The authors of this study draw on the experience of a Learning Network for Health and Human Rights (LN) involving collaboration between academic institutions and civil society organisations in the Western Cape, South Africa. The network aimed at identifying and disseminating best practice related to the right to health. The LN's work in materials development, participatory research, training and capacity-building for action, and advocacy for intervention illustrates lessons for human rights practice. Evidence from evaluation of the LN is presented to support the argument that civil society can play a key role in bridging a gap between formal state commitment to creating a human rights culture and realising services and policies that enable the most vulnerable members of society to advance their health. Through access to information, the creation of space for participation and a safe environment for learning to be turned into practice, the agency of those most affected by rights violations can be redressed, supported by civil society.
Values, Policies and Rights
In this interview with Adrienne Germain, President Emerita of the International Women’s Health Coalition, she talks about her experiences promoting women’s health in developing countries. She argues that there are many reasons why there is widespread resistance to integrating HIV and reproductive health services, including disease control models that emphasise risk, not vulnerability; competition for scarce resources; narrow disciplinary training that encourage health professionals to work separately rather than collaborate across subjects and services; and gender bias. She pointed out that research shows that women’s health has definitely suffered from the separation of HIV information and services from other components of sexual and reproductive health care. For example, in sub-Saharan Africa, most HIV services fail to provide contraceptives, safe abortion, treatment and referral following sexual coercion or violence, or human papillomavirus (HPV) screening to women living with HIV. She also noted that political commitment has improved, but most politicians act only in their own interests or when they are pressed to do so. In most countries, women and children don’t have a strong political voice, although in some they have gained considerable ground over the last decade or so. We must invest in both local and international advocates whose main task today is to persuade those with power and resources to transform their rhetoric into action.
The aim of ths paper was to examine the use of contraception in 13 countries in sub-Saharan Africa; to assess changes in met need for contraception associated with wealth-related inequity; and to describe the relationship between the use of long-term versus short-term contraceptive methods and a woman’s fertility intentions and household wealth. The analysis was conducted with Demographic and Health Survey data from 13 sub-Saharan African countries. Researchers found that the use of contraception has increased substantially between surveys in Ethiopia, Madagascar, Mozambique, Namibia and Zambia but has declined slightly in Kenya, Senegal and Uganda. Wealth-related inequalities in the met need for contraception have decreased in most countries and especially so in Mozambique, but they have increased in Kenya, Uganda and Zambia with regard to spacing births, and in Malawi, Senegal, Uganda, the United Republic of Tanzania and Zambia with regard to limiting childbearing. After adjustment for fertility intention, women in the richest wealth quintile were more likely than those in the poorest quintile to practice long-term contraception. In conclusion, family planning programmes in sub-Saharan Africa show varying success in reaching all social segments, but inequities persist in all countries.
Annex 2 of the International Health Regulations (IHRs) outlines decision-making criteria for State-appointed National Focal Points (NFP) to report a potential public health emergency of international concern to the World Health Organisation (WHO), and is a critical component to the effective functioning of the IHRs. The aim of this study was to review and evaluate the functioning of Annex 2 across WHO-reporting States Parties. The evaluation found that the IHR's Annex 2 is perceived as useful for guiding decisions about notifiability of potential public health emergency of international concern. There is scope for the WHO to expand training and guidance on application of the IHR's Annex 2 to specific contexts. Continued monitoring and evaluation of the functioning of the IHR is reported to be imperative to promoting global health security.
Article 14(2)(c) of the Protocol to the African Charter on the Rights of Women enjoins States Parties to take appropriate measures "to protect the reproductive rights of women by authorising medical abortion in cases of sexual assault, rape, incest, and where continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus." This paper considers the implications of Article 14 for access to safe, legal abortion. It is submitted that Article 14 has the potential to impact positively on regional abortion law, policy and practice in three main areas. First, it takes forward the global consensus on combating abortion as a major public health danger. Second, it provides African countries with not just an incentive, but also an imperative for reforming abortion laws in a transparent manner. Third, if implemented in the context of a treaty that centers on the equality and non-discrimination of women,Article 14 has the potential to contribute towards transforming access to abortion from a crime and punishment model to a reproductive health model.
In this paper, the authors describe an economic framework, including demand- and supply-side factors, for approaching the analysis and planning of health system reform in South Africa, in order to avoid piecemeal debates. They argue that there is an urgent need to re-engineer the way health facilities are internally organised to achieve better productivity and responsiveness. They further argue that funding is not the central problem of the South African public health system but rather the enormous inefficiencies in management and low productivity; and that separating the purchase from the supply side is a critical component of making significant efficiency gains. Finally, they suggest that income inequalities and a divided health system in South Africa are departure points for reform initiatives. The government must build on the strengths of the South African health system in preparation for the eventual achievement of a more homogeneous health-care system across the public and private sectors.
UNESCO’s Universal Declaration on Bioethics and Human Rights (2005) was drawn up by an independent panel of experts (the International Bioethics Committee) and negotiated by member states. UNESCO aimed for a participatory and transparent drafting process, holding national and regional consultations and seeking the views of various interest groups, including religious and spiritual ones. Furthermore, reflecting UNESCO’s broad interpretation of bioethics, the IBC included medics, scientists, lawyers and philosophers among its membership. Nevertheless, several potential stakeholders - academic scientists and ethicists, government policy-makers and NGO representatives - felt they had not been sufficiently consulted or even represented during the Declaration’s development.
The author of this article points to research suggesting that rape by non-military actors in the Democratic Republic of Congo may account for up to 40% of cases in the DRC, that not all rapists are men and not all victims women. She also points to the need to maintain a focus on comprehensive health care needs, noting that a humanitarian focus on rape alone creates perverse incentives, undermines more comprehensive service delivery and feeds into negative stereotypes, undermining recognition and measures to address the political crisis or areas of failure of service delivery.
As COP 17, the latest round of UN climate talks in South Africa, drew to a close Greenpeace declared that it was clear governments across the world listened to the carbon-intensive polluting corporations instead of listening to the people - people who want an end to global dependence on fossil fuels and real and immediate action on climate change. Negotiators blocking the imperative to set concrete goals, led by the United States, have succeeded in inserting a vital get-out clause that could easily prevent the next big climate deal being legally binding, according to Kumi Naidoo, Greenpeace International Executive Director. And the deal is due to be implemented 'from 2020' leaving almost no room for increasing the depth of carbon cuts in this decade when scientists say we need emissions to peak. Naidoo said that the global climate regime amounts to nothing more than a voluntary deal that’s being put off for a decade. Greenpeace campaigners decried the failure of political leadership to prosecute polluters and provide a fair, ambitious and legally binding agreement, thereby ignoring the poor in Africa and other parts of the world that stand to be most severely affected by climate change.
In this study, researchers investigated the prevalence, patterns and associated factors of intimate partner violence against women in Western Ethiopia. A cross-sectional, population based household survey was conducted from January to April 2011, using the World Health Organisation’s standard multi-country study questionnaire. A sample of 1,540 ever married/cohabited women aged 15-49 years was randomly selected from urban and rural settings of East Wollega Zone, Western Ethiopia. Results indicated that lifetime and past 12 months prevalence of intimate partner violence against women stood at 76.5% and 72.5%, respectively. The overlap of psychological, physical and sexual violence was 56.9%. Abduction, polygamy, spousal alcoholic consumption, spousal hostility and previous witnesses of parental violence were factors associated with an increased likelihood of lifetime intimate partner violence against women. The authors of the study call for immediate action at all levels of societal hierarchy, including policymakers, stakeholders and professionals, to alleviate these extremely high levels of domestic violence.