Reproductive Healthcare and Global Women

Transcription

1 Reproductive Healthcare and Global Women Elyse Johnson Minnesota Women s Consortium August 2, 2012

2 Women s contraceptives are not just used to prevent pregnancy but can transform women s lives. Access to contraceptives drives female empowerment and gender equality, and those things materialize the possibility of a better home, community, state, and world. The United Nations Millennium Development Goals of Sexual and Reproductive Health represent a worldwide initiative to bring women s health issues to the forefront of global conversation. These goals are to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, to improve maternal health, combat HIV/AIDS, malaria and other diseases, ensure environmental sustainability, and develop a global partnership for development. 1 All of these goals are dependent on the health and well being of women. In the Guttmacher Institute s Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health the obvious benefits of investing in female health are explained: More effective action is needed now, especially given the strong evidence of the benefits of investing in the health of women and their newborns: fewer unintended pregnancies; fewer maternal and newborn deaths; healthier mothers and children; greater family savings and productivity and better prospects for educating children, strengthening economies and reducing pressure on natural resources in developing countries. 2 The irrefutable benefits of contraceptives are numerous, ranging from ending the AIDS pandemic, to communities saving money on public-sector health. Of course, all of these things would in turn contribute to improving the status of women, increasing family savings, reducing poverty and spurring economic growth. 3

3 This same report states the benefits of higher contraceptive use. In 2008, 188 million unintended pregnancies were prevented, 1.2 million newborn babies were saved from death, and the lives of 230,000 mothers were protected with the prevention of maternal deaths. But despite these facts, the human right to family planning is still up for debate. Michelle Bachelet, the Executive Director of UN Women, expands on this, speaking at the Panel on Ensuring Equity and Promoting Rights including those of young people: The right to voluntarily choose whether or not to marry, whether or not to establish a family, the right to decide on the number, timing and spacing of children, the right to have access to the information and means needed to exercise voluntary choices, the right to the highest attainable standard of health, including sexual and reproductive health, are all universal human rights. When women and girls are able to exercise this human right, there are tremendous benefits not only for women themselves, but also their families, communities and nations. Sexual and reproductive rights are essential to allow women to enjoy most of their other rights and to empower them to fully participate in the economic and political life of their communities. Sexual and reproductive rights are in this respect truly essential to the development and to the kind of sustainable development we just agreed on in Rio 4. In the last 60 years, there has been an increase in the use of what we call modern contraceptives; however, there are extreme disparities based on gender, culture, race, and class. While in certain parts of the world contraceptives are readily available, there are regions where access is almost impossible. In the article Poverty and the Pill by Nicholas Kristof, the disparity among access

4 is mentioned, So the pill, 50 years old this month in the United States, has yet to reach parts of Africa. And condoms and other forms of birth control and AIDS prevention are still far too difficult to obtain in some areas 5. The authors of Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health agree, stating that the increase of contraceptives has been moderate, especially in Africa: Modern family planning methods have played a major role in the shift to smaller families in the developing world since they started to become available in the Increases in use have been gradual in recent decades: In developing countries, 56% of married women aged used modern contraceptives in , compared with 47% in At 21%, use was considerably lower in Africa in than in other regions 6. Within the international community there have been different attempts at furthering reproductive healthcare and making contraceptives a reality in women s lives. Melinda Gates has been doing great work in her continuous fight to make birth control an issue in the global community (through the Bill and Melinda Gates Foundation). Gates has done well in combating the criticism that is unfortunately unavoidable when discussing contraceptives, as Matthew Herper points out in a recent article in Forbes 7. Herper states that in fact over a billion couples use birth control, but the use of it is controversial because of ethics regarding population control, abortion, etc. And because of this, 200 million people lack access to contraceptives. Georgetown University s Institute for Reproductive Health was awarded the Fertility Awareness- Based Methods (FAM) Project in 2007 by the United States Agency for International Development (USAID). Through this 5-year endeavor, there have been many successful programs, including the GREAT Project in Northern Uganda, developed through Georgetown

5 University s Institute for Reproductive Health, Pathfinder International, and Save the Children. The uniqueness of culture is something to be understood and explored when furthering reproductive health, as information on the GREAT Project explains: Evidence suggests that gender norms- social expectations of appropriate roles and behaviors for men (and boys) and women (and girls), and the transmission of these norms by institutions and cultural practices- directly influence sexual and reproductive health (SRH) related behaviors and incidence of gender-based violence (GBV). After 20 years of civil strife, women and girls living in Northern Uganda, are particularly vulnerable to GBV and SRH risks like unintended pregnancy and sexually transmitted infections stemming from the massive disruption of services, internal displacement, erosion of traditional social and family structures and high poverty rates which resulted from the conflict 8. Georgetown also developed the Standard Days Method, which uses a visual structure to help women identify her most fertile times. Therefore, she can avoid unprotected sex on the days in which she is most fertile. These methods may not be somewhat of a compromise, but it does provide individuals with some form of family planning and an understanding of reproductive cycles. The Director of the Institute, Victoria Jennings, states that Fertility Awareness Methods may be the most useful in developing countries. She continues, It s something that she doesn t have to necessarily even engage with a health care provider around. This is something that is just something that is natural for her body. Ease of access and understanding is also discussed in the Guttmacher Institute s Access, Quality of Care and Medical Barriers in Family Planning Programs 9. The Standard Days Method attempts to remove medical barriers based on its

