If universal health coverage (UHC) cannot be achieved without the sexual and reproductive health (SRH) needs of the population being met, what then is the current situation vis-à-vis universal coverage of SRH services, and the extent to which SRH services have been prioritised in national UHC plans and processes? This was the central question that guided this critical review of more than 200 publications between 2010 and 2019. The findings are the following. The Essential Package of Healthcare Services (EPHS) across many countries excludes several critical SRH services (e.g. safe abortion services, reproductive cancers) that are already poorly available. Inadequate international and domestic public funding of SRH services contributes to a sustained burden of out-of-pocket expenditure (OOPE) and inequities in access to SRH services. Policy and legal barriers, restrictive gender norms and gender-based inequalities challenge the delivery and access to quality SRH services. The evidence is mixed as to whether an expanded role and scope of the private sector improves availability and access to services of underserved populations. As momentum gathers towards SRH and UHC, the following actions are necessary and urgent. Advocacy for greater priority for SRH in government EPHS and health budgets aligned with SRH and UHC goals is needed. Implementation of stable and sustained financing mechanisms that would reduce the proportion of SRH-financing from OOPE is a priority. Evidence, moving from descriptive towards explanatory studies which provide insights into the "hows" and "whys" of processes and pathways are essential for guiding policy and programme actions.
The women's rights movement and the sexual and reproductive health and rights (SRHR) movement have been actively involved in ensuring that the gains (on sexual and reproductive health, reproductive rights and women's sexuality) made during the 1994 International Conference on Population and Development (ICPD) in Cairo and the 1995 fourth World Conference on Women in Beijing are maintained and captured in the new development framework. International processes, especially the United Nations Population Fund's ICPD Beyond 2014 work, have proven essential platforms for this. However, the current geopolitical scenario provides a challenging environment to ensure that the comprehensive Cairo+20 agenda is given the due attention and place it deserves and requires. This article aims to articulate the critical gaps in political discourse and commitment to the ICPD agenda from 1994 to the time of ICPD beyond 2014. Governments' potential lack of commitment to crucial issues of SRHR is also examined and discussed in the first section. In the second section, the article looks at progress and gaps regarding specific and commonly used measures of SRHR as an indicator of where discourse and commitment are required. In the third section, as a follow-up to the previous one, the article discusses the need to and the possibilities of articulating and positioning the rights discourse more clearly within the current complex global discourse as a necessary step in the movement's political discourse. In the last section, some key challenges and opportunities, as well as identified recommendations, are discussed with regard to the way ahead for the SRHR agenda in the 2014 and beyond.
Michelle Remme and colleagues argue that if costs to users are considered and their financing is right, self care interventions for sexual and reproductive health can improve equity and efficiency
Sabah, located in Southeast Asia, hosts the highest number of non-Malaysian citizens (27.7%), predominantly the Indonesian and Filipino migrants in comparison to other states in Malaysia. Sabah has inadequate data on migrants' sexual and reproductive health and rights (SRHRs). Various migrant-related policies and laws are present, but they do not offer full protection and rights to legal migrants in terms of their SRHRs. The aim of the laws and policies appears to be controlling the migrants from having any negative impact on the locals, rather than protecting migrants' health and rights. This affected their rights to marriage, having children, increase their vulnerabilities to labour trafficking and sexual abuse and access to health-care services. Female migrant workers and undocumented migrants form the most vulnerable subgroups of migrants. This narrative review highlights the status of SRHRs of migrants in Sabah and the migrant-related Malaysian laws and policies affecting their SRHRs.