Summary
Denial of Reproductive Rights Kills or Harms
Millions of Women and Impedes Progress Towards Equality and Development
UNITED NATIONS, New York, 28 May 1997—Gaps and failures in
reproductive health care, combined with widespread discrimination and violence against
women, amount to a massive violation of human rights. Denial of sexual and reproductive
rights–including free choice with regard to pregnancy and childbearing–causes
millions of deaths every year, and much more illness and disability. Most of those
affected are women, the vast majority in developing countries.
These human rights
violations, and efforts to end them, are the focus of The State of World Population
1997 report by the United Nations Population Fund (UNFPA). The report, titled
“The Right to Choose: Reproductive Rights and Reproductive Health”, summarizes
the international understandings that define sexual and reproductive rights, presents
evidence on progress and problems in attaining and protecting those rights, and examines
the effects of denying them to millions of women and men.
To enable individuals to exercise their sexual and reproductive
rights, the report stresses the need for gender equality and increased investment in
education and primary health care. Specific recommendations focus on improving the
availability and quality of information and services that meet a broad range of sexual and
reproductive health needs.
At the International Conference on Population and Development (ICPD)
in 1994, 180 nations agreed that quality reproductive health information and services
should be available to everyone by the year 2015. The UNFPA report reviews the
considerable progress countries have made in implementing the conference recommendations,
and presents statistical indicators describing the current situation.
“The international community has agreed repeatedly that
reproductive health is a right for both women and men,” said Dr. Nafis Sadik,
Executive Director of UNFPA. “The challenge now is to make this right a reality for
every individual.”
The ICPD estimated that providing better reproductive health care
worldwide will cost $17 billion annually by the year 2000–less than the world
currently spends each week on armaments. But while many governments have increased their
allocations for population programmes since 1994, annual global expenditures are only
slightly above half the $17 billion mark.
Building on human rights treaties, the ICPD recognized a core set of
sexual and reproductive rights: the right to reproductive and sexual health,
throughout the life cycle; reproductive self-determination, including the rights to
voluntary choice in marriage, and to have the information and means to determine the
number, timing and spacing of one’s children; equality and equity for men and
women in all spheres of life; and sexual and reproductive security, including
freedom from sexual violence and coercion.
The State of World Population 1997 documents the effects of
denying these sexual and reproductive rights:
- 585,000 women–one every minute–die each year from
pregnancy-related causes, nearly all in developing countries. Many times this number are
disabled as the result of childbirth. Much of this death and suffering could be averted
with relatively low-cost improvements in health care systems.
- About 200,000 maternal deaths per year result from the lack or
failure of contraceptive services.
- 120-150 million women who want to limit or space their pregnancies
are still without the means to do so effectively. Altogether 350 million couples lack
information about and access to a range of contraceptive services.
- At least 75 million pregnancies each year (out of about 175 million)
are unwanted; they result in 45 million abortions, 20 million of which are unsafe.
- 70,000 women die each year as a result of unsafe abortion, and an
unknown number suffer infection and other health consequences. Many unsafe abortions could
be avoided if safe and effective means of contraception were freely available.
- 3.1 million people were infected last year by the human
immunodeficiency virus (HIV) which leads to AIDS; 1.5 million died from HIV/AIDS-related
causes in 1996; 22.6 million people are living with HIV/AIDS.
- 1 million people die each year from reproductive tract infections
including sexually transmitted diseases (STDs) other than HIV/AIDS. More than half of the
333 million new cases of STDs per year are among teenagers.
- 120 million women have undergone some form of female genital
mutilation; another 2 million are at risk each year.
- Rape and other forms of sexual violence are rampant, though many
rapes are unreported because of the stigma and trauma associated with rape and the lack of
sympathetic treatment from legal systems.
- At least 60 million girls who would otherwise be expected to be alive
are “missing” from various populations as a result of sex-selective abortions or
neglect.
- 2 million girls between ages 5 and 15 are introduced into the
commercial sex market each year.
The UNFPA report stresses that sexual and reproductive rights are
key to women’s empowerment and gender equality, and are also critical to the economic
and social life of communities, nations and the world. Global and national needs coincide
with personal rights and interests. Given the choice, most women would have fewer children
than their parents’ generation. Ensuring that women and their partners have the right
to choose will support a global trend towards smaller families, and help countries find a
balance between their populations and resources. Successful development efforts will in
turn bring sexual and reproductive health to more people.
The Legal Framework for Sexual and Reproductive
Rights
Reproductive and sexual rights are implied by
long-established human rights: to life and survival; liberty and personal security; equal
treatment; education; information; development; and the highest attainable standard of
health. The State of World Population report highlights the relevant guarantees in
the United Nations Charter, the Universal Declaration of Human Rights, the two human
rights covenants (on civil and political rights, and on economic, social and cultural
rights), and the conventions on the rights of children and on eliminating discrimination
against women.
