This study explored the relationship between the reinstatement in 2001 of a US policy requiring all nongovernmental organizations operating abroad to refrain from performing, advising on or endorsing abortion as a method of family planning if they wish to receive federal funding and the probability that a sub-Saharan African woman will have an induced abortion. The authors used longitudinal, individual data on terminated pregnancies collected by Demographic and Health Surveys (DHS) to estimate induced abortion rates. The study found robust empirical patterns suggesting that the policy was associated with increases in abortion rates in sub-Saharan African countries. Several observations were identified to strengthen this conclusion. First, the association was strong: and second, there was broad agreement among the aggregate graphical analysis and both unadjusted and adjusted statistical analyses, robust across a variety of sensitivity analyses. Third, the timing of divergence between high and low exposure countries was coincident with the policy’s reinstatement: in high exposure countries, abortion rates began to rise noticeably only after the policy was reinstated in 2001 and the increase became more pronounced from 2002 onward.
Values, Policies and Rights
Despite 20 years of democracy, South Africa still suffers from profound health inequalities and gender roles and norms associated with vulnerability to ill-health. Gender inequality influences women’s access to health care and agency to make health-related decisions. This paper explores gender-awareness and inclusivity in organisations that advocate for the right to health in South Africa, and analyses how this knowledge impacts their work. Ten in-depth interviews were conducted with members of The Learning Network for Health and Human Rights (LN), a network of universities and Civil Society Organisations (CSOs) committed to advancing the right to health, but not explicitly gendered in its orientation. The results show that there is a discrepancy in knowledge around gender and gendered power relations between LN members. This suggests that gender is ‘rendered invisible’ within the LN, which impacts the way the LN advocates for the right to health. The authors thus suggest that even organizations that work on health rights of women might be unaware of the possibility of gender invisibility within their organisational structures.
In January 2015, South Africa ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR). The South African government submitted its initial report to the United Nations Committee on Economic, Social and Cultural Rights (CESCR) in April 2017, raising the steps and measures taken to comply with the provisions of the Covenant, noting its progressive Constitution that includes socio-economic rights. A coalition of civil society organisations called “South Africa’s Ratification Campaign of the ICESCR and its Optional Protocol” (the Campaign) submitted a parallel report to the United Nations CESCR. The Campaign’s Steering Group is comprised of the Socio-Economic Rights Institute of South Africa, Black Sash, the Dullah Omar Institute, the People’s Health Movement South Africa and the Studies in Poverty and Inequality Institute. The Campaign’s parallel report provided a civil society perspective on socio-economic rights realisation in South Africa, and raised questions about areas of the state’s record in fulfilling these rights in order to promote greater accountability. The Campaign's report noted that actions to address the binding constraints to realising socio-economic rights are increasingly urgent in the South African context of severe poverty and inequality. For this reason, the authors identified the need for the state to address forced evictions and displacement; to assess the causes of under-expenditure on informal settlement upgrading; to address a lack of investment in infrastructure maintenance and services provision, and to address intergovernmental cooperation issues that impacted severely in the management of the drought in the Western Cape.
The WHO guidelines for drinking-water quality provide recommendations to support countries in developing drinking-water quality regulations and standards, as well as the associated risk management strategies. The guidelines provide an authoritative basis for the effective consideration of public health in
setting national or regional drinking-water policies and actions; provide a comprehensive preventive risk management framework for health protection, from catchment to consumer, that covers policy formulation and standard setting, risk-based management approaches and surveillance; emphasize achievable practices and the formulation of sound regulations that are applicable to low-income, middle-income and industrialized countries alike; summarize the health implications associated with contaminants in drinking water, and the role of risk assessment and risk management in disease prevention and control; summarize effective options for drinking-water management; and provide guidance on hazard identification and risk assessment.
In this journal feature, Issa Shivji, Peter Lawrence, John Saul, Natasha Shivji, Ray Bush and Ndongo Samba Sylla pay tribute to the late Samir Amin. Issa Shivji writes of Amin’s support for younger generations, ‘His intellectual works, scholarly contributions and political interventions have been sufficiently covered in dozens of tributes that are pouring in every day. I will not go over them. I wanted specifically to capture Samir’s attitude and treatment of younger generations, done as a matter of course and without pretense.’ Peter Lawrence highlights one of Amin’s key ideas, ‘Amin rejected the prevailing view in both the capitalist ‘West’ and the socialist ‘East’ that development entailed catching up with the developed capitalist countries. … The history of the world was not about followers catching up with leaders but about dominant civilizations being ‘transcended’ by peripheral ones as the former decline and the peripheral overtake them with different social organizations.’ John Saul illuminates Amin’s concept of ‘an actual and active ‘delinking’ of the economies of the Global South from the Empire of Capital that otherwise holds the South in its sway. For Amin, delinking was best defined as ‘the submission of external relations [to internal requirements], the opposite of the internal adjustment of the peripheries to the demands of the polarizing worldwide expansion of capital’. Amin saw it as being ‘the only realistic alternative [since] reform of the [present] world system is utopian.’ Ndongo Samba Sylla concludes by writing on Amin’s notion of ‘daring’ in coordinated struggles, ‘by the emergence of an anti-monopolies front [in the Global North] and in the Global South by that of an anti-comprador front' challenging subservience to neoliberal globalisation. The authors collectively highlight how through his writings, his interventions and engagement Amin profiled the perspective of the Global South 'and the wretched of the earth.’
