An adolescent woman requests a contraceptive method from a health provider in a country where access for under-aged users is restricted; a couple denounces an involuntary sterilization to a local nongovernmental organization; a woman requests a legal abortion in a context where termination of pregnancy is highly stigmatized and access to safe services is denied her. These are just examples of terribly unfortunate but common features in developing countries, where women, particularly poor women, lack the necessary power to successfully fight for their needs and rights. A meaningful and appropriate response to these complex situations requires a comprehensive approach. As acknowledged by the authors of ‘Reproductive health and human rights: integrating medicine, ethics and law’, no single discipline or perspective will resolve the many dilemmas involved in protecting reproductive and sexual health.
Values, Policies and Rights
"The fact that a very large part of the world’s population has inadequate access or none to essential and often life-saving medicines is of grave concern. It results in a vast loss of life and much suffering, more particularly among the poor and underprivileged. It is in blatant contradiction to the fundamental principles of human rights. And, even if one were to set humanitarian considerations side, it results in serious damage to the economy and to the functioning of society."
In this paper, the UK Department for International Development (DFID) sets out its position on sexual and reproductive health and rights, reaffirming its commitment to realising the goals of the International Conference on Population and Development (ICPD). New challenges are highlighted, including the HIV/AIDS pandemic; threats to international consensus; increasing demand for reproductive health services; and weak or failing health systems, alongside a shortage of skilled health workers.
Tradition and culture, the determination and ingenuity of women, and the concern and commitment of health care providers often circumvent the law to find expression. For example, though legal reform is not yet feasible in Mozambique, three large public hospitals have begun to provide elective abortions.
"I believe that we are at a turning point for public health - and that our choices are stark: either we reorient and strengthen public health within both modern and developing societies and institute a resilient system of global governance for health or we will face dire consequences in terms of human, social, and economic development. At present, it is the poorest countries that are paying the price for this negligence - but we have mounting signals that a new health divide is in the making as a large global underclass spreads out around the globe and defies the old definitions of vulnerable groups."
The right to health facilities, goods and services specifically includes the provision of essential medicines as defined by WHO. The Human Rights Approach should be incorporated in all national medicine policies and programmes, the selection of medicines for essential public health functions should be further refined, States parties’ international reporting obligations on access to essential medicines should be strengthened, and national NGOs should be empowered to put pressure on governments to fulfil their commitments and obligations under the international and national human rights instruments they have signed and ratified.
Most public health practitioners acknowledge the value of human rights in promoting human well-being. However, there is potential for tension between human rights approaches and public health objectives such as equity, access and efficiency, particularly in developing countries where resource constraints exacerbate balancing of competing priorities. This potential tension may stem from inappropriate conceptualizations of human rights and how they should be operationalised in a public health context. For example, where human rights are conceived as individual entitlements, public health officials could erroneously equate this to favouring individuals over the welfare of the community to the detriment of equity. Health and health care are recognized as human rights, which span the full range of civil, political and socio-economic rights, many of which are essential requirements for health.
The concept of reproductive health promises to play a crucial role in improving health care provision and legal protection for women around the world. Here now is an authoritative and much-needed introduction to and defence of the concept that, though internationally endorsed, is still contested by conservative agencies. The authors of this book are leading authorities on reproductive medicine, women's health, human rights, medical law, and bioethics: they integrate their disciplines to provide an accessible but comprehensive picture.
Gender-based violence and gender inequality are increasingly cited as important determinants of women's HIV risk; yet empirical research on possible connections remains limited. No study on women has yet assessed gender-based violence as a risk factor for HIV after adjustment for women's own high-risk behaviours, although these are known to be associated with experience of violence. Women with violent or controlling male partners are at increased risk of HIV infection. Research suggests that abusive men are more likely to have HIV and impose risky sexual practices on partners. Research on connections between social constructions of masculinity, intimate partner violence, male dominance in relationships, and HIV risk behaviours in men, as well as effective interventions, are urgently needed. (Access to this article requires registration.)
The World Health Organisation should be faithful to its Constitution, making health care and access to health care a human right, confronting powerful governments including the US government, which is in clear violation of the WHO Charter's instruction that member countries should ensure their citizens' access to health care in time of need. WHO should regain its credibility and moral standing, and could include growing movements of protest such as the anti-globalisation movement that are providing pointers to another possible world. Membership of WHO should be conditional on governments' acceptance of a whole set of principles and practices, including the promotion of health as a human right and the obligations deriving from this right. This is according to an article "The world situation and WHO", published in the Lancet.