Sexual and Reproductive Health within the SDC – A Comprehensive Three Level Approach

The Normative Framework

The SDC works within the global, normative framework of Health and SRHR. The basis for that is the “Right to Health”. It is defined in the Constitution of the World Health Organization (WHO) as “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” where “Health” is defined as “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The “Right to Health” is also defined in the Universal Declaration of Human Rights, where article 25 specifically addresses motherhood and childhood and links them to the need and right to special care and assistance (Art. 25 II. “Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.”).

Furthermore, the 1994 UN International Conference on Population and Development in Cairo continues to serve as a milestone in regards to the normative framework of SRHR. The action plan led to a paradigm shift away from traditional population policies with demographic goals to empowering people – particularly women – about their sexual and reproductive health. It covers a variety of areas ranging from gender equality to education and health and underlines the importance of addressing sexual and reproductive health comprehensively. The action plan was also a key element in the definition of the 2030 Agenda for Sustainable Development (SDGs) where goals N° 3 and N°5 specifically address SRHR.

The action plan led to a paradigm shift away from traditional population policies with demographic goals to empowering people – particularly women – about their sexual and reproductive health.

The SDC recognizes SRHR as a key factor for a person's social, economic and health-related development and the countries commitment to health is aligned with the Constitution of the WHO (as mentioned before). This is also reflected in the strategic frameworks and guidance that encompass the work of SDC. Overarching we have the Swiss Health Foreign Policy (2019-2024) which has SRHR included in its diverse set of priorities (like Health security and humanitarian crisis, Sustainable healthcare and digitalization as well as determinants of health). Taking it one step down, we have the International Cooperation Strategy of the SDC which is focused on poverty reduction and sustainable development whilst mainstreaming a gender and a “leave-no-one-behind-approach”. The operationalization of health in the international cooperation context is the Global Programme Health Framework (currently from 2021-2024).

The overall goal (to contribute to the health and wellbeing of people in low and middle income countries by addressing global development challenges through cross border action, policy shaping and strategic partnerships) is based on four pillars:

1. Fostering quality health systems
2. Promoting gender equality and human rights for health
3. Advancing inclusive, efficient and effective global health governance.

These four pillars are interlinked through sub-priorities like SRHR or health literacy. Policy work, strategic partnerships and equitable access to innovative common goods for health interconnect those four pillars which are the basis of SDCs work in health.

SDC partnerships working in SRHR

To achieve that, SDC is working together with its partners. To foster a close intersectoral cooperation partnerships with international organisations, the academia, public-private partnerships as well as NGO’s are essential. Examples of such partnerships are: UNFPA, UNAIDS, UNDP, IPPF, WHO, Terre des Hommes Suisse, SolidarMed or Enfants du Monde. This is by no means a comprehensive list, just a few examples which reflect the diversity of our partners as well as the complementary of the mandate of SDC within SRHR.

The Safeguard Young People Project (SYP)

Changing perspectives from a global to a regional level we are introducing you to the Safeguard Young People Programme (SYP). The programme was established in 2013 and is currently operating in 12 different countries. It is the flagship programme of UNFPA. SDC has been supporting the programme since its launch in 2013. In 2021 it has further extended its support to the countries of Rwanda, Tanzania and Mozambique. The programme follows a holistic and multi-stakeholder approach from a macro level all the way down to a micro level. That means, it fosters exchange and UN-level discussions between ministries and civil society all the way from the local level up to the national, regional and global level.

Under the leadership of the United Nations Populations Fund (UNFPA) East and Southern Africa Regional Office (ESARO) the project is co-funded by the SDC, UNFPA Supplies (formerly Global Programme on Reproductive Health Commodity Security) and the UNFPA/UNAIDS-implemented SRH and HIV Linkages Project, as well as by the European Union and the Swedish and Dutch International Development Agencies.

Overall, SYP works towards improving sexual and reproductive health & rights and gender equality among youth in the targeted countries. Specifically, that means, SYP is addressing three main focus areas: Reproductive health and Rights, Sexual and gender-based violence as well as sexually transmitted diseases including HIV/AIDS. It is primarily focused on youth (mainly adolescents and young people aged 10-24, with a special focus on young women and girls). Secondarily, it also addresses a diverse set of change agents involved in youth programmes (like ministries, teachers, media or parents).

The project entered its third phase of implementation in 2020 (-2022, right during the initial outbreak of the COVID-19 pandemic) and continues to build on its experience and technical expertise on adolescent sexual and reproductive health rights programming globally, regionally and nationally, as well as on the expertise of the newly established Middle Income Countries’ Hub, a team of technical and operational regional staff dedicated to addressing the needs of vulnerable populations in Middle Income Countries (MICs) in collaboration with other regional programmes from previous phases.

It further focuses on policy and legislative implementation, and quality of services provided. In addition to mainstreaming SRHR into existing economic empowerment programmes, emerging issues in Phase III include gender transformation, Comprehensive Sexuality Education and its link to referral services, climate change adaptation strategies, menstrual health management and universal health coverage.

Overall, SYP works towards improving sexual and reproductive health & rights and gender equality among youth in the targeted countries. Specifically, that means, SYP is addressing three main focus areas: Reproductive health and Rights, Sexual and gender-based violence as well as sexually transmitted diseases including HIV/AIDS.

Overall, the project works towards three main outcomes:

1. Strengthened enabling environment: Which includes improved inclusive policies, legislations and accountability mechanisms to promote and protect adolescents and young people’s rights at regional, national and sub-national levels with a focus on SRHR.
2. Youth empowerment and strengthened demand: which enables adolescents and young people to utilize knowledge, skills and agency to make informed decisions and positive actions about their body and life.
3. Strengthened delivery of services: to ensure equitable access to quality SRHR and HIV integrated services, including Sexual and Gender Based Violence (SGBV) services and to make them increasingly adolescents and youth friendly.

The same approach and intervention strategy are used in all the 12 implementing SYP countries with tailored activities, specific for each country. As the interventions are all linked to a certain outcome, the overall monitoring, evaluation and aggregation of the reporting is way more feasible. That way, the program interventions can also influence macro (legal and policy environment, universal health coverage frameworks and accountability mechanisms), meso (communities’ engagement, parliaments, CSOs, youth networks) and micro (young people, adolescents, teachers, parents) levels, which are built upon the three different outcomes areas. An example for such an integrated approach is the comprehensive sexual education and community activities, which are developed together with the community itself but at the same time embedded in the overall regional approach.