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Sexual Health and the Sustainable Development Goals: Emerging Competencies and Challenges

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Author: Hannah Madelon
Chief Editor: Alanna O’Malley
Dossier: Mind the gap, UN Governance in perspective

Abstract: In this article, I will examine how the SDGs address SRHR (sexual health and reproductive rights) and what areas still face challenges. The SDGs as they are do address SRHR in terms of maternal health, access to universal sexual and reproductive healthcare, and HIV treatment. However, I ultimately argue that there are two areas that need to be improved for the SDGs to better address SRHR: explicitly covering SRHR in the targets themselves and addressing context-specific barriers to promoting SRHR. Addressing these issues should make promoting SRHR and setting goals and collecting data on SRHR easier.

Introduction

The Sustainable Development Goals (SDGs) were formally established in 2015 as a follow-up to the Millennium Development Goals (MDGs) formed in 2000. These goals focus on poverty, sustainability, and peace. While sexual health was originally omitted from the Millennium Development Goals (MDGs),  the SDGs have included sexual health and reproductive rights (SRHR) explicitly in several of their targets. However, despite the progress and inclusion of SRHR in the SDGs, as the executive director of the UN Population Fund, Natalia Kanem stated, many young people, especially girls, “continue to be left behind”. She points out that there is still work to be done in data collection, in addressing adolescent needs specifically, investments, and other aspects of the SDGs. Kanem’s observations point to areas of improvement for the SDGs and SRHR. This issue is even more pressing now during the COVID-19 pandemic, which has exacerbated gender inequalities and access to health services in general. This article will establish how the SDGs currently address SRHR topics, then discuss two broad areas of improvement: SDG targets in this area and how they are implemented. 

How is sexual health covered by the SDGs already? 

SDG 3 on good health has two targets (1 and 7) which focus on women’s health: reducing the maternal mortality ratio and ensuring “universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs”. In simpler terms, access to sexual and reproductive healthcare for all. Sexual health in the SDGs is intended to be indirectly included in many or all of them, with some targets specifically addressing SRHR and others tackling related issues like gender equality. This is reflected in the description of the SDGs by the United Nations Population Fund (UNFPA). They highlight how their work relates to matters of gender equality, such as women’s health, rights, and economic opportunities. They also show how some of the SDGs are related to SRHR, for example, that to address poverty in SDG 1, they work to end child marriage.

Since sexual and reproductive health have an impact throughout a person’s life, it is logical that SDG 3 (health and wellbeing) recognizes sexual health as a part of universal healthcare. Yet, it also confuses what is needed specifically for sexual and reproductive health. Essentially, by only generally recognizing the importance of sexual health but not addressing specific needs or targets, it is difficult to set goals or devote attention to problems with implementation. While this issue led the World Health Organization to develop their own SRHR framework in 2017, this does not change the problem within the SDGs themselves. To understand how these gaps could be filled, it is first important to identify the precise gaps.

Areas to Improve

Content of the SDGs

The targets within SDG 3 could be better linked and SRHR could also be included in separate SDGs, like SDG 1 (ending poverty) and SDGs 4 and 5 (access to education and gender equality). To give a clear example, SDG 1 on poverty has seven targets. These targets focus on reducing poverty in general terms, for example reducing the number of people living in poverty, giving aid to the poor, and creating policies that will achieve these goals. None of these goals specifically address gender or SRHR. This is despite the fact that poverty usually impacts women more harshly, especially now during the pandemic. This is not to ignore the work of agencies like the UNFPA in ending child marriages and improving sexual healthcare access as a part of SDG 1, but to highlight an area for improvement. On top of that, the only SDGs that explicitly address SRHR only concern maternal health, HIV, and sexual health education and access in a very general sense. This leads to an important question: Why is it so important for the SDGs to directly address SRHR in the first place? Won’t the achievement of the SDGs directly lead to gender equality and improvement of human rights? The first reason is that data collection is an important step in improving and measuring any SDG goal. Without specific SRHR goals, there will not be any way to measure sexual and reproductive health progress specifically. Secondly, even with the SRHR focused SDGs there are still gaps, specifically in sexual education curriculums, access to abortion, and access to contraception. Without SRHR focused goals in the SDGs, SRHR and gender equality are even easier to ignore and miss altogether, worsening these gaps. By giving clearer targets and goals for SRHR, it would be easier to address shortfalls and discrepancies. However, this would not solve all problems the SDGs have faced challenges with implementation. 