These international instruments forbid states to interfere with
individual freedoms, and obligate them to actively promote the exercise of rights. United
Nations’ mechanisms for monitoring national compliance with human rights treaties
therefore offer powerful support for legal, political and social actions intended to
ensure reproductive and sexual health and rights.
Agreements reached at the ICPD and the Fourth World Conference on
Women (FWCW) in 1995 also protect reproductive and sexual health. These international
consensus documents, while not legally binding, can influence national lawmaking and
policies, and can help the human rights treaty monitoring bodies to set standards and make
recommendations. The FWCW Platform for Action, for example, calls on governments to
protect women’s “right to have control over and decide freely and responsibly on
matters related to their sexuality, including sexual and reproductive health, free of
coercion, discrimination and violence”.
A growing number of countries are incorporating sexual and
reproductive rights into their constitutions, legal codes and institutional procedures.
Many national population and development strategies now focus on meeting individuals’
reproductive health needs instead of on fertility reduction.
Rights for Sexual and Reproductive Health
In most societies, women’s social status and economic
opportunities are largely determined by their reproductive role, which has been
simultaneously over-valued and under-supported. Enabling women to control the timing and
frequency of pregnancy has made it possible to discuss reproductive roles in terms of
rights. Nearly 60 per cent of couples in the developing world use contraception, up from
15 per cent 30 years ago. While the right to health is recognized almost universally,
women carry a heavy and largely avoidable burden of poor health related to reproduction
and sexuality:
Malnutrition and anaemia—caused by poverty and
aggravated by gender inequality—contribute to many of the problems found in pregnancy
and delivery, and play a part in many maternal deaths.
Complications of pregnancy—obstructed labour,
haemorrhage and post-partum infection— could be reduced dramatically by prenatal
examinations, wider availability of trained birth attendants, and prompt referral to
emergency obstetric care. Many lives could be saved if more women were able to avoid
pregnancy as teenagers or after age 35, or too soon after having given birth.
Sexually transmitted diseases disproportionately afflict
women, particularly young women. Women’s biological susceptibility to STDs is
aggravated by social realities; young women especially may be forced into sex or have
little power to negotiate condom use with older sexual partners. Sexually active
adolescents are especially vulnerable to STDs, but most know very little about them.
The HIV/AIDS pandemic continues to destroy families and
communities in Africa and elsewhere, and is spreading rapidly in much of Asia and
countries of the former Soviet Union. About 42 per cent of infected adults are women, and
the proportion is growing; most newly infected adults are between ages 15 and 24.
Men’s concern about contracting HIV has led to increasing sexual exploitation of
girls.
Abortion done under unsafe conditions is a significant public
health risk. In Latin America, one in five clandestine abortions leads to complications
and subsequent hospitalization. Many women who resort to abortion would use contraception
if given a choice.
Female genital mutilation (FGM) has horrific short- and
long-term effects on the health of girls and women; it is often carried out under
unhygienic conditions. The international community has condemned the practice, yet it
remains widespread in some 28 countries. Several non-governmental organizations are
working to eliminate FGM, and to show that traditional practices can change without
compromising values.
Reproductive Health Services
The right to health and the right to determine the number
and spacing of one’s children imply a right to reproductive health services that
respect and promote clients’ rights, respond to their needs and desires, and
facilitate individual choice and informed consent. Despite considerable progress over the
last two decades, this right remains far from realization in most countries.
Population growth and “structural adjustment” programmes
have lowered per capita allocations for primary health care, reducing the availability and
quality of services and lowering life expectancy, particularly in sub-Saharan Africa.
Public health reforms–to provide a range of services under one roof, emphasize
training, and make the most of limited staff and funds–have only just begun,
supported by non-governmental organizations.
Since the ICPD, many reproductive health programmes have put more
emphasis on the quality of care offered to clients. This involves offering a full
range of services, including a choice among contraceptive methods, sensitive counselling
and complete and accurate information. Various barriers (formal and informal) impede
access to reproductive health information and services– particularly to adolescents,
both married and unmarried; spousal consent requirements in many countries effectively
deny contraceptive services to many women. The ICPD emphasized that programmes must fully
respect the right to informed reproductive choice; coercion in any form is unacceptable.
National targets for limiting population growth are ineffective and may lead to coercive
practices.
Adolescent Sexuality
Teenage mothers face a higher-than-average risk of maternal
death, and their children have higher levels of morbidity and mortality. Early marriage
and childbearing also impede young women’s educational and employment opportunities.
Both premarital sexual activity among teenagers and the average age at which young women
marry have increased in many societies in recent decades, particularly in industrialized
countries. In many places, however, early marriage and childbearing are still the norm.
High levels of adolescent pregnancy, childbearing and unsafe abortion reflect a lack of
educational and economic opportunities.
