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Sexual and reproductive health lies at the core of women’s health. This amply reveals why, at the heart of the contemporary global discourse on women’s health and rights, lies the unfinished agenda of the ICPD 1994 and the ambitious blueprint of the SDGs1,2,3. The 1994 ICPD conference in Cairo, with its groundbreaking approach to population and development, followed by the Program of Action (Bei**g, 1995) emphasized reproductive health and rights, gender equality and women’s empowerment as key to ensuring comprehensive health and rights for women and girls worldwide2,4,5,6,7. Likewise, the SDGs, particularly goals 3 (good health and well-being) and 5 (gender equality), authoritatively enshrined the rights to health and gender equity for all worldwide8.

Hosted by the United Nations in Cairo, the ICPD marked a paradigm shift by affirming the integral link between human rights, reproductive health and gender equality. It called for universal access to reproductive health services, including maternal and child healthcare, family planning, cancer prevention, fertility care and safe, legal abortion options, integrating these services into primary healthcare and addressing critical issues like maternal mortality and gender-based violence. The conference also spotlighted the importance of sexual and reproductive health and rights (SRHR) for adolescents, advocating for equitable access to education, employment and economic resources for women, alongside promoting women’s empowerment across all life stages1,9,10,11.

Our focus on the intersectionality between women’s SRHR is both a reflection of and a response to the mandates set forth by the ICPD and the SDGs3,12,13,14 as well as a call to implement their respective agendas. The urgency of this endeavor is compounded by the current global polycrisis marked by the disproportionate impact of climate change on the world’s women and children, demographic pressures underlined by increased population migration, emerging disease outbreaks and the politicization of women’s sexual and reproductive health15,16,17,18,19,20.

Furthermore, the twenty-first century is characterized by an unprecedented digital advancement, which offers both transformative opportunities and formidable challenges for the realization of women’s health and rights. These technological advancements, particularly the increase in telemedicine, could provide new opportunities to enhance access to healthcare, information and education21,22. These advances also have the potential to connect women and girls across borders, amplify their voices and advocate for their rights on a global scale23,24. Nevertheless, more than three decades after the inception of the ICPD 1994 and coming ever closer to the SDG 2030 endpoint, the full realization of their respective person-centered goals in favor of women and girls remains elusive1,3.

In this Review, we aim to succinctly explore the intersectionality between women’s health and rights against the backdrop of global progress and crises, emphasizing the importance of the ICPD 1994 as a guiding framework. We discuss how current global realities, including digital advancements, affect women’s health and rights, highlighting opportunities for innovation alongside risks that could worsen inequalities. In line with this, we propose evidence-based strategies and policy recommendations to ensure that no woman or girl is left behind, while advocating for progress in women’s health and rights well into the future.

The 1994 ICPD unfinished agenda

Figure 1 illustrates the historical progression toward recognizing the inseparable bond between women’s health and rights, tracing back to the nineteenth century and culminating in the landmark 1994 ICPD event as well as key milestones achieved since then toward ensuring better health and improved rights for women. Nevertheless, nearly 30 years since the landmark Cairo conference, the progress in people-focused development is under threat from global polycrises, diminished rights for women and girls in many settings worldwide, consequences of the coronavirus disease 2019 (COVID-19) pandemic and divisive opinions on reproductive health and rights3,13,25.

Fig. 1: Timeline of key events in women’s health and rights.
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Key events relating to women’s rights are shown on top (blue boxes), and those relating to women’s health are shown at the bottom (pink boxes), from the suffragette movements through the second and third waves of feminism, highlighting shifts toward social change, cultural inclusion and intersectionality15,131,132,133. The timeline highlights the critical links between women’s rights and health, spurred by reproductive rights activism and supported by key United Nations agencies, notably WHO, UNICEF and UNFPA, alongside initiatives like ‘Every Woman Every Child’, ‘Ending Preventable Maternal Mortality’ and the ‘Every Newborn Action Plan’, which emphasize the crucial interconnection between women’s well-being and their rights63,64,101,103,134,135,136,137. Additionally, grassroots movements, nongovernmental organizations and organizations such as the International Planned Parenthood Federation, Marie Stopes International, the Guttmacher Institute and national entities like Sonke Gender Justice and Sahayog have had a crucial role in advancing reproductive healthcare, sexual education and addressing women’s health needs across diverse cultural contexts41,123,138,139,140,141 (https://sahayogindia.org/, https://genderjustice.org.za/) (FDA, US Food and Drug Administration; MDG, Millennium Development Goals; v., versus).

