Challenges for Measuring Progress towards the Sustainable Development Goals.

With the adoption, in September 2015, of the Sustainable Development Goals with a time horizon of 2030, there is a dire need to exploit avenues for the monitoring of progress towards meeting the targets pertaining to sexual and reproductive health, whether at global, regional, national or grassroots level. The current process for the selection of indicators, to complement the targets, provides an opportunity for a concerted effort to improve monitoring procedures and ensure their relevance for programme adjustment and accountability. It is imperative for national processes to ensure effective reporting besides linkages with related sectors.

Sexual and Reproductive Health at 2015 and Beyond: A Global Perspective.

The International Conference on Population and Development and Millennium Development Goals propelled reproductive health into priorities for international development through declarations, statements, and frameworks. However, key indicators demonstrate that progress in both service provision and clinical outcomes has not been optimal, especially for certain disadvantaged groups. With the Sustainable Development Goals, efforts over the next two decades will focus on access to and quality of health services. Advocacy for mobilizing resources will be complemented by accountability, especially monitoring and evaluation, for utilization of these resources during the life cycle. Stakeholders should emphasize national commitments, with broad partnerships, to ensure long-term sustainability.

La Conférence internationale sur la population et le développement et les objectifs du Millénaire pour le développement ont porté la santé génésique au rang des priorités pour le développement international au moyen de déclarations, d'énoncés et de cadres de référence. Et pourtant, des indicateurs clés nous soulignent que le progrès (tant pour l'offre de services que pour les issues cliniques) n'a pas été optimal, particulièrement en ce qui concerne certains groupes désavantagés. Grâce aux objectifs de développement durable, les efforts déployés au cours des deux prochaines décennies seront centrés sur l'accès à des services de santé de qualité. La promotion de la mobilisation des ressources sera renforcée par l'obligation de rendre des comptes (particulièrement la surveillance et l'évaluation) quant à l'utilisation de ces ressources au cours du cycle de vie. Les intervenants devraient souligner l'importance des engagements nationaux, au moyen de partenariats élargis, pour ce qui est d'assurer la durabilité à long terme.

Progress towards the Millennium Development Goals: a long trek for reproductive health.

With only six years remaining to achieve the Millennium Development Goals in 2015, issues pertaining to universal access to reproductive health deserve more emphasis as part of current efforts in international health. The maternal health goal is the Millennium Development Goal with the most disappointing progress. Whereas much has been achieved globally for the utilization of family planning services, there are some geographical areas and subpopulations where progress is lacking. Health systems should be strengthened whilst addressing disparities. The rights and gender aspects of reproductive health have been fully documented, but equitable access and economic aspects should be considered in policy formulation and program implementation. Advocacy is needed for key players to leverage support, whereas efforts for accelerating progress should be sustainable in the long term.

Fertility preferences and the need for contraception among women living with HIV: the basis for a joint action agenda.

OBJECTIVES: HIV-positive women have particular needs for contraception to avoid unwanted pregnancy, to protect their own health and to eliminate the risk of transmitting HIV to an infant. In 2004, the United Nations described a four-element strategy to preventing mother-to-child transmission of HIV; the second element is preventing unintended pregnancies among HIV-positive women. However, fertility preferences among HIV-positive women who know their status remain poorly understood. This study seeks to demonstrate the degree to which knowledge of one's own serostatus is associated with fertility preferences and contraceptive demand and use. METHODS: This study uses Demographic and Health Surveys data and bivariate and multivariate methods to assess the contribution of a proxy variable for knowledge of own HIV serostatus to women's fertility desires, demand for contraception and contraceptive method choice for Zambia, Swaziland, Zimbabwe and Lesotho. RESULTS: Knowledge of one's own HIV-positive serostatus is significantly associated with a desire to limit childbearing with contraceptive use, but not necessarily with unmet need for contraception. HIV-positive women who know their status are more likely than other women to use condoms. CONCLUSION: HIV-positive women who know their serostatus exhibit fertility desires and contraceptive behaviors that are different from those of other women. These findings support the argument that efforts to scale up the second element of the strategy to prevent mother-to-child transmission of HIV should be accelerated: it is a cost-effective, rights-based approach to preventing incidence of mother-to-child transmission of HIV. Scaling up requires full commitment by both reproductive health/family planning and HIV constituencies to concerted integration at all levels of program planning, coordination and implementation.

Targeting access to reproductive health: giving contraception more prominence and using indicators to monitor progress.

Unmet need for contraception represents a major failure in the provision of reproductive health services and reflects the extent of access to services for spacing and limiting births, which are also affected by personal, partner, community and health system factors. In the context of the Millennium Development Goals, family planning has been given insufficient attention compared to maternal health and the control of sexually transmitted infections. As this omission is being redressed, efforts should be directed towards ensuring that an indicator of unmet need is used as a measure of access to services. The availability of data on unmet need must also be increased to enable national comparisons and facilitate resource mobilisation. Unmet need is a vital component in monitoring the proportion of women able to space and limit births. Unmet need for contraception is a measure conditioned by people's preferences and choices and therefore firmly introduces a rights perspective into development discourse and serves as an important instrument to improve the sensitivity of policy dialogue. The new reproductive health target and the opportunity it offers to give appropriate attention to unmet need for contraception will allow the entry of other considerations vital to ensuring universal access to reproductive health.

The role of reproductive health for attainment of the millennium development goals.

Universal access to reproductive health services is a major aim of current efforts towards attaining the Millennium Development Goals, and reproductive rights and poverty reduction are crosscutting issues for this current focus of international development. Political statements should be complemented by financial commitments for mobilizing resources and the formulation of country-owned action plans. Upscaling services will necessitate strengthening health systems, integrating care, and building capacities. Policy makers, service providers, and stakeholders have responsibilities and duties to ensure that frameworks are available for the adequate provision of services. The implementation of multiple international development strategies currently constitutes a priority for reaching the targets by 2015.

Family planning: the unfinished agenda.

Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling, and long-term environmental sustainability. In the past 40 years, family-planning programmes have played a major part in raising the prevalence of contraceptive practice from less than 10% to 60% and reducing fertility in developing countries from six to about three births per woman. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The cross-cutting contribution to the achievement of the Millennium Development Goals makes greater investment in family planning in these countries compelling. Despite the size of this unfinished agenda, international funding and promotion of family planning has waned in the past decade. A revitalisation of the agenda is urgently needed. Historically, the USA has taken the lead but other governments or agencies are now needed as champions. Based on the sizeable experience of past decades, the key features of effective programmes are clearly established. Most governments of poor countries already have appropriate population and family-planning policies but are receiving too little international encouragement and funding to implement them with vigour. What is currently missing is political willingness to incorporate family planning into the development arena.