Any woman in the U.S. or overseas who has tried to access reproductive
health care likely has a story about encountering barriers to obtaining quality,
human rights-based, comprehensive care.
In my advocacy work with the Center
for Health and Gender Equity (CHANGE), I’ve heard all kinds of these stories.
Self-identified sex workers have talked about reproductive health
care providers who go so far as to avoid making eye contact during visits. I’ve heard from women living with HIV
in countries from Namibia to Chile about being forcibly sterilized, violating
their right to make informed decisions about reproduction free from coercion. I’ve swapped stories with acquaintances
about the rising costs of contraception in the United States and the
ever-growing legal barriers to accessing safe abortion, especially for young
While these stories crisscross continents and issues, they show
how much we have in common. And they
illuminate how we as advocates can’t tease apart HIV from maternal health from
family planning, just as women don’t experience their health in boxes or
Achieving comprehensive sexual and reproductive health care
for all people was a rallying point at the NGO Forum on Sexual and Reproductive
Health and Development I recently attended in Berlin, Germany. Leaders of non-governmental
organizations from more than 130 countries met to formulate a Call to
Action for governments and donors to strengthen their commitment to the 1994
International Conference on
Population and Development (ICPD) Programme of Action
(PoA)–a landmark agreement that placed women, gender equality, and sexual and
reproductive health and human rights at the center of sustainable development.
Now, just as fifteen years ago, these groups called for a
comprehensive approach to achieving the ICPD and Millennium Development Goal
target of universal access to sexual and reproductive health and rights (SRHR).
I attended one workshop on HIV/AIDS services and barriers to
care that stressed why comprehensive SRHR is so urgently needed. A speaker from Botswana recounted the
multiple oppressions and rights violations she faced as a woman living with
HIV. For example, in order to be a
peer counselor for an HIV/AIDS network in her country, she had to sign a pledge
that she would not get pregnant – a clear abrogation of her right to make
reproductive decisions free from coercion. She also spoke of numerous human rights violations faced by
women living with HIV in Botswana, including the right to life, the right to
health, the right to choose the number and spacing of children and to have
access to the information and means to do so, and the right to make
reproductive decisions free from coercion, discrimination and violence. Her stories illustrated that HIV/AIDS
and sexually transmitted infections, family planning, maternal health, and
sexuality education are fundamentally connected.
All women – whether living with HIV, married, young, transgender,
poor, queer – experience their reproductive health in overlapping ways
throughout their lives, and reproductive health programs and services should
reflect this reality. And yet when
thinking in particular about the U.S. and its role in fulfilling the ICPD PoA
at home and abroad, it’s clear that U.S. policies and funding are falling short
in promoting comprehensive approaches to SRHR.
Take the issue of safe abortion. The U.S. restricts access to safe abortion for women in the
United States by denying public funding for most abortions through the Hyde Amendment, unfairly denying low-income
women a procedure that wealthier women can access. In a similar vein, the Helms
Amendment precludes women across the world from obtaining safe abortion by restricting
U.S. foreign assistance dollars from supporting the procedure. This runs counter to the ICPD PoA—which
the U.S. endorsed—that stipulates that unsafe abortion is a major public health
concern and that where abortion is legal, it should be safe and accessible. Abortion is just one instance of many
where the U.S. is failing to promote comprehensive sexual and reproductive health
care for its own citizens and for women worldwide.
It’s clear that we have a lot of work to do to hold the U.S.
accountable to the ICPD PoA, specifically around ensuring comprehensive SRHR
for women, men, and youth at home and abroad. A first step is to get educated to better inform our
advocacy. A new report from CHANGE,
Investing in Reproductive Justice for All, highlights the
advantages and challenges of comprehensive approaches to sexual and
reproductive health and rights and the role of U.S. foreign policy and serves
as a useful tool to urge our own U.S. government officials to adopt ICPD
principles in domestic and international policy and funding.
The Berlin forum and its Call to
Action are timely with the 2015 endpoint for the ICPD PoA quickly
approaching. We have an urgent
mandate to join advocates from around the world to push governments and donors
to carry out their commitment to achieving universal access to comprehensive
sexual and reproductive health and human rights.