Rajat Khosla, Amnesty International’s policy coordinator on health blogs from the Family Planning summit in London
Arriving at the summit (organised by the UK Department for International Development and Bill and Melinda Gates Foundation) this morning I was reminded of the testimony of a woman living in Ouagadougou, interviewed by Amnesty International a few years ago:
“After seven pregnancies and five live children, I told my husband that I wanted to use contraceptive methods but my husband refused and told me that if I did this, I should return to my mother’s home. I therefore had to obey him.”
In Burkina Faso, Amnesty International collected numerous testimonies of women who were denied the right to decide on contraceptive use. In many cases husbands and male relatives opposed the use of contraceptives and criticized medical professionals for providing contraceptive products and advice to their wives or other female members of their families.
Amnesty International has documented similar experiences in other countries as well. In Indonesia, for instance a human rights activist told Amnesty International, “[It] is very taboo for an unmarried person to look for contraceptives…S/he will be seen as looking for free sex.”
Laws in Indonesia provide that access to sexual and reproductive health services may only be given to legally married couples. Unmarried individuals are simply denied access to these services.
Nearly twenty years ago, governments at the International Conference on Population and Development agreed by consensus that respect for women’s reproductive autonomy is the cornerstone of population policy. This was a vital step as this moved the debate away from a narrow focus on demographic targets and family planning methods towards a more comprehensive approach to sexual and reproductive health.
However, women and girls around the world are systematically denied the right to make decisions about their sexual and reproductive lives free of discrimination, coercion and violence. As I listened to leaders from different countries express their commitments towards family planning and meeting the unmet need of millions of women for contraception, I was desperate to hear them reaffirm the commitment they made twenty years ago. I waited to hear them recognise the centrality of women’s human rights, their sexual and reproductive rights to this initiative. But disappointingly although a few notable references were made to these issues by some leaders women’s human rights were not appropriately addressed.
I spoke to Prof Gita Sen (of the Southern feminist network, DAWN, and the Indian Institute of Management Bangalore) about her thoughts on the Summit and she said “The reason we all got together in Cairo 20 years ago was a collective recognition in the women’s human rights community and among family planning policy people in governments/agencies that top-down family planning approaches, as in India during the political Emergency of the mid-1970s and after, have serious potential for coerciveness.
“Such approaches have done incalculable harm to the legitimacy of family planning and therefore to the rights and access of millions of women and men, young and old, married and unmarried, to safe and effective contraception. If money and attention are coming back to this field, it would be prudent if not wise for funders, agencies and governments and I may add, the large community of international and national NGOs to refocus on those lessons, and to bring human rights into the centre of this renewed agenda. Not just in the form of principles but of practical methodologies for how policies and programmes are implemented and monitored, how health workers are motivated, rewarded or punished, and how accountability for non-coercion, equity and access are built in.”
There is overwhelming evidence that a siloed approach to family planning just does not work. What is needed is an integrated approach within the framework of comprehensive sexual and reproductive health and rights. To meet the unmet sexual and reproductive health needs of millions of women and girls around the world sexual and reproductive health services must be provided with attention to quality of care and with full recognition of human rights.
The ICPD Programme of Action unequivocally recognizes that population targets and quotas should not condition whether and how services are delivered and that no one should be coerced in any way regarding their sexuality and reproductive lives. A target driven approach –such as one which focus exclusively on meeting family planning targets and fails to include protection for women’s human rights is likely to result in more harm than good.
I spoke to Francoise Girard, President of the International Women’s Health Coalition, about her thoughts on the focus on targets and incentives as key drivers for the Summit.
She said, “Renewed attention to contraception is a good development, but the commitments made this morning by governments run the gamut from providing increased access – which is good – to meeting specific targets for contraceptive use. These are very different ways of approaching program design and implementation. If the end result is to be 80% contraceptive prevalence rate, as was mentioned by Bangladesh this morning, how will this be done in practice? By setting targets for providers and health institutions to “put women on contraceptives.
“We also heard quite a few Ministers discuss post-partum contraception. The power dynamic after childbirth can and does lead to women being sterilized or fitted with an IUD without choice or information – witness recent scandals in India, Namibia, Kenyan etc. That worries us greatly.”
As I listened to discussions through the day I kept on thinking “What about accountability?” The issue was the focus of discussion in a parallel session in the afternoon. While the panelists spoke about indicators, data and drivers for progress, accountability for human rights was mentioned as an optional feature. While quantitative evaluations and hard data are necessary to measure progress, they fail to address the barriers and challenges faced by women and girls in their attempts to realise their sexual and reproductive rights. The discussions today did not go a long way in addressing the need to develop an accountability framework that is responsive to the root causes of high unmet need for sexual and reproductive health. A framework that tracks governments’ human rights obligations and not just resources and results. Much more needs to be done to ensure that these issues are not sidelined.
The writing on the wall is clear: women’s human rights and quality of care must be at the core of any such initiative. Any failure to do that will result in more harm than good being done and will undermine the sustainability of this initiative.
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