Reproductive Rights: Global Context

1. Reproductive Rights: Global Context Women’s Studies 101

2. Determining Reproductive Control • How would you determine the degree to which a woman has control over her reproduction in a culture? What questions would you ask?

3. Reproductive Control as a Symptom of Women’s Low Status • Jacobson(1992) has asked the following questions to determine the degree of women’s reproductive control: • Can she control when and with whom she will engage in sexual relations? • Can she do so without fear of infection or unwanted pregnancy? • Can she choose when and how to regulate her fertility, free from unpleasant or dangerous side effects of contraception? • Can she go through pregnancy and childbirth safely? • Can she obtain a safe abortion upon request? • Can she easily obtain information on the prevention and treatment of reproductive illnesses?

4. Reproductive Control • In countries where women are socially, politically, and economically disadvantaged, the answers are no, and high rates of reproductive illnesses and death are common.

5. Status in Motherhood • In many countries and cultures, motherhood is a source of social status • Many cultures grant status to women through marriage and children, particularly through giving birth to male heirs • Many societies have sought to control women’s sexuality in order to control paternity • At the same time, men are considered more suitable for public sphere roles

6. Status and Motherhood • Important private sphere responsibilities often limit women’s participation in the public sphere and reduces their economic and political power

7. Women’s Health and Reproductive Control

8. Female Genital Mutilation • Intentions: • To control female sexuality by preserving virginity before marriage and fidelity after marriage • Women who do not undergo the procedure may have difficult finding a husband • Condemned by the UN and WHO

9. Female Genital Mutilation • Removal of the female genitalia for nonmedical reasons • Some areas happens in infancy, childhood, at the time of marriage, during a woman’s first pregnancy, or after the birth of her first child • Most common age is between 7 and 10 • Over 130 million girls and women have undergone this practice, and at least 2 million are at risk of undergoing the practice every year—6000 per day.

10. Female Genital Mutilation • Four types: • Excision of the prepuce with or without excision of the part or entire clitoris • Excision of the clitoris with partial or total excision of the labia minora • Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening or INFIBULATION • OTHERS: pricking, piercing, incising, stretching, burning, scarping of the tissue, cutting of the vagina, introduction of corrosive substances or herbs to cause bleeding or tightening of the opening

11. Female Genital Mutilation • Consequences: • Pain • Severe bleeding • Infection • Some deaths from shock and above • Difficult urinating, menstruating, having sex, giving birth • Negatively affect sexual pleasure of women

12. Contraceptives • In most countries, reproductive choice lies not in women’s hands but in her husband’s or the government’s • Reliable and safe contraceptives are key to women’s health • In developing countries, Norplant and IUD are highly effective methods that are also less safe when used in un-sterile conditions • Lack of materials for menstruation or nutritional deficiency can be a problem with IUS use which has cramping and heavy bleeding as a side effect • IUD use is 3 times greater in developing nations then in developed ones

13. Obstetric Fistulas Obstetric fistula is an injury of childbearing that has been relatively neglected, despite the devastating impact it has on the lives of girls and women. It is usually caused by several days of obstructed labor, without timely medical intervention — typically a Caesarean section to relieve the pressure.

14. Obstetric fistulas The consequences of fistula are life shattering: The baby usually dies, and the woman is left with chronic incontinence. Because of her inability to control her flow of urine or faces, she is often abandoned or neglected by her husband and family and ostracized by her community. Without treatment, her prospects for work and family life are greatly diminished, and she is often left to rely on charity.

15. Obstetric Fistula • How does fistula occur? Unattended obstructed labor can last for up to six or seven days, although the fetus usually dies after two or three days. During the prolonged labor, the soft tissues of the pelvis are compressed between the descending baby's head and the mother's pelvic bone. The lack of blood flow causes tissue to die, creating a hole between the mother's vagina and bladder (known as a vesicovaginal fistula), or between the vagina and rectum (causing a rectovaginal fistula) or both. The result is a leaking of urine or faces or both.

16. Obstetric Fistula • Fistula occurs when emergency obstetric care is not available to women who develop complications during childbirth. This is why women living in remote rural areas with little access to medical care are at risk. Before the medical advances of the 20th Century, fistula was quite common in Europe and the United States. Today, fistula is almost unheard of in high-income countries, or in countries where obstetric care is widely available.

