The bill proposes a seven-year jail term for anyone who "attempts to commit the offence" or who "aids, abets, counsels or procures another to engage in acts of homosexuality." Under the proposed law, “promotion of homosexuality,” including publishing information or providing funds, premises for activities, or other resources, is also punishable by a seven-year sentence or a fine of US$50,000. The bill seeks to apply the death penalty handed down for the crime of “aggravated homosexuality,” defined as a sexual assault committed against a member of the same sex who is under 18 or disabled. An HIV test would be forced upon anyone found guilt of the offense of “homosexuality."
It is the blatant disregard for both the Uganda Constitution and international law that is most striking in this bill. Prohibiting “promotion of homosexuality” undermines the rights to free speech, expression, association and assembly. Prohibiting “funding and sponsoring of homosexuality,” undermines Uganda's public health efforts in the fight against HIV/AIDS. The bill also introduces the obligation to report a homosexual within 24 hours of knowing someone's sexual orientation. It even permits Ugandan law enforcers to arrest and charge a Ugandan citizen or permanent resident who engages in homosexual activities outside the borders of Uganda.
The bill is nothing short of discriminatory and stigmatizing, its objectives drawing upon stereotypical notions about homosexuality and homosexual relations. It aims to prohibit homosexual behavior and related practices in Uganda which are deemed a “threat to the traditional family.” Although the Bill aims “to safeguard the health of Ugandan citizens from the negative effects of homosexuality and related practices,” it is hard to believe that the Bill's drafters actually considered homosexuals as Uganda citizens. Indeed, if they had, they would consider the inevitability that this Bill, if passed, would drive homosexuals underground and further away from HIV prevention programs and essential medical treatment for those affected by AIDS, including life-prolonging anti-retroviral drugs.
The international community should be particularly alarmed at the bill's attempt to outright prohibit the ratification of any LGBT rights-protecting treaty and most shockingly, nullify previously ratified treaties if considered “contradictory to the spirit and provisions” of the bill.
Effectively, if the Committee on Economic, Social and Culture Rights were to state that the right to the highest attainable standards of health belonged also to homosexuals, or the Children's Rights Committee promotes scientifically-based sex education that does not condemn homosexuality or if the Committee on the Elimination of Discrimination were to state that lesbian women have a right to found a family and decide the number and spacing of their children, this bill states Uganda will withdraw its ratification or file a reservation to the treaty. This is nothing short of Uganda making a mockery of the international human rights system. The potential application of the death penalty, a blatant violation of the right to life, is yet another example of how this bill flouts basic human rights.
The bill has been condemned by a number of African organisations which promote equality for gay, lesbian, bisexual and transgendered (LGBT) people, including Sexual Minorities Uganda, Inclusive and Affirming Ministries (IAM) and The Rainbow Project of Namibia, all of which may become illegal for “promoting homosexuality” if the Bill is passed. When the bill was condemned by the US Embassy in Kampala in late October, the Ugandan Ethics Minister James Nsaba Buturo's response was to dismiss the very notion of human rights: "We are really getting tired of this phrase ‘human rights’. It is being abused. Anything goes, and if you are challenged? 'Oh, it's my right'”.
Yet, draconian anti-homosexuality laws are not new to Uganda. Homosexuality, or "carnal knowledge against the order of nature," as it is described under Section 140 of the Uganda Penal Code, is already illegal and can be punished with imprisonment of up to 14 years. Therefore, if the bill is rejected, homosexuals remain targets under the law. What these months of debate have revealed is the environment of fear in which homosexuals in Uganda have to live. According to Amnesty International, the existing law fosters arbitrary arrest and detention by police of men and women accused of engaging in consensual sex with another person of the same sex, with documented cases of torture and ill-treatment of lesbians and homosexual men in detention.
It is sad that in the same year that we have seen a momentous victory in India on these issues that we see the makings of an enormous setback for the human rights of all Ugandans. In the words of the Civil Society Coalition on Human Rights and Constitutional Law, this Bill is an attempt to “wish away core human rights principles of dignity, equality and non-discrimination, and all Ugandans will pay a heavy price if this bill is enacted."
]]>Now, a group of NGOs are petitioning the Government of Namibia to stop these coerced sterilizations and are seeking compensation for the 15 women who have thus far come forward with their stories which involve three public hospitals. The campaign, called End Forced Sterilization and public petition were launched on October 15. A march on October 20 commemorated the initiation of court proceedings on behalf of 6 women seeking redress in the Namibian High Court for violation of their constitutional rights to dignity, to be free from cruel, inhuman and degrading treatment, to found a family and to be free from discrimination. These women argue that their consent was extracted through various forms of coercion or without knowledge as to the contents of the forms they were signing.
The petition calls on the Government of Namibia to, among other things, issue a ban on the sterilization of women without their consent and to issue guidelines to govern the procedures for obtaining informed consent. It also calls on the government to train people working in health care about the policies that guide their work and on the rights of patients to informed consent and non-discriminatory treatment, regardless of HIV status.
These demands are not new. However, this petition, which remains open for signatures, will be delivered to the government on Human Rights Day, December 10. Petitioners are hopeful that the outcry from Namibians and the international community will this time around actually force the government to change the present situation. According to the Aids Rights Alliance of Southern Africa, one of the NGOs involved in putting forward the petition, this is not presumed to be an easy victory. “The fact that the government has not offered a settlement or engaged in constructive dialogue with the parties involved is a sign that we have a significant challenge ahead."
According to Linda Dumba Chicalu of the Legal Assistance Centre of Namibia (LAC), the group that is leading the litigation on behalf of the women going to court, the government argues is that there is no forced sterilization taking place in public health facilities. It further argues that the women gave their written and informed consent for the sterilisations. In response to a submission made to the Ministry of Health and Social Services in January 2009 by the AIDS Law Unit of the LAC, the Minister provided their assurance in June 2009 that mechanisms were put in place to address the alleged violations. However, in a statement delivered in Parliament on 2 July 2009, the Minister announced that his ministry undertook an investigation at various state hospitals and that their findings did not indicate any specific trend with regard to sterilization performed on HIV positive women. He further stated that the investigation clearly established that all women who had a caesarean section as well as a sterilisation had signed the relevant consent forms before the procedures were done. However, according to LAC, none of their clients who are on record as being sterilised were approached by the Ministry as part of the investigations. Further, LAC have expressed their concerns to the Ministry that no remedial actions are currently being taken to avoid the further sterilisation of HIV positive women without their informed consent. The Ministry has not provided LAC any further response since that time.
Through this petition, once again, the Government of Namibia is being asked to account for the rights of women living with HIV/AIDS. However, forced sterilization is one of many forms of discrimination facing women in Namibia. According to Dumba Chicalu, Namibian women face stigma even in their homes when they disclose their HIV status to their partners and are accused of having brought the virus home since they are the first to be tested for HIV.
Dumba Chicalu stresses the bigger picture when it comes to changing the lives of these women. She argues, “There is an urgent need to change the way women are perceived in society. And it will not change unless women are given an opportunity to get empowered through education, thus making them less dependent on their male partners and relatives. They should also be given the opportunity to control and own property.” Implementation and enforcement remain the key obstacles. Duma Chicalu argues, “We need to find ways that will ensure the actual implementation and enforcement of these laws at the grassroots level. One of the ways to achieve actual implementation is to educate women on their human rights so that they know how best to assert their rights when confronted with a situation where their rights are about to be violated."
