By Kathy Hall-Martinez
In the late twentieth century, the rush to address rising population growth rates around the world led to policy responses that focused blindly on reducing fertility rates, with little concern for the potential impact on women's reproductive rights.
One effect of this was that the policies adopted by some governments featured fertility quotas or targets. These measures sometimes led to abuses of women's right to reproductive self-determination and, in many cases, their right to bodily integrity.
There are, however, four guiding "pillars" (PDF) for crafting policies that can safeguard the human rights of all people, including women. Any government that wants to adopt a sound population law or policy should respect human rights norms; take a holistic approach to reproductive health; promote the advancement of women; and recognize adolescents' rights.
RESPECTING HUMAN RIGHTS
Every law or policy addressing population issues, especially those relating to fertility, should be grounded in the respect for and promotion of human rights, particularly women's reproductive rights. And as a guiding principle these measures should respect the right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children, with the information and means to do so.
In 1998, South Africa adopted a commendable rights-based approach to population policy. The government followed the mandate of the final document adopted at the 1994 International Conference on Population and Development (ICPD)(in PDF format), which recognized the centrality of human rights in all discussions of population and development. The South African policy states, "Government imposed and driven fertility control measures are not reconcilable within freedom of choice and human rights."
A HOLISTIC REPRODUCTIVE HEALTH APPROACH
Governments should steer clear of a single focus on fertility or family planning services in population policies or laws, and instead favor comprehensive health care that includes the following:
- counseling, information, education, and services for family planning
- education and services for prenatal care, safe delivery and postnatal care prevention and appropriate treatment of infertility
- abortion services
- treatment of reproductive tract infections, sexually transmissible infections, including HIV, and other reproductive health conditions
- information, education and counseling, as appropriate, on human
sexuality, reproductive health and responsible parenthood
- discouragement of harmful traditional practices, such as female genital mutilation (FGM)
The case of a fiercely pronatalist population policy, that of Romanian President Nicolae Ceausescu's regime, which held power from 1965 to 1989, offers a striking example of the dangers of a population policy that shows no regard for all elements of reproductive healthcare. Ceausescu's policy prohibited access to essential health services, including a complete ban on contraceptives, tight restrictions on sterilization, and limited circumstances for legal abortion services. During Ceaucescu's reign, Romania's maternal mortality ratio doubled from 85 deaths per 100,000 live births in 1965, to 170 deaths per 100,000 live births in 1983.
PROMOTING THE ADVANCEMENT OF WOMEN
Advancing the status of women is crucial to any successful population policy. The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) best reflects this principle. CEDAW calls on state parties to prohibit discrimination against women and secure their full development and advancement by adopting measures in various areas including social, political, economic, cultural, health, and legal matters. Thus, population policies are one of the governmental initiatives through which CEDAW can and should be implemented.
Mexico's National Program on Population (1995 to 2000) embraced the advancement of women as part of its strategy. The policy laid out the methods by which it sought to promote the full and effective participation of women in the economic, social, political, and cultural life of the nation and to increase women's involvement in the decisions, responsibilities and benefits of development. While this commitment to women "on paper" was important symbolically, there were abuses of women's reproductive rights involving coercion documented in Mexico's population program during the 1990s. This illustrates how important it is to integrate all four "pillars," discussed in this comment, into population policies and to fully implement the policies in programs serving women.
PROTECTING ADOLESCENTS' RIGHTS
Finally, governments must not neglect the reproductive health needs of adolescents-defined as those who fall between the ages of 10 and 19-when adopting a population policy or law. The 1990 Convention on the Rights of the Child, the ICPD Program of Action, and the Beijing Platform for Action (PDF) elaborate on the reproductive rights of adolescents.
While these documents recognize the rights of parents and guardians to provide guidance regarding reproductive health matters, these documents also declare that the best interests of the child take precedence in all instances.
Ghana's 1994 National Population Policy, currently in effect, aims to reduce the number of adolescents who marry before the age 18 by 80% and also aims to raise the proportion of girls and young women who receive at least a secondary education to 80% by 2020. The policy states, "Laws will be enacted, or where such laws already exist they will be enforced, to enhance the rights and access of children and youth to education, health and employment."
All governments should incorporate these four pillars-respect for human rights, a holistic approach to reproductive health, promotion of the advancement of women, and recognition of adolescents' rights-when considering population laws and policies. The lives and health of all people-particularly those of women and girls-depend on it.
Kathy Hall-Martinez is director of the International Legal Program of the Center for Reproductive Rights. This comment is based on the Center's briefing paper Rethinking Population Policies: A Reproductive Rights Framework. (PDF)
Women’s Enews, an online women’s news magazine, named Luisa Cabal, the Center for Reproductive Rights’ Legal Adviser for Latin America and the Caribbean, one of their "21 Leaders for the 21st Century." Cabal—who was selected from a pool of 300 nominees—was honored on May 20 in New York City.