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Despite the momentum of movements pushing for justice, climate action and equality, efforts to safeguard prior achievements and move toward the targets of the complementary ICPD agenda and SDGs are severely strained. Considering the disparities and competing priorities of health systems worldwide, we reflect on some of the most urgent issues that, if adequately prioritized, could have a transformative impact on women’s and girls’ ability to survive and thrive. This includes tackling preventable maternal and perinatal mortality, enhancing access to high-quality, respectful family planning and safe abortion care services, investing in adolescent-friendly sexual and reproductive health services and protecting women from gender-based violence26,27.

The pursuit of maternal and newborn health, a cornerstone of the rights-based frameworks established by the ICPD and the SDGs, remains fraught with substantial challenges. According to the World Health Organization (WHO), childbirth complications cause roughly 287,000 maternal deaths per year, disproportionately impacting sub-Saharan Africa, where certain regions report mortality ratios surpassing 1,000 per 100,000 live births. It is appalling to note that, in 2020, three countries in sub-Saharan Africa had maternal mortality ratios above 1,000, while six other countries in the region have reported maternal mortality ratios between 500 and 999 during the last decade28,29,30. Moreover, the issues of severe maternal morbidity and newborn mortality, including stillbirths, reveal deep-seated disparities in access to dignified, rights-based care, adversely affecting marginalized groups such as women of color, the economically disadvantaged, migrants, adolescent girls and those with limited educational opportunities31,32.

Progress toward global maternal mortality reduction has been stalled by drastic funding cuts, deprioritization of maternal health and religious, cultural or politically driven agendas that curtail the socioeconomic rights of women. In sub-Saharan Africa, where 70% of maternal deaths occur, risks are exacerbated by insufficient healthcare access, a dearth of skilled healthcare workers, the inadequacy of emergency obstetric services and economic dependency issues30,32. Likewise, middle- and high-income nations grapple with healthcare system challenges like fragmentation and the excessive medicalization of childbirth. This has precipitated a surge in interventions, such as labor inductions and cesarean sections, particularly driven by litigation fears and financial motives, contributing to what is known as the ‘cesarean section epidemic’ in regions of North and South America. The overuse of such interventions carries distinct risks, underscoring the necessity for strategies that transcend mortality rates to emphasize overall health and well-being, ensuring that women and newborns worldwide receive quality, respectful care33,34,35,36,37,38,39.

Globally, a key element of the unfinished SDG agenda continues to be the absence of person-centered, respectful sexual and reproductive health services, in particular, the failure to meet the family planning needs of women and girls, and the lack of safe abortion care35,40,41,42. Although some progress has been made, women in low-income regions such as sub-Saharan Africa and South Asia still bear the burden of sexual and reproductive health-related mortality and morbidity. Consequently, in 2019, 163 million women had an unmet need for family planning, with over half of these living in Africa and Asia43,44,45,46, and this despite repeated calls to reposition family planning on the international agenda through the global Family Planning 2030 movement47,48. This neglect is astonishing, as meeting the need for family planning has beneficial impacts on health but also fosters economic growth by reducing healthcare costs and enabling more women to enter the workforce. Additionally, it has a crucial role in promoting environmental sustainability by hel** to stabilize population growth, which can alleviate pressure on natural resources and support more sustainable land and resource management practices41,46,49,50.

Interestingly, despite the widespread availability of essential health services, high-income countries (HICs) also present substantial gaps in SRHR, including unequal access to services for women of color, migrant women and both young and elderly women51,52,53,54,55. Moreover, the inadequacy of comprehensive sexual education limits young people’s understanding of their SRHR, while the politicization of this ecosystem restricts access to life-saving safe abortion services, family planning and care for survivors of gender-based violence12,20,42,56,57. These gaps undermine the ICPD and SDG’s emphasis on universality and reproductive autonomy.

