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by. M.Hakimi
Introduction
According to the constitution of the World Health Organization, the right to health is one of the most basic of human rights:
“The enjoyment of the highest attainable standard of health is one of the fundamental rights every human being without distinction of race, religion, political belief, economic or social condition”
This means that everyone has the right to live in conditions with the minimum of health risks and with free access to health care.
Many women in various countries are being denied this basic human right. Their social discrimination is being reflected by the lack of this basic human right. Women’s health is limited by discrimination, in its broadest sense, against the female sex. Restrictive factors are on the one hand the socioeconomic or social discrimination of women, and on the other hand, discrimination in the health sector, in matters concerning their biological make-up, i.e. reproductive role. The consequences can be observed in all social areas. The situation of women lags behind that of men in almost all aspects of the economy and health. Women therefore constitute a disproportionately large section of the poor in all developing countries.
In the Cairo Program of Action (UNFPA, 2001), reproductive rights are defined to include the right of couples and individuals “to make decisions regarding reproduction free of discrimination, coercion and violence.” Further, reproductive health is defined as “a state of complete physical, mental and social well-being ... which implies that people are able to have a safe and satisfying sex life” (paragraph 7.3).
The Beijing Platform of Action (UNDP, 2001) also states that women have “the right to attain the highest standard of sexual and reproductive health” and “the right to make decisions concerning reproduction free of discrimination, coercion and violence” (paragraph 97).
Since then analysts concerned about population growth have explained the Cairo paradigm shift as a triumph of feminist ideology over demographic analysis. These analysts bemoan what they see as a dramatic shift away from demographic concerns, as a proscription of demographic targets, and as a downplaying of vertical family planning programs in favor of broader approaches to sexual and reproductive health that are premised on individual rights, especially of women’s rights. They assert that the International Conference on Population and Development’s (ICPD) approach to reproductive health, development, and rights is too complicated and too expensive to be implemented by resource poor countries (Germain, 2000).
While the right of women ‘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’ have been internationally recognized, we are still far from the goal (Cain, 2000).
The objective of this presentation is to trace the recent expansion of reproductive health policies and to describe different components of reproductive health.
Reproductive Health and Family Planning
Family planning programs are organized efforts in the public and private sectors, to provide contraceptive supplies, services, and information to couples and individuals who want to space, or limit their children. Family planning is an essential component of reproductive health because it helps couples to achieve their desired birth spacing and family size, offers protection against reproductive tract infections (condom) and reduces maternal mortality and morbidity by avoiding unsafe abortions and high risk pregnancies.
The ICPD recognized the critically important contributions of the first 30 years of contemporary “population” policy – that is, concentrated investment in the provision of contraceptives to the largest possible number of married women of reproductive age – and acknowledged the demographic impact of these conventional family planning services. Worldwide, contraceptive prevalence rates rose from less than 10% in the 1960s to 55% in 1998, and fertility rates have fallen. Some estimate that family planning programs have been responsible for as much as 40% of these changes. Certainly, many women benefited enormously from the investment.
There is still a long way to go, however, to ensure the minimum standard for high-quality family planning that was set more than a decade ago (Bruce, 1990). That standard includes not only technical quality but informed consent, a range of contraceptive choices, health services in addition to contraception, and respectful, accurate communication between client and provider. In too many places, the ICPD agreements to end coercion, discrimination, and violence in population programs remain to be implemented. Furthermore, services need to be redesigned to meet the needs of a wider clientele than is represented in the “unmet need for family planning,” narrowly defined as the 100 to 150 million married women who desire to space or limit births but who are not using contraception. Monitoring progress toward improved services will also require new indicators – not merely of contraceptive use but of individuals’ ability to achieve their reproductive right goals in a healthful manner.
Safe Motherhood and Reproductive Health
Every minute a woman dies of causes related to pregnancy or childbirth. She is most likely to be young, already a mother, and living in a developing country. For each woman who dies, an estimated 100 women survive childbearing but are afflicted by disease, disability, or physical damage caused by pregnancy-related complications. Overall, it is estimated that 585,000 women die yearly from causes related to pregnancy and birth; 99 percent of these deaths occur in the developing world. Women residing in Eastern and Western Africa face the highest risks of maternal mortality; women living in some parts of Asia also are at high risk (PATH, 1998).
The majority (60 to 80 percent) of maternal deaths are due to obstetric hemorrhage, obstructed labor, obstetric sepsis, hypertensive disorders of pregnancy, and complications of unsafe abortion (WHO, 1997). Pregnancy-related complications that result in maternal deaths are unpredictable, and most occur within hours or days after delivery (Li et al., 1996).
A mother’s death greatly influences the health and livelihood of her surviving children. When a mother dies, her surviving children are three to ten times more likely to die within two years than those with both living parents. In addition, surviving children often do not receive adequate health care and education as they grow up. The death of a mother has an impact beyond that of her immediate family: a productive worker – one who rears and guides the next generation, cares for the elderly, and contributed stability to the community – is lost.
The Safe Motherhood Initiative was launched in 1987 by international agencies and governments to raise global awareness about the impact of maternal mortality and morbidity, and to find solutions. The Safe Motherhood Initiative’s goal is to reduce maternal mortality and morbidity by one half by the year 2000. Global experiences has shown that pregnancy-related deaths are preventable, and a significant body of research on strategies for reducing maternal mortality has been generated. At the same time, it has been difficult to document a measurable decrease in maternal mortality (Graham et al., 1996). Available data suggest that maternal mortality remains high in many parts of the world.
