Prioritizing Gender in Universal Health Coverage

After months of negotiations, on September 23, UN Member States finally reached agreement on a political declaration to deliver universal health coverage (UHC) by 2030. Though negotiations were repeatedly threatened by attacks against sexual and reproductive health and rights (SRHR), women’s rights organizations and progressive countries succeeded in securing strong commitments to gender equality in the declaration.

Universal health coverage guarantees universal access to quality health services, essential medicines, and vaccines, and provides protection from catastrophic and routine health costs. It has transformative potential, but if it’s not inclusive of sexual and reproductive health and rights, it will fail to live up to its promise.

Allying to Protect Sexual and Reproductive Health and Rights

Civil society played a pivotal role in achieving the political declaration, even when staunch opposition to incorporating sexual and reproductive health and rights held up negotiations. Initially, even some civil society organizations were reluctant to include SRHR in shared priorities, viewing the topic as “too political.” As a result, the International Women’s Health Coalition (IWHC), Women Deliver, and Women in Global Health co-convened the Alliance for Gender Equality and UHC, a coalition of more than 100 organizations from more than 45 countries.

Throughout the negotiations, the Alliance lobbied Member States and spread awareness that if UHC is to be truly universal and leave no one behind it must be gender-responsive and include sexual and reproductive health and rights. The Alliance held a lobby week in June to meet with governments as a united, critical mass of concerned women’s rights organizations, and issued strong statements to preserve and protect language on SRHR at every opportunity.

Increasing Opposition at the UN

Unfortunately, the attempts to undermine the declaration were not surprising. Though the right to sexual and reproductive health care services has been formally established in international policy since 1994, it has become a sticking point in UN negotiations as powerful nations like the United States and Russia attempt to erode human rights and weaken global commitments.

The increase of hyper-conservative leaders worldwide—in the United States as well as traditionally moderate countries like Brazil and India—has steered the world away from multilateralism and toward isolationism, nationalism, and extremism. These governments often paint basic human rights, such as sexual and reproductive rights, LGBTQI rights, and others, as threats to their culture, tradition, and religion, while in reality they seek to restrict women’s rights and bodily autonomy. They conflate sexual and reproductive health care with only abortion services, and use this baseless claim to stoke fear among conservative stakeholders. These ideologically driven attacks have amplified what were once fringe views and led other countries with a history of conservatism and religious fundamentalism to strengthen their regressive positions. As a result, the bloc of nations opposed to SRHR, and women’s rights more broadly, continues to expand.

In negotiations on the political declaration, these governments at first sought to exclude SRHR as too “polarizing” and “political.” When this failed, they sought to caveat or weaken commitments, and sexual and reproductive health became an unwilling hostage in the ongoing negotiations. But, here too, their efforts failed.

Feminist Organizing Gets Results

Despite this difficult political climate, the Alliance, together with supportive delegations such as CANZ (Canada, Australia, New Zealand), the European Union, and some Latin American countries, was able to rebuff attacks and hold the line on progressive language to protect sexual and reproductive health and rights.

At the high-level meeting on September 23, Member States showed overwhelming support for the importance of integrating SRHR in universal health coverage in their oral statements. It was clear that regressive positions were in the minority, as the Netherlands delivered a powerful and passionate statement on behalf of 58 countries, many of which were from the Global South, refuting the narrative that SRHR is a “Western import.” The United States’ anti-SRHR statement, in comparison, received only 18 other supporters, and their views were rightfully left to the fringes of the conversation that day.

Thanks to the power of women’s rights organizations coming together, the Alliance was able to respond effectively when negotiations were particularly tense. It was successful in compelling Member States and previously hesitant civil society coalitions to recognize not only that gender inequality and inequity is a major barrier, but also that sexual and reproductive health services are crucial to achieving UHC.

Though negotiations were difficult and, at many times, the outcome uncertain, the final declaration is a clear win for women’s rights. Nevertheless, the fight to ensure SRHR remains central to UHC is far from over. As governments move to implement the declaration, feminist groups will be there to hold them to accountable.

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