Dissemination Workshop

“Mapping of Sexual and Reproductive Health and Reproductive

Rights Policies in the Arab World”

Results of Mapping of SRH Policies in 11 Arab States

Summary of workshop proceedings

October 26-27, 2015

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Background

As 2015, the end date for the Millennium Development Goals (MDGs), comes to a close, the post-2015 global development agenda is taking shape in a set of proposed Sustainable Development Goals (SDGs) that seek the eradication of poverty, promote inclusiveness and equity, and renew the world’s commitment to economic growth, environmental sustainability and protection, and social development. The proposed SDGs address health and health services in SDG 3 (“ensure healthy lives and promote well-being for all at all ages”), SDG 5 (“achieve gender equality and empower all women and girls”), and SDG 10 (“reduce inequality within and among countries”).

Sexual and reproductive health (SRH) care and services are pivotal to the aspirations for universal health coverage (UHC), gender equity, and education reflected in the SDGs. SRH is addressed specifically in targets aiming to reduce the global maternal mortality ratio and ensure universal access to SRH care services, including family planning, information and education, and the integration of reproductive health into national strategies and programs. These are proposed within the framework of UHC that promotes coverage, inclusiveness, quality, and protection.

The Arab states are currently transitioning from fulfillment of the MDGs to commitment to the SDGs. However, Arab states’ attempts to meet the MDGs over the past two decades have revealed various challenges. Some of these challenges persist, in particular in the integration of available services as part of comprehensive health policies.

The Middle East and North Africa Health Policy Forum (MENA HPF), in partnership with the United Nations Population Fund (UNFPA) Arab States Regional Office, will address the status of SRH and reproductive rights, a priority in the health development and advocacy agenda of UNFPA, especially during this period of transition to the post-2015 SDGs.

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Summary of workshop proceedings

MENA HPF, in partnership with UNFPA ASRO and with support from the World Health Organization (WHO) Egypt Country Office, organized a two-day regional workshop titled “Mapping Sexual and Reproductive Health and Rights in the Arab World.” The workshop is part of a broader collaborative work that aims to strengthen SRH in the Arab world through: (i) bringing policy agendas more in line with needed activities; (ii) empowering key decision-makers across sectors to foster a comprehensive SRH agenda and new ways of acting and collaborating to achieve needed transformational change; and (iii) supporting activities to achieve UHC, gender equity, and education by addressing key challenges and opportunities across regional and national interventions.

The primary objective of the workshop was to disseminate results of a regional report incorporating data generated by mapping policies on sexual and reproductive health and rights in 11 Arab states. Other objectives were to provide a platform for dialogue among regional professionals; highlight various approaches to align SRH policies with the post-2015 development agenda; share experiences and evidence-based observations for strategic investments in SRH; and recommend policy options to develop regional mechanisms.

The workshop was organized to allow discussions and promote the exchange of experience in an attempt to understand, define, and identify the challenges and opportunities that facilitate or weaken SRH policy contextualization and implementation.

Some 60 participants from various countries in the region and with diverse expertise and specialties—technical experts, policymakers, parliamentarians, academics, and private sector actors— came together to engage in dialogue and free interactions over the two days of the workshop. Keynote addresses were presented by Ambassador Dr. Mervat Tallawy, Prof. Dr. Maha El Rabbat, and Dr. Francois Farah.

Stressing the importance of the topic, Dr. Tallawy gave a historical overview of the leading role played by Egypt since 1969. She emphasized the importance of SRH issues and their impact on women’s status in the Arab world and worldwide. She then addressed existing challenges hindering sustainable efforts to advance the SRH agenda. Dr. El Rabbat acknowledged that the Arab states have made great strides in furthering the SRHR agenda, which gained momentum after the 1994 International Conference on Population and Development (ICPD) Program of Action. Nevertheless, many challenges remain that impede the universal access to care and services, particularly considering the unevenness of progress made.

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Stating that “reproductive health, reproductive rights, and gender equality are the trinity of human dignity,” Dr. Farah gave examples from around the world of the linkages between SRH and human wellbeing.

Through interactive sessions, on the first day of the workshop participants discussed the results of the study citing specific country experiences. Discussions extended on the second day to identify the roles of stakeholders and, from there, to suggest the way forward and required actions. Throughout the workshop, participants drew on their experiences to mark out a path forward with actions to serve the broader agenda, maximize benefits, minimize harm, and draw in the support of stakeholders.

