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Don’t Use India’s Missing Girls to Deny Women Reproductive Rights

11:57 am in Uncategorized by RH Reality Check

Written by Mallika Dutt for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Mallika Dutt

Mallika Dutt on the struggle for women’s equality in India.

On Tuesday last week, I testified at a hearing of the Congressional Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations, entitled “Improving the Status and Equality of Women and Girls—Causes and Solutions to India’s Unequal Sex Ratio.”

Gender-biased sex selection—the illegal misuse of medical technologies to determine the sex of a fetus in order to ensure a male child—has led to an alarming decline in the number of girls across India and elsewhere in the world. By some estimates, India is missing approximately 40 million girls. In the state of Haryana, there are only 832 girls for every 1,000 boys—a dramatically skewed ratio. This clear preference for sons is yet another manifestation of worldwide devaluing of women.

The problem requires an urgent and global response. So one might think that attention to son preference by the U.S. Foreign Relations Committee would be cause for celebration.

If only. The truth is that the people shaking their fists the hardest about the issue are actually those who are most hostile to women’s rights. Anti-abortion advocates have seized upon and rebuilt the issue as a Trojan horse for their own agenda. What they’re really trying to do? “Protect” women’s rights by denying women rights.

It is imperative that we stop gender-biased sex selection (GBSS). And it is imperative that we understand why we must stop it.

GBSS is a cultural practice driven precisely by devaluing and discrimination of women. Stopping it, therefore, is not about denying individual women their “choice.” It is about promoting the rights and worth of girls and women. What, after all, are the particular and age-old drivers of son preference? The view of girls as risks and burdens. Daughters are expensive—often requiring dowries, rarely able to bring in income. Daughters are “bad investments”—traditionally leaving their families for their husbands’ and not helping care for aging parents. Daughters are dangerous, inviting the risk of real assault or indiscretions that could besmirch family “honor.” Daughters are expendable.

So families have acted on son preference since long, long before the latest technologies facilitated, for a relatively small number of people, sex-selective pregnancy termination. Yet strangely, it is only when abortion enters the equation that certain individuals—like those I debated at the hearing—get interested in “saving” girls and women.

In reality, only 5 percent of abortions in India are connected to GBSS. At the same time, 47,000 women die as a result of unsafe abortion each year; the vast majority of these deaths occur in low-income settings. Deaths from complications of unsafe abortion account for 13 percent of all maternal deaths worldwide.

If you want to “protect” women, make sure they have access to safe abortions. And get to the root of the problem by challenging and changing the cultural and institutional norms that enshrine the devaluing of girls. We also need more reliable data to better measure the extent of sex-selection practices and progress made toward challenging them. And we need better law and enforcement on inheritance lines, dowry, and legal and safe abortion. Most of all, women and girls require access to information, health services, education, and security. When we make daughters welcome in households, neighborhoods, and nations, we are all able to thrive. What they don’t need is to have their rights taken away under false claims.

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You Can’t Have it Both Ways: The Interpretation of Catholic Health Policy and the Consequences for Pregnant Women

12:46 pm in Uncategorized by RH Reality Check

Written by Marge Berer for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Republished with permission from Reproductive Health Matters.

“There is only one way to be sure a woman’s life is at risk, that is, after she dies.” — Christian Fiala, 2012

 

A view of Galway Hospital and parking lot

Savita Halappanavar died at Galway University Hospital.

In 1987, the year the first Safe Motherhood Initiative was launched by the World Health Organization (WHO), there were more than half a million maternal deaths annually. The women who were dying were often anonymous and their deaths never recorded or studied. They were mainly from poor and often rural backgrounds in developing countries, such as India. A study in India published in 1999 comparing 100 maternal deaths in a Rajasthan hospital in 1983-85 to 100 in 1994-96 found that: “Most of the women who died in hospital in 1994-96 would have died at home in the earlier decade.”1 What had changed was that they had reached a hospital and were therefore no longer anonymous, but they were still overwhelmingly women living in poverty with little or no access to skilled pregnancy and delivery care. 

Contrast this with the death of Savita Halappanavar on 28 October 2012, a dentist from a privileged background in India, who miscarried 17 weeks into a very wanted pregnancy and died in the maternity ward of a hospital in Ireland, a country with a very low maternal death ratio.2 Savita’s death was anything but anonymous; her name and photograph circled the globe within days of her death and sparked street demonstrations and protests, not only across Ireland but also in many other parts of Europe and in India. Six weeks later, articles and blogs about her death continued to be published in many countries, demands by her husband for a maternal death audit were headline news, and the Irish government has been forced to consider the effects of her death for the law, health policy and the Constitution of Ireland. 

Savita’s death became iconic for a number of reasons. First, preventing maternal deaths has been a global priority since 1987 when the first WHO Safe Motherhood Initiative was launched. Since 2000, reducing maternal deaths by 75 percent by 2014 has been the main target of Millennium Development Goal No.5, and since 2010 it has been one of five main goals of the UN Secretary-General Ban Ki-Moon’s Global Strategy on Women’s and Children’s Health. Hence, maternal deaths have started to be a news item globally, with journals like Reproductive Health Matters carrying studies and the media in many countries where deaths remain frequent, reporting successes and failures to reduce deaths, and individual stories regularly.

