At Ipas, we envision a world where every girl and every woman has the right and the ability to determine her own sexual and reproductive health. As part of this, we are committed to working with the World Health Organization (WHO), governments and other partners to attain the Sustainable Development Goal (SDG) targets, which include achieving universal health coverage (UHC) as a major priority. UHC is an international effort to guarantee that all people, regardless of where they live, have access to essential, quality health services—including prevention, promotion, treatment, rehabilitation, and palliation—without financial hardship.
Why does sexual and reproductive health and rights (SRHR)—including safe abortion—belong in the UHC conversation?
Achieving UHC will only be possible if all girls and women have access to information and services and the self-efficacy needed to make informed decisions about their lives, including their individual sexual and reproductive health. Safe abortion care is an essential health care service. Approximately 56 million induced abortions occur each year globally. Long-term, sustainable and equitable access to SRHR can only be achieved when safe abortion care is not separated from other components of health care.
Upon agreeing to the Sustainable Development Goals in 2015, all UN member states committed to concrete steps to advance the health of all people. Leading the global charge toward achieving this, the WHO introduced its General Programme of Work for 2019 – 2023 (GPW 13) with three strategic, interconnected priorities to ensure healthy lives and well-being for everyone, including:
- Achieving universal health coverage
- Addressing health emergencies
- Promoting healthier populations
Integrated within each of these – and a component of the 16 essential health services used to track progress of UHC at the country level – is family planning. More specifically, and in alignment to the SDGs, the WHO will: “work to ensure 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 programmes;” and “ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences.”
Country-level snapshots: Nepal and Kenya
The implications of these services are most critical when looking at country-level policies and programs. Two experiences from Ipas’ programs in Nepal and Kenya, for example, highlight the importance of continued advocacy to ensure SRHR— including safe abortion care – is included in national commitments toward UHC:
UHC is the major priority of Nepal’s Health Sector Strategy 2015 – 2020 and its subsequent Implementation Plan 2016 – 2021; both provide a roadmap toward UHC, as enshrined in the Constitution of Nepal 2015.
In preparing these critical policy documents – most specifically the Implementation Plan 2016 – 2021 –Ipas Nepal provided direct input and assistance to prioritize safe abortion care. The government of Nepal also launched a National Health Insurance Scheme to achieve UHC, and drafted the Basic Health Service Package (BHSP), which mandates that government-prioritized health services be accessible for all. Following substantial advocacy efforts on behalf of Ipas and partners, the BHSP now includes free safe abortion care up to 12 weeks at public health facilities.
Recently, the government of Nepal also endorsed the Public Health Act and the Safe Motherhood and Reproductive Health Right Act, which provides a strong political and legal basis for safe abortion care to be provided free of cost as a fundamental human right.
Kenya provides another strong example. Here, Ipas sits on the National Task Force developing the Essential Benefits Package (EBP) for UHC which includes health services, medicines and commodities that will be available to all Kenyans, without causing financial hardship. Ipas is advocating for the inclusion of sexual and reproductive health and rights (SRHR)—including at a minimum family planning and post abortion care—to be covered under the EBP and the National Health Insurance Scheme. Ipas is also part of the evaluation team studying UHC implementation in four pilot counties to make recommendations on areas for improvement at the national level.
A lot of recognized advocacy campaigns are those with significant media attention and public awareness. But it is examples like these in Nepal and Kenya that demonstrate the power and importance of the behind the scenes advocacy – the advocacy which ensures SRHR and access to safe abortion is not forgotten, and in turn no girl or woman is left behind.