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Foreign Aid Cuts Will Affect Women’s Health

In Policy Blog on April 11, 2011 at 5:00 pm

This is a cross-posting of my monthly column on Gender Across Borders, the Sexual and Reproductive Health and Rights (SRHR) Situation Report.

In recent weeks I’ve gone to my state capitol several times to lobby for public health funding, and been told again and again that there is just no money.  The federal government is facing a similar situation, and as the fight over the 2011 federal budget continues, women’s health is consistently on the chopping block.  We’ve all been following cuts and abortion funding riders at the national level, but funding at the global level is at risk as well.

The Republicans’ proposed 2011 budget includes vicious cuts to the foreign aid budget — nearly a third.  This will mean drastic reductions in USAID’s Family Planning and Maternal and Child Health programs.  Guttmacher lays out just what this will mean in this fact sheet.  The international aid policy community is buzzing.  Oxfam America’s Aid Reform Campaign is working with a number of major NGOs to lobby congress (see how below).  The head of USAID recently testified before congress that the cuts will mean death for 70,000 children.  I love it when public figures speak frankly!  Here‘s more on testimony about the global health and security consequences of the cuts.

Although USAID programming has ping-ponged between reasonable and right wing as successive presidents have  rescinded and re-instated the dreaded Mexico City Policy, it currently has projects which run the gamut from information on contraception to postabortion care.  Their website even points out the evidentiary link between clandestine abortion and maternal death.

The Guardian’s poverty blog is pretty pessimistic about the fate of international aid funding as the debate wears on.  I know it’s undeniable that cuts must be made — you can’t have guns and butter.  But our priorities as a society are proving to be criminally absurd.

These are absolutely desparate times.  Rather than working to refine the attack on maternal death and build effective health infrastructures for women worldwide, activists are being forced to cling by our fingernails to the bare-bones funding sustaining lifesaving programs. 

Now is the time to make sure your senators and representatives know where you stand.  Call them every day! Especially if you live in a Republican district, let your congressperson know that you won’t stand for the crackdown on women’s health here in the US, or the decimation of funding for development and health programs worldwide.

Senate switchboard: 202-224-3121 

House of Representatives switchboard: 202-224-3121

Or, email them here.

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Gender Mainstreaming at the UN

In Policy Blog on October 14, 2010 at 12:00 am
This is a cross-posting from my column on the feminist blog Gender Across Borders.

The United Nations announced on September 14th that former Chilean president Michelle Bachelet will head a newly minted agency United Nations Women (UN Women).  Ban Ki Moon has stressed that UN Women, which will launch in January 2011 and bring several currently-independent agencies under its umbrella, will help with the final push to acheiving the Millenium Development Goals- especially those that impact women and girls.  It’s exciting that the advocacy of international women’s rights NGOs’ years of advocacy has paid off, and it’s important to think about both the potential, and the potential pitfalls.

Former Chilean President Michelle Bachelet appointed head of UN Women

The details
The new agency brings together the Office of the Special Adviser on Gender Issues and the Advancement of Women (OSAGI), the Division for the Advancement of Women (DAW), United Nations Development Fund for Women (UNIFEM), and the International Research and Training Institute for the Advancement of Women (INSTRAW).
Michelle Bachelet was appointed last month by UN Secretary General Ban Ki Moon, and will serve as an Under-Secretary General.  As president of Chile, Bachelet was a strong advocate for women’s rights; she’s a physician, and most of the international community agrees that she brings the rightdiplomatic skills and political experience to run an agency of this size.
The GEAR Campaign
For years, NGOs all over the world have been working together to advocate for the reform of the UN structure.  The Gender Equality Architecture Reform (GEAR) Campaign brought together human rights, feminist, and social justice groups to call for a “composite gender equality entity” which would bring together the multiple and fragmented groups working on gender issues.  GEAR has been working for years to ensure that the UN prioritize gender issues, and had a set of strong criteria for any leader of a composite gender equality entity.  Bachelet seems to fit the bill.
The master’s tools
My concern about this process is that radical change will need to take place to upset deeply entrenched, structural gender inequality in countries all over the world.  The UN is not about radical change, it’s about working within existing governmental and institutional frameworks.  When oppression is institutionalized to the degree that the heteropatriarchy is, however, working within that structure is not going to create real change.
I’m also worried the agency will be another way of compartmentalizing women’s rights as separate from human rights.  Even the idea of “gender mainstreaming” is troubling to me– often rather than giving added weight to the oppression of women and girls this sort of separation leads to the ghettoization of gender programs within agencies.  Why should the voice of women’s rights and humanity be just one voice at a conference room table?  Every member of every project should be focused on the human rights of every oppressed person, and it so happens that in our wonderful world the majority of those living in povertydying of preventable causes, the ones being objectified and dismissed are women.
Every UN agency should be focusing on women and girls.  Every international cooperative project should be designed, structured and implemented to ensure the increasing empowerment of women and girls and the full and real embodiment of our rights as human beings.  Of course, I’m a born critic.  None of that negates the powerful opportunity that this agency presents, with its increased power, attention, and hopefully funding.  Although the news of the creation of UN Women barely made a ripple in the US media, I’m very hopeful that the agency will use it’s resources to the full radical possibility for the future well-being and advancement of women and girls all over the world.
To take action and get ongoing news and updates about the reform, go to the GEAR Campaign’s website.

