Three weeks ago the Peruvian National Statistics Institute (INEI) released its 2007 Technical Report on Poverty in Peru. The report -- which applied the same methodology and procedures used to measure poverty in 2006 -- was received with optimism and great satisfaction by government officials and the media since it stated that the poverty rate decreased 5.2% in 2007 (39.3%) compared to the 44.5% rate in 2006. In the same way extreme poverty decreased from 16.1% in 2006 to 13.7% in 2007. This means that for the first time in more than 20 years the poverty rate was below 40%.
However, despite the
good news, there is not even a single reference in any
of the report's 31 pages about women and their poverty status; neither
the charts nor tables include data related to women. Are women more
or less poor? Is their poverty status similar to men's? Have they
also reached the best scenario in twenty years? This is not possible
to know from the report. On the other hand, the report does give detailed
information about poverty incidence rates in urban areas (25.7%) and
rural areas of the country (64.6%), where people are four times poorer
than the poor people in urban areas. Sixty-three percent of people whose mother tongue
is an indigenous language are poor, whereas only 32.6% of the people
whose mother tongue is Spanish are poor. The report also identifies
the profiles of the poor: households consisting of five or more family
members, with a young head of household, with only primary education or
no education at all, working on agriculture, fishing or mining. After
examining all these criteria, it is difficult to understand how the
report can omit every reference to women, who comprise half of the
Peruvian population.
This is even more shocking when taking into consideration that for this year's report, various international institutions that work on gender issues themselves, such as the Inter-American Development Bank and the World Bank, provided technical assistance to the INEI. It seems contradictory that apparently none of these institutions demanded that the report included a gender perspective.
The Advisory Committee set up to review the methodology applied by the INEI and formulate relevant recommendations issued a statement listing its main findings, which were principally related to minor changes in the sample, the accuracy of the methodology used and the importance of INEI's transparency policy. Again there was no mention regarding the lack of gender related or sex disaggregated data needed for a comprehensive estimation of poverty.
The relation between
women and poverty has been extensively researched. According to UNIFEM "poverty traps women in multiple layers of
discrimination and hinders their ability to claim their rights (...)
Not only do women bear a disproportionate burden of the world's poverty,
but in some cases, globalization has widened the gap, with women losing
more than their share of jobs, benefits and labour rights. (...) economic
policies and institutions still mostly fail to take gender disparities
into account." Arriagada believes that the gender analysis "highlights
the heterogeneous character of poverty, and therefore, helps to understand
it better and to adjust policies to eradicate it."
Fortunately, despite the INEI report's deficiency, there are several institutions and NGOs that have been working on gender and poverty issues in the country, monitoring the fulfillment of the MDGs. UNIFEM, for instance, has been funding projects regarding gender participatory budgets and assisting the Round Tables for the Fight against Poverty in outlining gender sensitive budgets. Likewise, UNDP provides technical assistance to design poverty reduction policies and to promote the role of women in development.
The INEI's report is supposed to reflect if poverty reduction strategies are working and help to outline and implement new policies to eradicate poverty. The question is then how can poverty reduction policies be properly reviewed from a report where half of the population is not being considered? It is time to realize that no real changes will be achieved unless gender analysis is seriously taken into account. ]]>Indeed, only Ecuador has explicitly included these rights in its Constitutional text. The women's movement played a key role and managed to include sexual and reproductive rights in Ecuador's 1998 Constitution after a remarkably hard-fought campaign, a significant milestone in Latin America. That is why, despite the fact that this country is currently working on a new Constitution, the draft still includes an explicit recognition of sexual and reproductive rights.
In the case of Bolivia, a Constituent Assembly, made up of 34% of women, almost half of whom are indigenous women, drafted a new Constitution that will be voted on in a referendum later this year and that specifically "guarantees women and men the exercise of their sexual and reproductive rights."
And at a provincial level, it is important to mention the Constitution of the City of Buenos Aires, whose text acknowledges "sexual and reproductive rights" as basic human rights.
For other
Latin American countries such as Brazil, Mexico, Colombia, Peru and Paraguay,
reproductive and/or sexual rights are recognized in their Constitutional
texts (although they are not literally stated) by acknowledging the
range of rights that inform them, i.e. the right of every person to
decide freely and
responsibly the number, spacing and timing of their children
and to have the information and means to do so.
However, in regards to Ecuador and Bolivia, it is interesting to consider what would happen if those countries' new Constitutions were to omit the expression "sexual and reproductive rights" from their text, as is the case in most Latin American Constitutions. Would that mean that sexual and reproductive rights would no longer be considered constitutional rights? Many argue that it is not essential that constitutional texts literally include the term "sexual and reproductive rights" since these can be interpreted from the fundamental rights already stated in Constitutions.
