"The fact is that women have been trapped. Reproduction is used, consciously or not, as a means to control women, to limit their options and to make them subordinate to men. In many societies a serious approach to reproductive health has to have this perspective in mind. We must seek to liberate women."
The importance of good health and education to a woman's well-being - and that of her family and society - cannot be overstated. Without reproductive health and freedom, women cannot fully exercise their fundamental human rights, such as those relating to education and employment. Yet around the world, the right to health, and especially reproductive and sexual health, is far from a reality for many women. According to the World Bank, a full one-third of the illness among women ages 15-44 in developing countries is related to pregnancy, childbirth, abortion, reproductive tract infections, and human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS).
Women's disproportionate poverty, low social status, and reproductive role expose them to high health risks, resulting in needless and largely preventable suffering and deaths. Many of the women and girls who die each year during pregnancy and childbirth could have been saved by relatively low-cost improvements in reproductive healthcare; yet high levels of maternal mortality persist. The benefits of eliminating the harmful and painful practice of female genital mutilation are easily demonstrated, yet it persists for cultural and traditional reasons. And a large proportion of abortions, some resulting in death and injury, would be avoided if women and men had access to safe, affordable and effective means of contraception.
Women's health status is affected by complex biological, social and cultural factors which are interrelated and can only be addressed in a comprehensive manner. Reproductive health is determined not only by the quality and availability of health care, but also by socio-economic development levels, lifestyles and women's position in society. In fact, the International Federation of Gynecology and Obstetrics asserts that improvements in women's health require state action to correct injustices to women. In its 1994 World Report on Women's Health, the Federation states that women's health is often compromised not by lack of medical knowledge, but by infringements on women's human rights.
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Over the years, a human rights-based approach to reproductive health has evolved which emphasizes the rights to health, to have children by choice, and to have a safe and satisfying sex life. It is now recognized that women have the right to the fullest enjoyment of health throughout their life cycle.
Since the right to family planning was enshrined in 1968 at the Teheran Human Rights Conference, the value of family planning and of individuals and couples being able to make their own childbearing decisions has been widely accepted. Today, 60% of all couples are planning when to have children by using contraception, and family size is falling in most areas of the world.
The 1994 International Conference on Population and Development in Cairo and the 1995 Fourth World Conference on Women held in Beijing expanded the right to family planning to include the right to better sexual and reproductive health. Building on the World Health Organization's definition of health, the Cairo Programme defines reproductive health as:
a state of complete physical, mental and social well-being and...not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition are the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant (para 72).
Furthermore, the Cairo Programme of Action clearly spells out the concept of reproductive rights in Chapter 7 which states in part that such rights "rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of reproductive and sexual health. It also includes the right of all to make decisions concerning reproduction free of discrimination, coercion, and violence as expressed in human rights documents."
The Platform for Action, which was adopted by 189 delegations at the Beijing Women's Conference, reaffirms the Cairo Programme's definition of reproductive health and advances women's wider interests. Paragraph 96 states:
"The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. Equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behaviour and its consequences."
"Much of the violence against women occurs in the context of sexuality and reproduction. The health consequences of violence often occur in the context of reproductive health and seriously contribute to the burden of disease in women and young people."
Gender-based violence is a profound human rights abuse and health problem for women around the world. Recent World Bank estimates of the global burden of the disease indicate that in established market-based economies gender-based victimization is responsible for one out of every five healthy days of life lost to women of reproductive age.
Gender violence can occur throughout a woman's lifecycle. Types include sex-selective abortion, battering during pregnancy, coerced pregnancy through rape, female infanticide, differential food and medical care for girls, child marriage, genital mutilation, child prostitution, dating and courtship violence, psychological abuse, marital rape, sexual harassment, trafficking in women, dowry abuse and murder, and abuse of elderly women.
Increasingly, reproductive health services are dealing with the issue of violence. Morning-after pills to prevent pregnancies resulting from rape are being dispensed, and health clinics are offering counselling and support services for victims of abuse and violence. The Beijing Platform for Action contains an entire chapter on violence against women, which outlines concrete policies to combat this global threat to women and girls.
| In December 1996, the UN Population Fund (UNFPA) and the International Organization for Migration (IOM) signed an agreement to pursue joint efforts to combat sexual violence, particularly against migrant women and girls, as well as enhanced reproductive health programmes for migrants. The agreement also calls for close cooperation in advocacy, research, and technical cooperation between the two agencies. |
More than half the world's population is under the age of 25, and a significant number of adolescents are sexually active. From birth through childhood and adulthood, girls and women need effective services and information to enable them to lead healthy productive lives. Boys and men also need information and services that contribute to responsible behaviour and equal treatment of women and girls.
It is estimated that about 15 million teenage women give birth each year, accounting for up to one-fifth of all births worldwide. And every year, 1 out of 20 teenagers contracts a sexually transmitted disease. To reduce the rising instances of teenage pregnancy and sexually transmitted diseases among young people, the Cairo and Beijing texts call for the removal of regulatory and social barriers to reproductive health information and care for adolescents.