6 simple structure. But while medical barriers must be at a minimum, we are reminded that quality must be assured. In Access, Quality of Care and Medical Barriers in Family Planning Programs it is written, the climate now exists for pursuing improvements in quality and access simultaneously. 10 There was an article recently published by the LA Times 11 that also reflects the cultured controversy over contraceptives. This particular story was about a family in the Philippines, a state that banned contraceptives at public clinics under the control of Roman Catholic bishops. Of course, the poorest families took the heat of this decision. Families such as the one of Yolanda Naz and her husband spend their days worrying about how they will provide the most basic care for their children. Thankfully a reproductive health bill hopes to change this reality, offering government subsidies for contraceptives as well as more education on sexual health and family planning. Although this bill is supported by 70% of the population, it still has not been passed. According to the article, the U.S. Agency for International Development contributed about 400 million dollars to help make contraceptives available to citizens of the Philippines. The Bush administration ended that help under the thought that the government needed to take more initiative. Also noted was the trouble that arises out of a lack of contraceptives, such as the risks that inevitably come with illegal abortion. Yolanda Naz states, When I go to Mass, I hear the priest give sermons saying that pills are bad, but whenever I hear that, I just say to myself that for me, it s not evil, it s not bad or it s not sinful What is more sinful is to have more children than I can afford to feed 12.

7 There is continuous work being done to solve these problems, such as The Family Planning Summit, which took place July 11 in London. This summit was primarily hosted by the UK Department for International Development (DFID) and the Bill and Melinda Gates Foundation. The event focused on developing countries and their lack of access to safe and effective family planning. The Family Planning Summit established a goal of providing 120 million more women and girls with family planning services by Andrew Mitchell, Secretary of State for International Development, states: This is a breakthrough for the world's poorest girls and women, which will transform lives, now and for generations to come. The commitments made at the Summit today will support the rights of women to determine freely, and for themselves, whether, when and how many children they have. Enabling an additional 120 million women in the world s poorest countries to access and use contraception, something women in the developed world take for granted, will save millions of lives and enable girls and women to determine their own futures. 13 Before the summit took place, an article titled "Family Planning Summit Could Mark Turning Point for Maternal Health" expanded on its importance. The Millennium Development Goal aimed at improving maternal health continues to be a goal that still requires a critical amount of time and effort. It is explained that far too many women continue to die by pregnancy and childbirth. By expanding family planning and emphasizing maternal health, we can work towards meeting out MDGs. And if we fail to invest in this, the article states that it would be a betrayal of the most vulnerable people and communities on our planet and an affront to our sense of justice. 14

8 Ewen MacAskill also notes in a similar article published by The Guardian that family planning through the UN Population Fund took a serious cut during the presidency of George W. Bush, with the administration claiming that it financed forced abortions. Since then, we have been making up for lost ground during those years with the Obama administration. Babatunde Osotimehin, the executive director of the UN Population Fund, states that family planning enables women to take charge of their lives and for young people to plan their lives. It empowers a woman to do what they want to do in terms of the number of children they want to have and can afford. It is important to note that since other countries have put more effort into family planning, they have been able to place money into other areas, such as education. This is why the summit is focusing on the poorest 69 countries of the world with the lowest access to contraceptives. 15 The Vienna Human Rights Conference and the Fourth World Conference on Women placed priority on violence against women and how that is connected to reproductive health. According to the United Nation s Population Fund, violence against women has a considerable effect on unwanted pregnancies, unsafe abortions, sexually transmitted infections, complications from high-risk pregnancies, and psychological problems. 16 These factors perpetuate gender-based discrimination, leaving it harder and harder for women to live productive and happy lives. The Beijing Platform for Action, which was a part of the United Nations Fourth World Conference on Women and one of the Minnesota Women s Consortium s guiding platforms, specifically addresses women s contraceptive healthcare. The following paragraph specifically

9 addresses the issues that the Affordable Care Act in the United States is going to solve. Paragraph 91 addresses the concerns that arise out of privatized healthcare and how those concerns disproportionately affect women. In many countries, especially developing countries, in particular the least developed countries, a decrease in public health spending and, in some cases, structural adjustment, contribute to the deterioration of public health systems. In addition, privatization of health-care systems without appropriate guarantees of universal access to affordable health care further reduces health-care availability. This situation not only directly affects the health of girls and women, but also places disproportionate responsibilities on women, whose multiple roles, including their roles within the family and the community, are often not acknowledged; hence they do not receive the necessary social, psychological and economic support. 17 The United Nations Foundation has agreed, every woman deserves the fundamental right to quality reproductive care, as it is critical not only to her own well-being, but also to the wellbeing of our world. The United Nations Foundation s Universal Access Project is dedicated to giving every woman in the world the access needed to reproductive healthcare. Also found in the Beijing Platform for Action, is the agreement that reproductive rights are a part of a standard of human rights that are recognized in national and international laws. In compliance with this standard, the promotion of the responsible exercise of these rights for all people should be the fundamental basis for government- and community-supported policies and programs in the area of reproductive health, including family planning. 18