Cabal was singled out for her work to secure justice for Paulina, a 13-year-old Mexican rape survivor who was denied a legal abortion, before the Inter-American Commission on Human Rights. If the Commission accepts the case, it will mark the first time that the international body has identified access to abortion as a human rights issue.
"In my case, I have found a voice in the law that has allowed me to speak up and seek justice," Cabal told Women’s Enews. "It is a voice that refuses to be silenced and speaks up for women like Paulina, who exist in our communities and whose rights continue to be violated."
Cabal is co-author of Bodies on Trial: Reproductive Rights in Latin American Courts, a groundbreaking treatise on regional laws and policies that impact women’s reproductive rights in five Latin American countries.
A Colombian attorney who graduated with honors from the Universidad de los Andes, Cabal received an LLM from Columbia University’s School of Law.
By Laura Katzive
Reprinted from "The Pop Reporter;" see below for details.
"A woman who gives birth opens her own coffin." So goes an expression that is well known in parts of Mali, a country in which one in 19 women dies of pregnancy-related causes.1
In Mali and in other countries where the risks associated with pregnancy and childbirth are high and well known, men and women alike accept maternal mortality as a tragic but inevitable fact of life. Women are often expected to spend most of their adult lives having and caring for babies. The associated risks of pregnancy and childbirth are merely a condition of womanhood.
For too long, fatalism and resignation have reigned over political resolve to save women's lives. Governments point to a shortage of financial resources and entrenched social and cultural practices as nearly insurmountable barriers to maternal survival. But maternal death is, in fact, most often the result of choices, including government choices about policy and resource allocation.
If astounding numbers of maternal deaths alone -- over a half a million per year worldwide1 -- do not motivate governments to take urgent steps, their obligations under international law should. All countries are bound by the basic principle articulated in the Universal Declaration of Human Rights: "Everyone has the right to life..." Nearly 150 countries have formally committed themselves to upholding this principle by ratifying the International Covenant on Civil and Political Rights (Civil and Political Rights Covenant), which provides that "[e]very human being has the inherent right to life. This right shall be protected by law." The Human Rights Committee, the U.N. body charged with overseeing implementation of this treaty, has drawn an explicit link between governments' obligation to protect the right to life and their duty to take positive steps to prevent maternal mortality.2
The causes of maternal mortality are many and can themselves be classified as violations of rights protected in major human rights instruments, including the Civil and Political Rights Covenant, the International Covenant on Economic, Social and Cultural Rights and the Convention on the Elimination of All Forms of Discrimination against Women. Shortages and inaccessibility of obstetric services, for example, constitute a denial of the right to health care. Harmful practices and social norms such as female genital mutilation and early pregnancy, which weaken women physically and heighten their risks of obstetric complications, violate women's basic right to equality and non-discrimination. Finally, denials of women's right to reproductive self-determination, including governments' failure to ensure access to family planning services, threaten women's lives by preventing birth spacing and by increasing the likelihood of unsafe abortion.
These international legal norms are powerful tools for promoting women's safety during pregnancy and childbirth. Women can claim their protected rights by demanding government action to support and expand maternal health services, repeal laws that restrict women's access to health care, invest in measures to promote women's status, and address social norms that limit women's ability to make choices affecting their reproductive lives. Government accountability for pregnancy-related deaths begins with recognition of women's rights and a refusal to view such deaths as inevitable.
References
1. Maternal Mortality in 1995: Estimates Developed by WHO, UNICEF, UNFPA (2001). Available at: http://www.who.int/reproductive-health/publications/RHR_01_9_maternal_mortality_estimates/rhr01-09_maternal_mortality.en.pdf. Accessed April 24, 2003.
2. United Nations Human Rights Committee, General Comment 28 on Equality of Rights Between Men and Women, CCPR/C/21/Rev.1/Add.10, 29/3/2000, paragraph 10. Available at: http://www.unhchr.ch/tbs/doc.nsf/(symbol)/CCPR.C.21.Rev.1.Add.10,+CCPR+General+comment+28.En?OpenDocument. Accessed April 24, 2003.
This article was originally printed in Volume 3, Number 18 of the May 5, 2003 Guest Commentary Supplement to "The Pop Reporter" ™. "The Pop Reporter" is part of the INFO Project at the Johns Hopkins University Center for Communication Programs and can be viewed at http://www.jhuccp.org/popreporter/index.shtml.
Laura Katzive is our legal adviser for Global Projects.
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