The increasing emphasis on the right to reproductive and sexual health is changing the way family planning services are devised and provided. Some non-governmental groups that provide family planning services, like Profamilia in Colombia, are now staffing their clinics with legal advisers. Women who come for reproductive health services have access to advocates who can educate them about their rights and counsel them if these have been violated.
At the national level, Guyana has enacted components of a reproductive health law. State policies that protect and promote reproductive health within a wider programme of women's health have been enacted in Colombia and Brazil. South Africa has included provisions on reproductive rights in its new Constitution which was signed by President Nelson Mandela on 10 December 1996. Unlike most constitutions, which include reproductive rights in the form of general rights -- to equality, freedom and security of the person, dignity, privacy, freedom of conscience and the right to life -- the South African Constitution specifically refers to reproductive rights.
One clause of the South African Constitution outlaws discrimination on the grounds of pregnancy. Another clause states that everyone has the right "to be free from all forms of violence from both public and private sources". This clause guarantees bodily and psychological integrity which specifically includes the right "to make decisions concerning reproduction" and "to security and control over bodies". Decisions concerning reproduction can include decisions related to family planning, pre-natal care, safe delivery and post-natal care, as well as prevention and treatment of reproductive tract infections, sexually transmitted diseases and abortion.
The Cairo and Beijing documents recommend that the health professions develop, disseminate and implement ethics codes to ensure practitioners' conformity with human rights and ethical and professional standards. In March 1994, before the Population Conference in Cairo, experts developed a Declaration of Ethical Propositions at a meeting sponsored by the Development Law and Policy Program of Columbia University's Center for Population and Family Health, and the United Nations Population Fund (UNFPA). The principles stress human dignity and respect, the right to reproductive and sexual health care and information, an equitable allocation of health services, and freedom from coercion. The Declaration concludes that "reproductive rights and reproductive health are part of a broader human good that every society should aim to achieve for all its members...To address these issues ethically, governments cannot compartmentalize their efforts but must devise strategies that are broadly integrated with social and economic development, improved education and political and legal reform."
Ethical guidelines have also been developed by medical associations such as the International Federation of Gynecology and Obstetrics and the Commonwealth Medical Association. Another promising sign is the elaboration of a Charter on Sexual and Reproductive Rights by the International Planned Parenthood Federation (IPPF), which was approved by the organization's governing body and 127 member associations in 1995. The Charter, which provides an ethical framework for IPPF's work, defines 12 rights. These include the rights to life, liberty and security of the person, equality and to be free from all forms of discrimination, privacy, freedom of thought, to information and education, to choose whether or not to marry and to found and plan a family, to decide whether and when to have children, to health care and health protection, to the benefits of scientific progress, to freedom of assembly and political participation, and to be free from torture and ill treatment.
Human rights activists have long argued that governments must be held accountable for all forms of discrimination against women, and they are increasingly urging that governments be specifically held accountable for violations of reproductive rights. Although these rights were clearly elaborated at the Cairo Population Conference in 1994 and the Beijing Women's Conference in 1995, it is clear that they will mean little to the well-being of women and men, if national, regional and international human rights instruments are not used to ensure governments' compliance with their Cairo and Beijing commitments.
Widespread recognition of the legal foundations for such claims form a first step in ensuring that reproductive rights become reality. In addition to the Cairo and Beijing documents, women's reproductive rights under international human rights law are a composite of a number of separate human rights treaties including the Universal Declaration of Human Rights; the International Covenant on Economic, Social and Cultural Rights; the Convention on the Elimination of All Forms of Discrimination against Women; and the International Covenant on Civil and Political Rights. The rights of girls and mothers are protected under the Convention on the Rights of the Child.
International efforts are under way to increase cooperation between United Nations agencies, non-governmental organizations and human rights treaty bodies to better promote, implement and monitor health-related rights, especially reproductive and sexual rights.
The UN Commission on the Status of Women will consider women and health in 1999 as part of its follow-up to the Beijing Women's Conference. In 1998, the Commission will review collaboration between United Nations agencies on this and other issues.
Women's right to health, and reproductive health in particular, is essential to gender equality and female empowerment. The benefits of better reproductive health for both women and men can easily be demonstrated, from the point of view of society as well as the individual. In addition to saving lives and preventing infection and suffering, better reproductive health will lead to smaller families and slower population growth.
An emphasis on human rights obligations is a tool in the battle to secure reproductive and sexual health. It reinforces the fundamental point that reproductive health programmes are essential to protect the dignity of men and women -- something governments are obligated to do.
For further information contact:
Development and Human Rights Section,
Department of Public Information
Room S-1040, United Nations, New York, NY 10017
tel.:(212) 963-3771, fax: (212) 963-1186,
Email: vasic@un.org
or
United Nations Population Fund (UNFPA)
tel: (212) 297-5052, fax: (212) 557-6146
Email: Ryan@unfpa.org
Internet: http://www.unfpa.org