In general, the petitioners believe that Namibia is “one of the most rights-respecting countries” in the region. The Namibian Constitution also provides strong protections for the rights of Namibian citizens, not to mention the relevant international and regional treaties to which it is a signatory. It is undeniable that the rights of the women whose cases were documented, and possibly others who stories are not yet known, have been violated. A positive response from the government in respect to these cases would make an essential contribution to efforts to fight the underlying problem of stigma and discrimination facing people living with HIV that encourages the sterilisation of these women again their will.
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A new study by the Guttmacher Institute has actually managed to quantify the direct costs of treating the complications that result from unsafe abortions on health systems in the global south. Based on two different methods of calculation, —a World Health Organization model and a comparison of 20 empirical studies, 9 from sub-Saharan Africa—the authors calculate that on average, treating post-abortion complications costs an estimated USD83 per patient in Africa (based on 2006 reported costs). When overhead and capital costs are included, these averages jump to USD114 for Africa. Assuming women continue to pay for their own abortions, if able to access safe, legal abortion services, the reduction in costs to healthcare systems in all African nations is undeniable.
These new estimates of the direct costs of treating abortion complications lend incredible weight to raising the profile of access to safe and legal abortion on the development agenda. We have seen the world community come together to discuss development on many occasions. A working committee drawn from a range of UN bodies, special agencies and specialists, including the World Bank, the International Monetary Fund, UNICEF, the Population Fund and the World Health Organization, put together the 18 specific targets and 48 indicators that formed the Millennium Development Goals, based on the Millennium Declaration of September 2000. Along with education and gender equality, health is a major focus of the MDGs and yet reproductive health seems to have received only cursory attention.
It was only in 2005 that a new target under MDG 5 (improved maternal health) was added: to ensure universal access to reproductive health by 2015. Quantitative measures now include contraceptive prevalence, adolescent pregnancies, antenatal care coverage and unmet need for family planning. The issue of maternal mortality certainly draws global attention. However, even when advocates highlight the correlation between unsafe abortions and maternal mortality, some of the world’s most restrictive abortion laws have remained in place.
So perhaps this new study is the impetus needed to advance the abortion agenda. It is indeed frustrating to need to put figures on the table. Ultimately, this is a woman’s life, health and rights we are talking about and it is easy to ask why money should matter. But when we have talked rights in the past, laws have not changed. The 2003 Protocol to the African Charter on Human and Peoples' rights on the Rights of Women in Africa, adopted by the African Union mandates countries to protect the reproductive rights of women by authorizing medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the fetus. In the context of women’s health programs and the high maternal mortality rates resulting from unsafe abortions, the Africa Health Strategy 2007-2015 recommends “safe termination of pregnancy and post-abortion services should be included as far as country’s law allow”. However, few African governments have implemented the Protocol’s recommendations. As of January of this year, for a host of African countries, abortion remains illegal in all circumstances or is permitted only to save a women’s life, including in Angola, Benin, Côte d'Ivoire, Kenya, Lesotho, Mali, Nigeria, Senegal, Somalia, Tanzania, Togo and Uganda. It is clear that change requires a fundamental shift in knowledge, attitudes and incentives.
For example, a study conducted in Nigeria by the Women’s Health and Action Research Centre in December 2008 involving interviews with 49 policy makers in 6 regions of the country on knowledge and perceptions of the causes of abortion-related maternal mortality found that policymakers were guided by moral and religious considerations rather than by current evidence-based considerations. Only four participants recognized the fact that abortion will go on regardless of the law. One-third of key informants were opposed to liberalizing the laws on abortion in Nigeria, while only one-fifth supported liberalization on “medical grounds” and to deal with unwanted pregnancies due to rape and incest. So will money talk? Arguments about the costs of abortion-related mortality and morbidity have been made several times over the past few decades. So will the cost argument succeed this time around?
A significant proportion of aid is spent on advancing healthcare systems in the global south. This study by the Guttmacher Institute evidences unnecessary and avoidable costs, money that could be diverted and invested elsewhere in the healthcare systems of many African nations. If aid money is aimed at creating cost-effective, efficient and sustainable health care systems, African nations and the global community cannot ignore the high number of unsafe abortions that continue to occur on a daily basis and the heedless money spent addressing complications. Let’s see whether money can break down the moral, religious and non-evidenced based perceptions that have thus far acted as barriers to change.
]]>Malawi has some of the harshest laws in all of Africa criminalizing homosexuality. Sex between men is punishable by up to 14 years imprisonment, although it appears that female-to-female sexual relations are legal. Only several months ago, in August of this year, the National Assembly passed a constitutional amendment banning same sex marriage. The ban follows an anti-gay campaign, jointly initiated by Christian and Muslim leaders, in response to advocacy by Malawi NGOs demanding repeal of the Penal Code criminalizing homosexuality and pushing for gay marriage. A member of parliament, Edwin Banda, even proposed that the constitution should include a clause stipulating that Malawi is a "God fearing nation", with homosexuality deemed ungodly, a proposal that was later rejected. Other stories from Malawi evidence how religion acts as a barrier to better protections for the rights of homosexuals. According to one report, when Anglican Bishop Nick Henderson was sent to head a diocese in rural Malawi, he was rejected by the congregation for his pro-gay stance and subsequent protests led to the death of a church member.
Unfortunately, what this new debate means is that homosexuality is once again being discussed in the context of sexually transmitted diseases, possibly furthering pre-existing negative perceptions and notions of deviance that exist towards homosexuality in Malawi. At the same time, it is unquestionable that the higher risk facing Malawi's homosexual population, formerly named as “invisible,” means this group must be included information campaigns and guaranteed enhanced access to services.
In November of last year, Malawi held its third annual testing week. Malawi has one of the highest HIV prevalence rates in the world. Estimates range from an 11.8 per cent adult prevalence rate found in the 2004 Demographic and Health Survey to a 14.1 per cent prevalence rate estimated by UNAIDS in 2005. Yet, a study released in Copenhagen in July at the World Outgames, involving 200 Malawi men, 75 per cent of whom had multiple male sexual partners, revealed a prevalence rate among respondents of around 21 per cent, an obvious difference with the national rate. The study's findings provide significant evidence to back Shawa's comments about the need to better target homosexual men. Among respondents, only 1.5 per cent had ever been told by a health professional that they were HIV positive, with 77 per cent never having been asked by a health professional to undergo an HIV test. The impact of criminality and stigmatisation is also revealed by the fact that only 10 per cent has informed a health professional that they have sex with men. The 2007 study also revealed that politicians and leaders in Malawi prefer to promote the idea that homosexuality does not exist in Malawi, making Shawa's comments all the more remarkable.
