Sexual and reproductive health: completing the continuum.

The addition of a new target (5.B) to have universal access to reproductive health by 2015 to Millennium Development Goal (MDG) 5 “Improve maternal health” has given renewed priority to addressing care related to the health outcomes of MDGs 4 and 5, and to redressing the large disparities in coverage of health services between and within countries. The analyses and country profi les of the Countdown to 2015 papers in today’s Lancet properly address the full range of necessary interventions from before pregnancy to the start of the third year of life. The original neglect of reproductive health and family planning in MDGs contributed to decreased atten tion, reduced funding, and increased risks for women and children. The data presented in the Countdown to 2015 paper show the eff ect of this lost focus. Poor sexual and reproductive health contributes to poor survival of mothers and children and to ill health among survivors, and impedes gender equality and poverty reduction. The new target is grounded in the concept of sexual and reproductive health defi ned at the International Conference on Population and Development (ICPD) held in Cairo in 1994: “Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infi rmity, in all matters relating to the reproductive system and to its functions and processes”. The ICPD defi nition of reproductive health includes sexual health as a core constituent. This defi nition refl ects that of health in the 1948 charter of WHO. The defi nition of reproductive health brings back the fundamental notions of informed and voluntary choice: access to safe and eff ective contraception (including emergency contraception) and other means to manage one’s own fertility as recognised in national laws. Access to sexual and reproductive health information and services enables women to go voluntarily and safely through pregnancy and childbirth, and provides the best chance of having a healthy, wanted baby. Maternal mortality could be reduced by a third through eff ective family planning to prevent unintended pregnancies. Preventing and managing the consequences of unsafe abortion, providing safe abortion when it is not against the law, and ensuring improved access to safe and emergency delivery services would help reduce maternal mortality to international target levels. The Countdown to 2015 report and national profi les clearly show that sexual and reproductive health services are essential for progress on MDGs 4 and 5. Such recognition has also been ratifi ed by the Ministers of Health and Heads of State of the African Union in their adoption of the Maputo plan of action for the operationalisation of the continental framework for sexual and reproductive health and rights. The indicators selected to monitor global progress on the new target include the contraceptive prevalence rate, unmet need for family planning, adolescent birth rate, and coverage of antenatal care. Additional indicators have been developed through other processes. The Countdown to 2015 reports show recognition that respect for human rights is essential for sexual and reproductive health by presenting both prevalence of contraceptive use and the unmet need for family planning. Taken together, these indicators refl ect the extent to which those who wish to limit or space their births are able to exercise their right to do so. The data on unmet need for family planning are stark and clear. Poor countries and poor members of society are least able to fulfi l their family size and spacing aspirations: they have the lowest proportion of total demand for contraceptive services satisfi ed. The most recently available data for the 68 priority countries selected for inclusion in the Countdown to 2015 report suggest that, at the national level, unmet need for family planning exceeds contraceptive use in at least 30 countries. Coverage of