Recap: Let's Talk About Sex(ual and Reproductive Health and Rights)
On both Health Day and Gender Day at COP28, Sexual and Reproductive Health and Rights (SRHR) became a frequently discussed topic. The intersectionality of health and gender, particularly for women and girls in the Global South, and how climate change impacts them cannot be denied. And yet, particularly in the case of SRHR, the funding is never provided specifically to alleviate the harms that are caused. There is a stigma associated with SRHR, both at the political level and in casual conversations. While people are eager to discuss gender inequalities and inequities, the subject of SRHR is often ignored as the elephant in the room. Whether it is about menstruation, contraceptives or perinatal care, people tend to shy away from discussing SRHR. Side events over the COP thematic days for Health and Gender took the opportunity to address this neglected issue.
The panel hosted by UNFPA and WHO on the very first Health Day at COP discussed the importance of SRHR and the implementation of nationally determined contributions (NDCs) into action. Climate-related emergencies have many negative impacts on the quality of sexual reproductive health services and women and girls often lose the ability to manage their reproductive health. Lack of menstrual products and clean water may prevent them from menstruating with dignity.
A girl out of school is at risk of being married off to a much older man, her education and aspirations ended, leaving her vulnerable to intimate partner violence and HIV due to an imbalance of power. Women and girls often lose control of their right to family planning and the ability to manage their reproductive health. National health plans must include strategies for adapting and building resilience, but frequently, countries have developed plans that are just sitting on shelves, waiting for funding and implementation.
The climate crisis also has a wide range of impacts that harm maternal health, either by aggravating existing factors or hindering access to lifesaving services. One story told about indirect consequences of climate change was from Bangladesh, where they have serious impacts of climate change, one of which is rising sea levels. High sea levels cause salination in the rivers and communities along those rivers ingest that water. Among other things, the increased salinity has a deep impact on skin, causing skin blotching and irritation. These particular communities in Bangladesh have higher incidents of child marriage because families want to ensure that their children are married before girls develop skin blotches, making them undesirable. Climate adaptation measures need to include strengthening health services, especially sexual and reproductive health.
In the panel on climate justice and gender equality, we learned more about why SRHR have often been overlooked. Our bodies are as local as it gets. SRHR are consistently contested, under threat, and are some of the most intersectional political and stigmatized issues in human society. There is growing evidence on the impact of climate change on perinatal health, and many of these impacts are facilitated by environmental racism; people of African descent are hit harder because of environmental exposure and less privilege. Women are not feeling safe enough to have children, and the ability to make vulnerable decisions to feel safe in our bodies is attacked.
While there is enough to take action, evidence is not as readily available about the relationship between climate change and SRHR because these are issues that are stigmatized and ignored. Adaptation and Loss and Damage have to have a specific mention of SRHR because simply calling them gender issues is not enough; these issues are specific and the funding must be specific as well.
Society has a patriarchal mindset that is connected to gender identities, which becomes extremely complex to the most marginalized and intersectional groups. Returning to the example of high sea levels, increase in salination in drinking water due to climate change can cause uterine collapse. For pregnant women and the fetus, salinated water can also lead to problems with liver function, lower platelet levels, slow fetal growth, and premature delivery. Discussions on health are incomplete without including SRHR.
A panel discussion on investing in family planning to empower women and girls urged everyone to make sure that all girls and all women have access to care, particulary when there are climate-related disruptions. This entire discussion revolved around choice; a woman or a girl's ability to exercise the choice of when and with whom to have children is a basic right. Every woman and girl must have the opportunity to think about and plan for their futures and to take care of themselves and their families, which includes knowing what providers are available. Care must be available from a family planning perspective, so women and girls can be provided with what they need. Whether they want an implant or an injectable contraceptive, they should have access to the complete range of contraceptive methods available. Irrespective of their choice, women and girls should be immediately offered care in line with quality standards. Feminist financing is what is needed.
