|TOP TEN WINS FOR WOMEN'S HEALTH AND RIGHTS IN 2006|
TOP TEN WINS FOR WOMEN'S HEALTH AND RIGHTS IN 2006
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1. COLOMBIA RECOGNIZES WOMEN'S RIGHT TO ABORTION
In a 5-3 decision, the court ruled in May that the procedure is legal when the health of the woman is in danger, when the fetus is malformed, and in cases of rape and incest. It called the ban on all abortions "disproportionate" and "irrational." Monica Roa, the lawyer who brought the case, argued that the outright ban violated Colombia's commitments to international human rights treaties that ensure a woman's right to life and health.
Will other countries live up to their health and human rights commitments? The decision gives hope to dozens of Latin American women's organizations, now positioned to use their countries' courts to overturn the highly restrictive abortion laws that prevail in the region.
The first such attempt may come in Nicaragua. In late October the national legislature voted 52-0 to ban all abortions without exception, joining Chile and El Salvador, the two other Latin American nations with complete abortion bans. "I think [Colombia's] decision will prompt countries in Latin America that have stringent legislation to reflect that abortion is not ideological, but a health care issue," said IWHC Board Member Mabel Bianco, President of the Foundation for Studies and Research on Women (FEIM) in Buenos Aires. (Click here to read Mabel Bianco's story.)
The ultimate goal is for African governments, nonprofit organizations, and businesses to work together toward achieving universal access to sexual and reproductive health for Africa's women. Key strategies to achieve this goal include integrating sexual and reproductive health services into primary health care, integrating the prevention, management, and treatment of HIV/AIDS and other sexually transmitted infections into reproductive health programs, providing safe abortions to the fullest extent of the law, and offering youth friendly services and sexuality education for young people in and out of school. (Click here to read physician Florence Tumasang's story from Cameroun.)
Will implementation and funding match rhetoric? African ministers of health have shown their commitment to tackling these critical health issues. Now finance ministers, along with donor nations and organizations, need to put money on the table.
The crisis in sexual and reproductive health—only one-third of African women have access to reproductive health services—is exacerbated by weak public health systems that lack qualified staff. Improvements require not only the expansion of clinical care, but also the realignment of national and international public health and funding priorities, and protection of women's human rights. Political and ideological roadblocks—such as opposition to contraception, condom use, or safe abortion—also obstruct progress unnecessarily.
Although WHO sets norms and standards for health care in 192 member countries and coordinates global public-health responses to epidemics, it has no regulatory power and an annual budget of only about $1.66 billion. The Lancet recently asserted: "The terrible failures at global and country levels to address malaria, tuberculosis, HIV/AIDS, child, newborn, and maternal mortality, together with sexual and reproductive health...demand a massively scaled-up response from WHO."
Will WHO and other leading global health actors come through for women? In 2007 a new cast of global leaders will take over—not only Dr. Chan, but also Ban Ki-Moon, the next United Nations Secretary General, the executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the senior vice president for the World Bank's Human Development Network, who oversees health policy and programs, both to be filled by mid-year.
To turn rhetoric about the importance of women's health and rights into results, each of these leaders will need to have expert staff in pivotal positions with significant resources, clear objectives, and the commitment to hold themselves and staff accountable for achieving progress.
That same month, the Centers for Disease Control (CDC) Advisory Board on Immunization Practices voted unanimously to recommend that all girls aged 11 and 12 receive the vaccine for best preventive results. Although more than 100 strains of HPV exist, the four prevented by the new vaccine account for 70 percent of cervical cancer cases.
Who will foot the bill? In the United States, Gardasil costs $400 to $500 for the three-shot series, plus doctor's fees, and few U.S. health insurers currently cover the vaccine. New Hampshire has announced that it will provide the vaccine free to all girls ages 11 to 18. Without similar measures elsewhere, the cost may put the vaccine out of reach for many Americans—and for most girls in developing countries.
All countries, in addition to affordability, will have to overcome the challenges of acceptability, delivery, and ignorance about the link between HPV and cervical cancer. With an estimated 630 million infected individuals worldwide, and very little access to pap smears, HPV is the number one cause of cancer-related deaths among women in the developing world. Mexico approved Gardasil for use in June, and the Seattle-based organization PATH is working to accelerate access to HPV vaccines in other developing countries.
Recognizing the feminization of AIDS—in sub-Saharan Africa, 60 percent of those living with HIV/AIDS are women—the agreement strengthens commitments to women's human rights, including the right to control "matters related to their sexuality," and recognizes the role of men and boys in achieving gender equality. Governments also vowed to ensure that pregnant women have access to services to reduce mother-to-child HIV transmission and to work with young people, specifically acknowledging the need to adopt "evidence-based prevention strategies," including condoms. (Click here to read more about women and HIV/AIDS.)
Will nations honor their commitments and provide adequate funding? The Bush administration, allied with conservative Islamic states like Syria, Pakistan, and Egypt, sought to weaken language defending women's rights. Further, the United States and donor nations watered down language to provide financing to achieve the declaration's goals. The recent Democratic victory in Congress should provide significant opportunities for more progressive U.S. policies and leadership at the UN and in the global battle against HIV/AIDS.