Sexually Transmitted Diseases and Reproductive Health
World Health Organization estimates that there are 330 million new STD infections annually and that 33.6 million men, women, and children worldwide live with HIV/AIDS (WHO, 1996). Over the course of 1999 alone, some 5.6 million people — 2.3 million of them women — became infected with HIV, the virus that causes AIDS. In Africa, where HIV is transmitted primarily through heterosexual contact, women are being infected at higher rates than men. Moreover, recent studies indicate that the rate of HIV/AIDS is increasing faster among young women than among young men in low-income countries. In Uganda, for example, the HIV infection rate among adolescent girls aged 13 to 19 years is three times higher than that for teenage boys.
The impact on women of HIV/AIDS is one of the most pressing reproductive health concerns of our time. Because women’s subordinate role in society heightens their risk of HIV infection, governments must approach this epidemic with a gender perspective. HIV prevention strategies that do not take the special needs of women into account violate women’s human right to nondiscrimination in enjoyment of the rights to health and life. Likewise, while discrimination against people with HIV/AIDS affects both sexes, women with HIV/AIDS must also contend with pervasive gender discrimination, making them doubly marginalized. Governments must therefore work to minimize the impact of the disease upon women’s ability to enjoy all of their civil, political, social, economic, and cultural rights.
Adolescents, Female Genital Mutilation, Violence and Reproductive Health
The ICPD recognized that adolescents, especially girls, need sexuality education; sexual and reproductive health services; technologies that protect against disease, not just unwanted pregnancy; and broader life opportunities (education, vocational training, employment) on an unprecedented scale. Girls are currently at enormous risk for violent and unwanted sex, HIV/AIDS, unsafe abortion, and early of forced marriage. For their own well-being, they must be given the skills and the power to decide whether to have sex and under what conditions, when and whom to marry, when to begin to bearing children, and how many children to have. Their choices on these matters will also be the primary determinants of future population growth (Germain, 2000).
One hundred and twenty million women have undergone female genital mutilation and another 2 million are at risk every year (UNFPA, 1998). Regardless of cultural differences, worldwide the most fundamental ethical principle of medicine is benefiting those we treat. Since there is no scientific basis for a benefit from the procedure, and well-documented harm, involvement of physicians in the performance of such procedures is ethically unacceptable. Advocacy for elimination of the procedure, condemnation of those who persist, pressure to assure that existing laws prohibiting the practice are enforced, education regarding the medical effects, and knowledgeable and sensitive care for women who have already undergone such procedures are the appropriate ethical stance of obstetrician-gynecologist (Cain, 2000).
The most recent survey of available data on the types of abuse dominant in the lives of girls and women around the world – coerced sex and the abuse of women within marriage and other intimate relationships – concludes that “at least one woman in every three has been beaten, coerced into sex or, otherwise, abused in her lifetime … most often [by] a member of her own family.” (Heise et al.,1999). As well as being a fundamental infraction of women’s rights, such violence inhibits
women’s contraceptive use, constraints their access to health services, and often leads to high-risk sexual behavior and other health risks, including adverse pregnancy outcomes (Hakimi et el., 2001). Actions to prevent such violence, similar to those that address STDs and HIV/AIDS, are urgently needed.
Conclusion
Meeting the far reaching “demographic” challenges of the 21st century requires implementing the comprehensive agenda agreed to in Cairo, repeated in the Fourth World Conference on Women in Beijing in 1995, and repeated again in the 5 years review of implementation of the Cairo Program of Action in 1999.
The fundamental denial of basic human rights to reproductive choice, freedom from violence, and economic and educational development for women remains the major underpinning issue in worldwide women’s health care, and unmet need for contraception, maternal mortality and morbidity, the prevalence of STDs and violence against women continue to be high.
References
Bruce, J. 1990. Fundamental elements of the quality of care: a simple framework. Stud Fam Plann. 21:61-91.
Cain, J.M. A global overview of ethical issues in women’s health. Int J Gynecol Obstet. 70:165-172.
Germain, A. 2000. Population and reproductive health: Where we go next?. Am J Public Health. 90:1845-1847.
Graham, W.J., Filippi, V.A., and Ronsmans, C. 1996. Demonstrating programme impact on maternal mortality. Health Policy Plann. 11:16-20.
Hakimi, M., Hayati, E.N., Marlinawati, V.U., Winkvist, A., and Ellsberg, M. 2001. Silence for the sake of harmony. Domestic violence and health in Central Java, Indonesia. Yogyakarta : Rifka Annisa Women Crises Center.
Heise, L., Ellsberg, M., and Gottemoeller, M. 1999. Ending violence against women. Popul Rep L. 11:1.
Li, X.F., Fortney, J.A., Kotelchuk, M., and Glover, L.H. 1996. The postpartum period: the key to maternal mortality. Int J Gynecol Obstet. 54:1-10.
PATH (Program for Appropriate Technology in Health). 1998. Safe motherhood: successes and challenges. Outlook. 1-8.
UNFPA (United Nations Population Fund). Programme of Action of the International Conference on Population and Development, UN Doc.A/CONF.171/13/Rev.1, U.N. Sales No. 95.XIII.18 (1995), Cairo, Egypt, September 5-13, 1994. available at http://www.unfpa.org/icpd/reports.htm (accessed June 29, 2001).
UNFPA (United Nations Population Fund). 1998. The state of the world population, 1997. New York: New York
UNDP (United Nations Development Program). Beijing Declaration and the Platform for Action, Fourth World Conference on Women, UN Doc.A/CONF.177/20 (1996), Beijing, China, September 4-15 1995 available at gopher://gopher.undp.org/00/unconfs/women/off/a20.en (accessed June 29, 2001).
WHO (World Health Organization). Sexually Transmitted Diseases (STDs), Fact Sheet N 110 (March 1996) available at http://www.who.int/inf-fs/en/fact110.html (accessed August 28, 2002).
WHO (World Health Organization). 1997. Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and UNICEF. Geneva: World Health Organization.
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