Sexual and reproductive health services central among prerequisites for eradicating global poverty

Sexual and reproductive health rights and services must be included among general health-related questions and the promotion of gender equality,” says Senior Adviser on Development Policy Iina Älli. Three questions about development cooperation is a series of interviews with specialists from the Department for Development Policy.

Iina Älli
Iina Älli on the shore of Lake Kivu in the district of Nyamasheke in Rwanda in June 2012. Photo: Aline Shyamba

1. Why are you interested in promoting sexual and reproductive health?

I left to study international relations and development studies to the University of Sussex at the end of the 1990s, because I wanted to obtain theoretical backbone for a possible career in development cooperation.  The very first lectures at the university inspired me to focus on and sexual and reproductive health and rights (SRHR) and in health and development in my career.

At the time, intersectional feminism was emerging in academic discussions particularly from the perspective of developing countries. In the very international crowd of fellow students, we were debating SRHR issues and questioning why we and so very few, had access to SRHR and services. In theory, the right to decide over one's own body is a simple matter. However, it has been made into an issue of political power, which results to millions of women and girls putting their lives at risk.

In my view, lack of access to SRHR and insufficient access to SRHR services are the root causes to prevailing global inequality.  The promotion of SRHR is one of the key elements in eradicating global poverty in a sustainable way. Through my work, I hope to expand the political space for SRHR issues that has been narrowing in the past decade. I also aim to contribute to the incorporation of SRHR services in all global discussion and that these issues will be included and discussed in all forums.

2. Can you mention an achievement in the area of SRHR that has made you particularly happy? What discourages you?

In 2008, I worked for a rural women’s organisation in Zambia's Eastern Province. The Eastern Province Women’s Development Association, EPWDA, had been involved in the empowerment of women and girls since the 1980s. In 2008–2009, EPWDA was planning new activities and objectives for the organisation. EPWDA wanted to utilise their past experience in human rights education and their wide network of volunteers for the improvement of sexual and reproductive health in the communities, especially among women and girls. The organisation identified their needs, skills and strategy. It was very rewarding to participate in the process, by supporting the organisation and helping the voice of the grassroots level become one being listened to. Later on I have heard that the impacts of the project are still visible in the communities.

From 2011 to 2013, I worked at an UNFPA Country Office in Rwanda. Given the historical background of Rwanda, UN agencies did not always have a straightforward way to support national policies. For instance, though UNFPA was widely active in the country, the agency focused its SRHR-work primarily  on maternal health services. During my time with UNFPA, we managed to organise prominent, state-supported campaigns to improve the wider visibility of SRHR issues, for example increasing awareness of adolescent SRHR service at the national level.  UNFPA’s work has gained more national trust from the governmental authorities and it was extremely rewarding to be part of this process.

 Workshop on contraceptives for health centre workers and people who work with sex workers in the district of Nyamasheke in Rwanda in June 2012. Photo: Iina Älli

Currently the debate concerning SRHR is circling around old debates, for example, what should be the role of the international community and its members concerning SRHR-issues. Discussions are taking place concerning which SRHR services should be supported, and which not. The question of rights concerning sexual and reproductive health is aimed to be erased.

Finland can be commended for its tireless and patient dialogue with the conservative front. Finland’s persistence even though the political space for SRHR has shrank, makes me very proud. For example, this year Finland is channelling an additional support of EUR 3 million to UNFPA’s work in Somalia in order to mitigate the negative gendered consequences of the coronavirus pandemic.  The position and rights of women and girls are at great risk in times of conflict and humanitarian crises. This is the case when it comes to the current pandemic too.

Discussion on human rights is currently stagnant and challenging at times, but in any debate, I consider it important to be able to listen to each other. When people experience that they are not being heard, this will of course cause discouragement, but in such case it is important to do what it takes to call more attention to the matter. 

3. What would you like to say to those who consider that the population growth in Africa shows that from the SRH perspective, the game is up?

I think that population growth, as a measure of success in SRHR matters, is a bit old-fashioned and black-and-white. From a SRHR perspective we should consider issues of fertility as a question of the rights of individual, especially of women’s rights, instead of seeing it as issues of merely lack of birth control, or family planning.

According to the United Nations Sustainable Development Goals (SDGs) SRHR and services must be included in the general health-related objectives and to the promotion of gender equality. Curbing population growth cannot be the only goal. SRHR as well as human rights and their realisation are key to achieving the SDGs.

Instead of population growth, it would be better to talk about population development, which is affected by fertility rates, mortality rates and life expectancy. Improving living standards and reduction of poverty in all parts of the world have been seen to have a direct impact to slowing population growth. Demographic changes such as decline in fertility and mortality rates are usually results of reduction in poverty and improving livelihoods.  

Globally, fertility rates have been decreasing for decades, but unevenly: In Africa, there are still countries where fertility rates are growing especially in rural areas, where as  in major urban centres of African states the fertility rates  are already near the global average, of  2.5 children per family.

African and many other developing countries populations are relatively young. In my experience young people demand and are eager to use SRHR services. When access to SRHR information and services are linked with availability of education and ensuring sufficient livelihoods. Future looks bright for Africa and the rest of developing world.


UNFPA is publishing its annual report, focusing on youth’s SRHR services, at its Rwanda Office in the district of Karongi in July 2013. Photo: Iina Älli