Advocacy in developed countries spanning the latter half of the 19th century and the whole of 20th century, succeeded in convincing the powers that be of the importance of sexual and reproductive health, especially the reduction of maternal mortality, the need for family planning and control of STIs. That is the reason why, by the second half of 20th century, we had achieved a high level of SRH in developed countries. Advocacy for SRH in developing countries did not take off in the same way until colonised countries became independent and until concern about the high global population growth rate in developing countries led to family planning being given a very high priority internationally, and FP programmes were tied to economic and development aid.

Developed countries have never questioned the high priority of SRH for their own populations to this day, and both women and men can take for granted that services are there when they need them, with some notable exceptions. Indeed, improvements in reproductive technology, ranging from new contraceptive methods, safer abortion methods, a growing list of infertility treatments, better screening and treatment for reproductive cancers, to name only a few, proceed at a rapid pace.

For developing countries, however, the picture is quite different. The priority given to family planning continues, and broad-based advocacy efforts finally succeeded in convincing the powers that be of the importance of sexual and reproductive health more broadly. This was evidenced in 1994 at the ICPD, where almost all world governments signed on to the ICPD Programme of Action, which was a 20-year programme for achieving sexual and reproductive health for all by 2015. Now, less than 10 years later, that international consensus is threatened and sexual and reproductive health in developing countries is being pushed off the international policy agenda. I have been asked to open this course by giving you an overview of why this is happening and what can be done about it.