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Key findings The post-2015 development agenda: Where do we stand? • In contrast to the MDGs, the SDGs were developed by the UN through a bottom-

up approach. They give strategic direction in 17 areas of concern and offer concrete targets to be achieved by countries by 2030. One of these goals is universal access to reproductive health packages by the year 2030.

• Capitalizing on the MDGs and analyzing the hurdles to fulfillment is a step to overcoming them and ensuring better implementation of the SDGs.

• Prioritizing SDGs based on country-specific features and national strategies is

crucial to avoid exceeding a country’s capacity. • Identifying the key stakeholder groups and their respective roles is of the utmost

importance for a comprehensive framework.

• Peer reviewers from various Arab countries tailor SDGs to fit national needs, while building on existing mechanisms to contribute to the implementation of SDGs on a national level.

• Outcomes of future collaborations are seen as part of a comprehensive framework

of action. As outlined in the 2030 agenda, more indicators are being developed to assist this work on the basis of accessible, timely, reliable, disaggregated data. This requires the enhancement of statistical capacities for better quality of data and information.

Mapping SRH policies: Importance of reviewing policies/legislation, mapping tools, and consolidated results • A review of best practices from other countries offers valuable lessons about the

inception and implementation of some SRH policies and helps identify the bottlenecks and how to overcome them.

• Specific and actionable recommendations for governments are key elements for proper implementation, but countries are the ones identifying their priorities.

• A mapping tool is essential for the review of laws and policies relevant to SRH,

including but not confined to abortion, maternal death due to abortion, virginity, fertility, nationality, and maternity leave.

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Mapping SRH policies: Country cases • While many Arab countries have made progress in tackling SRH issues, many

areas still require reform. Issues related to domestic violence, sexual harassment, the definition of rape, and female genital mutilation (FGM) aremutilation (FGM) is still problematic in many Arab countries. The lack of policies and laws that protect women after reporting violence coupled with the lack of awareness among women when it comes to their rights overpowers any attempt at progressive reforms. Male social dominance, particularly in rural areas, also has repercussions for women’s health and reproductive wellbeing.

• In countries like Sudan, a severe brain drain and the lack of funding has resulted

in a wide gap between existing legislation and actual implementation. In Morocco, the lack of laws on domestic violence and specific protection or medical support for pregnant and unmarried women is the main issue. This is similar to Jordan, where there is no explicit article in the constitution on SRH. In Lebanon, flawed or incomplete policies mean that domestic law neglects women’s rights and fails to address many issues related to SRHR.

• Although Tunisia’s government has committed itself to human development, this

commitment is not reflected in many sectors, among which is SRH. There is still high prevalence of HIV/AIDS, men are widely absent from SRH policies and programs, and youth have no access to SRH services.

• Although reproductive health rights and indicators have improved in Jordan,

administrative and technical mechanisms impede the implementation of relevant policies. Youth awareness of SRH is quite low.

• In Palestine, the constitution makes no reference to a right to life, consent to

marriage, or the freedom to decide on the number and spacing of children. Palestine also suffers from legal and judicial fragmentation, as Gaza and the West Bank each adhere to different systems.

• The empowerment of Arab women and making them aware of their reproductive

and sexual rights is a priority for national agendas.

• Sudan, Jordan, Lebanon, Morocco, and other Arab countries have not ratified some international protocols and conventions relevant to SRH.

SRH: Priorities, actions, role of stakeholders • SRH is a complex social phenomenon that is closely tied to issues of gender

equality. Relevant laws and policies can either create barriers to or enable the delivery of and access to SRH service packages.

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• Concord and consensus among different stakeholders—government (including

various ministries), religious leaders, public or private healthcare providers, research institutions, regional bodies, media, and international and civil society organizations—is an essential element for the success of any reform policy.

• Specific SRH issues raised highlight the lack of equitable access to healthcare

services, the fragmentation of service provision, migration, refugees and non-citizens, and sociopolitical unrest.

• A number of key points were identified affecting the state’s capacity to implement

and develop SRH, such as the lack of institutionalized mechanisms of accountability and demand for implementation, the absence of a concrete strategy leading to a plan of action, and the lack of health data and laws proactively geared to change.

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Policy implications

• Thematic work on rights should focus on the challenges of contextualizing and operationalizing the concept of rights in different local and national domains.

• • Arab states need to be more focused on sustainable development policies. The

obstacles to development, including traditional and often outdated socioeconomic norms, patriarchal societies, and the unavailability of data and sufficient research for many sensitive topics, were widely discussed.

