Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK.
BMC Int Health Hum Rights. 2011 Dec 16;11 Suppl 3(Suppl 3):S8. doi: 10.1186/1472-698X-11-S3-S8.
The continued poor sexual and reproductive health (SRH) outcomes in sub-Saharan Africa highlight the difficulties in reforming policies and laws, and implementing effective programmes. This paper uses one international and two national case studies to reflect on the challenges, dilemmas and strategies used in operationalising sexual and reproductive health and rights (SRHR) in different African contexts.
The international case study focuses on the progress made by African countries in implementing the African Union's Maputo Plan of Action (for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights) and the experiences of state and non-state stakeholders in this process. The case was developed from an evaluation report of the progress made by nine African countries in implementing the Plan of Action, qualitative interviews exploring stakeholders' experiences and perceptions of the operationalisation of the plan (carried out as part of the evaluation) in Botswana and Nigeria, and authors' reflections. The first national case study explores the processes involved in influencing Ghana's Domestic Violence Act passed in 2007; developed from a review of scientific papers and organisational publications on the processes involved in influencing the Act, qualitative interview data and authors' reflections. The second national case study examines the experiences with introducing the 2006 Sexual Offences Act in Kenya, and it is developed from organisational publications on the processes of enacting the Act and a review of media reports on the debates and passing of the Act.
Based on the three cases, we argue that prohibitive laws and governments' reluctance to institute and implement comprehensive rights approaches to SRH, lack of political leadership and commitment to funding SRHR policies and programmes, and dominant negative cultural framing of women's issues present the major obstacles to operationalising SRH rights. Analysis of successes points to the strategies for tackling these challenges, which include forming and working through strategic coalitions, employing strategic framing of SRHR issues to counter opposition and gain support, collaborating with government, and employing strategic opportunism.
The strategies identified show future pathways through which challenges to the realisation of SRHR in Africa can be tackled.
撒哈拉以南非洲地区持续存在的性健康和生殖健康（SRH）不良状况，突显了改革政策和法律以及实施有效方案所面临的困难。本文通过一个国际案例研究和两个国家案例研究，反思了在不同非洲背景下实现性健康和生殖健康及权利（SRHR）所面临的挑战、困境和策略。
国际案例研究的重点是非洲国家在实施非洲联盟《马普托行动计划》（为实施性和生殖健康及权利大陆政策框架而制定）方面取得的进展，以及国家和非国家利益攸关方在这一过程中的经验。该案例源自对九个非洲国家实施该行动计划进展情况的评价报告、探索利益攸关方经验和对该计划实施看法的定性访谈（作为评价的一部分进行），以及作者的反思。第一个国家案例研究探讨了影响加纳于 2007 年通过的《家庭暴力法》的过程；该案例源自对影响该法的过程的科学论文和组织出版物的审查、定性访谈数据和作者的反思。第二个国家案例研究考察了肯尼亚引入 2006 年《性犯罪法》的经验，该案例源自关于制定该法的过程的组织出版物以及对关于该法的辩论和通过的媒体报道的审查。
基于这三个案例，我们认为，禁止性法律和政府不愿制定和实施全面的权利办法来促进性健康和生殖健康、缺乏对资助性健康和生殖健康政策和方案的政治领导和承诺、以及对妇女问题的负面文化观念的主导，是实现性健康和生殖健康权利的主要障碍。对成功事例的分析指出了应对这些挑战的策略，包括组建和通过战略联盟、运用战略性的框架来处理性健康和生殖健康问题，以应对反对意见并争取支持、与政府合作以及采取战略性的机会主义。
所确定的战略指明了未来的途径，可以通过这些途径来解决非洲实现性健康和生殖健康权利方面的挑战。
