The 1994 Cairo International Conference on Population and Development helped governments, the organs and agencies of the United Nations system, and nongovernmental organizations move beyond the confines of traditional family planning approaches. This watershed event fostered and defined subsequent international and national reproductive and sexual health policies and programs as well as global efforts to realize reproductive and sexual rights. However, moving beyond history, or the “archeology of Cairo” (as a participant at a meeting I recently attended called it), are we now simply using the language of the Cairo conference with little attention to the conceptual and operational implications of its words? Has the politically charged notion of rights with its attendant government responsibility and accountability succumbed to the less controversial notion of health?
As the public health community recognized even before the Cairo consensus, barriers to reproductive and sexual health operate on a number of levels—including legal, social, cultural, political, financial, attitudinal, and practical—and interact in complex ways. What rights add to this mix is a framework for programming and for action and a legal rationale for government responsibility—not only to provide relevant services but also to alter the conditions that create, exacerbate, and perpetuate poverty, deprivation, marginalization, and discrimination as these affect reproductive and sexual health. By fixing attention on the responsibility and accountability of governments to translate their international-level commitments into national and subnational laws, policies, programs, and practices that promote and do not hinder reproductive and sexual health, the actions of governments are open to scrutiny to determine their influences—both positive and negative—on reproductive and sexual health, including barriers that affect the availability, accessibility, acceptability, and quality of reproductive and sexual health services, structures, and goods.
Despite the framework that the Cairo conference helped put into place, work falling under the rubric of reproductive and sexual rights now includes everything from the provision of abortion services to the reduction of maternal mortality—as though simply working on these issues is equal to working on rights. Consequently, one has to ask this: Are reproductive, and even sexual, rights becoming synonymous with reproductive, and sexual, health? Those who understand their work to be in the area of reproductive and sexual rights sorely need to discuss whether their efforts are aligned with the politics that underlie the words of the Cairo conference or whether, bluntly speaking, the politics are a historical artifact and it is simply time to move on.
Bringing the political back into reproductive and sexual rights would require going beyond the technical dimensions of addressing reproductive and sexual health issues to the application of the norms and standards that are engaged by a human rights discourse. This includes attention to the basics of reproductive and sexual rights: the efforts that exist to ensure the sustained participation of affected communities; how discrimination that affects both vulnerability to ill health and access and use of services is being tackled; the extent to which any legal, political, and financial constraints are being addressed; how rights considerations are brought into policy and program design, implementation, and evaluation; and the existence of mechanisms that require government as well as intergovernmental and nongovernmental institution accountability. And so yes, in a word, words do matter. And they matter for the actions they inspire.