17. Obstetric Fistula • Poverty, malnutrition, poor health services, early childbearing and gender discrimination are interlinked root causes of obstetric fistula. Poverty is the main social risk factor because it is associated with early marriage and malnutrition and because poverty reduces a woman's chances of getting timely obstetric care. Because of their low status in many communities, women often lack the power to choose when to start bearing children or where to give birth.

18. Obstetric Fistula • Childbearing before the pelvis is fully developed, as well as malnutrition, small stature and general poor health, are contributing physiological factors to obstructed labor. Older women who have delivered many children are at risk as well.

19. HIV/AIDS • Men’s higher status in some culture and women’s lower social and economic dependencies men women often lack the power to negotiate safe sex with their partners • AIDS now ranks as one of the leading causes of death among women age 20-40 years in several cities in Europe, sub-Saharan Africa and North America (UNAIDS 2003)

20. Maternal Mortality • Maternal mortality • In Africa, 1 in 19 • In Asia, 1 in 132 • In Latin American, 1 in 188 • In developed countries, 1 in 2976

21. Agents that Control Women’s Reproductive Lives • Male partners • In parts of Bangladesh, Ethiopia, India, Korea, Nigeria, and Tunisia, women’s bodies are viewed as the property of their husbands, and husbands decide the number and spacing of children • Many fear that use of contraception will lead to her promiscuity and oppose it • Many culture believe that if women could enjoy sexual relations and could prevent pregnancy, sexual morality and family security would be jeopardized (Cook, 1995)

22. Male Partners • Some countries like Philippines, Chile, and Lesotho, a husband’s permission is required for sterilization • In Chad, a woman must have spousal permission to get barrier or hormonal contraceptives • In over a dozen countries such as S. Korea, Honduras, Togo, and Turkey, a woman must have her husband’s consent for an abortion

23. Male Partners • Women’s inability to negotiate condom use or require fidelity without a threat of violence or actual physical violence makes AIDS a growing threat to women’s health • Rape, sexual abuse and sex work (including trafficking) resulting from economic hardship also put millions of women and girls at risk of HIV infection

24. Agents that Control Women’s Reproductive Lives • Governments • Examples • May 2003 judge in Argentina banned oral contraceptives and IUDs claiming that they were abortifacents that violated the constitutional right to life • Sterilization is illegal in some countries: Poland, Argentina, Ivory Coast

25. Agents that Control Women’s Reproductive Lives • Government • GWB first act of President was to reinstate the “Global Gag rule” a policy that restricts foreign non-governmental organizations that receive USAID family planning funds from using their own, non-US funds to provide legal abortion services, lobby their own governments for abortion law reform, or provide accurate medical counseling or referral regarding abortion

26. Government • In 18 of the 56 countries that receive US family planning funds, abortion is legal without restriction as to reason or on broad grounds

27. Agents that Control Women’s Reproductive Lives • Government: • Pronatalist Policies: sometimes intended to replace wartime casualties, such as in Iraq in the 1980s. Iraq banned contraceptives, waged a campaign stressing motherhood, and encouraged men to take second wives; Romania outlawed contraception in the 1970s and 1980s because of a feared population decline (legalized in 1990)

28. Agents that Control Women’s Lives • Antinatalist Polices: coercive antinatalism occurs when concerns about reducing population growth eclipse concerns about women’s health and control over their bodies; they are persuaded tricked or coerced into sterilization or contraceptive methods with the lowest failure rates regardless of the health risks of the method. • Such policies have been documented in China, Indonesia, Thailand, Sri Lanka, Bangladesh, Republic of Korea, Colombia, Mexico, Tunisia, and India

29. Agents that Control Women’s Reproductive Lives • Government • Coercive antinatalism examples: • China’s one-child policy resulted in the abandonment of thousands of infants, 90% of whom were girls

30. Coercive Antinatalism • Romany women in Slovakia are allegedly being sterilized without their consent to limit the Roma (Gypsy) population, an unpopular minority • 2003, Peruvian minister issued an apology to the 200,000 poor women who were sterilized without their consent or who were coerced through incentives from 1996-2000.

