The end of the semester and calendar lend themselves to reflections on the progress and challenges of the past year, and global health is no exception. In fact, last year we highlighted some of the year’s ups and downs in reproductive health. Both myself and Konyin Adewumi, DGHI MSc ’17, concluded that despite some setbacks, 2018 left us optimistic about progress toward reproductive and sexual health, reflected in a global call toward cervical cancer elimination, a historic decision on abortion rights in Ireland and a record number of women seeking (and achieving) government office in the United States and around the world. This year, the 25th anniversary of the International Conference on Population and Development (ICPD) facilitates reflections on not just the past year, but the past 25 years of achievements in global reproductive health.

The momentous discussion at the ICPD in Cairo, Egypt and the resultant 20-year Programme of Action were pivotal in shaping the agenda in women’s health around the world, moving away from population control and maternal-child health, toward a focus on gender equity and empowerment that placed individual rights and sexual and reproductive health outcomes at the center of sustainable development. One hundred and seventy-nine countries signed onto the ambitious Programme of Action, which sought to achieve gender equality and universal access to sexual and reproductive health care in order to improve key reproductive health outcomes.

In mid-November of this year, the United Nations Population Fund (UNFPA) and Denmark sponsored ICPD25, held in Nairobi, Kenya.  The three-day summit hosted almost 10,000 participants from around the world to reflect on the successes in global reproductive health in the wake of the Cairo meeting, identify areas in need of increased attention and develop strategies to achieve their targets in reproductive and sexual health by 2030. In the Conference Statement 55 countries re-committed to twelve of the specific targets identified in the ICPD Programme of Action, delineating the resources, policies and actions necessary to accomplish these, with a focus on inclusion of full sexual and reproductive health services in University Health Coverage. The summit resulted in 1,200 concrete commitments, including $1 billion in support from donor countries and $8 billion from private sector organizations.

ICPD25 was an energizing, action-oriented meeting that left attendees with a sense of optimism about commitments to achieve these goals. The UNFPA and organizers countered some of this with reminders of current, profound struggles in reproductive health and rights. The UNFPA report on the state of the population in 2019 focuses on pervasive unequal gender norms, inaccessible services and conflict and disaster as drivers of the remaining health disparities. Added to this is the increase in right-wing parties in government around the world, resulting in policies that threaten twenty-five years of progress in access to family planning, safe abortion and universal health care.

Working to achieve the stated commitments and address the remaining challenges are at the heart of the Center’s Mission and can play a key role in galvanizing action across the University and our partner sites. We continue to work toward the goals of cervical cancer elimination in our East Africa Sites, through innovative service delivery, partnership development and advocacy. Center members continue to work on improving and evaluating quality in reproductive health care and maternity services. We have a team looking at the impact of the Global Gag Rule on reproductive health outcomes, and the Bass Connections continues to look at ways in which big data can impact access to family planning.  Interest and action across the university seems to be increasing, with more student interest groups, advocacy and research projects. The ICPD Programme, as well as the updated commitment, provide a timely and important roadmap for current global priorities in reproductive health, and we are excited to see the passion and talent at Duke taking on the challenges for the next 25 years.

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