Rwanda.

• Author: Mukundwa, Aline
• Position: Reproductive & Sexual Health Rights in Cameroon, Egypt, Ghana, Malawi and Rwanda: An Advocacy and Communications Approach - Report

1.0 BACKGROUND AND INTRODUCTION

1.1 Background on Rwanda

Rwanda is a country in transition from a state of war and genocide. Since 1994 the Government of Rwanda (GOR) has embarked on transforming the country in nearly all aspects. This entails rapid social change, institutional reform, restructuring governance institutions, among others. This state of affairs provides opportunities and challenges in the realm of women's SRHR as well as for those involved in advocating for such rights. Among the priorities in the process of transformation, government has identified empowerment of women as one of its priorities.

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1.2 Study Purpose, Focus and Scope

The purpose of this research is to conduct an assessment of Rwanda's position, commitment and progress on SRHR. The research will identify the problems and policies that impair government's ability to maintain, respect and promote sexual and reproductive health rights in Rwanda.

The study focused on the degree to which Rwanda extends or violates SRHR as well as the mechanisms through which government and non-government actors guarantee SRHR of women. It assessed health policies, programmes, and initiatives designed to reduce and prevent sexual and reproductive health risks to Rwandan women. More specifically, the research focused on availability of and access to SRHR services.

The research outcomes are:

* Identification of major concerns within policies, strategies and initiatives addressing SRHR in Rwanda based on benchmarks established by international, regional and national instruments on the subject;

* Develop forward looking and actionable recommendations to enhance the capacity of the GOR and other stakeholders in the area of advocacy around women's human rights focusing on SRHR

1.3 Context and Rationale

1.3.1 Context

This report presents the outcome of an assessment of the status of Rwanda's implementation of the various international and national instruments on SRHR to Rwandans. In particular the survey focused on assessing the efficiency and effectiveness of the existing national framework for comprehensive action to maintain, protect, and promote SRHR of women in Rwanda.

Notwithstanding the positive developments in Rwanda and mindful of the remarkable negative effects induced by the war and 1994 genocide within the context of SRHR, the report intends to offer proposals that if actioned, would yield harmonized SRHR programmes to ensure enjoyment of SRHR by all Rwandan communities focusing primarily on the most vulnerable women and the girl child.

Overall, the research is intended to stimulate collaborative actions by partners inside and outside GOR. To achieve this, the report critiques the foundations upon which Rwanda's initiatives are based with a view to enhancing their effectiveness.

The success of recommendations presented in this report, are dependent on the speed with which social and cultural barriers to SRHR are deconstructed and rights guaranteed to deal with broad influences on SRHR at all stages of life of a woman. Thus the proposed approach is informed by the belief that a healthy start in life provides the capacity to develop a positive self-image early in a woman's life, enabling her to pursue or make autonomous choices, establish satisfying relationships, and enables her to cope with life challenges which is the very essence of SRHR.

1.3.2 Rationale

Persistent major violations against women despite the existence of the ICCPR and ICESCR led to the emergence of the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) in 1979 to specifically address all forms of discrimination against women. Subsequently, the UN identified significant inadequacies in the respect for women rights as codified in the three instruments and urged for a world agenda to adopt common standards and approaches to respecting and fulfilling women rights especially SRHR. Hence the Cairo, Beijing and Dakar conferences were convened. The outcomes of the conferences are reflected in their resolutions, Plan of Action (PoA) and Platform For Action (PFAs). However, there is increasing realization that governments are not fully and equally committed to the above processes as reflected by the ad hoc nature of their respective policies, programmes, initiatives and implementation mechanisms.

The indivisibility of rights means that rights relating to sexual and reproductive health are interconnected with other sets of human rights. On one hand, SRHR are viewed in terms of availability, accessibility, acceptability, quality of care, and associated rights in the process of health services delivery (1). On the other hand, determinants of these rights entail a broader sense of health including availability of food, access to education, housing, work environment, and others. The aim is for women to enjoy the highest attainable standard of health and pleasurable sexuality. Central to this study, are the rights to autonomy and privacy in making sexual and reproductive decisions, as well as the responsibility of health care providers to ensure informed consent and confidentiality in relation to health services.

The Beijing Conference defined the human rights of women to include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behaviour and its consequences (2).

Further to this, SRHR were plainly summed up by Dr Naris Sadik, a former Executive Director of the UNFPA while commenting on what should inform the world consensus on SRHR when he said that "world consensus means what it says: that reproductive health is a right for both women and men; that every individual has the right to decide the size and spacing of the family, and to have the means and information to do so, that there must be no coercion, either to have or not to have children; and that these rights are part of the international structure of human rights, which has its foundation in the concept that all men and women are equal. (3)"

While SRHR equally relate to women and men, women have specific health needs related to their sexual and reproductive functions. Their reproductive systems can cause health problems, even before they start to function (girls) and when they cease to function (older women). In addition, women suffer from the same diseases of other body systems that affect. men. However, women's disease patterns often differ because of their genetic constitution, the influence of hormones and gender-based role patterns. By extension, SRHR are directly linked to the cardinal right to life which includes the right to survival implying that women's health status and services should be improved to reduce the 585,000 maternal deaths that occur each year from pregnancy-related causes.

There has been remarkable progress since the Cairo, Beijing and Dakar conferences. However, a close consideration of the targets set at the time and the coherence or lack of it that is prevalent in the implementation of related programmes, reveals significant gaps both at international and national levels. The following statistical evidence on the increase in sexual and reproductive ill-health illustrate that a lot is still desired in the field of SRH rights and services which provides further justification for this study. Viz:

* A World Health Organisation (4)(WHO) evaluation shows that the level of disability and premature death due to poor sexual and reproductive health is huge and increasing. Accordingly, unsafe sex is the second most cause of illness and death in developing countries and ninth in developed countries. The analysis reveals a picture of growing unmet needs and neglect. For example, more than half a million women die as a result of complications in pregnancy and childbirth every year. Access to contraception has increased worldwide but there are still an estimated 120 million couples who do not get the contraceptives they would like or need. An estimated 80 million women have unintended or unwanted pregnancies each year, of these, 45 million end in abortion. WHO figures quoted in the survey show that there are 19 million unsafe abortions carried out each year, resulting in around 68 000 deaths and millions of injuries and permanent disabilities.

* The same study confirms increasing influence of conservative political, religious, and cultural forces around the world which threaten to undermine progress in sexual and reproductive health. The greatest challenge to SRHR promotion in most African countries including Rwanda, relates to the conservative forces opposed to harm-reduction strategies, such as supplying contraception to sexually active young people and providing safe, legal abortion services.

* According to the WHO Assistant Director-General for Family and Community Health in reference to the above statistics, said: "These statistics represent an appalling catalogue of human tragedy ... Far from making progress we seem to have been going backwards since the notion of reproductive health was born in Cairo in 1994. The issue is dropping down the international agenda and governments seem to be reluctant to tackle this most fundamental threat to health and well-being."

Drawing from the above targets as well as the statistical evidence of sexual and reproductive ill-health, we assess the implementation by the Rwandan Government of the various international, regional and...