Adolescent sexual and reproductive health is another area of concern reflecting intersections of age and gender. This underscores the importance of fostering a supportive and informed environment for the young person navigating this transformative physical, emotional and social journey. The key components of adolescent sexual and reproductive health include puberty and its inherent physical and hormonal occurrences, age-sensitive sexual and reproductive health education and information and the upholding of adolescent reproductive rights and autonomy. To do this, it is crucial to identify and encourage support systems in families and across different community settings and to identify the impact of novel technologies on adolescent health and well-being42,58,59.

Sadly, as for women of all ages, adolescents experience huge global disparities in terms of experiences, challenges and access to sexual and reproductive healthcare and education across cultures and regions. The main drivers of these disparities include stigma surrounding discussions on sexual health and barriers to accessing healthcare services, including systemic barriers such as unfriendly policies and health worker skill gaps, that lead to a dearth of adolescent-friendly health services. Adolescents are especially prone to gender-based disparities and discrimination, including gender-based violence42,59,60,61. Similar to women’s health, addressing adolescent sexual and reproductive health requires a multifaceted approach that recognizes the complex interplay of economic, cultural and social factors. This includes policy reforms to ensure equitable access to healthcare, comprehensive sexual education programs and initiatives that sustainably empower adolescent girls economically and socially26,62,63,64.

The pervasive nature of physical, sexual and psychological gender-based violence remains a harsh reality for over a billion women and girls worldwide, impeding their fundamental right to live free from harm. This is driven by deeply rooted cultural norms, inadequate legal frameworks and societal attitudes that trivialize violence against women and undermine women’s rights and autonomy60,65,66,67,68,69. Sadly, the pandemic of gender-based violence has huge economic consequences and has been linked to annual losses in the trillions of dollars. These losses are linked to care-related costs, lack of productivity owing to survivor invalidity and the disorientation of key resources that could serve other essential sectors such as education70,71.

In low- and middle-income countries (LMICs), gender-based violence remains prevalent, with some population-based studies reporting intimate partner violence in 10–60% of ever-partnered women, while characterizing sexual coercion and abuse as frequent female experiences72,73. Similarly, despite reporting lower lifetime and lower past-year prevalence than LMICs, the persistence of gender-based violence in HICs and the disproportionate affliction of young persons highlights a collective failure to align with gender equality and women’s empowerment objectives globally66,71,74. Ultimately, gender-based violence not only violates women’s right to equal opportunity and dignified living, it exposes them and their children to life-long physical, sexual and reproductive and mental health complications as a consequence of that violence60,66,69,71,75,76.

It is worth mentioning that a critical, but often overlooked, aspect of the alignment between the ICPD and SDG agendas is the mental health of women and girls, which is integral to their overall health and empowerment. The WHO’s 2022 World Mental Health Report revealed that women and girls represent 52.4% of the 970 million people living with mental disorders globally. Additionally, pregnancy and the post-partum period constitute a supplementary risk for women and girls, as more than 10% experience depression, while perinatal mood and anxiety disorders are known to directly influence immediate and long-term maternal, fetal and newborn health and well-being, contributing to as much as 20% of maternal mortality in HICs77. Additionally, adolescent girls and survivors of intimate partner violence have a higher risk of depression, anxiety and suicidal ideation78,79,80,81,82.

Despite the clear link between women’s and girls’ mental health and their overall well-being and rights, funding for women’s and girls’ mental health and especially pregnancy-related mental health is grossly inadequate. Also, poor quality or lack of mental health services, largely due to stigma and cultural norms, and a lack of integration with SRHR service have been reported in LMICs as well as a lack of clear policies and laws targeting women’s and girls’ mental health. Likewise, HICs face challenges including unequal mental healthcare access for women of color, migrants and those in rural areas. Despite greater resources, these nations struggle to fully address mental health issues related to SRHR, such as post-partum depression, which affects as many as one in seven women, and the psychological outcomes of abortion and infertility treatments35,40,80,81,82.

The importance of intersectionality

The concept of women’s health and rights is deeply influenced by the intersectionality of legal, societal, policy and health advancements (Fig. 2). Intersectionality, a framework introduced by Kimberlé Crenshaw, recognizes that individuals face multiple, overlap** forms of oppression or privilege based on gender, race, socioeconomic status, age, geographical location, sexual orientation or disability status83,84,85. Women’s and girls’ health and rights cannot be fully addressed without considering these intersecting identities, which cumulatively impact their access to healthcare and human rights61,86,87,88,89.

