NEW YORK — Health care is a human right, yet roughly half of the world’s population — 3.5 billion people — forgoes essential health services due to financial constraints or lack of accessible facilities. Universal health coverage (UHC) could change this worrying statistic. But if its promise is to be fulfilled, sexual and reproductive health services must be included.
The UHC idea is simple and powerful: guaranteeing access to quality health services, essential medicines and vaccines, and insuring people against catastrophic and routine health costs, would reduce poverty and improve health outcomes. That is why UHC was established in 2015 as a central tenet of the UN Sustainable Development Goals (SDGs).
The SDGs also enshrine sexual and reproductive health as an essential condition of gender equality; without it, women and girls cannot control other aspects of their lives. But sexual and reproductive health is often discarded from health care strategies for the sake of political expediency, threatening to derail efforts to ensure UHC by 2030.
As it stands, women face disproportionate political, social and financial barriers to health care access. Their out-of-pocket costs are consistently higher than men’s, primarily due to noncoverage or limits on sexual and reproductive health services, and they are often prevented by law or custom from obtaining care. These barriers are particularly high for LGBTQI individuals, women with disabilities, indigenous women, rural women and adolescents.
Instead of sidestepping the issue of sexual and reproductive health—and gender equality more broadly—governments must acknowledge their responsibility to address women’s needs. They must consider the central role that sexual and reproductive health plays in women’s lives, the integrated nature of women’s health and its impact on communities. And they must design UHC programs accordingly.
For example, reducing sexually transmitted infections (STIs), such as HIV and AIDS, is not possible without expanding access to testing, care and prophylactics, as well as addressing the gender and power dynamics that increase transmission. Other vital sexual and reproductive health services include access to contraception; infertility prevention and treatment; treatment for reproductive tract infections and cancers; and services to address gender-based violence.
If world leaders omit sexual and reproductive health from UHC strategies, they will send a powerful signal that women’s health and lives don’t matter. Health care costs for many women and their families would remain prohibitively high, and public health costs would rise, as women seek treatment for the life-threatening consequences of poor maternity care, untreated STIs and inadequate access to contraception services.
These expectations are confirmed by experience. Turkey’s Health Transformation Program was specifically designed to improve maternal health, and led to a significant decline in maternal mortality, from 61 deaths per 100,000 live births when implementation began in 2003, to 15.5 deaths per 100,000 in 2011.
Ghana’s UHC program, by contrast, was not developed with a focus on women’s needs, and did not lead to meaningful improvements in maternal mortality. A study of community health insurance coverage in West Africa confirmed that when maternal care is not covered, health outcomes do not improve.
One thing is clear: Only by emphasizing the needs and rights of women and girls can any UHC strategy be truly universal. —Project Syndicate
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Françoise Girard is president of the International Women’s Health Coalition.