10 At the AIDS 2012: XIX International AIDS Conference, Secretary of State Hillary Clinton spoke on the importance of access to adequate healthcare and reproductive services and women s role in preventing the spread of HIV/AIDS. Secretary Clinton expands on what the United States is doing in changing the lives of women and girls across the globe, The United States is emphasizing gender equality because women need and deserve a voice in the decisions that affect their lives. And we are working to prevent and respond to gender-based violence, which puts women at higher risk for contracting the virus. 19 Gender equity is a topic that Secretary Clinton has explored and emphasized in her years in politics, and it is something that is directly related to contraception use in Gender Equity and Women s Contraception Use by Rebecca Bentley and Anne Marie Kavanagh. Bentley and Kavanagh are sure to indicate that structural, social, cultural and political characteristics shape population-based indicators of contraception use and those factors play a role in the variance among the percentage of women that use contraceptives, especially in middle to high-income countries. Their study suggests gender inequality may have a stronger association with contraception use for women with lower levels of education. Knowing this, we affirm the notion that providing proving poor women contraceptives requires an enormous amount of money and time. 20 The amount of time, effort, and money needed to ensure women s global access to contraceptives is undoubtedly fierce, yet we must know that this access is necessary to ensure that human rights are met. Knowing the United Nation s founding charter, our goal is to achieve international co-operation... in promoting and encouraging respect for human rights and for

11 fundamental freedoms for all without distinction as to race, sex, language, or religion. As we consider our own differences in this quest for health and equality around the world, we can stand firm in the belief that contraceptives should not be a political issue, but in fact a reality in every woman s life. It should be our goal to grant every woman access to affordable, quality family planning.

12 1 Millennium Project. (2006). MDGs. Retrieved August 9, 2012, from 2 Singh, S., Darroch, J.E., Ashford, L.S., & Vlassoff, M. (2009) Adding it up: The costs and benefits of investing in family planning and maternal and newborn health (p. 4). Retrieved July 11, 2012, from 3 Singh, S., Darroch, J.E., Ashford, L.S., & Vlassoff, M. (2009) Adding it up: The costs and benefits of investing in family planning and maternal and newborn health (p. 5). Retrieved July 11, 2012, from 4 Bachelet, M. (2012). Ensuring equity and promoting rights including those of young people. Proceedings of the Panel on Ensuring Equity and Promoting Rights. London. 5 Kristof, N. (2010). Poverty and the pill. New York Times. Retrieved August 2, 2012 from 6 Singh, S., Darroch, J.E., Ashford, L.S., & Vlassoff, M. (2009) Adding it up: The costs and benefits of investing in family planning and maternal and newborn health (p. 9). Retrieved July 11, 2012, from 7 Herper, F. (2012). Melinda Gates fights to put birth control on the global agenda and save children s lives. Forbes. Retrieved August 9, 2012, from 8 Georgetown Institute for Reproductive Health. (2009). GREAT project, Northern Uganda. Retrieved July 19, 2012 from 9 Bertrand, J.T., Hardee, K., Magnani, R.J., and Angel, M.A. (1995). Access, quality of care and medical barriers in family planning programs [Electronic version]. International Family Planning Perspectives 21(2), Bertrand, J.T., Hardee, K., Magnani, R.J., and Angel, M.A. (1995). Access, quality of care and medical barriers in family planning programs [Electronic version]. International Family Planning Perspectives 21(2), Weiss, K.R. (2012). Philippines birth control: Filipinos want it, priests don't. LA Times. Retrieved August 9, 2012 from 12 Weiss, K.R. (2012). Philippines birth control: Filipinos want it, priests don't. LA Times. Retrieved August 9, 2012 from 13 Bill and Melinda Gates Foundation. (2012). Landmark summit puts women at heart of global health agenda. Retrieved August 9, 2012 from

13 14 Bill and Melinda Gates Foundation. (2012). Landmark summit puts women at heart of global health agenda. Retrieved August 9, 2012 from 15 MacAskill, E. (2012). Global summit aim to reverse years of family planning neglect. Retrieved July 19, 2012 from 16 United Nations Population Fund. (n.d.). Ending widespread violence against women. Retrieved August 9, 2012 from 17 United Nations Population Fund. (n.d.). Ending widespread violence against women. Retrieved August 9, 2012 from 18 UN Women. (n.d.) The United Nations fourth conference on women: Platform for action: Women and health. Retrieved August 9, 2012 from 19 Clinton, H. (2012). Proceedings of the 2012 International AIDS Conference. Washington, DC. 20 Bentley, R. & Kavanagh. A.E. (2008). Gender equity and women s contraception use. Australian Journal Of Social Issues 43(1),