Others argue that it
is necessary to include "sexual and reproductive rights" in the
constitutional texts, in part in order to end the debate with conservative
parties and movements, but also to strengthen the development and implementation
of public policy regarding sexual and reproductive rights issues and to protect these rights from internal struggles within political
parties or changes of the administration in power.
Some Constitutional Courts -- like the Courts in Colombia and Peru -- have dealt with cases regarding sexual and reproductive rights where they have had to interpret their constitutional texts: the decriminalization of abortion in Colombia and the free delivery of emergency contraception in Peru. In the first case, the Colombian Court's decision decriminalized the voluntary termination of the pregnancy based on the violation of women's rights to life and dignity for being forced to have an abortion in unsafe conditions. In the second case the Peruvian Constitutional Court decided that the Health Ministry failed to comply with a regulation that obliged it to freely deliver emergency contraception and ordered that it started right away.
There is no doubt that both decisions do tacitly guarantee and recognize the legitimacy of sexual and reproductive rights even though they are not quoted in Constitutional texts, but neither of them dares to explicitly mention these rights as the rights being ultimately protected by these decisions. It seems to me that despite the amount of international human rights treaties and bodies that promote and defend sexual and reproductive rights (to which Latin American countries are State parties), the Courts will keep on not alluding to them unless they explicitly see them stated on their constitutional texts.
It is important then, that although sexual and reproductive rights do not need to be literally recognized to be protected and guaranteed, Ecuador's new Constitution does not take a backward step on this matter, and fully guarantees the protection of sexual and reproductive rights. Likewise, Bolivia should take a further step and specifically recognize sexual and reproductive rights at a constitutional level and not as part of other fundamental rights already recognized, so that these rights are well noticed and more easily exercised.
]]>
For indigenous women
in the Andean and Amazonian areas of the country, giving birth at health
care facilities in the presence of strangers, without their relatives, half naked and lying in a horizontal position was and still is
just unbearable. Given those circumstances they prefer to stay home
and deliver in a vertical position assisted by a midwife or a relative,
which is what they have traditionally witnessed in their communities. But this trend has had alarming consequences for women's health
and lives because the lack
of medical assistance for any complications that can arise. A UNFPA
representative has pointed out the fact that "several women die when
they deliver at home and nobody gets to know because they live in distant
rural areas...this data is not registered."
Although health personnel
in a few departments have been assisting home deliveries in upright
positions, isolated efforts are not enough. In an attempt to reverse this tendency, the Ministry of Health decided to adapt its policies
to indigenous women's traditions instead of imposing Western ones.
Thus, in August 2005 the "Technical Standard for Vertical Delivery
with Intercultural Adaptation"
was approved by the National Sanitation Strategy for Sexual and Reproductive
Health. It officially introduced the "vertical delivery" as
part of the maternity services in the country with a multicultural and
gender sensitive approach.
This policy aims not only to respect indigenous women's customs and beliefs but also to "standardize the medical assistance on vertical delivery...adjusting the health care services offered to women in order to increase institutional delivery and thus, reduce obstetric complications that cause maternal death." The latter is especially disturbing; according to Health Ministry statistics the maternal mortality ratio is estimated to be 185 deaths for every 100,000 live births, mainly because of bleedings.
The National Concerted
Health Plan launched in July
2007 includes as its main goals the decrease of maternal mortality to
66 per 1000,000 live births by 2015, while increasing up to 70% the coverage
of institutional deliveries in rural areas. This is particularly
important considering that the number of deliveries in rural areas has increased from 24% in 2000 to 42.5% in 2004-2005.
The Technical Standard for Vertical Delivery emphasizes that above all, it is crucial that health personnel is technically trained to perform the obstetric procedures needed for any of the positions the parturient may adopt: squatting, kneeling, seated or holding rope. The standards also emphasize welcoming the patient and her relatives, explaining to them the procedures in a simple way and, most importantly, encouraging the patients "to express their will with respect to the position they wish to be assisted for delivery."
In order to increase the incidence of institutional delivery, Peru has developed "waiting houses" or maternity homes, houses specifically conditioned to "shelter pregnant women and their families coming from remote areas and keep them close to a health care facility with basic obstetric...facilities." This is especially crucial for vulnerable pregnant women such as victims of domestic violence, widows, single or abandoned mothers or the ones with complications.
A documentary on the impact of "vertical delivery" as a standard maternity service procedure, produced by the Health Ministry and UNFPA, shows how indigenous women are increasingly trusting the health personnel. All the women interviewed were satisfied with the service and mentioned that they were treated with respect. Some of them even said they were definitely going back to the health care facility for their next delivery and that they would tell other pregnant women to do so.