More generally, according to Doctors Without Borders (MSF), there are around 930,000 people living with HIV/AIDS in Malawi, accounting for 12 per cent of people aged between 12 and 49 years of age in Malawi. 60,000 people die from the disease every year. It can only be hoped that Shawa's comments foster increased, open public debate about some of the cultural causes that continue to spread the virus among men and women or foster stigma against people living with HIV/AIDS. This includes early marriage between young teenage girls and older infected men as well as other forms of sexual exploitation against young women, including forced sex in exchange for passing school imposed by male teachers. It is, in fact, particularly important that the rights of women living with HIV are not lost in this debate, given that 2004 figures reveal that women represent 56.8 per cent of the adult HIV positive population. The 2004 report of the UN Secretary General's Task Force on Women, Girls and HIV/AIDS in Southern Africa reveals that marriage is a risk factor, with 17.5% of married Malawi men having had extramarital sex in the 12 months prior to the study. The lack of recognition of marital rape also does not help. Many Malawi women are brought up to believe that a woman should not refuse to have sex with her husband. Additionally, as Avert notes, the practice of 'wife inheritance', where a widow is married to a relative of her husband upon his death, also increases risks of HIV infection were AIDs was the cause of death of the previous husband.
It remains to be seen whether Shawa's comments will have an impact on the rights of gay men in Malawi or the lives of people living with HIV in the country more generally. Unquestionably, given the climate, Shawa deserves high praise for putting on the table for public discussion the centrality of human rights to the fight against HIV/AIDS.
]]>AEP itself was not without its critiques. The Delhi-based group, TARSHI (Talking about Reproductive and Sexual Health Issues), which prefers the term "sexuality education" because they consider it a broader and more encompassing approach, issued a call for action last year, arguing that AEP provides scant information on sexual transmission and how to protect oneself. They further condemned AEP for underestimating the ability of young people to make decisions about their own lives and criticized the lack of information in the curriculum on reproduction, healthy sexual relationships and gender identity, with only one reference about those who do not identify with the "mainstream heterosexual norm."
TARSHI's Manager of Programs, Prabha Nagaraja, discussed with me their open letter campaign to the Government, all political parties and citizens of India, initiated in February to advocate for sexuality education. Highlighting that India is a signatory to the United Nations Convention on the Rights of the Child, the letter observes that failure to provide sex education denies the right to the highest attainable standard of health, the right to education, the right to participation and the right to protection from exploitation and abuse, including sexual exploitation and abuse. The statistics demonstrate the current failure of the government to guarantee these rights. At the time of the National Family Health Survey III (NFHS III), 16 percent of women aged 15-19 years were already mothers or pregnant at the survey. Additionally, according to a 2007 study by the Ministry of Women and Child Development, out of a total of 12,447 children, 53.22 percent reported having faced one or more forms of sexual abuse.
Rather than recognizing the need for sex education, the government has responded with a deplorable decision to eliminate all sex education in schools, one that has been criticized extensively. The director-general of National Aids Control Organization (NACO), Rao, who responded by saying, "If all Indians are bramhcharis [a reference to being morally pure or celibate], then how come 30 percent of all HIV infections at present are within the age group of 15-24 years?"
However, sex education extends far beyond the issue of HIV and the decision to ban sex education has united civil society in opposition. One such group is "Gains & Gaps- ICPD+15: A Civil Society Review in India," a loose conglomeration of organizations and networks working in the fields of women's rights, human rights, health rights and sexuality. Members include the Centre for Health and Social Justice (CHSJ), Jagori, Jan Swasthya Abhiyaan (JSA)/Peoples Health Movement India, National Campaign for Dalit Human Rights (NCDHR), Population Foundation of India (PFI), Positive Women's Network, SAHAYOG, SANGRAM and (Social Upliftment through Rural Action (SUTRA). Gains & Gaps has submitted a petition appealing for the Committee to overturn its decision on sex education.
Jaya Velankar, a consultant with the Center for Health & Social Justice, explained to me their goals in submitting this petition: "Through this petition we want our government to recognize and take necessary steps to impart age appropriate, non-moralistic and fact-based sexuality education to adolescents and youth both in schools and out of schools. It must also make efforts to dispel the fears and myths that people may have in their minds." The group emphasizes the social aspects of sex education, including the formation of attitudes about the self, relationships, sexual behavior and diversity, reproductive health and gender roles. It is also advocating for developing young people's skills so that they make informed choices about their behavior, and feel confident and competent about acting on these choices.
Advocacy against the government's stance is also about busting myths. The coalition argues there is no evidence that the introduction of sex education leads to an increase in sexual activity among youth, not to mention that according to the National Family Health Survey III, young people in India are already sexually active. Of those aged 15-24 years, 51 percent of women and 27 percent of men, state that they have had sex, with 10 percent of women and 2 percent of men in this age group indicating that they had sexual intercourse by age 15.
Sex education plays a pivotal role in guaranteeing rights to sexual diversity, sexual health and choice for all, preventing HIV and other STIs, unwanted pregnancies, discrimination and homophobia. In the words of Velankar, "As a signatory to Program of Action that emerged at the International Conference on Population & Development in Cairo in 1994, the government is committed to encourage reproductive health education amongst adolescents. This year being the 15th anniversary of Cairo, we hope the government will take appropriate action."
]]>The Government has already noted women's reproductive health needs in its report to the Committee. Its national population policy aims to ensure that all Cambodian people have access to comprehensive use of reproductive health service in 2015, with the goal of supporting couples and individuals to decide the number and spacing of their children and have the information and services to do so.
However, the reports previously submitted by a number of NGOs to the Committee revealed the extent of the current government's shortfall in achieving its international obligations, particularly with regard to maternal health as well as access to health care by indigenous communities.
A report by the Center for Economic and Social Rights highlighted the inadequate resources dedicated by the Government to economic and social rights. The Government's expenditure on health and education is particularly low compared to the country's GDP. Compared to other countries in the region, Cambodians are more likely to pay out-of-pocket for their health care. In fact, the World Bank has reported that Cambodia has the highest private health expenditure as a percentage of GDP of all low-income countries. The report also highlights the vast regional disparities in availability of reproductive health services in Cambodia. Women giving birth in the capital Phnom Penh are over six times more likely to be assisted by a skilled birth attendant than women in the regions of mondol Kiri and Rattanak Kiri.
The health disparities for indigenous people are also a pressing issue highlighted by several NGOs. The NGO Working Group argues that money, transportation, language, discrimination, low levels of education and traditional beliefs/obligations act as barriers and are impeding access to health services and information. The Indigenous Community Support Organization, one of several organizations reporting on the rights of indigenous peoples, has similarly reflected on the obstacle to accessible services created by language and cultural barriers, citing the lack of indigenous minority staff in public health services as a significant problem.
Maternal health has also received coverage among the NGO reports, unsurprising given that the World Health Organization reporting a Maternal Mortality Rate of 540 per 100,000 live births in Cambodia, though data varies with the Cambodian and Demographic Health Survey indicating an MMR of 437 in 1998 and 472 in 2005. Regardless, the estimates are alarming and can be addressed with greater prioritization of maternal health. The NGO Working Group has offered several recommendations including addressing basic needs for reproductive and child health services, supplies and infrastructure with particular emphasis on community-based health care, increasing the skill of birth attendants and emergency medical obstetrics care services and providing free maternal health services to all poor and marginalized women.
The NGO Working Group has also highlighted the needs of people living with HIV/AIDS, Cambodia having one of the highest HIV prevalence rates in Asia, falling second to Thailand. They have specifically noted the need for expansion and strengthening of Antiretroviral Therapy (ART) programs, increased coverage of the Prevention of Mother-To-Child Transmission (PMTCT) services, including better access to Voluntary Confidential Counseling and Testing (VCCT) services for pregnant women and, overall, an increase in the number of HIV positive pregnant women who received antiretroviral drugs to reduce mother-to-child transmission. They have also called for improvements in programs targeting specific at-risk groups, "such as brothel sex workers, women working in entertainment establishments, Men Who Have Sex with Men (MSM) and Injecting Drug User (IDU)."
