Access to contraception is only one element of reproductive health

On May 29 2013, during the Women Deliver Conference, global leaders made a call for Accelerated Progress on Family Planning.   This important initiative certainly deserves attention.  Not only because it aims to improve access to contraception, also because initiatives as this one, aimed to improve opportunities for family planning, must take sexual and reproductive rights into account.  Almost 20 years after the adoption of the International Conference on Population and Development (ICPD) Programme of Action, it is still necessary to stress that reproductive health is more than counselling and care related to reproduction and sexually transmitted diseases. It implies a constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems, which includes a recognition of people’s right to be free to decide if they want to reproduce, as well as when and how often.  This requires the recognition of the right to information, and to access to safe, effective, affordable and acceptable methods of family planning; as well as the right to have access to appropriate health care services during pregnancy, childbirth and after birth.

The rights component of access to contraception is crucial, especially in a context where rights are not always included in the measurement of policy goals.  Several unfortunate incidents clearly illustrate the risk of neglecting  the rights component of reproductive health.  In Peru, for example, between 1996 and 2000 more than 300,000 women and 16,000 men, mostly from rural areas in the Peruvian Andes and Amazon were sterilized as part of a national policy aimed to increase the use of “modern contraception” and reduce the risks of maternal mortality.  A praiseworthy objective, if it were not for the fact that many of the women and men were given no choice. They were forced. Currently, victims of this national policy have handed in at least 2,047 judicial claims against the authorities.

Equally violent to the forced use of contraception is the denial of access to contraceptive methods, as emergency contraception, and access to legal abortion.  This year, the UN Human Rights Committee criticized Peru for a wide range of reproductive rights violations, including highly restrictive abortion legislation and a high rate of maternal mortality.

But Peru is not the only Latin-American country with a restrictive abortion law, or with the most restrictive one. In Nicaragua, Chile, the Dominican Republic, Honduras, and El Salvador abortion is entirely criminalized even in situations of rape or health risk to the mother.

This implies that women’s sexual and reproductive rights are not respected. Women are not free to decide if they want to continue a pregnancy, even if it is the result of a rape, or when the pregnancy poses a threat to their health.  However, these countries also report a coverage of modern contraceptive methods that is equal to or above the world average,  (world 56%, Nicaragua 69%, Dominican Republic 70%, Honduras 56%, El Salvador 66%),  something which means that they actually have made progress in family planning.

Family planning is undoubtedly important, as is access to contraceptive methods. However, sexual and reproductive health is more than that.  It is true that women in El Salvador now have easier access to modern contraceptives than some years ago (47% in 1988 to 73% in 2008), but this does not necessarily mean that women’s sexual and reproductive rights are respected.  El Salvador is one of the most dangerous places in the world to be a woman. Nowhere else are so many women killed, and the rate of sexual abuse is high.  Some days ago, the Salvadorian supreme court denied a sick women the right to abortion, despite warnings from doctors who claim that her life is at risk (she has been diagnosed with lupus disease) and the foetus is likely to die only a few hours after birth (the foetus is missing large parts of the brain and skull, a condition known as anencephaly).  Unfortunately, this is not a unique case in El Salvador. Ever since the abortion law was banned in 1997, the authorities have investigated 600 cases, leading to the imprisonment of 30 women for up to 30 years on infanticide verdicts. So can we really argue that the women of El Salvador enjoy their sexual and reproductive rights based on data that show the use of modern contraceptive methods? My answer is no.

Commitments like the one achieved at the Women Deliver Conference are important, but we have to avoid that issues of reproductive health are reduced to a mere matter of access to contraception. We need to prevent situations as the ones in Peru and El Salvador, and we need to strengthen the rights component of sexual and reproductive health.



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About Camila Gianella

Camila Gianella is pursuing her PhD at the University of Bergen and the Chr. Michelsen Institute. She has worked as researcher and consultant for projects on maternal mortality, the right to health, HIV/AIDS, tuberculosis, mental health and transitional justice. She has also as a counselor in HIV and Tuberculosis services, and with asylum seekers.