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This article suggests that sexual and reproductive health and rights activists seeking to influence the post-2015 international development paradigm must work with sustainable development advocates concerned with a range of issues, including climate change, environmental issues, and food and water security, and that a way of building bridges with these communities is to demonstrate how sexual and reproductive health and rights are relevant for these issues. An understanding of population dynamics, including urbanization and migration, as well as population growth, can help to clarify these links. This article therefore suggests that whether or not sexual and reproductive health and rights activists can overcome resistance to discussing "population", become more knowledgeable about other sustainable development issues, and work with others in those fields to advance the global sustainable development agenda are crucial questions for the coming months. The article also contends that it is possible to care about population dynamics (including ageing and problems faced by countries with a high proportion of young people) and care about human rights at the same time. It expresses concern that, if sexual and reproductive health and rights advocates do not participate in the population dynamics discourse, the field will be left free for those for whom respecting and protecting rights may be less of a priority.

This paper analyses the impact of decentralisation on the political organisation, management and provision of sexual and reproductive health services in Ghana. It draws on qualitative research and interviews with key informants from the Ministry of Health, donors, NGOs, regional and district health management teams, local government and community leaders. Within a national reproductive health policy framework, previously disparate family planning, maternal and child health, STI and HIV/AIDS programmes have become more integrated, and donors have pooled or co-ordinated their funding. Some decision-making about resource allocation is meant to happen at district and regional level but in practice, this remains centrally controlled, which may be a necessary safeguard for sexual and reproductive health services. Earmarked donor funds still ensure a regular supply of contraceptives and STI drugs. However, paying for these is problematic at local level. Sexual and reproductive health staff make up a large proportion of primary health care staff, but especially in rural areas they experience poor working conditions, and there is high turnover and vacancies. District and sub-district level links are working well in this new system, but clarity is still needed on how different national sexual and reproductive health bodies relate to each other and to regional and district health authorities. The development of formal mechanisms for priority setting and advocacy at local levels could help to secure benefits for sexual and reproductive health care.

Ghana, like many countries, has taken up the call to integrate STI management with MCH/FP services. Since 1994 a range of policies has been developed on safe motherhood and family planning, as well as syndromic STI management guidelines for 'mid-level' staff and an all-encompassing 'reproductive health' policy. The success of these policy initiatives depends to a large extent on the processes and contexts of implementation, yet analysis of this has rarely been undertaken. This paper analyses the rural context of policy implementation in the rural Upper East Region of northern Ghana and suggests that a 'blanket' policy to integrate STI and FP/MCH services may be inappropriate in particular contexts. It illustrates how the implementation of health policies is influenced--and often impeded--not only by local service contexts, economic and epidemiological factors but also by culturally defined social attitudes and behaviours. These can influence not only whether a policy is accepted by a population but also how it is implemented by health staff. Future reproductive health policy needs to address these issues in order to develop goals which can realistically be implemented in specific settings. Enhancing at district level the voice of nurses working at community level and promoting collaborative, culturally-specific and community-based initiatives could facilitate this.