Equally concerning, however, are the issues that have been given inadequate attention in the government and NGO reports. Wide-scale gender inequality persists in the country, with UNFPA reporting high rates of gender-based violence, with limited services for survivors and limited strategies for finding perpetuators of violence, rape and indecent assaults that disproportionately affect young women and girls. UNFPA and others like the Global Health Council report alarming evidence of gang rape, resulting in unintended pregnancies, HIV and other STIs as a result. Other groups whose health needs appear to be neglected in these reports are migrant workers and those living in urban slums.
It is clear the inadequacy of reproductive health care is much more complex than a question of improved physical access and increased government investment. At least, however, the Cambodians, through the NGOs participating in the process, have an opportunity to seek some accountability for the shortfall, and a new platform to lobby for change.
]]>In some respects, the Government's motives are suspect. With the National Population and Family Planning Commission estimating that 70 percent of the migrant population is of childbearing age, fear of breaches of the one child norm is at play. To the extent that male migrants are the primary targets of this initiative, a further and valid driving force is the spread of HIV transmissions among migrants, given the vulnerability of mobile groups. This stems from the Ministry of Health's fears that sex has overtaken intravenous drug use (IDU) as the main cause of HIV/AIDS transmission in China.
"Relations involving multiple sexual partners have increased as male farmers flocked to cities, thus increasing the possibility of HIV transmission," said Wu Zunyou, director of the National Center for AIDS/STD Prevention and Control. He believes that migrant groups are sexually active, but unaware of how to protect themselves.
The inclusion of migrants in the free contraceptives program is one of several government initiatives since late 2008 designed to reduce HIV vulnerability among migrant populations. However, insufficient numbers of people undertaking HIV tests, underreporting of rates of HIV infection and general lack of transparency about the issue, which I have discussed previously, mean it is difficult to assess whether such programs have or will be successful.
In December 2008, the Government was involved in the launch of a joint campaign to reduce discrimination against HIV/AIDS and to encourage safe sex among male migrant workers. In some areas, including bars in Beijing and construction sites with more than 500 workers, the Government has also set up automatic condom-vending machines. In Dalian City, in the northeast province of Liaoning, the Government also provided 3,000 migrants with free HIV tests in 2008.
One of the gravest shortcomings, in terms of reproductive rights, is the common case of public health initiatives and reproductive health programming aimed migrant populations. In an effort to target HIV-prevention, insufficient attention is given to other reproductive health vulnerabilities associated with mobility. Migrant women, in particular, frequently lack access to sexual and reproductive health services, whether because of unaffordable user fees or lack of access to national health schemes.
Several years ago, one Chinese writer revealed the vulnerability of migrant women in China, reporting that although China's Labor Law guarantees women workers maternity leave and protection for their reproductive health. The large supply of workers places employers in a position to refuse to pay maternity leave, or fire women who are pregnant. Zhang Ye also reported the general and specific reproductive health harms resulting from factory working conditions, specifically in the footwear and garment factories, where workers face chemical fumes, unbearable heat and long hours of standing.
This is not to suggest that migrant women are completely being ignored. In April, Li Bin, China's minister in charge of the National Population and Family Planning Commission, reported to the United Nation's Commission of Population and Development the intention of the Government to issue regulations on reproductive and family planning of migrants to protect their reproductive rights. Recently, there has also been an increased focus on corporate social responsibility, targeting companies like Nike, Disney and Levi Strauss. One project is focused on the role of companies to recognize the harmful effect of neglecting women's reproductive health.
In reality, HIV vulnerability is one of many vulnerabilities internal migrants in China face, particularly with respect to lack of redress for violations of labor rights, including workplace hazards and absence of pay. However, in the specific case of the reproductive rights of migrant women, it seems that Government-funded programming, at present, is insufficient at addressing the very particular set of vulnerabilities facing this population, including mandatory health testing, denied pregnancy, forced abortion and lack of access to healthcare. Though the Government of China's efforts in terms of free HIV testing are indeed commendable, in reality they are only one part of a wider approach that is essential to guarantee the reproductive rights of the very significant internal migrant population in terms of the reproductive rights violations Chinese women migrants suffered in the past.
]]>Indian Constitutional Law does not permit the statutory criminal law to be held captive by the popular misconceptions of who the LGBTs are. It cannot be forgotten that discrimination is anti-thesis of equality and that it is the recognition of equality which will foster the dignity of every individual.
Chief Justice S. Muralidhar, Deli High Court
The decision this week of the Delhi High Court to decriminalize homosexuality has received coverage from around the globe, and rightly so. This monumental judgment follows years of activist efforts, such as ‘Voices Against 377’, battling Section 377 of the Indian Penal Code, which describes homosexual sex as an “unnatural offense” and “against the orders of nature”. The case itself has been an eight year long battle, with NGO Naz Foundation having first filed the Public Interest Litigation (PIL) seeking legalization of homosexual sex back in 2001.
The High Court concluded on Thursday that Section 377 violates articles 14, 21 and 15 of the Constitution. Article 14 guarantees all people “equality before the law,” Article 15 prohibits discrimination “on grounds of religion, race, caste, sex or place of birth,” and Article 21 guarantees “protection of life and personal liberty.” The Petitioners had argued that Section 377 targets homosexuals in an unfair and arbitrary way, infringes upon their rights to privacy and “conveys the message that homosexuals are of less value than other people, demeans them and unconstitutionally infringes upon their right to live with dignity”. They also challenged morality as a basis for restricting rights.
The judgment of the High Court was unquestionably progressive, drawing on decisions from Canada which discuss the meaning of dignity, provisions in the Universal Declaration of Human Rights, International Covenant on Civil and Political Rights and European Convention on Human Rights to analyze the right to privacy, as well as Roe v Wade. The High Court also discussed the Yogyakarta Principles on the Application of Human Rights Law in Relation to Sexual Orientation and Gender Identity in detail as well as the impact that criminalization of homosexual sex has had in different parts of the world, including South Africa. They also cited the opinion of Justice Kennedy in Lawrence v Texas that “when homosexual conduct is made criminal by the law of the State, that declaration in and of itself is an invitation to subject homosexual persons to discrimination both in the public and private spheres”. The High Court further recognized the impediment created by criminalization to public health programming. A remarkable and essential declaration on the rights of LGBT people indeed!
The former Central Government itself was brought into the case in 2006, with the High Court allowing a senior Bharatiya Janata Party (BJP) leader, whose party was then in power, to join the case and oppose decriminalizing homosexual sex. The Central Government’s position throughout the case has not been without controversy, with a clear division of opinion between the Ministry of Home Affairs, which opposed any change to Section 377 and the Ministry of Health which was not in favor of the criminal provisions, largely due to their contribution to pushing those infected with HIV underground. Both Ministries filed what the Chief Justice of the High Court referred to as “completely contradictory affidavits”. Even though the decision applies only in National Capital Territory of Dili, according to advocates, it will either force India's Central Government to appeal the decision to the Supreme Court, or the Parliament of India to amend the law nationwide.
