Does “Sexual and Reproductive Health” Mean Abortion?

By Stefano Gennarini, J.D. | November 28, 2018

An unprecedented series of votes on amendments to exclude or qualify the term “sexual and reproductive health” in the General Assembly’s third committee just before Thanksgiving revealed a roadmap to exclude abortion from UN policy altogether. All that is missing is the political will and resources to make it happen.

In recent years delegations have retreated from contesting “sexual and reproductive health” in UN resolutions. Even delegations that took staunch pro-life positions against the term in the past, because of its relation to abortion, felt it was no longer possible to oppose the term and questioned the necessity of contesting it at all.

The Obama administration took advantage of this and streamlined the term into just about every UN policy, with little opposition. It seemed the term was set in stone. Despite several missteps and faux pauxs, thanks to the Trump administration’s U.S. pro-life diplomacy this may no longer be the case in the future.

A New Day in Pro-Life Diplomacy

By merely attempting a break from the status quo left by Obama’s presidency, the Trump administration has brought to light just how much “sexual and reproductive health” remains a highly contentious term. More importantly, it shows that the United States is not isolated in opposing abortion in UN policy.

Most astonishing, in the first ever UN vote on “sexual and reproductive health”, 73 nations voted to keep out the term from a paragraph in the annual General Assembly resolution on the rights of the child. Though three other mentions of the term remained in the draft, and the victory was possible because of a great number of abstentions, it is still a powerful symbolic victory.

The vote was the result of an amendment proposed by Mexico as a reaction to U.S. pro-life diplomatic efforts. The U.S. opposed all references to “sexual and reproductive health” throughout negotiations on UN resolutions in recent weeks, and proposed amendments to delete the term or qualify it to exclude abortion in two other resolutions on women’s issues. Those amendments failed, but not without gaining upward of 40 total supporting votes.

Abortion groups and their government supporters were on high alert as a result, and they found a willing ally in Mexico’ Ambassador, Juan José Gómez Camacho, to push back on these U.S. efforts.

Ambassador Gómez explained he could not accept any “rollback” on “sexual and reproductive health.” He proposed an amendment to the resolution on the rights of the child to reintroduce a mention of “sexual and reproductive health” in the resolution’s paragraph on the right to health that had been taken out by African delegations.

In a passionate off-script speech, Gómez explained that the amendment was presented more as a political statement than an earnest effort to improve the resolution.

“I have no doubt that if this amendment is voted it will lose. We will lose. I know that lamentably the immense majority of the room will abstain or vote against it… It is lamentable. Very well, I don’t’ care,” he said.

“The value here is not in winning or losing. It is to keep defending and not lowering our guard,” he explained.

“Clearly we are going through complex times in which a series of principles and values and convictions that had stopped being a reason of controversy are beginning to be so again,” he observed.

Mexico’s conviction about keeping the term in UN policy was not matched by any equally fervent pro-life political statements. Even so, Mexico’s amendment was defeated, with only 11 votes in favor, 73 against, and 85 abstentions.

Just What Exactly Does “Sexual and Reproductive Health” Mean?

Despite this, some delegations still seem confused about what “sexual and reproductive health” means in UN resolutions, and why it is controversial at all. Even delegations that have laws generally or wholly protective of children in the womb seem confused about the term.

In a statement on a resolution on trafficking the week before Thanksgiving, the Philippine sponsor thanked the U.S. for withdrawing an amendment to delete “sexual and reproductive health” from the resolution. He  then proceeded to lecture the U.S. about how the term is not controversial.

“Sexual and reproductive health-care services was accepted at the level of head so states in 2030 Agenda,” the delegate of the Philippines observed.

“Sexual and reproductive health-care services does not in itself include abortion,” he declared, adding that, “There is no need to make any qualification, else we would have to do this every time. My delegation could not sponsor a document that produces abortion.”

The Philippines delegate was merely repeating the talking points of UN agencies and donor states for the last 25 years. They have always insisted that “sexual and reproductive health” does not necessarily mean abortion. Their remarkably deceptive scheme to give cover to the UN system to promote abortion internationally has been very successful thanks to the fact that diplomats from countries with laws protecting the unborn have been remarkably gullible.