• SRHR is a multidisciplinary problem, but there is a range of solutions that can be implemented. It is crucial to consider policies and legislation addressing the root causes of the problem and acknowledge the need to legislate, monitor, and oversee government actions and approve financial allocations. It is also important to define the person or body responsible for identifying problems that need addressing.

• Further recommendations need to be more specific and actionable for governments and UN agencies, keeping in mind the crucial need to prioritize approaches that are country-specific and tailored to each context.

• There is clear consensus on the need to adopt a lifecycle approach in order to foster awareness of the opportunities and risks of future actions and policies. Policymakers should refrain from reinventing the wheel; looking at specific country cases can offer lessons derived from the previous implementation strategies of some policies.

• Suggested policy priorities include strengthening health services and ensuring technical, political, and institutional sustainability in terms of financing, institutional reforms, political acceptance, and community awareness. Many SRH laws need to be amended and reviewed and service availability increased. The capacity of health workers should be developed and built and research must be supported.

• The media can play an important role in engaging and educating the population,

but in the long term, SRH should be included in school curricula. Curricula should include rights and social and health perspectives.

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• Supporting and promoting a strong civil society will help it to work on cultural change. Often excluded, awareness programs targeting youth need to be developed.

• The key recommendations to strengthen Arab countries’ SRH policies and programs is to create a culture that accepts SRH, engage and educate healthcare professionals, and conduct further evidence-based research on SRH.

• Making culture-sensitive, age-appropriate SRH education available to all women should be a priority. Adopting a multidisciplinary approach to raise awareness by involving the media and creating an interdisciplinary team can help to shape cultural perceptions.

• It is important to acknowledge that this issue requires a multi-stakeholder approach, which is why raising the awareness of different stakeholders will be valuable in the long run. A specific body is needed to coordinate among all stakeholders.

• The government should be a partner, not the sole leader on SRH issues. It is nevertheless important to enhance state capacity and formulate strategies leading to state plans of action.

• Training healthcare professionals such as doctors and nurses and tailoring national healthcare policy to distribute services evenly and appropriately would be a successful first step to promoting research and creating an educated group of professionals. Accurate and up-to-date databases based on in-depth research and studies will also serve as a framework on which future policies can be built.

• SRH needs to be acknowledged as an integral part of healthy living, included in national development plans and services, and laws should be revised to accommodate that. A rights-based approach needs to be adopted.

• The priority today should be narrowing the gap between drafting policies and strategies and implementing them. This can be achieved through strengthened laws and legislation, successful coordination among partners and stakeholders, or a reliance on evidence-based tools, especially for advocacy.

• Integrating family planning programs, for example with sexual health or post-abortion and postpartum health, can also play a role in setting the agenda.

• The adoption of a lifecycle approach, capacity building, and proper monitoring and evaluation all contribute to the fulfillment of this task. Campaigns should also focus on raising the awareness of stakeholders, not only the community.

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• In conclusion, the recommended actions include amending some country laws,

developing and reviewing family law, increasing the coverage of health insurance and health services, and improving the capacity of actors in the health sector. Also recommended is an emphasis on social and cultural change through media engagement, the inclusion of SRHR from a rights, social, and health perspective in school curricula, and the promotion of civil society awareness and participation. Increasing research and collaborative work among stakeholders will also contribute to reaching goals and putting SRHR on the national and international agenda.

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Role of MENA HPF

Due to the diversity and large number of its partners, as well as its regional and international outreach, the MENA HPF has the capacity to play a leading role in putting issues concerning sexual and reproductive health and rights on the agenda as well as finding solutions to problems of implementation and policy. The roles highlighted during the conference include:

1. Addressing prevailing inequalities in countries of the MENA region.

2. Adopting a multidisciplinary approach by drawing in professionals of different academic and scientific backgrounds, especially non-health partners such as lawyers, economists, and sociologists. This integration of disciplines will be an important tool in responding to different kinds of challenges.

3. Researching successful interventions geared to the MDGs and advocating for similar approaches and interventions.

4. Advocating for the alignment of the SDGs and national plans of action.

5. Proposing a balance between the role of the international community and that of national actors, to allow both parties to contribute to success instead of hindering it.

6. Assisting in the creation of a framework of strategies for implementation, planning, monitoring, and evaluation for possible adoption by member countries, to serve the SRHR agenda.

7. Proving a crucial platform of accountability to pressure policymakers. During the workshop, several participants highlighted the need to institutionalize mechanisms of accountability to optimize results.

8. Overseeing the process of turning the mapping report into an accessible, actionable policy brief for policymakers and decision-makers.