The legacy of colonialism behind Section 377 is worth noting, as we cannot forget the other countries around the globe that continue to criminalize homosexuality. Section 377 was introduced in the 1860 Penal Code when India was under British rule. In fact, this history was used as an excuse by the delegation of the Central Government at the Human Rights Council’s Universal Periodic Review of India’s human rights record in April 2008 in Geneva when criticized by the Government of Sweden for criminalizing homosexual conduct. The delegation claimed it was “a Western concept, which has remained over the years (PDF)”, even though homosexual sex was decriminalized in England and Wales in the late 1960s under the Sexual Offences Act 1967. According to a report released by Human Rights Watch last year, almost half the world’s remaining "sodomy laws" stemmed from the spread of Section 377 by British rulers to other colonies. This includes Bangladesh, Malaysia, Papua New Guinea and Singapore in Asia and the Pacific as well as Botswana, Kenya, Nigeria, Uganda and Zimbabwe in Africa. It brings to mind the ban on abortion introduced to the Philippines based on a direct translation of the Spanish Penal Code of 1870, with Spain having since liberalized its own abortion law, with Filipino women stilled denied their rights.
The indignity and rights violations perpetrated as a result of Section 377 should not be forgotten as we celebrate this victory. The Petitioners argued that Section 377 had been a “weapon for police abuse,” creating a continually victimized class of vulnerable people. According to the Naz Foundation, it was used to facilitate harassment, extort money, blackmail, and even rape homosexuals in India, mainly those from the lower socio-economic classes who had little knowledge of the law and their rights. Section 377 was also used by police to justify raids on parties and events.
Unfortunately, the battle continues, both in terms of building awareness of the decision and advocating for change on issues of discrimination, harassment and corruption in India and for LGBT rights activists in other countries around the world where homosexual sex remains criminalized. Yet we see in the decision of the Delhi High Court an important precedent. This should bring hope to rights activists around the globe, such as Repeal 377a, a group still fighting Singapore’s ban and encourage global recognition, particularly politically, of the rights of all people to equality and a life free from discrimination and of the importance of respect for personal dignity.
]]>On May 20, Nepal's Supreme Court ordered the Nepalese government to enact a comprehensive abortion law to guarantee that women have access to safe and affordable abortion services. Abortion has been legal in Nepal since 1992 when the government introduced an amendment to the National Code to allow a woman to have an abortion within the first 12 weeks of pregnancy, up to 18 weeks if the pregnancy is the result of rape or incest, or at any time if it is believed that the pregnancy will affect her physical and mental health. The amendment represented not only a step towards improving the health of Nepalese women but also what an untenable situation the former law created, with one-fifth of women in prison in Nepal at the time of the amendment incarcerated for having had an illegal abortion.
Since the introduction of the new law, however, numerous barriers have continued to prevent women from accessing safe and legal abortions, the most obvious being the lack of service providers but also a lack of awareness among women that abortion is legal. Familial and religious values have frequently deterred women from seeking an abortion while stigma persisted, heightened by number of women who served prison time under the previous law. The Supreme Court's new decision requires the government to set up a fund to cover the cost of abortion for poor and rural women and invest enough resources to meet the demand for abortion services. The Supreme Court has also instructed the government to raise awareness about legal and safe abortion and take steps to eliminate the stigma surrounding the practice.
The petitioner in the case was Lakshmi Dhikta, a woman from a poor household in the rural western region of Nepal who had been denied an abortion simply because she could not pay the fee for the procedure and was forced to give birth to her sixth child. The case was filed back in 2007 by the Nepalese NGO, Forum for Women, Law, and Development supported by the Center for Reproductive Rights (CRR) in New York. According to the CRR's regional manager and legal adviser for Asia, Melissa Upreti, the decision was not unexpected but rather a reflection of the maturity, sensitivity and progressive attitude of the current court. According to Upreti, the Nepalese Supreme Court has issued a number of gender sensitive decisions over the years, including ordering the government to review the provisions for punishing marital rape, which were considered too lenient. In August 2007, the Court also rejected a writ that challenged the new abortion provisions on the basis that they discriminated against men for allowing a woman to terminate a pregnancy without the husband's consent as well as criminalizing marital rape. Upreti also credits the consistent efforts of activists over the years to sensitize judges about gender equality and human rights, with one of the judges who handled the case having been involved in a CRR training on reproductive rights litigation back in 2006.
In one of my previous posts I have discussed the value of
the Government of Nepal's Interim
Constitution adopted
in January 2007 which explicitly recognizes that "every woman
shall have the right to reproductive health and other reproductive matters"
as a fundamental right. Upreti believes that this recognition
of reproductive rights as fundamental provided a strong legal basis
for the Court to recognize the claims made in this case. This is not
to suggest that the case was an easy win, in light of Nepal's conflict-ridden
history. Upreti also notes that "the case is in large part premised
on a woman's autonomy, a concept that does not exist in the patriarchal
framework that has dominated Nepalese society for centuries."
The decision comes after a recent announcement by the Ministry of Health and Department of Health Services of a plan to bring medical abortion to the primary health-care and community level throughout Nepal, particularly poor, underserved women, especially those living in difficult-to-reach rural communities. The government will train midlevel providers (such as nurse midwives), as well as doctors, to counsel women and provide medical abortion.
There had been a number of efforts over the years by local and international NGOs to raise awareness about the legality of abortion and help address the ingrained fears and shame that were standing between women and safe abortion. Path, for example, have been working to create "dialogue groups" allowing groups of women to have discussions about issue such as unwanted pregnancy, choice, AIDS prevention and gender inequality. Ipas Nepal also began training health-care providers in comprehensive abortion care in 2004, as a result of which, nearly 500 providers, including nurses, have been trained and 74 out of 75 districts have at least one trained provider. However, despite such efforts many poor, rural women still cannot access safe abortion services, making this Supreme Court decision truly monumental.
A significant portion of Nepal's maternal deaths is attributable to unsafe abortion, heightened by persistent poverty, low rates of contraceptive use and a high percentage of deliveries occurring without a skilled birth attendant. With one of the highest maternal mortality rates in Asia, 830 deaths per 100,000 live births in 2005, this Supreme Court decision reflects a much-needed push for the government to account to its people in guaranteeing the right to life and the highest attainable standard of health. Now civil society groups must maintain this momentum and monitor the decision's implementation, working with the government to continue to make access to abortion a reality.
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The injustices suffered by
women across the globe led us to devote most of our time to the discussions
about justice for women survivors of war, justice for survivors of gender-based
violence and the need to stop domestic violence and rape against women.
However, the words of East Timor's Prime Minister (and former President) Xanana Gusmao
reminded us to look beyond the wrongs: "When we talk about the rights
of women, these are human rights. We normally talk about human right
as being violated but we need to start talking about these rights as
obligations" (oral translation from Tetum).
Among the very rich discussions, one that peaked my interest was the session devoted to the impact of culture and religion on women's rights, with a particular focus on reproductive rights. Madalena Hanjam Leste, Deputy Minister for Health of the Government of Timor, started her presentation by citing the definition of health in the Constitution of the World Health Organization: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." She highlighted the importance of women being guaranteed safety, autonomy and choice. In her view, the institutional challenge for East Timor is increasing the value given to women's voice; ensuring women have access to decision-making; and prioritizing women's health throughout the life cycle. She admitted that reproductive health in East Timor is insecure, with only 37 per cent of births attended by skilled health professionals and 20 to 42 per cent of pregnant women undernourished and anemic.
