Implementing the Action plan for sexual and reproductive health – how policies can make a real difference

WHO/David Kharatishvili

When national and regional experts in sexual and reproductive health from 21 countries met in Stockholm, Sweden, on 30–31 August 2018, a success story from Portugal illustrated how policy changes in this area can make a huge difference.

In the late 1970s in Portugal, the maternal mortality rate was over 40 per 100 000 live births; in 2017, following the implementation of wide-ranging sexual and reproductive health reforms, the rate had dropped to 6.9. The country also saw a dramatic decrease in the infant mortality rate (to 2.6 per 1000 live births), which is currently among the lowest in the WHO European Region.

The reforms that changed the scenario in Portugal are among the recommendations of the Action plan for sexual and reproductive health, which Member States endorsed at the WHO Regional Committee for Europe in 2016. In Portugal, these reforms focused on:

  • providing quality preconception information and services and strengthening antenatal care;
  • reorganizing health services to ensure availability, accessibility, acceptability and quality of services for obstetric and newborn care;
  • facilitating access to safe abortion and providing free contraceptive services and commodities;
  • offering adolescent health services with personalized care and sexuality education; and
  • taking additional measures to strengthen sexual and reproductive health and rights.

This was one of the success stories presented at the meeting, which aimed to assess how well countries have managed to implement the Action plan in the 2 years since its endorsement. A wide range of key professionals with roles in health policy-making and sexual and reproductive health discussed progress, successes and barriers to implementation.

The meeting was rich with examples from countries at different stages of implementation. This gave countries an opportunity to learn from each other and inspired further action to:

  • address the challenges in delivering universal access to sexual and reproductive health and rights;
  • strengthen the role of primary health care in promoting sexual health, from the perspective of both the health workforce and health-care users;
  • increase health literacy to improve sexual and reproductive health, promote equity, and support the achievement of the Sustainable Development Goals (SDGs);
  • develop monitoring and accountability for sexual and reproductive health and rights; and
  • build stronger health systems for universal access to sexual and reproductive health.

Alanna Armitage, United Nations Population Fund (UNFPA) Regional Director for Eastern Europe and Central Asia, underscored that sexual and reproductive health is a cornerstone of reaching the SDGs. “There is no health without sexual and reproductive health,” she stated.

She also pointed to several global events that are putting sexual and reproductive health on policy-makers’ agendas as fundamental moments to reaffirm this commitment. These include the Global Conference on Primary Health Care, which will mark the 40th anniversary of the Declaration of Alma Ata, and the upcoming 25th anniversary of the Cairo Programme of Action on population and development.

Key challenges for sexual and reproductive health

European Member States have achieved remarkable progress over the past 20 years. Maternal and child mortality rates have decreased substantially, contraceptive prevalence has increased and the abortion ratio has fallen. Despite this, there are still wide variations between and within countries. For example:

  • infant mortality rates in countries with the highest rates are 20 times those with the lowest;
  • the highest national maternal mortality rate in the Region is now estimated to be 25 times the lowest;
  • unmet family planning needs differ widely across the Region – from 5% to nearly 23% – and are highest among the most vulnerable, such as those with a low socioeconomic status, migrants and adolescents;
  • insufficient focus has been given to expanding access to services for safe abortion, for the prevention and management of sexually transmitted infections, for infertility, and for adolescent sexual health; and
  • there is still substantial resistance to investing in sexuality education.

The Public Health Agency of Sweden, the UNFPA Eastern Europe and Central Asia Regional Office, and WHO/Europe co-organized the meeting in Stockholm as part of Europe’s work to implement the 2030 Agenda for Sustainable Development. This work aims to accelerate development to improve sexual and reproductive health in countries of Europe and central Asia.

Nino Berdzuli, Programme Manager for Sexual and Reproductive Health at WHO/Europe, stated, “We can see a clear difference in countries that have implemented the policies we know are effective. Countries need to improve efforts to create an enabling environment to eliminate barriers to sexual and reproductive health services and information. They also need to work with sectors outside of health, which can play a significant part in promoting and protecting populations’ sexual and reproductive health and rights.”

Ulrika Karlsson, Swedish Member of Parliament and President of the Parliamentary Forum, underscored this message and urged for action at the policy level, saying, “It is time to deliver on the rights that people want.”