UHC Declaration: Countries Object Over Sexual & Reproductive Health, Migrants & Refugees

NEW YORK – Negotiations over a planned United Nations political declaration on universal health coverage (UHC) reopened last week after about a dozen countries reportedly objected to language in the final draft covering two sensitive issues – sexual and reproductive health and rights (SRHR) and the health needs of migrants, refugees, internally displaced persons and indigenous peoples.

The United States was one of the 10-14 countries posing objections, sources told Health Policy Watch, after negotiations over the draft were closed on 24 July. The draft was then put under a “silence procedure” for five days, a period in which countries may file objections to effectively reopen debate.

“We regret to inform you that the silence procedure has been broken by several delegations on paragraphs 29, 68, 69, 70 and 71,” the Ambassadors of Georgia and Thailand, co-facilitators of the UN High-Level Meeting on Universal Health Coverage, wrote in a 29 July letter to the president of the UN General Assembly, María Fernanda Espinosa Garcés.

As of Monday, 5 August, it remained unclear which other countries besides the US had broken the silence procedure, and over which paragraphs. But time is now running out for negotiators to reach agreement on the declaration, which will be the focal point of the 23 September UN High-Level Meeting on Universal Health Coverage, bringing heads of state and other political and health leaders to the UN in New York.

After the silence was broken, the negotiations were elevated from the level of expert to the level of ambassador, in order to ensure that national representatives with the highest possible level of authority would be engaged to finalise the declaration as soon as possible, sources said.

The emerging dispute over language on SRHR and migrants represented a shift in focus of the debate over the painstakingly negotiated declaration text. Earlier debates had centred around language calling for greater public disclosure of prices of health products, more transparency for related research and development (R&D), and alternative incentives for R&D beyond conventional patent monopolies.  However, member states have now reached consensus on those issues, according to civil society observers.

The sections of text that are now under debate (noted below) include final draft paragraphs 29, 68 and 69 on women’s and girls’ rights to “sexual and reproductive health, free of coercion, discrimination and violence;” as well as paragraphs 70 and 71 on addressing “the particular needs and vulnerabilities of migrants, refugees, internally displaced persons and indigenous peoples.”

According to sources, the US objected to the language on SRHR in the declaration because it can be interpreted to include abortion, which is inconsistent with the US rule under the “Protecting Life in Global Health Assistance” policy to not commit funds to international health activities that are in any way related to abortion.

The recent US pick for the Ambassador to the UN in Geneva, Andrew Bremberg, has also vowed to oppose any UN resolutions that allow for abortion, even in the case of sexual violence and conflict.

Health Policy Watch previously reported that the silence procedure was likely to be broken according to sources close to the negotiations, and due to the fact that the paragraphs on SRHR had remained unchanged since the initial draft of the declaration, despite the controversy in previous UN fora that SRHR can be interpreted to include abortion.

Sources said that the United States ultimately hopes to reach consensus on the declaration before the 23 September high-level meeting.

More information on universal health coverage and the UN High-Level Meeting on UHC is available here.

Medicus Mundi International, an international network of health NGOs, published a comparison of the revisions of each of the drafts of the UHC declaration, since the initial “zero draft” was released on 17 May.

Final Draft Paragraphs 29, 68 and 69 on Sexual and Reproductive Health and Rights

  1. “Take measures to reduce maternal, neonatal, infant and child mortality and morbidity and increase access to quality health-care services for newborns, infants, children as well as all women before, during and after pregnancy and childbirth, including in the area of sexual and reproductive health;”
  1. “Ensure, by 2030, universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes, which is fundamental to the achievement of universal health coverage, while reaffirming the commitments to ensure universal access to sexual and reproductive health and reproductive rights in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences;
  2. Mainstream a gender perspective on a systems-wide basis when designing, implementing and monitoring health policies, taking into account the specific needs of all women and girls, with a view to achieving gender equality and the empowerment of women in health policies and health systems delivery and the realization of their human rights, consistent with national legislations and in conformity with universally recognized international human rights, acknowledging that the human rights of women include their right to have control over and decide freely and responsibly on all matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence;”

Final Draft Paragraphs 70 and 71 on the Health of Migrants, Refugees, Internally Displaced Persons and Indigenous Peoples

  1. “Ensure that no one is left behind, with an endeavour to reach the furthest behind first, founded on the dignity of the human person and reflecting the principles of equality and non discrimination, as well as to empower those who are vulnerable or in vulnerable situations and address their physical and mental health needs which are reflected in the 2030 Agenda for Sustainable Development, including all children, youth, persons with disabilities, people living with HIV/AIDS, older persons, indigenous peoples, refugees and internally displaced persons and migrants;
  2. Address the particular needs and vulnerabilities of migrants, refugees, internally displaced persons and indigenous peoples which may include assistance, health care, psychological and other counselling services, in accordance with relevant international commitments, and in line with national contexts and priorities;”

Image Credits: Wikimedia Commons.

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