Alicia Ely Yamin, Director, Program on Health Rights of Women and Children, Francois-Xavier Bagnoud Center for Health and Human Rights, Harvard University
In June, a High Level Panel will be convened by the United Nations to take the lead in framing a proposed set of successor goals to the Millennium Development Goals (MDGs), which are to be adopted by 2015, when the MDGs officially expire. Human rights should be the organizing framework for the new development agenda.
Although the MDGs have garnered unprecedented political and financial support, they have also been justifiably criticized. For example, they selectively overlooked key human rights issues that had been recognized in international law and UN conferences, such as reproductive and sexual rights (the only topic of reproductive health included was the relatively depoliticized goal related to improving maternal health, MDG 5). They also ignored fundamental accountability and equity concerns, which are both central to a human rights framework. Indeed, studies - including a major report from UNICEF - indicate that the push to make progress on aggregate health outcomes, such as child mortality and maternal mortality, has in fact not benefited the poorest sectors of society in many countries, and that in some cases disparities have even been exacerbated.
The MDGs were also implemented in an extremely top-down, one-size fits-all manner. The Goals were never intended to be national planning targets; yet, that is exactly what they have become. That is, the goal of reducing child mortality by 2/3 was a global goal - the architects of the MDGs never meant that Zimbabwe, India, and Sweden, for example, were all supposed to reduce their respective child mortality rates by 2/3 from 1990 levels. The rigid imposition of the MDGs as national planning targets was exacerbated in some cases by the selection of indicators. For example, Maternal Mortality Ratios (MMRs) used to measure progress on MDG 5, are notoriously unreliable and have large confidence intervals. This has produced a virtual industry in global modeling exercises of MMRs. And, at the national level, governments are employing every possible empirical method to assess changes in MMRs, while they lack the most basic data about their own health systems, such as the numbers and capacities of providers and facilities. As a result, we lack the information to make sustained systemic change, and governments in aid-dependent countries are often more concerned with reporting to their donors than accountability to their own people.
Much has changed since the MDGs were formulated and it is worth pausing to consider what a Post-2015 agenda that took human rights seriously might look like. The MDGs were based on a compact between the North and the South, mobilizing aid in exchange for progress on certain select issues, from reducing income poverty to increasing access to improved water sources. In a world where almost three-quarters of people living in poverty live in Middle Income Countries (MICs), and where a handful of MICs (i.e., 'BRICS') are also increasingly important donors those categories cease to make sense.
It is clear that development cannot rely on aid anymore, and it is questionable whether it was ever a good deal for those governments on the receiving end. We have to reconsider the global architecture to understand where the “maximum available resources”, as required by human rights law, can come from for health, education, housing, water and sanitation, and other social development programming. For example, the resources that leave the global South simply via lost tax revenues - roughly USD 60 billion per year - dwarf all aid that is given to the same countries.
A post-2015 development agenda must recognize that we need systems of global responsibility and global redistribution if we are to have an international order in which the rights and freedoms set forth in the Universal Declaration of Human Rights can be fully realized. If the basic rules of the game are not changed, simply aligning the language used to describe the post 2015 goals with international human rights norms, as has been suggested by some, is beside the point. Indeed, it may amount to no more than co-opting rights rhetoric to give a patina of legitimacy and universality to a deeply flawed neoliberal paradigm in which the mantra of scarcity is invoked for the masses, while elites continue to live in luxury.
As 2015 approaches, we have an opportunity to develop a truly global development agenda based on genuine concern for universal human rights, which places everyone on the same political map. In addition to requiring policy coherence to extend to fiscal and financial arrangements, such an agenda would acknowledge that countries around the world face common problems which, although they manifest differently, require shared approaches and collective responsibilities. Climate change, income inequality, migration, gender justice, financial regulation, and other issues all have fundamental human rights dimensions that present themselves across countries with very different levels of income.
Take gender equality, a fundamental aspect of respect for human rights. UN Women released a report on the Progress of the World's Women in July 2011, which details the scandalous disparities between men and women in regard to domains from health to access to justice. It may not be surprising that there remain gaps in secondary school enrolment between boys and girls in Tanzania, or that marital rape is not criminalized (except in cases of separation). But Norway - usually at the top of human development markers - does not criminalize marital rape either, and 1 out of 10 women over fifteen have been raped.
And of course women face intersecting inequalities based on race, class and other factors as well. Amnesty International's 2010 report on maternal health in the United States revealed horrific disparities between white women and women of color with regard to access to maternal health care; women of color have 3 times the risk of dying in pregnancy and childbirth as whites. Compounded inequalities and discrimination that deprive women and girls of the most basic control over their bodies, and lives, are issues that affect both rich and poor countries.
Part of enabling women and girls to exercise agency is ensuring access to family planning, which although set out in MDG 5B has been neglected and underfunded in the MDG process, and is now receiving heightened attention as critical to sustainable development. But taking gender equality and women's human rights seriously in a post 2015 agenda would not only require that appropriate protections are in place to ensure all contraceptive use is voluntary. It would also demand that the old - and newly resurgent - argument that economic growth objectives are hindered by high rates of population growth, not be considered in isolation from the broader context of growing inequality in access to basic resources and livelihoods, and the way national economies are inextricably affected by the global economic system.
Indeed, adopting a "human rights-based approach" implies understanding that development is about more than growth, and even more than certain human development indicators; it is about expanding freedoms and redistributing power within and across societies. In turn, remedying these "pathologies of power", in Paul Farmer's term, requires more than numerical targets (as helpful as these are to capture imaginations and mobilize constituencies); it requires adequate legal and policy responses, effective accountability mechanisms at national and international levels, and civil society participation in shaping the solutions as well as defining the problem.
In order to realize a bold vision of sustainable, equitable and human-rights based development, we need to start with a process that incorporates the meaningful participation of people and groups who were not included when the first set of MDGs were developed. The decision to establish thematic global consultations, complementary to the fifty plus national-level ones planned, is a welcome one. However, it is not sufficient.
At a minimum, within the UN there need to be greater efforts to link plans for follow up on Rio Plus 20, from which preliminary plans for Sustainable Development Goals (SDGs) are likely to emerge, and the Cairo Plus 20 review, which is looking at the progress and possibilities for a holistic framework of sexual and reproductive rights and development, with post-2015 planning. These are currently being led by different UN agencies and are overly fragmented. As a result there is a serious risk that constituencies and issues given short shrift in the MDGs, such as sexual and reproductive health, will yet again be marginalized or reduced to partial and distorted frameworks in whatever eventual agenda is put forward in 2015.
Moreover, we need to hear the voices of grass-roots groups and social movements in the country-level consultations that are being undertaken. The increasingly common incantation that we need to “listen to the poor” is, if anything, a discouraging trope, as “the poor” do not speak with one voice. Meaningful efforts need to be made to ensure the participation of youth groups, women's movements, disabled people, indigenous groups, landless movements, LGBT groups and other stigmatized populations, and other disadvantaged people living in poverty. They need to be part of designing the solutions to the problems that they and their members face.
Of course the post 2015 agenda cannot be unduly overloaded with so many issues as to undermine its mobilizing potential. However, nor can we afford to leave the critical decisions regarding the future of development to technocrats and bureaucrats who need not live with the consequences of their choices. Setting a new development agenda is an opportunity to catalyze broader democratic deliberations on what kind of world we want, and what we owe to each other as human beings. We can't afford pass up this opportunity.