Like many tenets of public health, SRH has evolved greatly over time. As early as the medieval ages, rapid spread of syphilis and gonorrhea placed an emphasis on managing sexually transmitted infections (STIs). More recently, throughout the 20^th century, SRH was primarily understood within the frame of population control: a narrow focus that allowed for appalling infringements of bodily integrity and human dignity, such as mass forced sterilization. Key to shifting that narrative were:

• The Universal Declaration of Human Rights in 1948
• The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) in 1979
• The International Conference on Population and Development in 1994

These affirmed SRH as a universal human right, explicitly stated women’s right to reproductive choice, and promoted comprehensive family planning.

Now, sexual and reproductive health encompasses a broad spectrum of definitions. According to the World Health Organization (WHO) and the United Nations Population Fund (UNFPA), SRH includes everything from access to contraception and safe abortion care to an overall state of mental/physical wellbeing, reproductive autonomy, safe and satisfying sexual experiences, the prevention of sexual and/or gender-based violence, and the freedom to govern one’s own body. The 2030 Sustainable Development Goals, specifically Goals Three and Five, also directly link improved SRH with gender equality, universal health care, and reduced maternal mortality.

Despite this progress, major gaps in SRH service provision and research persist. Certain groups remain excluded, in particular women, adolescents, sex workers, men who have sex with men, migrants, people with disabilities, and the LGBTQIA+ community. Their exclusion halts global progress and puts these populations at undue risk. By the numbers, that looks like 350 million people requiring treatment for a curable STI, 200 million women desiring pregnancy prevention but lacking modern contraception, 5.6 million adolescents receiving abortions annually, over 1/3 of women worldwide experiencing violence,and 1.7 million people newly infected with HIV.

And all of these issues are preventable.

So, what is impeding progress? The Guttmacher Institute cites factors such as weak political commitment, systemic poverty, gender-based discrimination, barriers to care, and silence surrounding SRH.

The case of modern contraception illustrates the varied progress of SRH. Since the 1970s, there has been a sharp increase in the availability and use of contemporary contraceptive methods. In 2019, the proportion of women 15 to 49 years whose contraceptive needs for family planning were met was 76 percent globally: nearly double the proportion from 50 years ago.

Despite the provision of contraception rising overall, this provision is geographically unequal. In Sub-Saharan Africa and Western Asia, for example, the same figure was just 55 percent, with some countries within the regions falling well below even that. This need is shown to amplify among young women; there are an estimated 10 million unintended pregnancies among adolescent girls ages 15 to 19 in developing countries annually. The disparities in unmet needs for safe and affordable contraception are clear.

What often goes unsaid, however, are the newborn and maternal deaths that could be avoided: estimated as an 80% and 73% decline in mortality, respectively.

At the London School of Hygiene and Tropical Medicine (LSHTM), researchers such as Cicely Marston, Nambusi Kyegombe, and Rebecca French aim to reach marginalized and excluded populations and geographies in innovative ways. This includes the use of mobile health and online platforms, which have revolutionized youth engagement and make data collection in remote areas more efficient.

• The ACESS project strives to provide a continuum in SRH care for ‘people on the move,’ people with disabilities, and young people in complex environments across four countries.
   
• The STRIVE research consortium, led out of LSHTM, seeks to understand the structural determinants of HIV in India, South Africa, and Tanzania.
   
• The DREAMS impact evaluation, a PEPFAR partnership, explores the disproportionately high risk of HIV for young girls in South Africa, Kenya, and Zimbabwe.
   
• Safetxt, a randomized control trial (RCT) of over 6,000 participants, is spearheaded in tandem by the National Health Service (NHS) and the University of London and explores the power of text messages to increase safer sexual precaution behaviors among young people in the UK.
   
• The LINEA Project, operated out of LSTHM’s Gender Violence and Health Centre, focuses on understanding the drivers of child sexual exploitation.
   
• Representing a growing need for non-hormonal contraceptive methods and fertility awareness, the Freyja Study collects ethnographic information on user experiences with the Natural Cycles app: the only mobile fertility-tracker certified and FDA-approved as a birth control method.

Together, these projects reflect the diverse needs and components of SRHR, as well as the complex responses required to address them.

Sexual and reproductive health is tied to universal human rights and is a pillar of universal health care. It is essential to national economic development and individual wellbeing, yet far too many people and populations lack available, accessible, acceptable, and quality SRH services. In the face of these ongoing disparities, it is therefore a global duty to pursue the betterment of SRH worldwide.

References

History of sexually transmitted infections (STI). - Abstract - Europe PMC [Internet]. [cited 2020 Feb 10]. Available from: https://europepmc.org/article/med/23007208

UNFPA. Sexual & reproductive health [Internet]. [cited 2020 Feb 6]. Available from: https://www.unfpa.org/sexual-reproductive-health

United Nations. SDGs: Sustainable Development Knowledge Platform [Internet]. [cited 2020 Feb 10]. Available from: https://sustainabledevelopment.un.org/sdgs

WHO. WHO | Four curable sexually transmitted infections still affect millions worldwide [Internet]. [cited 2020 Feb 10]. Available from: http://www.who.int/reproductivehealth/curable-stis/en/

Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, et al. Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission. The Lancet [Internet]. 2018 Jun 30 [cited 2020 Feb 1];391(10140):2642–92. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30293-9/abstract

WHO. Adolescent pregnancy [Internet]. [cited 2020 Feb 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy

UNAIDS. Global HIV & AIDS statistics — 2019 fact sheet [Internet]. [cited 2020 Feb 10]. Available from: https://www.unaids.org/en/resources/fact-sheet

United Nations, Department of Economic and Social Affairs, Population Division. Trends in contraceptive use worldwide, 2015. 2015.

Accelerate Progress: Sexual and Reproductive Health and Rights for All — Executive Summary [Internet]. Guttmacher Institute. 2018 [cited 2020 Feb 10]. Available from: https://www.guttmacher.org/guttmacher-lancet-commission/accelerate-progress-executive-summary