摘要：Sexual and reproductive health remains the contentious concept it was at the 1994 United Nations International Conference on Population and Development (ICPD), held in Cairo, Egypt. In light of the recent 15-year review of ICPD, we suggest several areas where advocates, practitioners, and researchers can inform future progress for sexual and reproductive health. These include the following: improving measurement and accountability related to the evidence base for sexual and reproductive health, indicators of program success, and the tracking of resource flows; creating and renewing alliances to strengthen advocacy; and employing new resource mobilization strategies. Given the 20-year goals established at ICPD, now is the time to move toward finally achieving the sexual and reproductive health and rights agenda. The year 2009 marked the 15th anniversary of the United Nations International Conference on Population and Development (ICPD), held in Cairo, Egypt. There is general consensus that ICPD and its Program of Action 1 created a tangible shift from a narrow focus on population and fertility reduction to a broadened agenda that addresses the range of sexual and reproductive health issues that constitute the individual lives of men and women. Sexual and reproductive health and rights were defined to include services and information relating to, for example, family planning, prevention and treatment of HIV and other sexually transmitted diseases, safe abortion, and safe pregnancy—all to be provided in a rights-based approach without coercion, discrimination, or violence. 2 , 3 A goal of universal access to reproductive health for all by 2015 was established, and the progress that governments had made on achieving this and related goals was reviewed by the UN General Assembly in October 2009. Although the earlier 5- and 10-year reviews led to revised actions to strengthen implementation, 4 preparations for the most recent review were relatively quiet. 5 There was no new political outcome document outlining revised actions for implementation, regional meetings were unremarkable, and the political rhetoric that had mobilized civil society in the past was muted. This in part reflected a deliberate decision by the United Nations Population Fund (UNFPA), governments, and civil society supporters of the Program of Action to avoid enflaming any opposition. Indeed, the years since ICPD have not been without their challenges for sexual and reproductive health and rights; in fact, sexual and reproductive health has remained a subject of political, social, and policy debate. 6 , 7 The US government had been a major promoter of the Program of Action in 1994 and was its major detractor in 2004. The beginning of the new millennium witnessed a rise in political conservatism, religious fundamentalism, and attention to other global health concerns that have, in some cases, pushed back the ICPD agenda and stalled its progress. However, the recent political change in the United States with the election of President Barack Obama and the statements from Secretary of State Hilary Clinton 8 have fueled optimism that sexual and reproductive health and rights issues will be restored to their priority status in US foreign assistance. 9 , 10 President Obama's repeal of the Mexico City Policy (also known as the Global Gag Rule), which prevented international organizations from receiving any US government funding to address abortion as part of any of their activities, and the reinstatement of US funding for UNFPA are tangible and encouraging symbols of such change. The future landscape for sexual and reproductive health and rights may be far from certain. Concern about the impact of the current global economic crisis on health spending 11 compounds the already competitive environment for health resources. 12 Nonetheless, we believe the recent 15-year anniversary of ICPD presented an opportunity to be bold and to refocus attention and resources on sexual and reproductive health and rights. Between 2005 and 2007, a group of scholars associated with the Group on Reproductive Health and Rights at the Harvard Center for Population and Development Studies examined different arguments (e.g., economic, demographic, programmatic, human rights–based) for and against the Program of Action. Taken as a whole, their conclusions demonstrate that the Program of Action speaks directly to the challenges facing global health today: neglect of health systems, increase of poverty and inequity, persistence of gender inequality, and stagnation of health indicators across the board. The results of their work were published in 2009; we offer the following observations based on their findings. 13