Fig. 2: Intersectionality between women’s health, women’s rights, policy and environment.
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Applying an intersectionality approach requires understanding multiple and intersecting drivers that work together to determine women’s and girls’ ability to realize their health and human rights. CEDAW, Convention on the Elimination of All Forms of Discrimination against Women; GBV, gender-based violence; SRH, sexual and reproductive health.

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Reproductive justice, a term rooted in this intersectional framework, expands beyond reproductive rights to include the physical, social and economic conditions necessary for making autonomous decisions about one’s reproductive health. It encompasses not just the right to have children and to parent children in safe and sustainable communities but also the right to not have children. This broader perspective acknowledges that individual choice is substantially influenced by intersecting social determinants of health and systemic inequalities19,20,49,90,91,92,93. Intersectional issues between women’s and girls’ rights and health manifest in various ways. Women and girls in vulnerable and marginalized communities often face enhanced barriers in accessing quality women-centered healthcare, including reproductive services, due to discrimination and socioeconomic constraints. Reproductive justice highlights the need to address these barriers by ensuring equitable access to comprehensive sexual education, contraception, safe abortion services and respectful maternity care but also the underlying requirement to preserve the overall health and well-being of women (encompassing cancer screening and care, and care for noncommunicable diseases), recognizing that such access is inextricably linked to broader health outcomes and women’s autonomy35,94,95 (https://www.icpd25commitments.org/).

Intersectionality and reproductive justice together draw attention to the pervasive issue of gender-based violence, including practices like genital mutilation, child marriage, harassment at work and sexual exploitation, which disproportionately affect the world’s most vulnerable women and girls and reflect deep-seated power imbalances60,68,96,97,98. Addressing these issues requires multifaceted strategies that include legal reforms, support systems for survivors and initiatives to change harmful societal norms. By embracing an intersectional approach and the principles of reproductive justice, efforts to advance women’s and girls’ health and rights can more effectively tackle the complex, layered challenges they face. This necessitates comprehensive policies and programs that are responsive to the diverse experiences and needs of women and girls across different communities and contexts26,56,66,68,75,96,97.

The way forward in advancing women’s health and rights

The quest for gender equality and the promotion of women’s health and rights are intrinsic components of global development. Acknowledging the multifaceted challenges that women face is key to crafting a comprehensive strategy addressing diverse aspects of women’s well-being42,63,64,99. While it is almost impossible to exhaustively discuss the issues that are sure to impact women’s health and rights, in this section, we outline five essential, actionable priorities for advancing this cause. In particular, we advocate for the need to pursue the unfinished ICPD agenda, alleviate the impacts of climate change, empower women and girls, harness technology to benefit women and girls and promote gender equality in global health leadership.

Implementing the unfinished ICPD agenda

The 1994 ICPD established a forward-looking agenda for women’s and girls’ health and rights including SRHR, while underpinning their importance in achieving sustainable development1,2,9,10,26,100. Delivering this agenda will entail a multi-stakeholder approach focused on policy advocacy, funding allocation and community mobilization targeting key issues like gender equality, enhanced sex education, respectful maternity care, universal family planning access, upholding women’s and girls’ bodily autonomy and the eradication of harmful practices13,14,64,100,101.

Thus, governments worldwide and especially in the most burdened countries must be supported to reinforce their commitment, aligning national laws and policy frameworks with ICPD principles. This requires bolstering international cooperation and partnerships and advocating for substantial investments in high-impact comprehensive sexual and reproductive health services, which remain underfunded, but would provide a substantial return on investment. For example, the Guttmacher Institute highlights that meeting the need for modern contraception in develo** regions could prevent 76,000 maternal deaths each year, underscoring the potential of targeted interventions13,63,102.

