This paper is about sexual and reproductive health and rights, especially the issue of unsafe abortion and female genital mutilation. Sexual and reproductive health and rights present the most vital part of every society, and thus should be treated with the highest importance. The selected fields of these rights, unsafe abortion and female genital mutilation, highlight a small part of the possible violation of these same human rights, while at the same time, revealing the gravity of bad practices that stand behind it. The proposed strategies for affecting these issues mainly rely on well-developed international policies, not excluding any of the recognized duty barriers.
The United Nations Human Rights Office of the High Commissioner provided the list of human rights that imply the sexual and reproductive health and rights, and those are: the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination. In addition, the Committee on Economic, Social and Cultural Rights and the Committee on the Elimination of Discrimination against Women have clearly defined that women's right to health include their sexual and reproductive health. The human rights that derive from sexual and reproductive health include access to sexual and reproductive healthcare and information as well as autonomy in sexual and reproductive decision-making.
Table of contents
Abstract
1 Definition of Sexual and Reproductive Health and Rights
2 Report on Current Global Issues on Sexual and Reproductive Health and Rights and Possible Ways for Their Improvement
2.1 The issue of unsafe abortion
2.1.1 The Strategy for Strengthening Prerequisites for Securing the Safe and Legal Abortion
2.2 The Issue of Female Genital Mutilation
2.2.1 The Strategy for Stopping Female Genital Mutilation
3 Conclusion
4 Bibliography
Abstract
Sexual and reproductive health and rights present the most vital part of every society, and thus should be treated with the highest importance. The selected fields of these rights, unsafe abortion and female genital mutilation, highlight a small part of the possible violation of these same human rights, while at the same time, revealing the gravity of bad practices that stand behind it. The proposed strategies for affecting these issues mainly rely on well-developed international policies, not excluding any of the recognized duty barriers.
1 Definition of Sexual and Reproductive Health and Rights
At the very beginning, it is necessary to explain what sexual and reproductive rights are, or, more precisely, which human rights fall within the scope of sexual and reproductive health and rights. The United Nations Human Rights Office of the High Commissioner provided the list of human rights that imply the sexual and reproductive health and rights, and those are: the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination.1 In addition, the Committee on Economic, Social and Cultural Rights and the Committee on the Elimination of Discrimination against Women have clearly defined that women's right to health include their sexual and reproductive health.2 For the sake of a clearer understanding of this issue, it would be necessary to separately define what sexual and reproductive health is and what sexual and reproductive health rights are. In accordance with the definition given by Amnesty International, sexual and reproductive health is:
̏ an essential component of the universal right to the highest attainable standard of physical and mental health, enshrined in the Universal Declaration of Human Rights and in other international human rights conventions, declarations, and consensus agreements. Sexual and reproductive health needs must be met for both men and women. Human rights standards require states to respect, protect, and fulfill the right to sexual and reproductive health, and states must also ensure that individuals have the opportunity to actively participate in the development of health care policy and in individual care decisions—including determining whether and when to have children and in protecting the rights of others to sexual and reproductive health, including through ensuring violence-free relationships and homes and in seeking information, education, and care for one’s children ̋ (Amnesty International USA, p.1).
The human rights that derive from sexual and reproductive health include access to sexual and reproductive healthcare and information as well as autonomy in sexual and reproductive decision-making.3 These rights are grounded in the previously mentioned human rights (right to health, the right to be free from discrimination, etc.).4 More precisely, sexual and reproductive rights presume that:
̏ all people have the right to a healthy, safe, consensual and enjoyable sex life; to control their bodies and have sufficient accurate information to use in making decisions and seeking healthy behaviors; and to have affordable, accessible services that keep them healthy, not only when pregnant but before and after—and even if they choose never to get pregnant ̋ (Amnesty International USA, p.1).