Her co-speaker, Bishop Gunnar Stålsett, the Special Envoy of Norway to Timor, also advocated for the need to enhance the capacities of religious leaders to monitor laws and fight against all forms of rape and violence against women. When asked about the sometimes-oppressive role of the church when it comes to women's rights, Bishop Stålsett responded, "The discussion needs to be open and free in every society. The church has sometimes stood against the freedom and equality of women. It is important to raise the issues and rise above taboos."
In a predominantly Catholic
community, with a strong presence and involvement of the Catholic Church,
it was unsurprising that the issue of abortion was highly controversial
and created heated debates. It unfortunately broke some of the solidarity
that had been achieved over the three days amongst the women participants
of diverse national, religious and ethnic backgrounds.
Both Indonesian activist Gadis
Arivia, and Maria Barreto, of the Timorese NGO Fokupers (The East Timorese
Women's Communication Forum), also raised the issue of abortion in
their respective countries. In Indonesia, 2.3 million women each year
have an abortion because access to contraception is significantly limited.
In East Timor, despite increasing recognition of the importance of women's
empowerment and gender equality for the development of the country,
women who fall pregnant as a result of incest and rape do not have access
to safe and legal abortions. Advocates continue to push for change and
a group of Timorese women attending the conference went before the East
Timor Council of Ministers on March 6 to argue that the exception for
abortion in cases of rape, currently in the draft penal code, should
be kept. Alarmingly, in light of the backlash and pressure from the
clergy, this exception may be removed from the final version.
Yet, a consensus was almost reached on a number of key recommendations, including completely implementing CEDAW and the other human rights treaties that the Government of East Timor has signed, putting an end to rape, torture and other forms of violence against girls and eliminating all laws that discriminate against women.
Timorese women certainly have the courage and passion to fight for their rights and voice their grievances. What is clearly lacking, however, is the space, particularly political space to do so. We will have to wait to see in particular how much this momentous meeting has given Timorese women more space and the creative tools to push for their right to choose and protect their own lives and health. At the same time, though far away from most readers, the conference recommendations included a valuable call for action to all of us: "We need to strengthen networking among women internationally in the fight for justice, to support victims to speak out, and to find creative solutions for holding human rights violators accountable."
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Sexual rights activists and
scholars from all around the globe met from April 15-18 in Hanoi to
share their thoughts and experiences on these questions, discussing
gender equality, sexual diversity, sexual identity, sexual health, social
justice and human rights. The VII Conference of the International Association
for the Study of Sexuality, Culture and Society (IASSCS), convened for the first time in Asia,
involved a diverse range of participants undertaking multidisciplinary
study from a range of countries, such as Kenya, Indonesia, the United
States, Senegal, Taiwan, Peru, Pakistan, Argentina and Switzerland.
Past conferences have been held in Amsterdam (1997), Manchester (1999),
Melbourne (2001), Johannesburg (2003), San Francisco (2005), and Lima
(2007). The title of the 2009 conference drew upon the presumed sexual innocence
often used to define female sexuality and adolescent sexuality: "Contested
innocence: Sexual agency in public and private space."
One of the strongest messages that I took from the conference was that of challenging society's expectations and norms about gender and sexuality. A gay rights activist from Indonesia, Dédé Oetomo, opened his discussion with a reference to sex-selective abortion and how Asian cultures have an obsessive preference for male babies: "It is a perilous moment if we turn out or are even suspected of being female". He questioned society's obsession with conformity and asked why "gender" has become synonymous with "women" or "gender identity" with transgender, "as if men and women don't have gender." Referring to homosexual men, men who have sex with men (MSM) or men who love men, he criticized the emergence of "MSM language," which I myself have fallen into the trap of using in previous posts: "With all this diversity, it is dangerous to classify it all by ‘MSM.'" A similar comment that homosexual men who have sex with men do not commonly use the label "MSM" was made by another researcher in reference to Vietnam.
Similarly, US researcher Evelyn Blackwood criticized the notion of LGBT as a "western" concept." Referring to the June 1969 rebellion in New York City's West Village that helped spark the modern LGBT movement, she recognized that having these labels creates a sense of community that one can identify with, but concluded: "There's a lot more going on with gender and sexuality that can ever be encapsulated in four letters." This is particularly the case with terms like Tongzi, tomboi or lesbi used in Asia. She also felt that lesbian women or women loving women had been less visible in the global homosexual movement.
A great deal of discussion was dedicated to the stigma of living with HIV. HIV prevention campaigns have a "missing link" where the campaigns target men who have sex with men but these men are unwilling, unable or, simply, do not identify this way. The peculiar vulnerability of migrants and mobile populations to HIV infection was also highlighted, particularly with reference to Vietnam and China. Low condom use, either because of lack of knowledge or lack of access among these vulnerable populations, was also evident in the data presented by researchers.
Proposition 8 also received some brief negative coverage. South African activist and scholar, Pierre de Vos, highlighted that the introduction of same-sex marriage alone is unable to change the deeply patriarchal and homophobic society in which he lives: "Laws alone will not affect the radical social change that some of us want to see." A more positive picture was presented about Spain, where there were 1,275 same-sex marriages in 2005, 4,574 in 2006 and 3,250 in 2007 following the introduction of same sex marriage in mid 2005. In Spain too, however, homophobia remains a challenge, with families sometimes absent at weddings and same-sex couples fearful of telling colleagues at work, and therefore losing the right to 15 days off work, a legal entitlement for all couples getting married.
To me, the entire conference pushed boundaries and raised challenging ideas, particularly in light of the backdrop of conservative Communist Vietnamese society. Many of these activists and scholars will meet against at the VIII IASSCS Conference which will take place in two years time. No doubt, they will discuss new ways of tackling new obstacles in the fight for dignity, citizenship and sexual freedom for all. For now, I walked away from this conference with a better understanding of the influence of culture in creating diverse sexuality. Any transnational fight for equality must recognize this.
]]>However, the decision to overturn the ban, imposed in 1996 by the previous conservative government, in fact challenges the personal beliefs of Prime Minister Rudd. Rudd said he had "long-standing conservative views" on the issue and did not support the change. Rather, after extensive consultation with parliamentary colleagues, Foreign Minister Stephen Smith made the decision to lift the ban: "I was left with the very distinct impression that the substantial, if not the overwhelming majority of the parliamentary members of the Labor Party believed that this was also the correct outcome."
Sarah Hanson-Young, an Australian senator from the Australian Greens, who was the youngest Australian woman ever elected to parliament, noted how out of step Australia has been with the international community. Although not an entirely accurate statement about the changes introduced by the Obama Administration, Hanson-Young stated: "Australia, until this morning, was the last country who had these ridiculous, archaic, inhumane restrictions placed on our aid funding and support. What we now see is Australia has stepped up in line with Barack Obama, who in his very first week as president moved to ensure that these restrictions would be lifted," she said. In the February Parliamentary sitting of the Australian Senate, Senator Hanson-Young also moved for the Senate to recognize that an estimated 34,000 mothers die in the region each year due to the lack of maternal health care.