Implementation 

While positive progress has been made for the existing SRHR SDG indicators such as for SDG 5 on gender inequality, there are still improvements to be made generally. The UNFPA has already made and highlighted important suggestions in improving the implementation of SDG 5. The UNFPA and UN Commission on Life Saving Commodities for Women and Children have highlighted the need for more medicines and contraception to improve maternal, sexual, and reproductive health. With regard to other challenges, it has been difficult to implement and measure SDG progress in specific regions and countries. For SRHR specifically, this difficulty is caused in part by political climate and cultural norms. In other words, simply setting targets to achieve gender equality and SRHR aren’t enough when the inequality is caused by more deeply rooted problems. 

Conclusion

Overall, challenges to acting on the SDGs have not been addressed enough, especially when it comes to SRHR. The SDGs need to more directly and explicitly address SRHR and gender equality. Without doing so, progress in this area will be difficult to measure. Context-specific obstacles, such as cultural and social norms and political climate, have to be taken into account and directly addressed for implementation and measurement of indicators. In other words, there are two main challenges the SDGs face right now with addressing sexual and reproductive health and rights; not directly addressing sexual health and not directly addressing context-specific problems in improving sexual health. Addressing the first issue will help with setting specific goals and collecting data and addressing the second issue is necessary to promote SRHR. 

May be an image of Hannah Madelon

Hannah Madelon

Hannah Madelon is a Masters student of International Relations at Leiden University and an intern for UN Studies in Peace and Justice. She has research and personal interests in sexual health and reproductive rights as well as the United Nations.

Sources

  1. Zuccala, Elizabeth, and Richard Horton. 2018. ‘Addressing the Unfinished Agenda on Sexual and Reproductive Health and Rights in the SDG Era’. The Lancet 391 (10140): 2581–83;

2. Newmann, Karen, Sarah Fisher, Susannah Mayhew, and Judith Stephenson. 2014. ‘Population, Sexual and Reproductive Health, Rights and Sustainable Development: Forging a Common Agenda’. Reproductive Health Matters 22 (43):53

 3. Kanem, Natalia. 2018. ‘Sexual and Reproductive Health and Rights: The Cornerstone of Sustainable Development.’ The UN Chronicle 55 (2):35

3.  Daher-Nashif, Suhad, and Hiba Bawadi. 2020. ‘Women’s Health and Well-Being in the Uited Nations Sustainable Development Goals: A Narrative Review of Achievements and Gaps in the Gulf States.’ International Journal of Environmental Research and Public Health 17 (1059): 1-8; World Health Organization see https://www.who.int/health-topics/sustainable-development-goals#tab=tab_2. ; Stephenson, Rob, Lianne Gonsalves, Ian Askew, and Lale Say. 2017. ‘Detangling and Detaling Sexual Health in the SDG Era’. The Lancet 390 (100099): 1015

4.  Target 3 focuses on HIV specifically and SDG 5 has two targets which focus on access to reproductive rights and health care. See: SDG Tracker https://sdg-tracker.org/gender-equality.; UNFPA https://www.unfpa.org/sdg-5-6.

5.  Yamin, Alicia Ely. 2019. ‘Power, Politics and Knowledge Claims: Sexual and Reproductive Health and Rights in the SDG Era.’ Global Policy 10 (1): 55.

6.  They also list SDGs 2-6, 8, 10, and 16 as connected to SRHR and gender equality (https://www.unfpa.org/sdg). 

7.  Stephan et. al 2017, 1015

8.  Morgan, Rosemary, Roopa Dhatt, Chandani Kharel, and Kui Muraya. 2020. ‘A Patchwork Approach to Gender Equality Weakens the SDGs: Time for Cross-Cutting Action’. IUHPE-Global Health Promotion 27 (3):, 4

9. Daher-Nashif and Bawadi 2020, 6

10.  United Nations 2020, 24

11.  Morgan et al. 2020, 4

 12. UNFPA p.22-23 see https://www.unfpa.org/sdg-5-6

13.  Morgan et al 2020, 4

14.  See also: UN Commission on Life-Saving Commodities for Women and Children 2012, esp. p.3, 6-8:  https://www.unfpa.org/sites/default/files/pub-pdf/Final%20UN%20Commission%20Report_14sept2012.pdf

15.  For example, in Southeast Asia and Africa, sex taboos, patriarchy, and political climate have made it difficult to protect SRHR (Sciortino, Rosalia. 2020. “Sexual and reproductive health and rights for all in Southeast Asia: more than SDGs aspirations.” Culture, Health & Sexuality 22(7): 744-761; IPPFAR see https://www.ippfar.org/sites/ippfar/files/2017-01/SDG%20E%20fn.pdf).

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