Under the law, all forms of physical, sexual, verbal, emotional, and economic abuse are considered domestic violence and a human rights violation, punishable by jail terms and fines. The law also forbids harassment in the form of dowry demands. Previously, a woman could not obtain protection orders against a brutal husband. Although she could file a complaint with the police, she did not have the right to remain in her home or to receive financial support if forced to leave. The Indian law follows on the heels of ambitious legislation in Brazil this summer, imposing strict new penalties for violence against women, also based on a human rights argument. (Click here to read Claudia Vasconcelos's story about violence in Brazil.)
Will the laws be enforced and attitudes changed? Even educated women in both India and Brazil remain largely unaware of their rights and the legal protections that the new laws provide.
In the short term, police and the legal community need to be educated and trained in how to deal with domestic abuse. Over the longer term, public education and intensive work with young people is required to change men's attitudes and behavior. Says Beth Fredrick, Executive Vice President of the International Women's Health Coalition: "To prevent such violence, we must teach children and young people that violence is wrong, and that girls and women are people with full human rights, not objects."
In a landmark victory in November, South Dakota voters rejected a proposition passed by state legislators that outlawed abortion under all circumstances, except to save the mother's life.
Since the Supreme Court legalized abortion, opponents have claimed that pro-choice policies could never win at the ballot box. South Dakota voters proved that wrong. Voters in California and Oregon also defeated parental notification laws that sought to require doctors to notify a parent or guardian before providing an abortion to a minor. And in Kansas voters threw out Attorney General Phill Kline, an anti-abortion zealot, who had sought access to patient records from family planning clinics.
Will the ballot box succeed in advancing women's rights worldwide? Pro-choice women's groups are going directly to the people in other countries as well.
In February, Portugal, which has one of the strictest abortion laws in Europe, will hold a national referendum on the issue. Currently, abortion in Portugal is legal only in the case of rape, when a woman's life is at risk, or in the first 12 weeks if a fetus is deformed. Women who have abortions face prison terms of up to three years, and televised abortion trials, showing women humiliated before judges, have helped galvanize support for liberalization.
After a three-year stalemate, the FDA's leadership finally bowed to overwhelming scientific evidence in August—and pressure from Senators Hillary Rodham Clinton (D-NY) and Patty Murray (D-WA)—to permit emergency contraception, or the "morning-after pill," to be sold without a prescription to women 18 and older.
Nonprescription availability of the drug, known as Plan B, is expected to reduce unintended pregnancies and the need for abortions. Plan B prevents pregnancy by preventing implantation of a fertilized egg in the uterine wall.
Will emergency contraception be widely accessible and reasonably priced? Opponents secured both age and location restrictions. Plan B can be sold only in pharmacies and health clinics, and must be kept behind the counter forcing buyers to show proof of age. Women under 18 need a doctor's prescription, which greatly impedes access.
Plan B is expensive in the United States, selling for $35 to $45 over the counter. Washington should look south for a more beneficial approach to curbing unplanned pregnancies and the need for abortions. Chile recently announced that public health clinics will offer emergency contraception and other forms of birth control free to young women over 14. Currently, emergency contraception is readily available over the counter in 44 countries.
A landmark study provides conclusive evidence that female genital mutilation (FGM), widely practiced in Africa as well as parts of Asia and the Middle East, puts mothers and their babies at risk, raising by more than 50 percent the likelihood that a woman or her baby will die during childbirth. (Click here for more information.)
In the first large medical study of FGM, published in The Lancet in June, researchers found that all forms of the procedure, which vary in severity, contribute to mother and child mortality, with more extensive cutting causing the most deaths. The health impacts of stopping this practice would be enormous: Africa has the highest infant and maternal mortality in the world. In the six African nations studied, FGM rates range from a high of 83 percent in Sudan to a low of about 40 percent in Ghana. Said Adrienne Germain, President of the International Women's Health Coalition: "Finally we have data to prove what health workers have long known: that female genital mutilation is a health issue, a killer of women and children, as well as a human rights issue."
Will countries and communities take action? The study's Nigerian authors suggest that genital mutilation "should now be included among critical health indices for less developed countries."
With concrete evidence of the procedure's deadly consequences, countries with populations practicing FGM need to outlaw the practice, or enforce bans already in place, and launch public health campaigns that highlight the cost in lives and health. In a positive step, a group of prominent Muslim scholars meeting in Cairo in November called for an end to FGM and encouraged governments to enforce existing laws.
Four microbicides, which will enable women to protect themselves against HIV transmission, have reached the final phases of clinical trials and are being tested by women in several countries with high HIV rates, including South Africa, Uganda, and India.
Currently, an estimated 17.7 million women worldwide are living with HIV/AIDS. Women are twice as likely as men to contract HIV through heterosexual intercourse, which is responsible for the majority of new infections. In many developing countries women's lack of social, cultural, and economic power limits their ability to use existing prevention strategies (abstinence, condom use, and the treatment of sexually transmitted diseases that facilitate HIV transmission). Microbicides, which are products used vaginally to prevent HIV transmission, would put women in control. (Click here for more information about microbicides.)
Will funds match needs? The microbicide funding gap is significant. Although total global investment in research and development increased from $65 million annually in 2000 to $163 million in 2005, funding levels need to reach $280 million annually to expeditiously complete the trials.
If even one of the four products in Phase IIB/III trials—BufferGel, Carraguard, PRO 2000, and cellulose sulfate—proves to be safe and effective, governments, organizations, and international bodies will need to ensure that the product is also accessible and affordable for microbicides to fulfill their promise. Fortunately, work is already being done to interest industry and to lay the ground for public health pricing.