Any woman in the U.S. or overseas who has tried to access reproductive health care likely has a story about encountering barriers to obtaining quality, human rights-based, comprehensive care. In my advocacy work with the Center for Health and Gender Equity (CHANGE), I’ve heard all kinds of these stories.
Self-identified sex workers have talked about reproductive health care providers who go so far as to avoid making eye contact during visits. I’ve heard from women living with HIV in countries from Namibia to Chile about being forcibly sterilized, violating their right to make informed decisions about reproduction free from coercion. I’ve swapped stories with acquaintances about the rising costs of contraception in the United States and the ever-growing legal barriers to accessing safe abortion, especially for young people.
While these stories crisscross continents and issues, they show how much we have in common. And they illuminate how we as advocates can’t tease apart HIV from maternal health from family planning, just as women don’t experience their health in boxes or compartments.
Achieving comprehensive sexual and reproductive health care for all people was a rallying point at the NGO Forum on Sexual and Reproductive Health and Development I recently attended in Berlin, Germany. Leaders of non-governmental organizations from more than 130 countries met to formulate a Call to Action for governments and donors to strengthen their commitment to the 1994 International Conference on Population and Development (ICPD) Programme of Action (PoA)–a landmark agreement that placed women, gender equality, and sexual and reproductive health and human rights at the center of sustainable development.
Now, just as fifteen years ago, these groups called for a comprehensive approach to achieving the ICPD and Millennium Development Goal target of universal access to sexual and reproductive health and rights (SRHR).
I attended one workshop on HIV/AIDS services and barriers to care that stressed why comprehensive SRHR is so urgently needed. A speaker from Botswana recounted the multiple oppressions and rights violations she faced as a woman living with HIV. For example, in order to be a peer counselor for an HIV/AIDS network in her country, she had to sign a pledge that she would not get pregnant – a clear abrogation of her right to make reproductive decisions free from coercion. She also spoke of numerous human rights violations faced by women living with HIV in Botswana, including the right to life, the right to health, the right to choose the number and spacing of children and to have access to the information and means to do so, and the right to make reproductive decisions free from coercion, discrimination and violence. Her stories illustrated that HIV/AIDS and sexually transmitted infections, family planning, maternal health, and sexuality education are fundamentally connected.
All women – whether living with HIV, married, young, transgender, poor, queer – experience their reproductive health in overlapping ways throughout their lives, and reproductive health programs and services should reflect this reality. And yet when thinking in particular about the U.S. and its role in fulfilling the ICPD PoA at home and abroad, it’s clear that U.S. policies and funding are falling short in promoting comprehensive approaches to SRHR.
Take the issue of safe abortion. The U.S. restricts access to safe abortion for women in the United States by denying public funding for most abortions through the Hyde Amendment, unfairly denying low-income women a procedure that wealthier women can access. In a similar vein, the Helms Amendment precludes women across the world from obtaining safe abortion by restricting U.S. foreign assistance dollars from supporting the procedure. This runs counter to the ICPD PoA—which the U.S. endorsed—that stipulates that unsafe abortion is a major public health concern and that where abortion is legal, it should be safe and accessible. Abortion is just one instance of many where the U.S. is failing to promote comprehensive sexual and reproductive health care for its own citizens and for women worldwide.
It’s clear that we have a lot of work to do to hold the U.S. accountable to the ICPD PoA, specifically around ensuring comprehensive SRHR for women, men, and youth at home and abroad. A first step is to get educated to better inform our advocacy. A new report from CHANGE, Investing in Reproductive Justice for All, highlights the advantages and challenges of comprehensive approaches to sexual and reproductive health and rights and the role of U.S. foreign policy and serves as a useful tool to urge our own U.S. government officials to adopt ICPD principles in domestic and international policy and funding.
The Berlin forum and its Call to Action are timely with the 2015 endpoint for the ICPD PoA quickly approaching. We have an urgent mandate to join advocates from around the world to push governments and donors to carry out their commitment to achieving universal access to comprehensive sexual and reproductive health and human rights.