Secondly, holding governments accountable for their failure to provide the required services, both antenatal and delivery care and emergency obstetric care, to prevent avoidable maternal deaths has become the subject of public protests by women’s rights advocates, of court cases, including in India, and of hearings by human rights bodies, particularly CEDAW, examining individual cases and making policy recommendations to governments.3

What was different about Savita’s death, however, was the fact that it was also about whether and when to terminate a pregnancy when it is not viable and the woman’s health and life are at risk, and how that intersected in Savita’s case with individual health professionals’ interpretation of Catholic health policy and the law on abortion in Ireland. 

As a committee of the Irish Parliament considers proposals to offer limited legal abortion in Ireland, this paper explores how these issues came together around Savita’s death, the interpretation of Catholic health policy and the consequences for pregnant women.

Preventing maternal deaths as global policy

Maternal deaths, especially in countries where they remain frequent, are getting more and more media coverage. The Millennium Development Goals have made countries with continuing high maternal mortality ratios4 conscious of their shortcomings, and civil society organizations are beginning to pursue justice and even compensation in individual cases. 

In India, for example, a petition for legal redress was filed in the Delhi High Court in the case of Shanti Devi, who died in childbirth in January 2010 after two high-risk pregnancies in which she received delayed and insufficient care. With the first of these two pregnancies, she fell down the stairs and afterwards could no longer feel the baby moving. Induction of the pregnancy was delayed until she required intensive care which, when she finally received it, was inadequate. With her health still very precarious, she became pregnant again six months later, went into labor prematurely at seven months, delivered the baby at home without a skilled birth attendant or any medical assistance, and within an hour after delivery, began hemorrhaging and died. This case ensured that the Court took into account not just the individual death but also the constitutional and human rights obligations of the central government of India.5

Some communities where women are at high risk because of the lack of routine and emergency obstetric care are also beginning to protest against maternal deaths. One such event took place in Uganda where, in May 2011, hundreds of concerned citizens and health professionals stormed the Constitutional Court in Kampala, Uganda, protesting the deaths of women in childbirth, in support of a coalition of activists who took out a landmark lawsuit against the government over two women who bled to death giving birth unattended in hospital.6

Another example from India comes from Barwani district, Madhya Pradesh, India, where there were local protests against 27 maternal deaths in the period from April to November 2010. In January 2011, an NGO fact-finding team found an absence of antenatal care despite high levels of anemia, absence of skilled birth attendants, failure to carry out emergency obstetric care in obvious cases of need, and referrals that never resulted in treatment.7

Events like these are making the governments concerned highly sensitive to criticism. As an upper middle-class woman, Savita Halappanavar would have been highly unlikely to die in India from the appalling treatment experienced by Shanti Devi or the tribal women in Barwani. Yet, ironically, the Indian government was among the first to criticism those in Ireland who failed to prevent Savita from dying. For example, India’s ambassador to Ireland said that Mrs Halappanavar may be alive if she had been treated in India.

Emergency obstetric care, termination of non-viable pregnancies and Savita’s death

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Our Current Approach to Sex Work: Flawed Laws, Flawed Policies, and Flawed Programs Will Not Right Our Wrongs

12:51 pm in Uncategorized by RH Reality Check

Written by Meena Saraswathi Seshu for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Cross-posted in partnership from the HIV Human Rights blog and part of RH Reality Check’s coverage of the International AIDS Conference, 2012.

Photobucket

Just two months back, I marched with hundreds of sex workers in India to demand justice for Anu Mokal. Anu, a sex worker, was picked up by the police at a bus stop one evening, charged with ‘soliciting’ customers at the bus stand, abused and beaten up. As a consequence, Anu, who was then four months pregnant, suffered a miscarriage.

With the support of a collective of sex workers, Anu filed a complaint against the policemen who assaulted her. But two months down the road, has her complaint progressed any further? No. Has the promised State inquiry into the incident taken place? Unlikely. If it has, the results have not been made known. Has Anu been given a fair hearing? Not that I know of. (Instead, while she was complaining, she was told that sex workers cannot be mothers). Have the policemen faced any action for assaulting a woman in a public place, an action that was witnessed by others? No.

Anu Mokal’s case is emblematic of the situation faced by the more than one million sex workers who live and work in India. On the one hand, they routinely face violence, including the violence of stigma. On the other, they are not able to rightfully claim their place in the sun as citizens, who deserve respect, dignity, justice, and rights – like any other citizen of our country. This is why the banner leading our march says:

“The violence of stigma we dare to survive
Of dignity we dare to dream.”

Freedom from abuse and violence is a human right that we will continue to fight for at every forum, including the Sex Worker Freedom Festival, which is on at Kolkata at the same time as the International AIDS Conference takes place in Washington DC. (Come to Kolkata and support us, you guys!) But for now, I want to go a little deeper into this whole thing and show how flawed national laws, HIV policies and programs contribute to reducing freedoms for sex workers and depriving them of their daily rights.

To begin with, sex work is itself seen as a moral blot by all sections of society – from opinion makers in the media to the forces of law and order. I see this as ‘moral criminalization’, a situation in which public morality ‘criminalizes’ sex workers, regardless of their legal status. But when laws, policies and programs reflect this kind of thinking, the situation gets much worse.

We still have:

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