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01.20.09 - Six months pregnant and feeling unwell, a poor woman goes to a state-run clinic in Rio de Janeiro for help—and is turned away. A week later, she is dead. Halfway around the world, in Hungary, a Roma woman is about to undergo emergency surgery because of a miscarriage. She is asked to sign a consent form for a C-section, but never told that she is also agreeing to be sterilized. In Poland, a young pregnant woman is told that she will lose her sight if she continues with the pregnancy. She seeks an abortion on health grounds, which is allowed under Polish law, but doctors override her judgment and refuse to give her one. She is now almost completely blind.
All of these women were denied their reproductive rights and suffered because of it. But does that mean their human rights were violated as well?
The idea of reproductive rights as human rights is new and challenging. But consider this: Each one of us has indispensable human rights—rights that underpin our ability to live with dignity, to enjoy full and equal citizenship, to lead a healthy and fulfilling life. If a woman is to make her own decisions and live the healthiest life possible—her basic human rights—she must be able to control her reproductive life and obtain good reproductive healthcare and accurate information.
Simply put, reproductive freedom lies at the heart of the promise of human dignity, self-determination, and equality. When a woman is denied her reproductive rights—when she is denied obstetric care, birth control, the facts about reproductive health, or safe abortion, as the women above were—she is denied the means to direct her own life, protect her health, and exercise her human rights.
The values that underscore reproductive rights are embodied in the oldest and most accepted human rights documents—the U.S. Constitution, as well as the Universal Declaration of Human Rights. At the 1994 International Conference on Population and Development in Cairo, governments explicitly acknowledged, for the first time, that reproductive rights are grounded in already existing human rights obligations. Representatives of over 180 nations agreed that women needed to be empowered to take charge of their reproductive lives, that unsafe abortion is a public health concern, and that forced sterilization has no place in family planning efforts.
The Cairo Conference marked a turning point. The following year, at the World Conference on Women in Beijing, governments pledged to guarantee reproductive rights for all women. United Nations and regional human rights bodies started to urge governments to respect and ensure women’s reproductive rights. Women in Africa and those with disabilities, meanwhile, won crucial recognition of their rights to control their reproductive lives and to live healthy lives in two new human rights agreements, the 2008 UN Disability Rights Convention and the 2005 Protocol on the Right of Women in Africa. These gains set the stage for legal breakthroughs that would expand women's access to reproductive healthcare.
Six months pregnant with her second child, Alyne da Silva knew her nausea and abdominal pain were not normal. But when she went to a state clinic just outside Rio de Janeiro for help, the attending physician refused to admit her, sending her away with just vitamins and cream. One week later, she died after delivering a stillborn baby in a state hospital. She didn't have to.
Maternal mortality is usually seen as either an unfortunate fact of life or a poverty issue. But the vast majority of maternal deaths—some half a million worldwide every year—could be prevented at low cost. Most of them are caused by hemorrhages, infection, eclampsia, obstructed labor, and unsafe abortions—complications that some 15% of all pregnant women will experience at some point.
While not preventable, these conditions can be treated. When women die in childbirth or pregnancy, it’s all too often because their governments have failed to value their lives and ensure every woman can get basic health services. Their deaths represent a violation of their most basic human right—the right to life.
Maternal mortality rates reflect discrimination and inequity. One out of every six women in Afghanistan and every 22 women in sub-Saharan Africa will lose her life to pregnancy-related complications; in the United Kingdom, only one out of every 3800 women will. In Brazil, indigenous, poor, single, and Afro-Brazilian women like Alyne face the greatest risk of dying.
Alyne's family sought justice in Brazilian courts, to no avail. So, in November 2007, the Center for Reproductive Rights took the case to the UN Committee on the Elimination of Discrimination against Women on their behalf, marking the first time an international human rights body has been asked to rule on maternal mortality as a treaty violation (the case is pending).
A human rights approach is a powerful tool in the fight to save women from Alyne’s fate: it holds governments accountable, places women’s health and well-being at the center of efforts to reduce maternal deaths, and empowers women to defend their right to maternal health. For this reason, leading human rights and public health advocates from around the world launched the International Initiative on Maternal Mortality and Human Rights in 2007. This initiative, the first of its kind, urges policymakers, donors, and activists to tackle maternal health as a human rights imperative.
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K.L. was 17 years old when doctors told her that the fetus she was carrying was severely deformed and would die soon after birth. Her country, Peru, allowed abortion under these circumstances, and she decided to seek one. But doctors refused to perform an abortion. K.L. was forced to carry to term and breastfeed for four days until the baby died. She then fell into a severe depression. In 2005, the United Nations Human Rights Committee found that her suffering was foreseeable and amounted to cruel, degrading, and inhumane treatment. K.L.'s case, brought by the Center for Reproductive Rights, was the first abortion case to be decided by the Human Rights Committee.
Other human rights courts also began to address access to abortion. A young Polish woman, Alicja Tysiąc, was left nearly blind after she was denied a legal abortion on health grounds. She took her case to the European Court of Human Rights—and won. In Mexico, 13-year-old Paulina Ramírez was denied an abortion after she was raped, even though the law allowed for it. The Center for Reproductive Rights reached a landmark settlement with Mexico on her behalf in 2006, the first time a Latin American government acknowledged that access to legal abortion is a human right.
These breakthroughs did more than strengthen access to abortion where it was already legal. They also changed how abortion is understood by lawmakers and national courts—as a right central to a woman’s health and autonomy—and opened the door for legal reforms. In May 2006, Colombia’s Constitutional Court made history when it ruled that the country's blanket ban on abortion was unconstitutional. "Women's sexual and reproductive rights have finally been recognized as human rights," the court declared, going on to say that these rights "emerge from the recognition that equality in general, gender equality in particular, and the emancipation of women and girls are essential to society. Protecting sexual and reproductive rights is a direct path to promoting the dignity of all human beings, and a step forward in humanity's advancement towards social justice."
Less than a year later, Mexico City lawmakers voted to legalize first-trimester abortion. Mexico's Supreme Court upheld the law in August 2008, paving the way for women in other parts of the country to demand that their local governments follow Mexico City’s example.
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If you are an African-American woman in the United States, these are the odds you face: you are more likely than a white woman to live in poverty, less likely to have private health insurance, four times more likely to die in childbirth, and fourteen times more likely to die from HIV/AIDS. Unfortunately for you, your equal right to healthcare has not been recognized by U.S. courts. But it has been by human rights treaties, including those that the U.S. has signed.
Human rights give us a powerful moral language, legal commitments, and a broad array of strategies to make change happen—to expose violations, redefine public perception, and tackle economic and social barriers to reproductive healthcare. In early 2008, more than 250 U.S. groups highlighted persistent racial inequities in the U.S. before the UN Committee on the Elimination of Racial Discrimination. The committee then took the U.S. to task publicly, telling the government that, among other things, it needs to take aggressive measures to guarantee equal access to reproductive healthcare.
Victories such as these are pivotal for making sure that reproductive health services are not only legal, but also available to all who need them, even those who cannot afford them. Only then will the promise of human rights, of dignity, autonomy, and equality for all of us, be truly realized.
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