SDGs, Human Rights, and Health Ethics

• SDGs, Human Rights & ethics are the focus in the presentation delivered by Anneli Eriksson from the Karolinska Institutet

Planning

• The lecture will cover health from a human rights perspective and global targets.
• There will be an exercise and poster presentation as part of the SDGs discussion

Health and Global Health Definitions

• Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
• The constitution of WHO defines health in these terms
• Global health is an area for study, research, and practice that prioritizes improving health and achieving equity in health for all people worldwide
• WHO defines global health in these terms

Social determinants of health

• Economic stability is a key factor
• Education access and quality are important
• Social and community context impacts health
• Health care access and quality effect health
• Neighborhood and built environment matters

Ethics Behind Health and Human Rights

• The Enlightenment influenced thinking on human rights
• Philosophers claimed all humans can reason and have basic natural rights
• Key philosophers included Rosseau, Voltaire, Kant and Locke
• The Declaration of the Rights of Man and of the Citizen (1789) is relevant to human rights

Health as a Human Right

• It is stated "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being"
• This is from the Preamble to the WHO Constitution

Universal Declaration of Human Rights, Article 25.1

• Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family
• This includes food, clothing, housing, medical care, and social services
• Also including the right to security in events beyond control

International Covenant on Economic, Social, and Cultural Rights (ICESCR) 12.1

• The States Parties recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health
• The covenant was adopted December 16, 1966, and put into force January 3, 1976

International Covenant on Economic, Social, and Cultural Rights, (ICESCR) Article 12.2

• State parties must reduce the stillbirth rate and infant mortality rate to ensure the healthy development of a child
• The improvement of all aspects of environmental and industrial hygiene is crucial
• Need to prevent, treat and control of epidemic, endemic, occupational and other diseases
• Create conditions assuring medical services and attention in sickness

Resources and Capacity

• General Comment No. 14 (2000) addresses the right to the highest attainable standard of health under article 12 of the International Covenant on Economic, Social and Cultural Rights
• States must progressively implement health access, the core or minimum health care

Right to Health in other International Documents

• Constitution of the World Health Organization (WHO) emphasizes
• Convention on the Rights of the Child is relevant
• African Charter on Human and People's Rights states this clearly
• Convention on the Elimination of all Forms of Discrimination against Women (CEDAW) is relevant
• Convention on the Elimination of All Forms of Racial Discrimination (CERD) supports this

Global Targets

• MDGs and the SDGs are the focus

Goals Related to Global Health

• Alma Alta's goal was Health for all 2000, focus on primary health care with a public health perspective
• Millennium Development Goals sought to reduce extreme poverty by 2015
• There were successes and failures
• There were 8 total goals, and 3 directly related to health.

Sustainable Development Goals (SDGs)

• Agenda for Sustainable Development (SDGs) for 2030
• There was a broad consultative process
• 17 comprehensive goals were made
• 169 targets exist
• Several indicators exist per target
• 1 directly related to health

SDG Assignment

• Conduct and bring a poster session
• Focus is on Goals 1, 2, 3, 4, 5, 6, 11, 13, 16, creating groups of 2 or 3
• Present the targets for one of the listed goals
• Choose five indicators and present their development globally
• What is the relevance of “your” SDG goal for health, and how does it relate to or affect disasters?

Global Perspectives on Sexual and Reproductive Health and Rights

• Hannah von Reding presented it as part of the Course “Global Health and Disasters” on February 4, 2025

Outline of Talk

• History of SRHR is important
• Definitions and concepts behind SRHR
• Certain groups or demographics require distinct SRHR Needs
• There is a Global agenda: Sexual and reproductive health interventions
• Trends across the globe affecting sexual and reproductive health and rights are important

Discussion Statements around Sexual Health

• “Talking about sexual health is controversial" is discussed
• “Reproductive health is a women's issue” is discussed
• "SRHR is context-dependent"

History of SRHR

• It has long been a controversial global health topic because it requires frank discussions about sexual behaviors and gender issues.
• International Conference on Population and Development (ICPD) occurred September 5, 1994 in Cairo, Egypt
• The International Conference on Population and Development (ICPD) was the largest intergovernmental conference on population and development ever held with 179 governments
• This ICPD conference emphasized the role of women's interests in population matters and reproductive rights and introduced SRHR

Additional History of SRHR

• 1995; The Fourth World Conference on Women in Beijing occurred in 1995
• Said, "The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence"
• In 2000, the MDGs promoted Universal Access to Reproductive Health
• The SDGs for 2015 included universal access to sexual and reproductive health care services

SRHR Defined

• The global health community recognizes each component is linked to other components of SRHR.
• Achieving sexual and reproductive health relies on realizing sexual and reproductive rights

