean (2008)
Informative reports and publications
that can give facts and guidance
Bernstein, S & Juul Hansen ,C, Public Choices, Private
Decisions: Sexual and Reproductive Health and the
Millennium Development Goals (2006)
Cornwall, Corrêa, Jolly, Development with a Body. Sexuality,
Human Rights and Development (2008)
Guttmacher Iinstitute, Abortion worldwide. A decade of uneven
progress (2009)
Guttmacher Institute, unfpa, Adding it up. The benefits of
investing in sexual and reproductive health care (2003)
Guttmacher Iinstitute, Adding it up. The benefits of investing in
sexual and reproductive health care (2009)
ippf, Charter on Sexual and Reproductive Rights (2003)
ippf, Sexual rights an ippf declaration (2008)
Population Action International, Funding common ground.
Cost estimates for international reproductive health (2010)
rfsu, Breaking Through. A guide to sexual and reproductive
health and rights (2004)
rfsu, Fokus Kairo [Focus Cairo]. Tio år av kamp för sexuella
och reproduktiva rättigheter [Ten Year of Battle for Sexual
and Reproductive Rights] (2004)
rfsu, Reality counts. Focusing on sexuality and rights in the
fight against hiv /aids (2004)
rfsu Respect choice. Safe abortion a prerequisite for safe
motherhood (2004)
Sida concept paper, Sexuality a missing dimension in
development (2008)
unifem, Progress of the world’s women 2008/2009. Who answers
to women? Gender and accountability (2008)
unesco, unfpa, Unicef, who, International Technical Guidance
on sexuality education. An evidence-informed approach for
schools, teachers and health educators (2009)
who, Defining Sexual health. Report of a technical consultation
on sexual health. 28 –31 January 2002, Geneva (2002)
60
Thematic areas
Maternal mortality
Human Rights Council, Eleventh session, Agenda item 3
unfpa, No Woman Should Die Giving Life (2008)
unfpa, Giving Girls Today and Tomorrow; Breaking the cycle of
adolescent pregnancy (2007)
who, Unsafe abortion, Fifth edition (2007); ippf, Death and
Denial – Unsafe Abortion and Poverty (2006)
unfpa, who, Granada Consensus on Sexual and Reproductive
Health in Protracted crises and recovery (2009)
Bernstein, S & Juul Hansen, C, Public Choices, Private
Decisions: Sexual and Reproductive Health and the
Millennium Development Goals (2006)
The Alan Guttmacher Institute & unfpa, Adding it up
– The benefits of investing in sexual and reproductive health
care (2003)
Guttmacher institute & unfpa In Brief 2008 Series, No.5
unfpa, State of the World Population (2005)
who, Fact sheet who / mps/08.11, Skilled birth attendants (2008)
Access to safe abortion
ippf, Death and denial (2006)
who, Unsafe abortion, Fifth edition (2007)
unfpa, No Woman Should Die Giving Life (2008)
Guttmacher Institute, Abortion worldwide. A decade of uneven
progress (2009)
rfsu, Breaking Through. A guide to sexual and reproductive
health and rights (2004)
unfpa, Healthy expectations. Celebrating achievements of the
Cairo Consensus and highlighting the urgency for action
(2009)
Alan Guttmacher Institute, Sharing responsibility. Women
society and abortion worldwide
Young people and srhr
Center for Global Development, Start with a Girl: A New
Agenda for Global Health (2009)
undesa, The Millennium Development Goals Report (2008)
unfpa, State of the World Population (2005)
unaids, 08 Report on the Global aids Epidemic (2008)
unfpa, Giving girls today and tomorrow. Breaking the cycle of
adolescent pregnancy (2007)
Gender-based violence
unfpa, State of the World Population (2005)
unfpa, A Holistic Approach to the Abandonment of
Female Genital Mutilation/Cutting (2007)
Sex education
Guttmacher Institute, Protecting the Next Generation in Sub Saharan Africa (2007)
undpi, Goal 2: Achieve Universal Primary Education (2008)
Human rights Watch, The less they know, the better Abstinence Only hiv /aids Programs in Uganda (2005)
ippf, Reference guide to policies and practice. Sexuality education
in Europe (2006)
Condoms and contraception
unfpa, No Woman Should Die Giving Life (2008)
Guttmacher Institute, unfpa. Adding it Up – Costs and Benefits
of Family Planning and Maternal and Newborn Health
Services (2009)
hiv and aids
who, Towards universal access: scaling up priority hiv /aids
interventions in the health sector. September 2009. Progress
report (2009)
unaids, 08 Report on the Global aids Epidemic (2009)
Fact sheet for the High level event on the Millennium
Development Goals, United Nations headquarters, New York,
September 2008
un General Assembly Sixty-fourth session, Agenda item 44
Implementation of the Declaration of Commitment on hiv /aids
and the Political Declaration on hiv /aids. Progress made in the
implementation of the Declaration of Commitment on hiv /aids
and the Political Declaration on hiv /aids. Report of the
Secretary-General (2010)
LGBT rights
rfsl, Hbt i utveckling [lgbt in Development] (2008)
yogyakartaprinciples.org
61
Article nr: UD 10.053
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