The first occasion when the importance of sexual and reproductive health and rights was recognized by the international community occurred when a program of action was adopted at the International Conference on Population and Development, held from 13 to 15 September 1994 in Cairo.5 The adopted Programme of Action, among other numerous things related to the improvement of population and development, envisaging a set of basic principles to guide future action towards the further development and strengthening of reproductive health and rights.6 In that regard, and in accordance with the Programme of Action, reproductive health, among other things, implies voluntary, informed, and affordable family planning service, safe motherhood services, assisted childbirth from a trained attended, prevention and treatment of sexually transmitted infections, prevention and treatment of violence against women, access to safe abortion services, sexual health information, education and counseling.7
2 Report on Current Global Issues on Sexual and Reproductive Health and Rights and Possible Ways for Their Improvement
There are a vast number of topics considering both sexual and reproductive health and rights. Any of these possible topics would not be less worthy of our consideration. For the purpose of this research, I decided to explore the issues that, in my opinion, have most deeply affected this area of human rights. By passing through every selected field of sexual and reproductive health and rights, the latest challenges will be explained and possible advocacy strategies presented; strategies that may mitigate and/or remedy those obstacles on the path towards the protection and improvement of the listed rights. Depending on the challenges presented in the following section, the proposed advocacy strategies will be constructed in a way that would affect the range of stakeholders, from states, to the population itself, international organizations and their agencies that work within the specific field of a given health challenge.
2.1 The issue of unsafe abortion
Prior to elaborating on this issue, it is necessary to define what a safe abortion is. A safe abortion is an abortion which is performed in accordance with World Health Organization (WHO) guidelines and standards. Those standards, beside the development of the needed state policies, imply numerous guidelines and obligatory actions that range through pre-abortion, abortion and to post-abortion stages.8 The lack of access to health and reproductive health services and information, contraception and safe abortion care causes the risk of unsafe abortion, putting the women's life and well-being at risk.9 According to a new study titled, “Global, regional and sub-regional classification of abortion by safety 2010-14: estimates from a Bayesian hierarchical model”, published by authors from the World Health Organisation and the Guttmacher Institute, estimates that of 25 million abortions, 45 percent of all abortions that occurred every year worldwide between 2010-2014 were unsafe.10 Moreover, the majority of all unsafe abortion occurred in developing countries; in Asia, Africa and Latin America.11 The new study classifies abortions as 'safe', 'less safe' and 'least safe'.12 In accordance with the classification methods of the listed study, the 'safe abortion' means that they were performed by a trained health worker, applying the WHO recommended methods.13 Approximately 55 percent of all abortions occurred from 2010 to 2014 fall within this category.14 The 'less safe' abortion implies that an abortion was performed by a trained health worker but using the unsafe methods and the amount of these types of abortions, performed from 2010 to 2014, was 30 percent.15 Finally, the 'least safe' abortion means that an abortion was performed by an untrained person, using dangerous methods. The number of abortions falling under the category of 'least safe' abortion that occurred within the time period 2010-2014 was 14 percent out of the total number of abortions performed during the provided timeframe. The listed data confirms that 45 percent of all abortions performed within that time period were unsafe, especially if we keep in mind that in 45 percent of all cases of abortion the recommended standards and methods were not implemented. The above-mentioned study also illustrates the main obstacle on the path towards the reduction of cases of unsafe abortions.16 The main obstacle is restrictive laws that regulate this issue in the majority of the countries where a high level of unsafe abortion occurs. The existence of restrictive laws in a country implies various forms of restrictions on abortions. These forms of restrictions vary from cases in which abortion is completely forbidden to cases where abortion is allowed only in situations where it is needed to save the women's life and her physical health.17 One of the consequences of these kinds of laws is that in Latin America only 1 out of 4 abortions was deemed safe in the provided time period, while during the same time period, in South-Central Asia, less than 1 out of 2 abortions were performed in a safe manner.18 It can be concluded that where the restrictive laws on abortion are in force, all women with unintended pregnancies are excluded from the healthcare system. Their right to have access to safe and legal abortion and post-abortion care is violated.