SRHR Defined Comprehensively

• Sexual and reproductive health is a state of physical, emotional, mental and social well-being in relation to sexuality and reproduction
• It is not merely the absence of disease, dysfunction or infirmity, a positive approach recognizes trust and communication
• All individuals have a right to make decisions governing their bodies and to access services that support that right
• In this context The Guttmacher-Lancet Commission is an authority

GL-C:s Essential package of sexual and reproductive health interventions includes

• Comprehensive sexuality education
• Counseling and services for a range of modern contraceptives, with a defined minimum number and types of methods
• Antenatal, childbirth and postnatal care, including emergency obstetric and newborn care
• Safe abortion services and treatment of complications of unsafe abortion
• Prevention and treatment of HIV and other sexually transmitted infections
• Prevention, detection, immediate services and referrals for cases of sexual and gender-based violence
• Prevention, detection and management of reproductive cancers, especially cervical cancer
• Information, counseling and services for subfertility and infertility
• Information, counseling and services for sexual health and well-being

Cost of SRH Services

• The Guttmacher Institute says, a package of SRH services costs USD 10.60 per person annually in LMIC, & would help by:
  • decreasing rate of unintended pregnancies (68%)
  • decreasing rate of unsafe abortions (72%)
  • decreasing number of maternal deaths(62%)
  • increased participation of girls in schools, and women in the labour market

Key SRHR and UHC targets in the SDGs by these dates

• By 2030, the global maternal mortality ratio is to be reduce to less than 70 per 100,000 live births
• By 2030, end preventable deaths of newborns and children under 5 years of age
• By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases
• By 2030, ensure universal access to sexual and reproductive health-care services, for information and education

More SDG targets

• Eliminate all forms of violence against all women and girls including trafficking and sexual exploitation
• Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation
• Ensure universal access to sexual and reproductive health and reproductive rights, as agreed in accordance to ICPD and review conferences
• Unlike the MDGs, the SDGs recognize sexual and reproductive health as being essential to health, development and women's empowerment.

Distinct SRHR Needs exist for

• Adolescents ages 10-19 years
• Adults ages > 60 years
• Sex workers
• Lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people
• Displaced peoples and refugees
• People with disabilities
• People who inject drugs
• People who live in rural areas

Access to Sexuality Education

• Most adolescents lack the knowledge required to make decisions responsibly, and are left vulnerable to violence
• CSE goes beyond anatomy, addressing gender, psychological, social and emotional issues
• Sex ed should be scientifically accurate, based on human rights and culturally relevant

More facts on Condoms

• The number of modern contraceptive users has nearly doubled worldwide since 1990.
• There are 164 million women who want to delay or avoid pregnancy using without contraceptives

Why Condoms aren't used more often

• Reasons for slow increase in use of modern contraceptive methods include:
  • Limited choice of methods
  • Limited access to services, particularly among young, poorer and unmarried people
  • Fear or experience of side-effects
  • Cultural or religious opposition
  • Poor quality of available services
  • Users' and providers' bias against some methods
  • Inconvenience or discomfort

Facts Regarding Access to Abortion

• Six out of 10 of all unintended pregnancies end in an induced abortion.
• Each year worldwide, 25 million unsafe abortions take place
• Only around half of all abortions take place under safe conditions
• Unsafe abortions cause around 39 000 deaths every year
• Restricting abortion access doesn't lower the number

Abortion Laws

• Over the past 30 years, more than 60 countries and territories have liberalized their abortion laws
• Only four countries have rolled back the legality of abortion, those were United States of America, Poland, Nicaragua and El Salvador

Gender Based Violence

• GBV is any act of violence due to the victim's sexual orientation
• The violence can take forms, physical, sexual, or psychological, and it encompasses harmful practices
• Harmful practices can be child marriage, sex trafficking, honor killings, sex-selective abortion, female genital mutilation, and sexual harassment and abuse
• Most victims/survivors are women and girls, the violence is is inflicted on women and girls, by men.
• 1 in 3 (30%) of women worldwide have been subjected to physical and/or sexual intimate partner violence

Cervical Cancer

• Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV)
• Cervical cancer is the fourth most common cancer among women globally
• Effective vaccines work to prevent or eliminate it
• WHO recommends:
  • One or two schedule doses for girls aged 9-14 years
  • For 15-20 years, one or two doses can occur
  • For those over 21, two doses with a 6 month interval

Menstrual Health

• WHO calls for menstrual health be recognized and health issue and human rights issues, not hygiene
• 300 million are menstruating, and 500 million lack access to product and facilities for adequate hygiene management
• There's dimensions of infections, missing school the stigma, the economy and what's affordable-MH

Global trends affecting SRHR are changes in

• Size and composition of populations, and the size of reproductive age demographics
• SRHR problems are accentuated among displaced and refugee populations
• Women and girls in emergency situations
• Social, economic, and cultural determinants

Central strategies suggested, to acheive SRHR are

• Dismantling discriminatory legislation and changing harmful social norms
• Investing in sexuality education and quality health systems
• Involve, protect and fund civil society organisations