C2030Europe welcomes the UN 2023 Political Declaration of the High-Level Meeting on UHC – but highlights critical gaps in advancing sexual and reproductive health and rights

The Political Declaration on UHC (Universal Health Coverage) was passed at a High-Level Meeting on the 21st September 2023 and is now due for formal adoption by the United Nations General Assembly (UNGA).

The first ever Political Declaration on UHC was adopted in 2019. It marked a collective commitment to UHC as a vital component towards achieving the Sustainable Development Goals (SDG). The declaration underscored the importance and centrality of universal access to both sexual and reproductive health-care services as well as rights.

Countdown 2030 Europe welcomes the new Political Declaration of the High-Level Meeting on UHC – ”Universal Health Coverage: expanding our ambition for health and well-being in a post-COVID world” – especially given the backdrop of unprecedented humanitarian and financial crises and the aftereffects of the COVID-19 pandemic. These overlapping and heightened global crises have further entrenched inequalities in access to health care and the realisation of human rights, including sexual and reproductive health and rights (SRHR).

Despite continued politicisation, we are particularly pleased to see that the existing language on sexual and reproductive health care and rights in the new declaration has been maintained, and recognise positive additions that spotlight rights, gender, rates of adolescent mortality from complications in pregnancy and childbirth, and menstrual health.

However, given the urgency of health needs and crises globally, we are concerned that more progress on SRHR was not reached. Significant omissions within the declaration include references to provision of quality, integrated and comprehensive health care services, access to comprehensive sexuality education, the importance of bodily autonomy, and ensuring lifesaving sexual and reproductive health care in humanitarian settings.

As we look towards the Summit of the Future and implementing the outcomes and reform track of ‘Our Common Agenda’, we call for increased recognition of the fundamental importance of integrating SRHR within the UHC agenda, as these ambitions cannot be achieved without realising the right to health for all.

Read our in-depth analysis below.

Achieving a rights-based and gender-responsive approach 

It is encouraging to see additional commitments within the declaration to approaches that are grounded in human rights and are gender responsive.  In order to reach the most marginalised communities, it is critical that consideration is given to how to make services and financing gender responsive, as well as the importance of respecting, protecting and fulfilling the human rights of all, in particular those groups who are structurally excluded.

We regret that more progress was not achieved in terms of references to multiple and intersecting forms of discrimination, and marginalised and structurally excluded communities. These groups are often the most overlooked in terms of access to rights and life-saving health services – and should be included as a critical part of the Agenda 2030’s ambition of Leaving No One Behind.

Addressing issues related to sexual and gender-based violence, rates of adolescent mortality connected to complications from pregnancy and childbirth, and menstrual health and hygiene 

Countdown 2030 Europe welcomes new recognition of preventing sexual and gender-based violence against health workers, highlighting the importance in ensuring they have safe working environments and protection against discrimination. However, we are disappointed that sexual and gender-based violence was not referenced more widely in relation to implementation of the Universal Health Care package. Sexual and gender-based violence against women and girls is endemic across the globe. 

It is positive to note that the declaration draws attention to the issue of complications in pregnancy and childbirth as one of the leading causes of death in adolescents and young adults. Yet we regret that more explicit references to the specific sexual and reproductive health challenges faced by adolescents were not included. This remains the primary cause of death among 15-19 year-old adolescent girls. 

We were also pleased to see language on the importance of access to menstrual health and hygiene management services – an ongoing barrier for the participation of women and girls in public life.

Inadequate access to quality, integrated and comprehensive sexual and reproductive health care

We were disappointed to note the omission in recognising that women and girls continue to have inadequate access to quality, integrated and comprehensive sexual and reproductive healthcare services. 

Evidence shows that sexual and reproductive health services can be both preventative and lifesaving in treating and responding to reproductive and sexual health, pregnancy complications, reproductive cancers, and many other health-related problems. Sexual and reproductive health services must be integrated within the UHC package to support the ambitions that we all share of achieving gender equality and ensuring realisation of the right to health for all.

Vital need to ensure lifesaving sexual and reproductive health care in humanitarian contexts

The declaration does not highlight the vital importance of providing sexual and reproductive health care in humanitarian settings. This is despite the fact that over 500 women die in pregnancy or childbirth every day in humanitarian and fragile settings, where they face heightened risks and additional barriers to accessing services. 

The timely provision of sexual and reproductive health-care services can be lifesaving and prevent disease, and disability related to unintended pregnancy, obstetric complications, sexual and other forms of gender-based violence, HIV infection, and a range of reproductive disorders. The Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in crisis situations must be prioritised and implemented during response initiatives.

Continued lack of bodily autonomy for women and girls

Countdown 2030 Europe regrets that the declaration does not express concern for the lack of bodily autonomy experienced by many women and girls across the globe. The right of women and girls to make choices about their reproductive health is an SDG indicator that remains persistently low and on which insufficient progress has been made. 

More action must be taken to ensure women and girls realise their right to have control over all matters related to their sexuality, including sexual and reproductive health – free of coercion, discrimination and violence. The realisation of the SGDs and UHC in particular will not be realised otherwise. 

Insufficient provision of comprehensive sexuality education (CSE)

While the importance of providing information and education related to sexual and reproductive health-care services remains within the new declaration, it falls short of recognising and promoting CSE as a crucial and evidence-based intervention to improve the health and well-being of young people. Existing studies suggest it can reduce unwanted adolescent pregnancies and improve access to sexual and reproductive health-care services. CSE is essential for young people to develop the skills and knowledge to make free and informed decisions about a person’s sexual and reproductive life, and remains of increasing importance within the context of widespread mis- and disinformation.

Illustration: Alexandra Koleva