31. Agents that Control Women’s Reproductive Lives Religious organizations: • Religious fundamentalism is often associated with the curtailing of women’s reproductive rights • In the Islamic Taliban fundamentalist state, Afghan women had no access to contraception or abortion

32. Agents that Control Women’s Reproductive Lives • Catholicism: opposed to contraception and abortion • Contraceptives are legal in Chile, a largely catholic country, but are limited in availability due to resistance from the Catholic church • Almost all Catholic hospital in the US will not perform sterilizations, abortions, or emergency contraception, even in cases of rape • Doctors in Catholic-owned medical buildings have complained that their leases prevent them from prescribing birth control or doing vasectomies in their offices

33. Religion • By 2001, more than 1 in 10 US hospitals and eight of the country’s fourteen largest healthcare systems were catholic • Although a first trimester abortion has been legal in Italy since 1978, the law permits any healthcare workers to claim conscientious objector status and refuse to participate. In the first year 72% of Italian doctors became objectors • In Wausau, the Marshfield Clinic recently made a policy that all babies will be delivered at the new St. Clare’s Weston facility, a Catholic-run hospital, which limits doctor’s ability to perform certain reproductive procedure.

34. Abortion • Worldwide, about half of unintended pregnancies end in abortion (about half of pregnancies are unintended) • Some 21 million of the 52 million abortions performed annually occur in countries where abortion is legal or allowed only to save a women’s live. • Legality does not influence incidence of abortion but does influence safety • About 70,000 women per year die from unsafe abortion (UNFPA, 2003)

35. Abortion • Abortion was illegal in almost every country until the second half of the 20th century • In 2003 , 35 countries forbid abortion under any circumstances • In most countries, it is permitted under special circumstances (Ireland, Egypt, Iran, Guatemala, to save the woman’s life and preserve her physical health)

36. Abortion • In 52 countries abortion is available “on request” without justification (S. Africa, Cuba, Vietnam, France) • Availability vs. legality: In Zambia, three doctors must approve the abortion, it must be deemed medically necessary, and it must be performed in a hospital • 87% of counties in the US have no abortion provider

37. Abortion • Activists favoring the liberalization of abortion laws emphasize that illegal and restrictive abortion laws are human rights violations, arguing that they threaten women’s rights to autonomy in reproductive decision making and threaten women’s right to physical and mental health

38. Abortion • Most women’s activities prefer increasing the availability of contractive and reproductive health education to abortion • Higher abortion rates are most strongly tied to a lack of contraceptive information and availability (UN, 1993)

39. Abortion • Netherlands’ abortion rate is lowest in the world, even though abortion is legal, free, and available upon request. They have one of the most extensive sex education and reproductive health programs in the world and the highest rates of contraceptive use • In the Netherlands there are 6 abortions for every one thousand women aged 15-44 compared with 26 abortions per 1000 young women in the US

40. Conclusions • Reproductive choice is often linked with socioeconomic status in that rich women are almost always guaranteed these choices where other women are not • Women in developing nations face greater reproductive health risks than women in more developed nations • In some countries the right to choose abortion and contraceptive is the issue; in others, the right to refuse is the issue

41. Conclusions • What differs and is similar across cultures: • Methods of preventing AIDS may not be the same across cultures (abstinence vs. condom use) • Some countries require a prescription for the contraceptive pill, often at the same time as gynecological exams and screenings, allowing doctors to screen out those women for whom the pill is contraindicated (heart disease, diabetes, smoking)

42. Conclusions • Heavy bleeding that accompanies some methods like Depo Provera or IUDs can be difficult for poor women who have inadequate materials for menstruation hygiene or for women in some Muslim countries where ea woman’s everyday activities are curtailed for religious reasons during menstruation

43. Conclusions • Reduced lactation as a side effect of some hormonal contraceptives, which is a great danger in some developing countries where breast milk is the main source of nutrition for infants and toddlers. This can result in malnutrition or higher infant mortality rates • Greater attention needs to be paid to the variable social and biological circumstances of women’s lives so that available methods can be appropriately applied

44. Cross-Cultural Perspective • Cross cultural perspective: Feminists feel strongly that the women must be able to control the number and spacing of their children before they can achieve equality • However, in many countries, high value is placed on women’s fertility and maternity, and her social status is determined by it • In many African countries, women strive to bring to maturity at least six children and view childbearing as their primary responsibility • Reduction in fertility can reduce their main source of satisfaction and their claim to social consideration

45. Conclusions • Reproductive control is both a reflection and a determinant of women’s equality • Reproductive control greatly affects women’s health