Advocacy groups, civil society and nongovernmental organizations also have pivotal roles in mobilizing support and pushing for policy reforms, while international bodies like the United Nations Population Fund and WHO can leverage their influence to ensure that nations adhere to their ICPD commitments. Simultaneously, researchers and healthcare professionals must contribute by generating strong evidence on barriers to access and best practices in women’s sexual and reproductive healthcare and should specifically make the case for its integration into primary health services to ensure widespread accessibility, affordability, acceptability and safety of services39,45,49,81,103. By prioritizing SRHR within the global development agenda and ensuring adequate resource allocation, the vision of the ICPD can move closer to realization.

Mitigating the impact of climate change on SRHR

Extreme weather events, changing ecosystems and resource scarcity impact women’s access to healthcare, exacerbating maternal and reproductive health risks17,104. Furthermore, women often have pivotal roles in agriculture and resource management, making them vulnerable to climate-induced disruptions16.

Addressing these issues requires recognizing women’s rights as integral to sustainable development, empowering women in climate adaptation efforts and ensuring equitable healthcare access17,105,106. Addressing the gender-specific impacts of climate change on women’s health requires a comprehensive and intersectional approach88,104. Policymakers and healthcare providers must recognize the unique vulnerabilities of women in the face of climate-related challenges and work toward develo** adaptive strategies.

A key actionable priority should be to integrate climate change considerations into the design and implementation of policies and services relating to women’s SRHR16,107. Health infrastructure needs to be able to ensure continuous access to essential reproductive health services during emergencies. More specifically, infrastructure and policies must address the increased vulnerability of pregnant women during extreme weather events and must ensure the availability of contraceptives and maternal healthcare in the aftermath of disasters, for example, by preventing commodity shortages and promoting self-care where applicable16,104,106. Also, it is important to invest in education and awareness campaigns, as these are essential to inform communities about the intersection of climate change and health, fostering resilience and preparedness16,104,106,107. Ultimately, by integrating climate change adaptation measures into SRHR programs, we can ensure that women are not only protected from the immediate impacts but are also equipped to navigate the long-term challenges posed by environmental changes.

Empowering women and girls

Empowerment lies at the core of advancing women’s health and rights and encompasses a range of strategies and approaches aimed at fostering autonomy, education, economic independence and dismantling discriminatory norms and practices. Thus, it is utterly vital today to empower women and girls to make informed choices about their bodies toward fostering gender equality, while simultaneously addressing social and economic inequalities that bar women from achieving optimal levels of well-being18,26,64,99. This includes empowering women and girls to make decisions about the size of their families, providing them with the information and resources to make such decisions and enabling them to exercise their reproductive rights. This would not only result in better maternal, newborn and child health outcomes but would ultimately lead to more empowered and resilient communities in the face of environmental challenges3,35,42,64,108.

Quality education is a powerful catalyst for empowerment of women and girls and will be fundamental to break the cycle of poverty and empower future generations84,94,109. Comprehensive sexual education is also crucial in equip** women and girls with the knowledge and skills to make informed decisions about their bodies and health91,92,110. Furthermore, economic empowerment programs must have a pivotal role in enhancing women’s agency via initiatives such as microfinance programs, vocational training and support for female entrepreneurship. Economic vulnerability amplifies existing inequalities for women and girls and contributes enormously to the challenges women face in accessing healthcare and exercising their rights37,40,88,90. By creating economic opportunities, women are more likely to gain financial independence, enabling them to access healthcare services, including reproductive health services, on their own terms7,95,111,112.

Above all, efforts to eliminate discriminatory practices and norms must be intensified. This includes addressing gender-based violence, child marriage and harmful traditional practices, while legal frameworks that protect women’s rights and awareness campaigns need to be enforced toward changing societal attitudes and perceptions that perpetuate discrimination60,66,68,76. Also, increasing the involvement of men and boys in gender equality initiatives is crucial. By challenging and transforming traditional gender roles and fostering an environment of mutual respect, we can create a society where women and girls are empowered to make choices that positively impact their health and rights68,76,96,111.

Technology for women’s health and rights

Sadly, access to information and education remains a substantial hurdle for many girls and women, particularly in regions with entrenched gender biases28,37,113. In an increasingly digital world, however, technology (when leveraged effectively) can be a powerful tool for informing, educating and empowering women. The digital gender divide, which manifests via disparities in digital literacy and access to technology, still persists, thereby limiting women’s ability to participate fully in the digital economy, access online health information and engage sustainably in advocacy efforts21,24,99,114. Digital literacy programs, online platforms for education and employment, and initiatives that bridge the digital gender divide will enhance women’s participation in not only their healthcare but also in the rapidly evolving global landscape21,22,23,24, and such interventions should therefore be a priority.

