Women’s Right to Health

Examining reproductive rights & reproductive health thru the gender justice lens
Fatima Alvarez Castillo
UP Manila

The case of Doris*
29 year old mother of 3 Tried mixed methods of rhythm & contraception Efforts failed

Pregnancy aborted, profuse bleeding Scolded by doctor in hospital for “killing” her baby mas masakit pa yong panlilibak sa ospital kesa sa pagdugo ko….
( *One of our key informants from Manila)
Drawing: Tanya Villanueva Arrows for Change, 10 (1), 2004

Repro Rights are basic rights of all couples & individuals to decide freely & responsibly the number, spacing & timing of their children, to have the information & the means to do so and to attain the highest standard of sexual & repro health (WHO)

Repro Health is physical, mental and social well being - not merely the absence of disease or infirmity - in all matters related to the reproductive system, its functions & processes
(UN Conference On Pop & Development, 1994).

Women’s rights are human rights: obligations states are accountable for


1945 UN Charter – obliges states to promote universal respect for & observance of human rights & fundamental freedoms without discrimination as to race, sex, religion or language. 1948 UN Declaration of Human Rights 1979 UN Convention on the Elimination of All Forms of Discrimination Against Women

Philippine government legally accountable for: domestic laws

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1987 Constitution recognizes fundamental equality of men & women Family Code Agrarian Reform Law Women in Dev & Nation Building Law

What is the situation?
Abortions mostly unsafe 78,900 women hospitalized for post abortion care (year 2000) Large increases in abortion rate in Metro Mla (41 in 1994; 52 in 2000)
(Guttmacher,31(3), 2005)

Maternal mortality: death due to complications of pregnancy, pregnancy related causes
230/100,000 (adjusted mortality rate, Statwatch 2005) – 2nd highest in SEA; 10 women die/24 hours (PopCom, 2000) MMR highest in ARMM

Maternal mortality, access to reproductive health services and MDG Targets
Indicators 1993 2001 2006 MDG Target by 2015 52

Maternal 209 Deaths/100,0 00 live births

162*

Access to repro health services (1549 age )

49%

50.6%

80%

Source: NEDA & UN Country Team (UNCT). 2007. Philippine Midterm Program Report on the Millennium Development Goals.

Global improvements in narrowing gender gap
INDICATORS
Educational Attainment Political Empowerment

2006
91.55% 14.07%

2007
91.60% 14.15%

Economic Participation
Health

52.25%
96.25%

57.30%
95.8%

( World Economic Forum 2006 and 2007 Reports)

Why is the situation for women’s repro health like this? While other global indicators are improving why is the health gap worsening?

Why is it that Doris has to resort to abortion to limit the number of her children? Why did the doctor behave the way she did? Why did she place the full burden of guilt on Doris? What larger issues are implicated in this case?

Gender refers to socially constructed identities, roles and status that influence the allocation of power, entitlements, opportunities and prestige to men and women.

Gender-based inequities are imbalances in power, opportunities, and resources between men and women irrespective of social class or ethnicity or geographic location. These imbalances are commonly suffered by women more than men

Gender is a social stratifier, but unlike class, the power differential is between men and women although class and gender tend to correlate. Example: poor women tend to have less access to health care than rich women because of differences in material resources, but poor women tend to have less access to health care than poor men.
Thus poor women tend to have less access to health care compared to rich women and to poor men due principally to the combined impact of their poverty and their gender.

Ethnicity and age could worsen the impact of gender & poverty as in the case of Muslim women (ethnicity) who are adolescent (age)

Gender-based discrimination: norms, practice, policy, programs
The problem is highly complex: - Deep seated biases, norms of patriarchy - Multiple factors that intersect at all levels of social life - Many aspects of discrimination are hidden, unrecognized for what they are

Gender-based discrimination, inequities found in
Open & hidden structures & practices in:  Individual relationship  household  community  health system & other institutions  State & global programs

Most internationally binding Human Rights instruments do not explicitly mention sexual and reproductive rights; No domestic law on RR & RH

Efforts to promote RR & RH demonized

Inquirer 1/31/2010

Medical ideology & practice

Patriarchy in medical practice Technical interest of doctors

…kaya I transferred from (private teaching hospital) to here (public hospital) kasi for training, so that I can train on complicated OB cases…e ang nagyayari nagiging raspa hospital ng mga nagpapalaglag; nauubos oras naming residents sa kanila… (one of our resident-key informants)

Gender justice in Universal Health Care
To be truly just, universal health care must not only be sensitive to class-based injustice in health care but also to gender-based injustice. Explicit protection of women’s full enjoyment of right to health.
Why should it be explicit? Because gender inequity tends to be obscured by or conflated with other inequities such as those brought about by class or ethnicity or religion.

Critique of gender mainstreaming
Overall the international experience w/ gender mainstreaming not positive: -de politicized whereas social transformation is a political project -instrumentalist intent – mainstreaming becomes end rather than means to redress inequality

Mukhopadhyay & Singh, 2007

Gender Justice
Gender justice: the ending of, and the provision of redress for, inequalities
It is both outcome & process: As process, it has the element of ACCOUNTABILITY of those who are supposed to protect women’s rights As outcome, it implies ACCESS to & CONTROL over resources, combined with AGENCY (the FREEDOM & CAPABILITY of women to make choices). (Anne Marie Goetz 2007)

Realization of reproductive rights & reproductive health linked to realization of other human rights

Political leadership required…

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So that women are not forced to abort their pregnancy So that health care providers respect women’s right to the best possible care & to dignity So that families, communities, schools, churches, state institutions, laws are not the sites of discrimination against girls, women So that those responsible are made accountable

Thank you