Bundling forces: planetary, sexual and reproductive justice for equitable health for all

The planetary health or climate justice movement shows similarities with the activist movement that for decades has strived to improve sexual and reproductive health and rights (SRHR – see text-box). However, where planetary health is currently ‘hot’ and has a label of urgency, SRHR remains neglected and is even regressing globally. This is evident through a decrease in funding for SRHR programmes and through poor SRHR outcomes, especially among the most marginalised. The most recent United Nations figures show a stagnating global maternal mortality ratio, with maternal deaths even increasing in 17 countries. [1] In many societies, there is reduced space for sensitive SRHR issues such as abortion, comprehensive sexuality education, and services for LGBTQI+. How can we reverse these trends? There might be an opportunity in bundling forces.

The SRHR and planetary health movements show similarities in their discourse grounded in equity and justice, with a focus on human rights, public health, and the intersection with behavioural and social sciences. Both movements address the power imbalances that put the most vulnerable in a position of being threatened by economic, cultural or political dominance of others.

‘Climate Change has a negative impact on almost all SRHR indicators, including maternal health, fertility, the risk of sexual and gender-based violence, as well as via the disasters that disrupt health systems and access to SRHR services,’ says Anke van der Kwaak from the KIT Royal Tropical Institute, who contributed to the Women Deliver report on the link between climate change and sexual and reproductive health and rights.[2] ‘On the other hand, there is growing evidence of how realising SRHR, including the improvement of services and systems, reducing gender inequality, and increasing girls’ and women’s resilience, can be an accelerator for climate action.’

The same intricate link between SRHR and climate change is emphasised by Dr. Ba Sidi Yaya, president of the Association of Private Health Schools of Mali. Together with public and private institutions for higher education in health, this association collaborated on the integration of adolescent and youth reproductive health issues into the basic curriculum of health technicians and senior health technicians in Mali (also known as the FORCE project[3]). ‘Climate action and SRHR are linked for the simple reason that it concerns everyone and particularly adolescents and young people. It is a guarantee of health for future parents, with healthy children.’ Mali, like other countries in the Sahel, is heavily impacted by climate change with increasing droughts, floods and crop pests, which risk further aggravating poor SRHR outcomes due to poor access to services and the undermining of women’s economic and social independence. [4]

It is clear that, if we are to tackle the urgent and linked global problems of climate change and SRHR-inequity, healthcare professionals must have appropriate knowledge and skills for both. In the biomedical ‘Western’ tradition, healthcare has long prioritised individual clinical care at the expense of equally important public health and wider health system thinking. As global health professionals we have a role to play here.

‘Health care professionals are key stakeholders in improving health and we have the opportunity and often also the power or credibility to make a difference,’ says Goknur Topcu, a young gynaecologist and president of the World Association of Trainees in Gynaecology and Obstetrics (WATOG). WATOG, together with the International Federation of Gynaecology and Obstetrics (FIGO) and the International Federation of Medical Students Associations (IFMSA), worked on an international joint statement of support and model curriculum for the inclusion of SRHR and wellbeing education into the core structures of medical curricula. [5] ‘It’s strange that, as a healthcare professional for women’s and children’s health, I only started to learn about SRHR, and now also planetary health, once I began to engage in the international field. In fact, these are the fundamentals for rights-based and holistic health in our communities.’ During the recent FIGO-conference in Paris, also attended by a large delegation of the NVTG Working Party for International Safe Motherhood and Reproductive Health, both SRHR and planetary health as well as their inclusion in medical curricula, were – although unfortunately still not centre-stage – emerging themes.

How do we ensure that current and future generations of healthcare professionals commit to improving both SRHR and planetary health? The planetary health movement can build on what the SRHR movement has been advocating, and their intersection offers a crucial opportunity for the medical community to tackle both. Therefore, skills and knowledge should be integrated in the curricula of medical students and early career professionals. ‘We need to understand the determinants and different complex factors that impact our public, sexual and reproductive health and rights at the global, regional and national level,’ says Goknur, representing a voice of new healthcare professionals. This even requires broader integration, beyond planetary health and SRHR in a narrow sense. On the agenda should be planetary health, social sciences, determinants of health, human rights, medical ethics, sexual rights, reproductive freedom and gender equity.

It might be a lot to tackle all at once. But, if we truly are to understand this intersection and, moreover, if we as healthcare professionals commit ourselves to social justice and equitable health for all human beings and the planet, we do have a chance for a (better) future.

This article is a reproduction of the article “Why Sexual and Reproductive Health and Rights and planetary health are inextricably linked and why health care professionals should care” by Irene de Vries, published in Vice Versa special edition on Planetary Health, 2023: https://viceversaonline.nl/magazine/.

References

1. WHO (2023). Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO. Available via: https://iris.who.int/bitstream/handle/10665/366225/9789240068759-eng.pdf?sequence=1
2. Women Deliver (2021). The link between climate change and sexual and reproductive health and rights: an evidence review. Available via https://womendeliver.org/wp-content/uploads/2021/02/Climate-Change-Report.pdf.
3. FORCE (Education on Sexual and Reproductive Health and Rights) – Mali. https://www.kit.nl/project/force-mali-english/
4. OHCHR (2021). Human Rights Climate Change and Migration in the Sahel. Available via https://www.ohchr.org/sites/default/files/2021-11/HR-climate-change-migration-Sahel.pdf
5. FIGO, IFMSA, WATOG (2021). Joint statement of support for the inclusion of contraception and abortion in sexual and reproductive health and wellbeing education for all medical students. Available via: https://www.figo.org/resources/figo-statements/joint-statement-support-inclusion-contraception-abortion-srhr-education