The ESC Madrid Declaration: promoting evidence-based SRHR policies with respect for human rights

Despite many advancements in the past decades, we are currently being confronted with a threat of regression of SRHR. In several European countries, SRHR-related policies and laws have been made more restrictive. The situation in Poland is particularly worrying, as abortion is severely restricted in the country and the emergency contraception pill is no longer freely available. These restrictive policychanges are influenced by ultra-conservative forces that are actively working against progress in SRHR and advancements in gender equality [1]. They oppose access to contraception and safe and legal abortion, deny the need for comprehensive sexuality and reproductive health education (CSRE) and want to roll-back the rights of LGBTI-people. They want to promote the so-called ‘traditional’ family and do not want to protect the rights of minorities that do not fit in this picture. The ultra-conservative forces Europe have been extremely well-organised in their campaigns to roll back human rights for SRH. The European Parliamentary Forum for sexual and reproductive rights (EPF) launched a report which provides insight into the clandestine workings and deliberate strategy of the anti-choice advocacy network ‘Agenda Europe’, which is driven by religious dogma [2]. Agenda Europe was established in 2013 and holds annual summits attended by over 100 anti-SRHR activists from all over Europe. Being aware and understanding this ultra-conservative movement is essential for those who want to safeguard a modern, inclusive and tolerant Europe. The European Society of Contraception and Reproductive Health (ESC) has been increasingly worried about the appearance of these anti-gender views and publicity, and is concerned that this might undermine the organisation’s aim to improve and facilitate knowledge on SRHR. Therefore, the ESC decided to draft a Position Paper on SRHR that was launched in September 2019 in Madrid at the World Contraception Day event organised by the Spanish Society of Contraception. The decision to develop this paper was also triggered by the inspirational and comprehensive report from the Guttmacher-Lancet Commission that was launched in 2018 and proposed a new, comprehensive definition of SRHR, an associated essential package of health services, and outlines several actions needed within and beyond the health sector to uphold human rights [3]. The Madrid Declaration is based on this report but focuses in particular on the European perspective and is therefore relevant for all 53 states within the WHO Europe region. The paper is an important contribution to ongoing discussions in European governments and civil society on a wide range of SRHR-related issues. It highlights in particular the importance of evidence-based decisionmaking and respect for human rights when planning and implementing SRHR policies. Evidence-based medicine and policy-making