Bob McMullan, Australia's Parliamentary Secretary for Development Assistance, also recognized the potential significance this decision will have for maternal health, "the greatest gap in health services between the developed and developing world." Honing in on the rights of women to decide the number and spacing of their families, Jane Singleton, chief executive officer of the Australian Reproductive Health Alliance (ARHA), also commented on this reform. In Singleton's opinion, "It will have huge impacts on hundreds of thousands of women and their families who want to make choices about the numbers of children they have and the spacing and it will also free up funds for family planning generally." She also highlighted that while these restrictions have been in place, Australia's funding for a whole range of family planning has diminished by 84 per cent. Foreign Minister Smith has promised to reverse this decline in aid for family planning organizations. As part of Australia's commitment to advancing the Millennium Development Goals (MDGs) and to improve child and maternal health, the Government will also provide additional funding of up to $15 million over four years through UN agencies and NGOs for family planning and reproductive health activities to help reduce maternal deaths.
The potential for this change to save women's lives and guarantee women their right to health is enormous. AusAID, the Australian Government's Overseas Aid Program, funds a range of countries in Asia and the Pacific, with $AUS3.7 billion worth of official development assistance planned for 2008-2009. I have previously drawn the spotlight on East Timor and expressed my hope that a change in Australia's foreign aid funding requirements would help stop the 68,000 unsafe abortions that unnecessarily take place every year, risking the lives of young Timorese women. However, women all around the region, including those from some of Australia's biggest recipients like Bangladesh, Pakistan, Cambodia, and the Solomon Islands, could now have the opportunity to access legal abortions, safely, more affordably and be armed with the necessary information to do so. This is particularly important in South Asia. Whilst more than half of the world's unsafe abortions take place in Asia (10.5 million), more than one-third of these are in South Central Asia. According to Action Canada for Population and Development (ACPD), in the Asia region, excluding East Asia where safe abortion is widely accessible, one unsafe abortion occurs for every 5 live births.
In Nepal, unfortunately one
of the smaller recipients of Australian Government aid (with an estimated $AUD8.2 million foreign aid to be
received from the Australian Government in the period 2008-09), unsafe
abortion causes 20 to 27 per cent of all maternal deaths. Given that nearly a quarter
of Nepalese women give birth before the age of 18 and over 50 percent
women give birth by the age of 20, the number of young women dying is
staggering. An increase in family planning funding will help to address
the low levels of education, including reproductive health education,
limited access to health services and the higher risks of complications
that exist for these some of the younger women, whose reproductive system
may not being fully developed in light of their age.
Sexual and reproductive health and rights groups have been waiting a long time for this decision. One of the key outcomes of roundtable discussions held in 2006 on Australia's family planning aid was the realization that unsafe abortion could not be left out of a comprehensive approach to sexual and reproductive health programs in the region. Donor money isn't everything, but it certainly can have a huge impact on countries that de-prioritize reproductive health. All recipients of Australian funding can now freely use this money to arm women with the information and services they need to make choices about their own lives, hopefully shrinking the gap between the rights, health and choices of women in the global north and south.
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Justice Cameron is indeed correct
when he says that China has a very good treatment program. China's Statute
on AIDS Prevention,
in force from March 2006 consists of 64 regulations, which require local
governments to provide anti-retrovirals at no cost to rural and low-income
urban HIV-positive people. Local governments also must provide treatment
to pregnant women at no cost and counselling and prevention information
about mother-to-child HIV transmission. In addition, the Statute also
requires that all HIV tests be given at no cost and bars officials from
disclosing the names or personal information of those who test positive.
According to UNAIDS, in 2007,
there were 700,000 people living with HIV/AIDS in China.
The figure, however, could in fact be 10
times higher given
the extent of under-reporting and since HIV-testing remains uncommon
throughout China. According to a report by the Chinese Ministry of Health, there were 22,299 new HIV/AIDS cases
reported in the mainland in the first half of 2008. Low rates of condom
use have been blamed for the steady
rise in the ratio
of sexually transmitted infections, a marked change from the pre-2003
situation, when intravenous drug use was the dominant means of HIV transmission.
The Ministry of Health reported that heterosexual and male homosexual
transmission climbed to 37.9 percent and 3.3 percent in 2007, respectively,
from 10.7 percent and 0.4 percent in 2005, respectively.
A study conducted by Beijing's Renmin University and supported by UNAIDS is particularly telling with regard to attitudes to HIV-positive people. The study, released September 2008, which involved interviews with 6,000 people in six Chinese cities, found that more than 63% said they would be unwilling to accept services such as hairdressing from an HIV-positive person, and more than 41% said they would be unwilling to work with someone living with HIV/AIDS. Also of concern is the study's finding that less than one-fifth of respondents said they would use a condom if they had a sex with a new partner. According to another report, although it is illegal to discriminate against people living with HIV/AIDS in China, HIV-positive people continue to be banned from public facilities such as gyms and bathhouses, and some offers of employment make HIV tests compulsory.
The Government of China is
certainly not ignoring the issue when it comes to men who have sex with
men (MSM), having launched a campaign earlier this year targeting the estimated
5-10 million Chinese men in this group. The campaign involves stronger
promotion of condom use, expanded coverage and quality of HIV prevention
activities, increased access to voluntary HIV counselling and testing
services, and improved access to treatment for sexually transmitted
infections. UNAIDS, however, has highlighted the shortcomings of these
efforts, with stigma and discrimination still all too prevalent amongst
the general population and even within the MSM community itself.
Paul Causey, a Bangkok-based consultant working with the Asia Pacific Coalition on Male Sexual Health (APCOM) and the United Nations on MSM-related issues, has highlighted not only the MSM-related stigma but also that the problem in China has impacts beyond the MSM community: "Most Asian men who have sex with other men are not open about their sexual behavior. Social taboos and discrimination mean that many opt to disguise their sexual preferences...Given that many men who have sex with men also have sex with women, high HIV rates among MSM can also translate into substantial numbers of women at risk of exposure to HIV."
HIV-related stigma and discrimination impede all efforts towards an effective response for HIV prevention, treatment, and support. The stigma attached to sexual preferences will clearly impede any potential success of China's latest MSM campaign. Such a campaign, if successful, would clearly have positive benefits beyond the MSM community. However, given the alarming rise in infection rates since 2005 for heterosexual transmission (up to 37.9 per cent of infections) and the low-rates of condom use indicated in the Renmin University study, too great a focus on the MSM community would leave other vulnerable groups, including women in hetereosexual relationships, without the necessary information or services to protect themselves.
If the Government of China is serious about addressing the increasing rates of HIV-infection, not only in the MSM community but across all vulnerable groups, it must recognize how discrimination and other human rights violations inhibit not only access to testing, treatment and other essential services but also discussion amongst the wider population about prevention and treatment of persons living with HIV/AIDS.
]]>International Women's Day is an opportune moment to reflect on whether the process has had any positive impact on the reproductive and sexual health of women in countries that have been reviewed. Has the process created a space for high-level discussions on key issues like abortion and maternal health that particularly matter to women?
Following the introduction
of UPR, the Sexual
Rights Initiative (SRI)
moved to promote sexual and reproductive rights before the Human Rights
Council. Formed in 2005 and originally known as "Reframing Sexual
Rights", the aim of SRI is to broaden the concept of sexual rights.