Telemedicine stands out as a particularly transformative tool in providing rights-based and respectful reproductive health services, especially in remote or underserved areas22,89,113,115,116. Virtual consultations enable women to access healthcare professionals without the associated geographical constraints, thereby addressing mobility- and infrastructure-related health system gaps117,118. Mobile applications can also have a vital role in delivering high-quality health information and education materials on key issues like menstrual health, family planning, maternal care and gender-based violence21,23,67,89,119. Thus, innovative technologies can enhance the accessibility and acceptability of key health interventions for women and girls, while tailoring these to their diverse needs and preferences.

Ensuring digital literacy among women is critical in harnessing the full potential of technology. It is important that, going forward, countries and organizations should invest in the implementation of training programs aimed at empowering women to navigate digital platforms, access information and use technological tools for their health and rights, thereby preventing technology from becoming a source of further inequality23,24,113,115,119. Innovative research and development in digital health should be encouraged, with a focus on creating solutions that are girl and woman friendly, gender and culturally sensitive, available and affordable115,116,117,118.

Thus, by leveraging telemedicine and mobile health services, key health information, health access and referral gaps can be addressed, ensuring continuity of care for women and girls living in remote or affected communities or displaced by climate events22,23,89,115,116. Moreover, digitalization is key to creating low carbon-emitting healthcare systems and thus addressing the health sector’s 5% share of global greenhouse gas emissions120,121,122. Going forward, it is therefore important to invest in implementation research as well as digital solutions seeking to address the intersection between climate and women’s health and rights. Navigating this intersection requires adapting legal frameworks and societal norms to the evolving digital landscape and ensuring that women can harness the benefits of technology while safeguarding their rights and well-being.

Gender equality in global health leadership

Discrimination, stereotypes and systemic barriers still hinder women’s participation in decision-making processes, and, globally, women remain under-represented in decision-making spheres, even on issues relating to women’s well-being4,7,95,123. In the twenty-first century, the pursuit of gender equality within global health leadership is not just essential to global development but also critical to creating environments where women and girls thrive124. Today, gender equality should not just be seen as a matter of fairness but rather an unconditional strategic imperative for promoting women’s health and ensuring that their rights are upheld worldwide. Gender equity in health leadership will be crucial for addressing the pervasive disparities in health outcomes61,65,75,125.

Women leaders in global health bring perspectives that are often overlooked in an exceedingly male-driven ecosystem, leading to more inclusive and effective policies and interventions65,111,126,127. These informed perspectives are very much needed today and essential for fostering an environment where women can contribute not only to their own health and well-being but ultimately to positive societal transformation. Women and girls can therefore lead the process of dismantling systemic barriers that continue to hinder women’s advancement, such as discriminatory hiring practices, unequal pay and limited opportunities for career progression124.

Empowering women in leadership positions sets a precedent for inclusivity and creates role models for the next generation of women in healthcare worldwide. Efforts to promote gender equality in global health leadership must also consider intersectionality33,89,128,129,130 to facilitate comprehensive health policies that address the diverse needs of women from different backgrounds, toward creating an inclusive and equitable healthcare system.

Conclusion

The future of women’s health and rights demands a multifaceted and dynamic approach, ultimately aimed at promoting the health, autonomy and economic empowerment of women. International collaborations are indispensable in the pursuit of this goal, by fostering knowledge exchange, supporting advocacy efforts, addressing cross-border challenges and facilitating resource allocation. As the world becomes ever more interconnected, collaboration and inclusive digital advancement will help to shape a future in which every woman can exercise her rights and enjoy optimal health. As we advance, adopting a global perspective that broadens the scope of women’s health beyond maternal or reproductive health to encompass comprehensive well-being including emerging challenges like noncommunicable diseases is essential for aligning with the ICPD and SDG agendas100. Through concerted efforts, we can shape a world where women’s health and rights are not just aspirations but lived realities.