One need not look far in the UN system to see exactly how “sexual and reproductive health” is the main conduit for the promotion of abortion internationally both normatively and programmatically. It is a routine exercise of UN agencies and the UN human rights office to promote abortion and to interfere in the internal legislative and judicial affairs of states to pressure them to liberalize abortion. All of this is done precisely under the rubric of “sexual and reproductive health.”

Just this summer UNFPA, UN Women, the UN human rights office, and even the UN agency for drugs and crime promoted judicial activism on abortion in Mexico, interfering in a Mexcian state’s judicial process before it came to a conclusion. They did this precisely under the rubric of realizing the right of women and girls to access sexual and reproductive health. And in a bizarre response to questions from this writer, the agencies said they were merely carrying out the wishes of the federalgovernment of Mexico!

This specific action followed a UN-systemwide handbook on “access to justice” for women prepared by UN Women, and rolled out for all UN agency personnel who work on access to justice, which instructs UN personnel to promote abortion as a “gender-specific” measure of access to justice. The handbook specifies that governments “must” include abortion as part of “sexual and reproductive health.”

That “sexual and reproductive health must include abortion” is now a refrain of the UN human rights office and UN agencies.

Earlier this year, the UN Committee on the Rights of Persons with Disabilities, which monitors the UN disabilities treaty, published an opinion prepared by the UN human rights office that says states party to the treaty must include abortion as part of “sexual and reproductive health.” This is especially egregious since the states who negotiated that treaty, the only binding UN agreement to mention “sexual and reproductive health,” they specifically excluded a right to abortion from the treaty.

In November the UN Human Rights Committee finalized a legal commentary on the “right to life” in the UN treaty on civil rights, one of two foundational UN human rights treaties, which defines the right to life as including a “right to abortion” among other “sexual and reproductive health” implements. The committee that monitors the implementation of the other foundational treaty, on economic and social rights, also issued a legal commentary to promote abortion as part of “sexual and reproductive health” two years ago.

And a landmark report in the Lancet in May 2018, co-authored by UN agency researchers, that insists abortion must be part of “sexual and reproductive health for all” based on the guidance of UN agencies, UN human rights mechanisms, and reproductive health advocates. The head of the World Health Organization, Tedros Adhanom Ghebreyesus, and the head of the United Nations Population Fund, Natalia Kanem, gave this Lancet report a full-throated endorsement in a comment in the same Lancet edition titled “Defining sexual and reproductive health and rights for all.”

These are just recent samples of UN abortion advocacy from the past year, all under the rubric of “sexual and reproductive health.” What has allowed UN agencies and the UN human rights office to advocate abortion with impunity is the ambiguity of the term itself, but also the lack of accountability of UN agencies and the UN human rights office.

To suggest in the context of UN policy and programming that any term related to “reproductive health” does not necessarily mean abortion is imprecise, if not outright wrong. UN member states themselves defined abortion as part of “sexual and reproductive health” in the International Conference on Population and Development (ICPD). The term was only ever defined by the General Assembly in 1994 at that conference. Even if these definitions are not binding as law on states, they are certainly normative for the UN system.

The following terms are all defined expressly as including abortion in the ICPD agreement: “sexual and reproductive health”, “reproductive health”, “reproductive health care”, “primary health-care”, and “reproductive health services” (ICPD 7.6 and 13.14).

However, ICPD and Beijing included caveats that cast abortion in a negative light and make it impossible to consider abortion a human right or even a humane solution to a crisis pregnancy. It states that (1) Abortion is a subject that may be exclusively addressed in national legislation (ICPD 8.25); (2) Governments should take appropriate steps to help women avoid abortion (ICPD 7.24); (3) In no case should abortion be promoted as a method of family planning and women must be provided with post-abortion health-care and (ICPD 8.25); (4) Abortion is presumptively illegal, and should be safe where it is legal (ICPD 8.25).

