Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission

Elsevier, The Lancet, Volume 391, Issue 10140, 9 May 2018, Pages 2642-2692
Ann M Starrs, Alex C Ezeh, Gary Barker, Alaka Basu, Jane T Bertrand, Robert Blum, Awa M Coll-Seck, Anand Grover, Laura Laski, Monica Roa, Zeba A Sathar, Lale Say, Gamal I Serour, Susheela Singh, Karin Stenberg, Marleen Temmerman, Ann Biddlecom, Anna Popinchalk, Cynthia Summers, Lori S Ashford

Sexual and reproductive health and rights (SRHR) are fundamental to people's health and survival, to economic development, and to the wellbeing of humanity. Several decades of research have shown—and continue to show—the profound and measurable benefits of investment in sexual and reproductive health. Through international agreements, governments have committed to such investment. Yet progress has been stymied because of weak political commitment, inadequate resources, persistent discrimination against women and girls, and an unwillingness to address issues related to sexuality openly and comprehensively.

Health and development initiatives, including the 2030 Agenda for Sustainable Development and the movement toward universal health coverage, typically focus on particular components of SRHR: contraception, maternal and newborn health, and HIV/AIDS. Countries around the world have made remarkable gains in these areas over the past few decades, but the gains have been inequitable among and within countries, and services have often fallen short in coverage and quality. Moreover, in much of the world, people have insufficient access to a full set of sexual and reproductive health services, and their sexual and reproductive rights are not respected or protected. Acceleration of progress therefore requires adoption of a more holistic view of SRHR and tackling of neglected issues, such as adolescent sexuality, gender-based violence, abortion, and diversity in sexual orientations and gender identities.

Progress in SRHR requires confrontation of the barriers embedded in laws, policies, the economy, and in social norms and values—especially gender inequality—that prevent people from achieving sexual and reproductive health. Improvement of people's wellbeing depends on individuals' being able to make decisions about their own sexual and reproductive lives and respecting the decisions of others. In other words, achieving sexual and reproductive health rests on realising sexual and reproductive rights, many of which are often overlooked—eg, the right to control one's own body, define one's sexuality, choose one's partner, and receive confidential, respectful, and high-quality services.

The evidence presented in this report reveals the scope of the unfinished SRHR agenda. Each year in developing regions, more than 30 million women do not give birth in a health facility, more than 45 million have inadequate or no antenatal care, and more than 200 million women want to avoid pregnancy but are not using modern contraception. Each year worldwide, 25 million unsafe abortions take place, more than 350 million men and women need treatment for one of the four curable sexually transmitted infections (STIs), and nearly 2 million people become newly infected with HIV. Additionally, at some point in their lives nearly one in three women experience intimate partner violence or non-partner sexual violence. Ultimately, almost all 4·3 billion people of reproductive age worldwide will have inadequate sexual and reproductive health services over the course of their lives.

Other sexual and reproductive health conditions remain less well known but are also potentially devastating for individuals and families. Between 49 million and 180 million couples worldwide might be affected by infertility, for which services are mainly available only to the wealthy. An estimated 266 000 women die annually from cervical cancer even though it is almost entirely preventable. Men also suffer from conditions, such as STIs and prostate cancer, that go undetected and untreated because of social stigma and norms about masculinity that discourage them from seeking health care.