The complications of unsafe, illegal abortions are a significant cause of maternal mortality in Botswana. The stigma attached to abortion leads some women to seek clandestine procedures, or alternatively, to carry the fetus to term and abandon the infant at birth. The author conducted research into perceptions of abortion in urban Botswana in order to understand the social and cultural obstacles to women’s reproductive autonomy, focusing particularly on attitudes to terminating a pregnancy. She carried out 21 interviews with female and male urban adult Batswana. The findings however, suggest that socio-cultural factors, not punitive laws, present the greatest barriers to women seeking to terminate an unwanted pregnancy. It is argued that these factors must be addressed so that effective local solutions to unsafe abortion can be generated.
Values, Policies and Rights
This paper reviews the legal and policy context of HIV disclosure in sub-Saharan Africa, as well as what is known about rates, consequences and social context of disclosure, with special attention to gender issues and the role of health services. Persistent rates of nondisclosure by those diagnosed with HIV raise difficult ethical, public health and human rights questions about how to protect the medical confidentiality, health and well-being of people living with HIV on the one hand, and how to protect partners and children from HIV transmission on the other. Both globally and within the sub-Saharan African region, a spate of recent laws, policies and programmes have tried to encourage or – in some cases – mandate HIV disclosure. These policies have generated ethical and policy debates. While there is consensus that the criminalization of transmission and nondisclosure undermines rights while serving little public health benefit, there is less clarity about the ethics of third party notification, especially in resource-constrained settings. Despite initiatives to encourage voluntary HIV disclosure and to increase partner testing in sub-Saharan Africa, health workers continue to grapple with difficult challenges in the face of nondisclosure, and often express a need for more guidance and support in this area. A large body of research indicates that gender issues are key to HIV disclosure in the region, and must be considered within policies and programmes. Taken as a whole, this evidence suggests a need for more attention to the challenges and dilemmas faced by both clients and providers in relation to HIV disclosure in this region and for continued efforts to consider the perspectives and rights of all those affected.
The Aids and Rights Alliance for Southern Africa (ARASA) has strongly condemned Uganda’s Anti-Homosexuality Act, signed into law by Ugandan President Yoweri Kaguta Museveni in February. According to ARASA the new law is contrary to the provisions of Uganda’s own constitution and goes against its purported aim of protecting the country’s people. The alliance claims that provisions in the law place unacceptable limitations on the rights to freedom of expression and association and will undermine proven prevention, treatment and care efforts targeted at vulnerable populations, such as men who have sex with men, placing them at greater risk both of contracting HIV and of persecution, harassment, violence and even death. According to ARASA the law contradicts the recent recommendations of the Global Commission on HIV and the Law, whose members included prominent African leaders such as Festus Gontebanye Mogae, former president of Botswana. The Global Commission report recommended that in order “to ensure an effective, sustainable response to HIV that is consistent with human rights obligations, countries must prohibit police violence against key populations. Countries must also support programmes that reduce stigma and discrimination against key populations and protect their rights”.
The issue of homosexuality arouses different but deeply felt emotions in many parts of the world. In Africa, 38 countries criminalize homosexuality with sentences ranging from a small fine to life imprisonment. The author notes that criminalization goes well beyond the human rights discourse; it is also a public health issue. He notes the many well researched papers that provide evidence on the negative public health impact of criminalization, not just on the homosexual persons, but also on the public health system of a country, leading global health organizations such as World Health Organization and UNAIDS to issue guidelines on the issue of criminalization. The author presents the arguments, given the demonstrable negative impact of stigma and criminalisation on public health and human rights, whether the Kenyan society can broker a middle ground between morality aspirations on the one hand and public health & human rights on the other.