2.1.1 Strategy for Strengthening Prerequisites for Securing Safe and Legal Abortion
As it derives from the above presented facts, the right to health is highly threatened by countries where restrictive abortions laws are in force. Since human rights are interdependent, indivisible, and interrelated, all other human rights related to the right to health, such as the right to life, the right to be free from torture, the right to privacy, the right to education, and the prohibition of discrimination, which have been assigned to women as human beings, are under threat by not providing women with the conditions that would guarantee a safe and legal abortion procedure(s).19 The package of measures which should secure a safe and legal abortion for women have to be supported by government, with constant advocacy actions taken by the UN and its competent bodies such as the United Nations Economic and Social Council, the World Health Organisation and the United Nations Population Fund. The first recommended action (step) of the UN and its accompanied bodies is to strengthen attempts towards full legalization of abortion for women worldwide because it presents the main precondition for implementation of health-care services, goods, and facilities to which women are entitled to, in accordance with the interpretation of the right to health provided in the General Assembly of the United Nations' document titled, “The right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”20 The availability in adequate numbers presents the second prerequisite for the improvement of a women's right to a safe abortion.21 This means that a state has an obligation to increase the number of health professionals as well as the general terms and conditions under which an abortion should be performed.22 The health service should be accessible physically and economically.23 This presents the third step towards securing a safe abortion. More precisely, this step implies two conditions, easy physical access to, and affordable costs of health services due to the fact that these two conditions often present a dissuasive factor for women when they decide whether or not to seek health services.24 When we speak about easy physical access, it means that the health services needed for the conduction of safe abortion should also be placed in rural areas. The fourth action that should be taken in order to secure the women's right to health service with the final aim of providing them with much-needed healthcare during the pre-abortion, abortion and post-abortion stages is the accessibility to all health services without discrimination.25 This step is the most complex step in the recommended package of the strategy. It includes numerous actions that should affect and address gender sensitivity, the rights and cultures of minorities and indigenous peoples and social, political, and legal factors ̏ which influence women's decision to seek maternal and other reproductive health-care services ̋ (The United Nations' General Assembly, 2006, p.7). This step also requires a state, to change, adjust the laws in force, as well as adopt new laws which should meet the requirements that derive from this action. Finally, the fifth recommended step of the provided strategy should secure that the envisioned healthcare services have to be of good quality.26 This is mainly due to the fact because it influences the outcome of an intervention as well as a woman’s decisions whether or not to seek care.27 I firmly believe that if all the above explained actions are seriously taken into consideration by all the relevant UN bodies with the aim of providing a platform to all countries reporting a high level of unsafe abortions, followed by a strong advocacy campaign, the number of unsafe abortions will begin to decrease within a ten-year period of time. Although I am fully aware of the fact that the provided strategy presents the beginning of the entire process of dealing with the issue of preventing unsafe abortions, at the same time, I deem that after the crucial point has surpassed in high-risk countries, advancements within this field of human rights will be guaranteed.
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1 The listed human rights that fall within the scope of human rights titled sexual and reproductive health and rights have been presented by the United Nations Human Rights-Office of the High Commissioner (http://www.ohchr.org/EN/Issues/Women/WRGS/Pages/HealthRights.aspx).
2 Ibid.
3 The provided definition of sexual and reproductive health rights is presented has been presented Amnesty International USA (http://www.amnestyusa.org/pdfs/SexualReproductiveRightsFactSheet.pdf).
4 Ibid.
5 The exact date when the International Conference on Population and Development was held is presented on the website of the United Nations Population Fund (http://www.unfpa.org/publications/international-conference-population-and-development-programme-action).
6 The basis for action is prescribed by the Programme of Action adopted at the International Conference on Population and Development (http://www.unfpa.org/sites/default/files/pub-pdf/programme_of_action_Web%20ENGLISH.pdf).
7 Ibid.
8 The WHO standards that should enable safe abortion are presented in the WHO publication titled Clinical practice handbook for Safe abortion (http://apps.who.int/iris/bitstream/10665/97415/1/9789241548717_eng.pdf).
9 The main causes that produces the risk of an unsafe abortion are presented by the WHO in 2017 (http://www.who.int/reproductivehealth/topics/unsafe_abortion/abortion-safety-estimates/en/.
10 The exact data on number of unsafe abortion occurred between 2010-2014 are presented in the article titled Global, regional and sub-regional classification of abortion by safety 2010-14: estimates from a Bayesian hierarchical model (Lancet, 2017).
11 Ibid.
12 Ibid.
13 Ibid.
14 Ibid.
15 Ibid.
16 The relation between the existence of restrictive laws and the high level of unsafe abortion was presented in the article titled Global, regional and sub regional classification of abortion by safety 2010-14: estimates from a Bayesian hierarchical model (Lancet, 2017).
17 Ibid.
18 The number of unsafe abortion performed in Latin America was presented in the article titled Global, regional and sub-regional classification of abortion by safety 2010-14: estimates from a Bayesian hierarchical model (Lancet, 2017).
19 The interdependent structure of all human rights was presented in the Article titled The Right to Health (United Nations, 2008).
20 The United Nations' Generally Assembly (2006) presented four measures that need to be fulfilled in order to satisfy the women's right to health.
21 ibid.
22 ibid.
23 ibid.
24 ibid.
25 ibid.
26 Ibid.
27 Ibid.