So, on the one side UN policy includes abortion by definition. On the other, it casts abortion in a negative light. It requires governments to provide women alternatives to abortion and prohibits the UN system from promoting abortion.

Sadly, UN agencies and the UN human rights office have reinterpreted these caveats and turned them on their heads to promote the oxymoronic notion of “safe abortion.” The ambiguity of the term allows them to do this. And tragically, no UN member state has ever attempted to hold UN agencies and the UN human rights office accountable for their disingenuous abortion advocacy.

Diplomats and politicians from developing countries are often muzzled by their dependence on foreign aid. They fear making abortion a political issue for fear of upsetting their Western development partners. Others from more developed states fail to grasp the nuances in UN abortion advocacy, much like the delegate from the Philippines, and are either easily confused or easily assuaged by the ambiguity of the term “sexual and reproductive health.”

What is Agreed, Is not Always Consensual

This is where the 2030 Agenda—the latest major UN political agreement about social issues—becomes highly significant. The delegate of the Philippines pointed to the fact that the 2030 Agenda agreement refers to “sexual and reproductive health-care services”, that it does so without “any qualification”, and that no qualification is therefore needed. That was dispositive to him. But he left out the full picture of and full background of that agreement.

The term “sexual and reproductive health” was not consensual in the 2030 Agenda. Between the African Group and the Gulf Cooperation Council, over 60 countries made reservations on the inclusion of the term in the 2030 agenda. And while the 2030 Agenda has a paragraph (Sustainable Development Goal Target 3.7) on “sexual and reproductive health” that does not include any qualification, Sustainable Development Goal Target 5.6 of the 2030 Agenda does qualify “sexual and reproductive health” as well as “reproductive rights” by referring back to the ICPD agreement. And several UN agreements qualified “sexual and reproductive health” by reference to ICPD prior to that. So, the term is not quite as agreed as the delegate of the Philippines tried to make it out to be.

In fact, the attempt to make “sexual and reproductive health” a UN agreed term, that does not need to be qualified by reference to ICPD, came directly from the Obama administration in concert with European governments in the lead up to the 2030 Agenda. Obama and the Europeans, the Nordics especially, wanted an open reference to “sexual and reproductive health”, without any qualifiers, to be streamlined in all UN policy.

This writer personally heard U.S. diplomats attempting to convince delegates from Africa and Asia to drop the ICPD qualifiers to the term during UN conferences in 2014. They found the ICPD qualifier incorporating the caveats listed above too constraining. What they wanted was an ambiguous but open-ended term without caveats for UN agencies to be able to promote abortion.

The compromise that was reached was to give the Obama administration paragraph 3.7 of the 2030 Agenda, “by 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.” It was a last-minute addition on the very last day of negotiations on the Sustainable Development Goals in July of 2014.

In light of how UN agencies and the UN human rights office understand “sexual and reproductive health,” it seems the Philippines’ UN delegation is excessively sanguine about the use of the term. The term inevitably directs politcial and financial support to abortion groups and gives cover to UN abortion advocacy. It is unfortunate that UN delegates can be so easily persuaded about UN agreed terminology. Sadly, this happens often as the turnover of UN diplomats is frequent and they are not always up-to-speed.

But the vote in the General Assembly 3rd committee to exclude “sexual and reproductive health” from a paragraph in the resolution on the rights of the child is a positive sign. It shows that despite the efforts of the Obama administration and European donors to make “sexual and reproductive health” an agreed term it remains controversial.

Above all it shows what countries will side with the U.S. if the Trump administration finally puts in place a State Department-wide diplomatic strategy making pro-life diplomacy a U.S. foreign policy priority. And it shows what countries the U.S. needs to work on to succeed. What remains to be seen is if the Trump administration backs up its opposition to “sexual and reproductive health” with as many resources and zeal as the Clinton and Obama administrations did to promote it.

Until now, the Trump administration had been content to sit back and fall back on the status quo and to make reservations without really advancing the pro-life cause internationally, much like the Bush administration. Perhaps the unprecedented votes in the 3rd Committee are a sign that the Trump administration will finally deploy the might of the U.S. State Department to promote the pro-life cause.

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