Young people are typically poorly informed about how to protect
against unwanted pregnancy and STDs including HIV/AIDS. Parents are often uncomfortable
talking to children about sexual matters, and young people get information (much of it
incorrect) from their peers. Contrary to the myth that sex education leads to promiscuity,
experience indicates that it encourages responsible sexual behaviour.
Worldwide, there is increasing agreement that adolescents need
unrestricted access to information, and to private and confidential reproductive health
services.
Choice in Marriage and Forming Families
Age and educational differences between husbands and wives, while narrowing in many
countries, continue to reinforce stereotypes of female dependency. Laws defining a minimum
age of marriage are not always enforced, and typically apply only when parental consent is
lacking; young people often lack legal protection from forced marriages. Young couples
often face strong pressure to begin childbearing immediately after marriage, and to go on
having children until they produce sons.
In some countries, sons are often better fed and receive more
medical attention than daughters. As fertility levels have fallen, notably in parts of
Asia, son preference has led to sex-selective abortion, resulting in an abnormal excess of
boys born compared to girls, especially after the first birth. Surveys show that men and
women generally know how many children they would like to have, and increasingly know
about modern contraceptives and where to find them. But spouses often fail to discuss
family size desires, limiting the practice of family planning.
Violence Against Women
Violence against women may be the most pervasive yet least
recognized human rights abuse in the world. Gender violence, physical or emotional,
perpetuates male power and control. Studies link violence against women to male
socialization and peer pressure, rather than biology or sexuality. Eighty per cent of
women raped already know their attackers. The majority of sexual assault victims are
young. Women subjected to rape and assault face numerous health risks, including severe
injuries, mental illness, sexually transmitted diseases and unwanted pregnancy.
Rape in time of war and other emergency situations is still common.
In the former Yugoslavia, Rwanda and elsewhere, it has been used systematically as an
instrument of torture or ethnic domination.
Sexual exploitation and trafficking in children affects tens of
millions of children worldwide. In developing countries, the sex industry draws girls from
poor rural families to cities. Many commercial sex workers in developed countries are from
poorer countries. Sex workers are particularly at risk from STDs and HIV infection.
Gender Equality and Male Involvement
Women’s social empowerment and economic security
clearly contribute to, and depend on, good reproductive health. But their access to
reproductive health services is constrained by their lack of resources, restrictions on
social participation, and limited access to information due to illiteracy. Men are
frequently insensitive to women’s reproductive and sexual health needs. Boys and men
need to learn to be responsible in sexuality and parenthood, and to understand the risks
women face from harmful traditional practices, sexual initiation too early in life, and
when they or their spouses have multiple partners. Because men dominate positions of
power, they have a key role to play in eliminating gender inequality.
Education of girls is a key factor in improving family health,
reducing infant mortality and changing reproductive behaviour. Globally, nearly 600
million women remain illiterate, compared with about 320 million men.
Recommendations
The State of World Population 1997 report calls for
greater attention to human rights, especially the promotion of gender equality and
women’s empowerment. This requires legal reforms, better enforcement of existing
laws, new procedures to document violations, education about human rights, and alliances
among institutions concerned with rights. International assistance programmes should give
greater priority to human rights goals. To combat the poverty that prevents the exercise
of sexual and reproductive rights, the report advocates increasing women’s access to
credit and economic resources. It stresses the value of both general education and
specific education on sexual and reproductive health.
The report calls for greater investment in primary health care,
particularly for sexual and reproductive health. Health services should be restructured to
focus on the reproductive and sexual health needs of clients, including underserved
groups, using new guidelines, standards of conduct and evaluation methods.
Non-governmental organizations and the private sector must help design, implement and
monitor programmes.
Implementing the ICPD Programme of Action
A special section, based on reports from UNFPA field
offices, describes national implementation of the ICPD Programme of Action: revisions of
population and development policies and related institutions; legal and constitutional
reforms to protect women’s rights and promote gender equality; and reorganization of
health services to reduce maternal mortality and address the full range of reproductive
health concerns. The report notes that while many developing countries have made important
progress, many others suffer from a shortage of funds and trained personnel.
The ICPD Programme of Action estimates that a basic package of
population and reproductive health programmes for developing countries will require some
$17 billion annually by the year 2000, and $21.7 billion by 2015; about two thirds of
these global costs will have to come from domestic resources, and about one third from the
donor community.
For further information:
Information and External Relations Division
United Nations Population Fund
220 E. 42nd Street
New York, NY 10017, USA
Telephone: (212) 297-5020
Fax: (212) 557-6416
Email: ryanw@unfpa.org
The State of World Population 1997
Editor: Alex Marshall
Research and Writing: Stan Bernstein
Managing Editor: William A. Ryan
Editorial Assistant: Phyllis Brachman
Last modified: 24 April 2001 |
