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

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

Maternal

Deaths/100,0

00 live births

209 162* 52

Access to

repro health

services (15-

49 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

( World Economic Forum 2006 and 2007 Reports)

INDICATORS 2006 2007

Educational Attainment 91.55% 91.60%

Political Empowerment 14.07% 14.15%

Economic Participation 52.25% 57.30%

Health 96.25% 95.8%

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…

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