Perpetuating power: some reasons why reproductive health has stalled.

The 1994 International Conference on Population and Development represented a paradigm shift from vertical population control programmes to the broad-based promotion of sexual and reproductive health as human rights, through strengthening of health services and dealing with the underlying social determinants of health. In its Programme of Action, the global community set ambitious targets for reproductive health, based on strong political will among senior politicians and supported by many grassroots NGOs. Today, too little progress has been made, and the targets are not expected to be met. One of the reasons why may be that support for the reproductive health agenda has been de-politicised, with a focus on management and technical issues instead of unleashing the power necessary for change. Two other contributory trends, affecting more than reproductive health are discussed. Firstly, there has been a call for measurable goals and the use of indicators as a basis for planning, instead of valid and reliable measures for monitoring complex processes. This has led to a new form of vertical programme in reproductive health, in which the comprehensive nature of reproductive health has been left out, and a narrow definition of maternal health has been singled out for attention. Secondly, instead of nurturing the different roles of different actors in the struggle to achieve better reproductive health, the focus has been on coordination and harmonisation, which are not appropriate for dealing with controversial issues.