This report provides the summary findings of a team of expert scientists constituted by the Director General Health Services Uganda at the request of the Minister of Health to review research data, deliberate and advise him on key questions about homosexuality. The conclusions of the report as presented by Pambazuka were that there is no definitive gene responsible for homosexuality; that homosexuality is not a disease or an abnormality; that in every society, there is a small number of people with homosexual tendencies; that homosexuality can be influenced by environmental factors (e.g. culture, religion, information, peer pressure); that the practise needs regulation like any other human behaviour, especially to protect the vulnerable and that there is need for studies to address sexualities in the African context.
This paper seeks to determine how the corporate responsibilities of pharmaceutical companies in relation to access to medicines can be clarified and enforced. Two cases, one each from India and South Africa, are examined to determine how the domestic courts in both countries indirectly utilized the right to health to ensure that pharmaceutical companies did not impede access to affordable medicines through exercising their patent rights. There is a need to clarify and enforce the responsibilities pharmaceutical companies have to promote the right to health. The two cases from India and South Africa demonstrate the potentials of domestic courts as forums where these responsibilities can be effectively enforced. In the absence of a global enforcement mechanism for enforcing the right-to-health responsibilities of pharmaceutical companies, domestic courts can effectively fill this gap. In addition, this paper demonstrates that domestic courts can equally serve as forums for health diplomacy.
The complications of unsafe, illegal abortions are a significant cause of maternal mortality in Botswana. The stigma attached to abortion leads some women to seek clandestine procedures, or alternatively, to carry the fetus to term and abandon the infant at birth. The author reports in this paper on research into perceptions of abortion in urban Botswana in order to understand the social and cultural obstacles to women’s reproductive autonomy, focusing particularly on attitudes to terminating a pregnancy. She carried out 21 interviews with female and male urban adult Batswana. The article presents a review of the abortion issue in Botswana based on the research. She notes that restrictive laws must eventually be abolished to allow women access to safe, timely abortions. The findings however, suggest that socio-cultural factors, not punitive laws, present the greatest barriers to women seeking to terminate an unwanted pregnancy. These factors must be addressed so that effective local solutions to unsafe abortion can be generated.
The right to health is a fundamental human right which is recognized in international and regional human rights systems. The African Human Rights System is also duly recognized the right to health. Although recognizing the right in the human rights instrument is important, the meaningful protection of the right needs appropriate and consistent interpretation and adequate implementation mechanisms. This article scrutinizes the Justiciability and Enforcement of the right to health in the African Human Rights System. Based on analysis of relevant African Human Rights Instruments, literatures and cases of African Commission, the author argues that the justiciability of the right to health in African Human Rights System is upheld. Regarding its enforcement, the article argued that there are relevant institutional frameworks in African human rights systems and African political architecture. Hence, the enforcement of the right to health falls squarely in most of these institutions’ mandate.
There is growing dissatisfaction and even mistrust of human rights as an instrument for radical social change. The author argues that what is needed is a revolutionary approach to human rights informed by an analysis of the oppressive, anti-human social/historical context of national and global social relationships. For many social justice activists, moral contradictions in thye use of rights frameworks by both Western and non-Western states has created dissatisfaction and even mistrust of human rights as an instrument for radical social change. A “people-centered human rights” concept and approach has been developing, based on the communitarian principles of social solidarity, cooperation, non-discrimination in all social relationships, collective public ownership of the earth’s resources, respect for difference, self-determination of all peoples’ and the recognition and respect for the inherent dignity of all individuals and people’s.
The WHO Executive Board meeting in Geneva in Jan 2014 will consider a proposal from Finland (see EB134/1 Add.1) entitled: “Contributing to social and economic development: sustainable action across sectors to improve health and health equity” which is a follow up from the 8th Global Health Promotion Conference in Helsinki in June 2013. Finland has requested the inclusion of a new agenda item for the 134th session
of the Executive Board. It will provide an opportunity for the Board to have a debate, adopt a recommendation for an Assembly resolution calling for concrete steps forward, carried out within existing resources, and expressing the importance of actions across sectors for health and health equity in the final efforts to achieve the MDGs and in the debate on the post-2015 development agenda.