SEXUAL and reproductive health rights climbed up the public health agenda after the groundbreaking International Confe­rence on Population and Development in 1994 in Cairo. It was on that occasion that the plan of action for putting SRH rights on the development agenda was drawn up. Most of the countries attending the conference duly signed the plan of action. Pakistan was one of the signatories.

Fortuitously, the timing of the Cairo action plan coincided with the negotiation phase of the millennium development goals. In the early phase of the negotiations, SRH rights did not figure much in MDG discussions. However, after vigorous lobbying by women’s rights and SRH rights organisations who were galvanised by the new vision of SRH outlined in the Cairo declaration, SRH rights were shoehorned into the MDGs. The right to universal access to SRH services was inserted into MDG 5 as its subpart. This marked a significant achievement for the SRH movement.

Pakistan, by virtue of being a signatory to both the MDGs and the action plan, had a double responsibility to adhere to the implementation timetable on sexual and reproductive rights. This has required periodic assessments of the progress being made on both the Cairo action plan and the MDGs. However, like the tardy movement on all other MDGs, Pakistan’s progress on sexual and reproductive rights has also been excruciatingly slow and falls far short of the targets built into the MDGs.

Sexual & reproductive health is a basic human right.

Part of the reason for this failure lies in the way Pakistan has dealt with SRH rights throughout its history. SRH issues have been tiptoed around rather than tackled frontally in our health promotion strategies. One way of doing this was to incorporate SRH into population planning as happened in the 1960s.

According to this, SRH issues were subsumed wholly into the contraception part of the population planning programmes. This was the conception of SRH at its narrowest, which has continued largely unmodified in later iterations of population programmes such as the family planning and family health programmes. The restricted agenda focused on education about contraception and birth spacing for the welfare of the family without uttering the word ‘population’.

These iterations of the population programme were promoted because of the clergy’s opposition to population welfare programmes which were depicted as a Western ploy to dilute the ummah’s strength. However, the larger reason for not tackling SRH issues head-on lies in the way issues around sex and sexuality are handled. Sex remains a taboo subject in Pakistan, often talked about in a hushed way despite its centrality to human biology, psychology, procreation and health. So much so that even among medical students, discussion on sexual issues is strictly limited to its biological and anatomical aspects.

This leaves out of the discussion the wider role of SRH issues in population explosion, the soaring rates of sexually transmitted diseases, HIV and Aids. Sexuality education is a taboo term: the idea of imparting it is treated with horror. Nowhere is this more apparent than the recent case of a private university where rudimentary sexuality education was withdrawn under pressure from adverse media coverage and protests from parents. Implicit in anti-sex education propaganda is the notion that sexuality education would lead to promiscuity, though this widely held notion has been disproved by various studies on the subject.

In contrast, the notion of sexual and reproductive rights is steadily expanding worldwide, with an increasing number of governments becoming receptive to the importance of SRH rights in tackling the problems of population, unwanted pregnancies, HIV and Aids, sexually transmitted disease and promoting people’s health. More importantly, SRH is also being increasingly linked to poverty and inequality issues. Yet this broader conception of sexual and reproductive rights has yet to permeate our policy discourse and practice.

The broader interpretation sees SRH rights as fundamental human rights. SRH rights allow everyone to make free, informed and responsible decisions on every aspect of one’s body, sexuality, health, relationships and decisions about when and whom to marry and when to have children, without coercion, discrimination, stigma and violence. This right also enshrines the element of universal access to SRH rights information, education and health services.

Despite countless millions poured into the population programme and its various different incarnations, Pakistan’s contraception prevalence rate remains at 35pc as compared to Bangladesh’s 62pc. And the population growth shows few signs of slowing down. This is because Pakistan has historically adopted the narrowest notion of SRH rights. So far, however, there has been no post-mortem conducted on the outcome of failed policies that have skirted around SRH rights issues. Such a rethink has never been so urgent, given that Pakistan boasts of what is commonly referred to as the youth bulge. This section of the population needs to be made aware of SRH rights for a better and more productive future.

The writer is a development consultant and policy analyst.

Published in Dawn, November 12th, 2015