The Progress Report by the WHO on Reproductive Health Strategy in July 2010, identified strategies used to promote improving universal access to, and quality of, sexual and reproductive health care. The strategies that the WHO used to implement new policies held the following characteristics: strengthening health systems capacity, improving information for priority setting, mobilizing political will, creating supportive legislative and regulatory frameworks, and strengthening monitoring, evaluation and accountability. Each of these aspects is a positive attribute of the WHO policies in place, but I think that a component addressing cultural barriers should be added. Political will is important, but if policies go against the cultural and religious values of a society, then it will be difficult for a policy to have any real traction. This is particularly crucial in the area of reproductive and sexual health care, where religious values often dictate how a society reacts to policy changes.

For example, in Senegal (a predominantly Muslim country) it was greatly frowned upon for anyone but a married woman to seek reproductive health services, and even then a monogamous, married female could be chastised by her husband for seeking such services. Often reproductive health services were sought in a clandestine manner, and the birth control, which was distributed, was mostly Depo-Provera. This form of birth control only required an injection once every three months. This allowed women to hide their methods of birth control if they so desired to; an injection is much less apparent to a partner than pills which could be found around the house, or even using condoms, which requires the consent of both parties. The WHO should also take into consideration such cultural or religious biases against reproductive and sexual health services, and seek to include methods, which allow women to seek these services in a private manner when creating policies in this area.

How can reproductive health policies address the cultural and religious biases against seeking reproductive and sexual health services? Can politics address this by seeking approval from the leaders of communities, or should policies focus on gaining approval of these policies at a grassroots level first?