The memorable day was 13 September 1994, in Cairo, Egypt. Representatives from 180 nations, among them thousands of women of every race and creed, jubilant for having won more than they had dared hope for. The world had publicly acknowledged that health and well-being, and equity and equality, for women are important ends in themselves. They had agreed that finding the balance between resources and population, development and sustainability, concerns people, not numbers. This is the Cairo Programme of Action, which has set the course for the next twenty years following the declaration focusing on people and their needs.
This was the beginning of the paradigm shift--from maternal and child health to reproductive health. Many issues can be encompassed within reproductive health concerns. Yet, the diversity and breadth of issues mean that even if a single, universally applicable, all-encompassing definition of reproductive health is ever agreed, it will be almost impossible to operationalize.
I have defined reproductive health as a marriage between social sciences and medical sciences, because it affects everybody. It reflects health in childhood and sets the stage for health even beyond the reproductive years for both women and men. It affects and is affected by the broader context of peoples' lives, their economic circumstances, education, employment, living conditions, family environment, social and gender relationships, and traditional and legal structures within which they live. For example, gender discrimination in intra-household allocation of food may lead to stunted growth and anaemia in girls by the time they reach adolescence. In later life, they may experience obstructed labour due to contracted pelvises, or increased infections or contraceptive contra-indications from anaemia. Reproductive health also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counselling and care related to reproduction and sexually transmitted disea ses (STDs).
The five core areas of reproductive health are healthy childbearing, fertility regulation, maintenance of a healthy reproductive system, sexuality and sexual behaviour, and the social-cultural context within which reproductive behaviour and ill-health takes place. Cost-effective, service-based strategies for preventing or treating reproductive health problems exist for many of the leading issues in this field. Preventive approaches, in the form of family planning, safer sex, immunizations and breast-feeding promotion programmes, are at the heart of efforts to combat unwanted and unplanned pregnancy, STDs, HIV/AIDS, induced abortion, maternal morbidity and mortality, and general ill-health.
All nations accepted that the aims of the International Conference on Population and Development (ICPD) Programme of Action were realistic and achievable because it responds to people's needs, involves the participation of communities, has the greatest impact for most of the people, and is affordable and sustainable, based on existing infrastructures, with revitalization, reorganization and integration, and it implies real location of resources. …