Whilst initially addressing only LGBT concerns, it has become a tool
for advocacy on issues such as sexual violence, abortion, transgender
issues, and sex worker rights. It therefore brings together feminist,
LGBT and southern and northern organizations fighting for political
space and has played a pivotal role in lobbying Members States to heighten
the attention given to sexual and reproductive health in the UPR process.
UPR has "great potential to shed light in the darkest corners of the globe," claimed the President of the Human Rights Council, Martin Ihoeghian Uhomoibhi, at the end of the 4th UPR session in February of this year. The President also expressed his view that several of the States which have already been reviewed have started to implement recommendations, including "adopting new polices, programs and measures aimed at improving the human rights". Yet Sunita Kujur, from CREA in India, who attended India's review during the 1st Session, holds a different view: "The potential of the UPR can only be realized if States view UPR as an opportunity to check ground realities and review human rights standards in their countries, instead of being defensive of their "failures". Kujur adds, "For India, the bridge between the Human Rights Council and domestic laws and policies is very wide. Until the Government of India can consistently be held accountable for the promises it makes at the international level, domestic laws and policies will not reflect a human rights framework."
Reflecting on the 1st year of UPR, Ximena Andión Ibañez, International Advocacy Director at the Center for Reproductive Rights, also expresses disappointment at how reproductive rights have largely been ignored in the process. "Until now reproductive rights have not gained enough attention during the sessions of the UPR." In Andión's opinion, not only does this suggest that these issues are not a priority for many States but also that "they do not even consider these human rights issues". Like Kujur, she reflects on the disappointing review of India last April: "It was shocking that during the review of India, no State inquired from the government to explain the dire state of maternal health, despite the fact that India has the highest number of maternal deaths in the world."
Both Kujur and Andión also reflect on whether the UPR process remains as politicized as its predecessor. Andión believes that instead of "being a good accountability mechanism, the process has the danger of being just a meeting for political concessions and trade offs". She does, however, note the surprising level of attention given to what would otherwise be considered too controversial an issue, sexual orientation, though credits this attention to the great advocacy efforts of the NGOs working in this area. Whilst the February review of Malaysia was considered "extremely disappointing" by the co-secretariat of COMANGO (the Coalition of Malaysian Non-Governmental Organizations in the UPR Process), issues such as sexual orientation were raised, with a recommendation made to amend the Penal Code to decriminalize sexual acts associated with a person's sexual orientation. Malaysia was also asked to specify time frames for removing reservations to the CEDAW Convention and ratifying its Optional Protocol, which establishes an individual complaints mechanism for CEDAW. If implemented, this would indeed be a good starting point for individuals or groups to claim their rights under CEDAW have been violated.
On the need for civil society
to get more involved, Andión believes that "it is important for the
women's rights organizations at the national level to get more involved
in their States review." As UPR is a mechanism designed to facilitate
discussions on the human rights situation at the local level, Andión
advocates for more input from more groups involved in this work. "Furthermore,
the only way to ensure accountability for the commitments made by the
States under review is for women rights and other civil society organizations
to get involved and follow-up on the recommendations made."
In the words of Andión, "The
HRC is really a thermometer to measure how serious States take their
human rights obligations and the collective obligation to ensure that
human rights are respected, protected and fulfilled." We therefore
have an opportunity for States to have an honest dialogue on the situation
of women's rights. With some optimism, Andión reflects on the progress
that has been made since the 1st session last April: "We
are seeing a very slow but important evolution on the quality of the
dialogue between States and also in the quality of the recommendations."
Available in Europe since 1992 and approved by the US Food and Drug Administration in 1993, the female condom is currently used in public health programs in 108 countries and is commercially marketed directly to consumers in ten countries. Yet, for the Asia-Pacific region, in ten years since its introduction, less than 1 million female condoms had been distributed amongst a population of close to 1 billion women of reproductive age. At the 7th International Congress on AIDS in Asia and the Pacific, held in Japan in 2005, it was recognized that both demand and political will needs to be built. As is a pertinent problem around the globe, this demand must be met by access.
So the question remains: Are low rates of usage a problem of access, demand or both? Demand may be affected by problems with the condom itself. Some women cite difficulties in insertion, the size of the condom and its visual appearance as well as challenges in negotiating with male partners as reasons to explain its lack of acceptability. On the other hand, while there has been a range of promotional programs to increase support and use for the female condom in such countries as South Africa, Ghana, and Brazil, with support from UNAIDS and Governments, this uptake has not been matched in the Asia region.
Rather, in countries like Thailand and Vietnam the focus has largely been on female sex workers, this approach already creating stigma around the female condom's use. In a trial conducted in Vietnam in 2000, under a joint UNAIDS and World Health Organization initiative, 481 women in districts around Hanoi were invited to use the female condom. Among the 428 women who actually ended up using the condom, more than half affirmed that female condoms were acceptable and 230 said they would continue to use them if they were provided free of charge, or if they could buy them at a suitable price. Unfortunately, one of the study's recommendations was giving priority to sex workers and women with STIs in order to help them prevent the spread of STIs and HIV/AIDS, ignoring the interests of all women who might choose to use the female condom if it was more readily available. In Vietnam, where sexual violence including marital rape remains a pressing issue, the value of the female condom for women's ability to protect themselves against unwanted pregnancy should not be understated.
Similarly in other countries, distribution and cost are blamed for low female condom use. In Indonesia, which Family Health International ranks the lowest in terms of condom usage in Asia, the strong patriarchal culture and sporadic approach to promoting condoms are blamed for the low usage. In an attempt to address rising rates of HIV in Indonesia, the government ran a trial of female condoms in selected areas of Papua in August 2006. In response to the initial success, the government launched a national female condom program in February 2007. Yet, six months later, local groups in the Papuan provincial capital, Jayapura, criticized the poor distribution and high cost of the female condoms at 15,000 rupiahs, or US$1.60 for a pack of two.
Narrow-mindedly,
some activists in Indonesia have criticized the female
condom, arguing that it is "once again, putting the burden on women."
Rather than seeing it as a tool for empowerment, these activists fear
women will be blamed when HIV infections remain uncontrolled in ten
years time. They also insist that campaigns continue to call on men
not to have unsafe sex with sex workers rather sending the message that
men should not have sex with their wives without using condoms.
Of course, the higher price of the female condom over the male condom remains an obstacle. Though the newer FDA approved version of the female condom is 30 percent less expensive than its predecessor, prices still ranging from US$1.40 to US$2.10 for consumers, considerably higher than the male condom and out of the price range for many women. However, economies of scale suggest that the price will decrease as demand increases, which will allowing the female condom to be a tool for empowerment that it was initially seen to be. Further research must also be undertaken. In 2004, the Guttmacher Institute, calling for a renewed commitment to research on the acceptability and implementation of female condom programs, highlighted the short-term nature of many studies on female condom use, with only a few studies tracking use beyond six months.
The female condom gives women more options and empowers them to have control over their own lives. Interestingly, some studies have revealed that female condom has opened the door for women to discuss sex with their partners. With global efforts, including advocacy, program scale-up, public and private sector investment, to overcome some of the negative perceptions and the very real barriers to accessing the female condom, such as costs, women in Asia can join others around the world who currently benefit from its use.
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