More than a dozen women died earlier this month in Chhattisgarh state in India after receiving tubal ligations in a government-run "camp." After being promised financial compensation, 83 women received sterilization procedures conducted by one surgeon in six hours. Village "motivators" were paid to persuade the women to go, and midwives were told that their pay would be docked if they did not meet certain quotas. Regulations stating that only 30 such operations can be performed in one day were ignored. Proper measures for the use of hygienic tools were disregarded. Some of the medications prescribed to the women may have included ingredients commonly used in rat poison. The government is taking action, including prosecuting a surgeon, with an official referring to the catastrophe as "a serious matter of negligence."
This news in India raises issues far more profound than either sloppy medicine or negligence.
Incidents like this are a stark reminder of how reproduction remains one of the most highly charged political and social issues in the world. For centuries, societies and governments have attempted to control reproduction, especially of women, for a whole host of reasons focused on their overall goals for their communities. For example, in the 1960s, Romania's Ceausescu severely restricted contraception and abortion and mandated gynecological examinations of childless couples and unmarried people in a blatant attempt to raise the country's birthrate. Governments have also limited reproduction. Nazi Germany forced sterilization. In the U.S., in the late 19th and early 20th centuries, many states had eugenic laws mandating sterilization of people with "mental handicaps." With the rising awareness of individual rights and the power of the women's movement, we have witnessed women and men demand their human right to determine if and how they will have children and to have access to the services to realize these rights.
The human right to reproductive self determination includes not only the right to bodily integrity, but also the right of "couples and individuals to decide freely and responsibly the number and spacing of their children and to have access to the information, education and means to enable them to exercise this right." The means by which to realize such rights includes the right to reproductive health services.
Reproductive rights relating to services, especially family planning, are being violated daily. 222 million women around the world have an unmet need for family planning, meaning that they want to delay or avoid their next pregnancy but are not using contraception. 162 million of these women live in the world's poorest countries. This includes 24 percent of married women in Africa, 15 percent of married women in Asia, and 13 percent of married women in Latin America and the Caribbean.
Like every other human right, the right to family planning needs to be respected. Period. In addition, the promotion of this right will result in enormous benefits. If the worldwide unmet need for contraception were filled, roughly 79,000 maternal deaths and 1.1 million infant deaths could be prevented. Also, 54 million unintended pregnancies - including 7.4 million adolescent pregnancies - and 16 million unsafe abortions would be averted. If men and women could enjoy their right to reproductive health services, their ability to gain education and employment would be enhanced and they would be better able to protect themselves against sexually transmitted diseases (STDs), including HIV/AIDS.
Despite the importance of the human right to reproductive health care, this right continues to be infringed on in numerous ways.
The most notorious examples of such human rights abuses occur when individuals are pressured into using contraception. Zealous attempt to control reproduction, particularly by enacting policies that combine numeric "targets" with monetary incentives that push clients into using specific family planning methods, have often resulted in highly publicized human rights problems. One of the most infamous instances of such governmental policy occurred in China, where, in 1979, authorities instituted the notorious "One Child Policy." Although this policy has been liberalized recently, the original policy permitted only one child per couple and provided monetary bonuses and other benefits as incentives. Those that disobeyed the original law were subjected to fines, and officials admitted that forced abortions and involuntary sterilizations occurred.
But human rights are also breached when people cannot access the services necessary to exercise their right to decide freely and responsibly about the birth spacing of their children.
Creating barriers to prevent individuals from accessing the reproductive health care they desire results in rights violations. More recent examples of this include attempts to restrict abortion as well as access to emergency contraception. Some countries have far stricter policies. For example, in Myanmar, Spain and Iceland, intrauterine devices are illegal.
Moreover, rights are violated when clients receive poor quality reproductive health care, including family planning, or when there are inadequate supplies of safe and effective contraception. Sometimes patients are not provided adequate and accurate information or allowed sufficient privacy. Increased use of family planning in countries such as Ethiopia, Tanzania, Mexico, and Thailand has led to stock outs of contraceptive supplies.
Current instances of coercive contraceptive practices cast a dark shadow over the equally important reality of the pervasive and daily violations of human rights that occur by depriving millions of people of their right to reproductive health care, including family planning. While quality reproductive health care services are important to ensure that women and men exercise their rights, they are insufficient. We need laws, policies and health systems that promote and protect the rights of individuals to make choices.
Most importantly, we need to live fully into the reality of the human rights associated with reproduction. We need to affirm that our common humanity demands that we recognize how issues of reproduction lie at the core of being human.
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