This policy certainly proves that access to health care services for Andean and Amazon women can be improved simply by respecting their traditions and rights and making reproductive health policies more inclusive, that is, bearing in mind the multicultural nature of the country. ]]>Editor's Note: With this post we welcome Karim Velasco, a lawyer based in Lima, to RH Reality Check. Karim will join our Global Perspectives team reporting on reproductive and sexual health and rights issues internationally.
After more than a hundred years of legally allowing women access to a therapeutic abortion if her life or health was in danger, in October 2006 the Nicaraguan National Assembly banned this procedure in all circumstances under pressure from conservative movements and the church. A year later, despite international pressure and claims to respect the human rights of women, the hopes and efforts of women's rights organizations and medical associations were shattered when a new Penal Code reaffirming the ban was approved in September 2007 by the National Assembly.
Although in January 2007 a group of civil society organizations filed an appeal to the Supreme Court to declare the amended provision unconstitutional, the appeal had to be resubmitted since the Penal Code had been rewritten.
Besides the importance of drawing a legal strategy to challenge the ban on constitutional grounds, it is necessary to think of the consequences and challenges that this ban is already bringing to public health. The CEDAW Committee, Pan-American Health Organization (PAHO), UNFPA and the Interamerican Commission of Human Rights among others warned the Nicaraguan government of the alarming effects that the ban on therapeutic abortion would have not only on women's lives and health but also on health service providers' behavior. And it is now clear that clandestine abortions and maternal mortality rates have spiraled since the ban was introduced.
According to UNICEF, the adjusted maternal mortality ratio is estimated to be 170 deaths for every 100,000 live births, one of the highest in the region. PAHO, Human Rights Watch (HRW), and IPAS have documented cases of women who died because they were denied or delayed treatment for obstetric emergencies, mainly because of the fear of prosecution or misperception of the law on the part of medical personnel. Some women have reportedly tried to get medical treatment because of constant bleeding or proved ectopic pregnancies but were left unattended for hours or transferred to a different health center, which in some cases led to their deaths. Women have no choice but to look for emergency obstetric care elsewhere, even though in many cases they need to be treated for incomplete miscarriages that have nothing to do with induced abortions.
The ban on therapeutic abortion is not only affecting the access to emergency obstetric care, it is also affecting the quality in delivering the service. For IPAS the ban has a double impact on the health system: i) the economic costs of treating these preventable emergencies, caused by delays in care, consume a major portion of the health sector's limited budget, and ii) health providers find themselves having to choose between appropriately treating the patients by ignoring the law or denying them the necessary care to preserve their health and lives.
It is also important to highlight the fact that not only medical staff fear prosecution. Women also fear seeking treatment because they are afraid of being accused of having induced an abortion themselves. This vicious circle is certainly affecting the most vulnerable women, that is, young poor women. IPAS has even pointed out that "75 percent of the maternal deaths recorded this year [2007] were women who lived in rural areas and more than 80 percent were adolescents and youth." Although the strong link between adolescent pregnancy and poverty is not new, the ban on therapeutic abortion severely worsens the risks for these women.
Up to now the only serious attempt carried out by the government to mitigate consequences of the ban was the issue of "mandatory protocols for the provision of emergency obstetric care." In December 2006 the Ministry of Health issued the Norms and Protocols for Treatment of Obstetric Emergencies. According to Human Rights Watch these guidelines "cover most if not all obstetric emergencies, including ectopic pregnancies and post-abortion care. If fully implemented, it is possible that these guidelines could overcome a good part of the negative consequences of the blanket ban." However, HRW's research also shows that doctors and health officials are not willing to implement the guidelines; they usually ignore them or delay their implementation due to fear of prosecution. It is not clear to them whether the protocols are compatible with the ban or not, which usually leads to leaving patients unattended or turning them away from the hospital. Unfortunately, the Ministry of Health "does not monitor the full implementation of protocols, does not systematize complaints received for the delay or denial of care, and so far has not studied the impact of the law on the lives and health of women."
PAHO and Human Rights Watch have issued a list of recommendations to the Nicaraguan government to amend the Penal Code and decriminalize therapeutic abortion, guarantee women immediate access to emergency obstetric services and postabortion care and appropriately implement the guidelines on emergency obstetric care. HRW additionally called on donors and United Nations agencies to expand funding for reproductive health related programs in Nicaragua and to support campaigns seeking to educate women about their right to access contraception.
In an attempt to lessen the impact of the ban IPAS Central America's work is not only focusing on "ensuring access to high-quality postabortion care (PAC)", but has also included among its activities "improving the availability and quality of abortion-care services in the context of comprehensive reproductive health care."
Similarly, it is imperative that additional initiatives are implemented to mitigate the impact of the ban on women's lives and mental and physical health, especially by the government and national organizations.
]]>