On 11th April 2018, Uganda joined the rest of the world to commemorate the International Day for Maternal Health and Rights under the Theme: “Rights Based Approach to Maternal Health in Uganda: No Woman Should Die Giving Birth.” Civil Society, led by Center for Health, Human, Rights and Development (CEHURD), and other stakeholders including policy makers marched from the Independence Monument to Parliament where a dialogue with Members of Parliament was held to collectively find sustainable solutions to the alarming maternal mortality rate. Civil Society used dialogue to petition Parliament in demand for the implementation of the resolution that was passed by the house on December 15, 2011 urging Government to institute measures to address Maternal Mortality in Uganda. Among these included tasking government through the Ministry of Health to strictly enforce maternal health audits and take actions to the established causes, together with developing a policy of compensation to the families of all women who die as a result of maternal related cases through government facilities.
Zimbabwe's 2007 National Maternal and Neonatal Health Road Map provided an over- arching strategy for scaling up the national response to reduce the current levels of maternal and neonatal mortality and morbidity in line with the MDG health related targets, bringing together all national stakeholders to support one national MNH programme, one national MNH coordination mechanism, and one national MNH Planning, Monitoring and Evaluation Framework. The concept of the Four Pillars of Safe Motherhood describes comprehensively all prerequisites to be met in order for a woman to safely live through her life cycle, from informed teen age through supervised, healthy pregnancy, through safe delivery and childbirth, the safe-guarding of her newborn’s health start of life, and through a continued, problem free reproductive life. The MNH Road Map sets two clearly defined phases, a first phase of prioritisation on the supply issues of the interventions to make services available first, before fully focusing on a further creation of demand in the second phase.
Although intellectual property (IP) Rights are intended to promote innovation and creativity, the author argues that they act as barriers for access to essential medicines as they create monopolies for pharmaceutical manufacturers who charge exorbitant prices, making these medicines out of reach for many especially in least developed countries. According to 2016 health data compiled by the Institute for Health Metrics and Evaluation , HIV was ranked number one cause for premature death in Uganda. Moreover women, in particular, were disproportionately affected in comparison to men. Many of the medicines they need are noted to be under patent protection and expensive for those who need them, as inventors seek to make a return on the high costs of research and development. The author proposes that the solution to this lies in the effective utilization of provisions incorporated in the WTO- Trade Related Aspects of Intellectual Property Agreement, commonly referred to as the TRIPS flexibilities. One flexibility is compulsory licensing which allows third parties to use an invention without the holders’ consent. Another is parallel importation which allows procurement of drugs at a lower price from another country without consent of a patent holder of a patented product that is on the market of the exporting country. A further flexibility is the exemption of least developed countries from enforcing pharmaceutical patents until 2033 which can be exploited to promote transfer of technology. The author regards it as imperative to think of those women who are unable to access essential medicines due to their high cost caused by the strict enforcement of IP Rights.
On 25-26 October 2018, the world will come together to renew a commitment to strengthening primary health care to achieve universal health coverage and the Sustainable Development Goals. The World Health Organisation (WHO) have received over 500 comments on the Draft Declaration on Primary Health Care and incorporated them in this updated draft. This draft describes the need for Primary Health Care to address today’s health challenges. WHO are reopening the public consultation to ensure that voices of a broad range of stakeholders are included and has circulated a draft declaration for comment. It goes to in-person member state consultation in early August. The proposed text is provided at the website.
With increasing adoption of universal health coverage (UHC), the health for all agenda is resurgent globally. This commentary discusses the origin of the health for all agenda in the 1970s and the influence of global politico-economic forces in shaping that agenda and its demise. The author proposes that it has resurged in the form of UHC in the twenty-first century, but also discusses UHC’s focus on finances and the increasing role of market economy in health care, and the need to regulate the market based provision of healthcare, and incorporate more of the people and community centred ethos of the PHC of 40 years ago.