Quoted in On The Issues article

In Policy Blog on August 30, 2010 at 6:13 pm

My Gender Across Borders piece on the Gates Foundation’s problematic failure to address abortion issues in their sexual and reproductive health funding strategy has been quoted in an On the Issues article by a friend and respected colleague, Marcy Bloom.   In her powerful piece, titled Health Inequality: Gates Foundation Bans Abortion, Ms. Bloom calls unsafe abortion a form of violence against women and scoffs at the idea that the Gates Foundation can remain “neutral” on the issue of abortion.  An excerpt is below, full article available here.

Bill and Melinda Gates are undoubtedly aware of these realities of women’s unequal lives. The end result of their “neutrality” is but one choice for women and girls who become pregnant. That one choice equals no choice.

Allowing the further stigmatization of abortion validates and strengthens the belligerent anti-choice movement.

But the power and influence of the foundation go further. Because of its prestige, size and assets, the foundation is central to “setting the sexual and reproductive health and rights agenda around the world,” in the words of policy researcher and writer Brook Elliott-Buettner in Gender Across Borders.

Whatever the intent, the Gates Foundation is establishing, even distorting, the direction of investments by other foundations, individuals and even governments. Although Bill and Melinda Gates have the right to spend their money as they wish, it is also true that their inordinate power in determining universal health agendas demands accountability.

SRHR Sit Report: Surrogacy in India

In Policy Blog on August 20, 2010 at 10:48 pm

The Sexual and Reproductive Health and Rights Situation Report is a monthly column I write for Gender Across Borders.

This month’s column focuses on so-called “reproductive tourism,” the growing trend of women in the U.S. finding gestational surrogates in India.  Gestational surrogacy is the practice of implanting a fertilized egg in another woman’s uterus.  Through the miracle of modern science and hassle-free air travel, western women are traveling to India, where the medical infrastructure is good and most of the doctors speak English, to find a surrogate to carry their baby.  Medical tourism has been around for a while, complete with travel agencies that set you up with the doctor and the spa/hotel where you’ll recoup after your nose job.  This new twist, however, brings up a lot of problems.

In the U.S., the surrogacy process can cost up to $100,000.  In India, it’s a steal at about $12,000.  The old familiar argument is that the women who serve as surrogates benefit from the payment they receive.  According to a Marie Claire feature story on the practice, the $5,000-$7,000 each pregnant woman is paid is equivalent to 10 years salary for rural Indians.  Women serving as surrogates quoted in the story were often using the money to improve their own children’s chances at a good life.  One woman says she now has “a chance to make good marriages for my daughters,” and another that she is working as a surrogate only to pay for the expensive medical care needed by her 8-year-old son who has a heart defect.

Human Rights Watch has a webby-nominated video on maternal death in India, and a Center for Reproductive Rights advocacy document highlights maternal mortality as a human rights and gender equity issue.  The shocking stats on maternal mortality in India, which I’ve written about before, are another powerful reminder of the context in which Indian women choose to be surrogates.  For many women without expensive medical care paid for by a rich couple, pregnancy and childbirth are a potentially life-threatening proposition.

The problem is not surrogacy itself- it’s the issue of consent and exploitation.  Poor women are being pushed by  circumstance into paid pregnancies.  In a threepart series on surrogacy for RH Reality Check, Karen Smith Rotabi writes, ”poverty is coercive and the fertility choices that are made, on both sides of the global surrogacy arrangement equation, will be determined by both economic opportunity and oppression.”  The series examines the intersection between surrogacy and trafficking.

It’s difficult and ethically wooly to pay a woman to carry your child for the same reason that it is problematic to pay for organ donation; the same reason that bioethics rules limit financial compensation for people that participate in medical research.  According to the National Institutes of Health, payment could create “undue incitement” for people to participate in research that is “against their interests,” “obscure the risks,” and would preferentially attract “poorer populations.”

A number of prospective parents have expressed that it is too difficult to find a woman willing to be a surrogate in the U.S. or the U.K.  Maybe that’s because pregnancy is hard, and you’d have to be pretty poor or desperate to go through it to make a baby for someone you’ve never even met.  The Indian women profiled in every story I read on gestational surrogacy were just that– desperate to lift themselves and their families out of extreme poverty, and concerned about the future of their own children.  And many of the women who work as surrogates have to hide what they’re doing from their families or communities because it’s frowned upon and even seen as a “peculiar form of prostitution.”

This video report from Australia gives a peek into the lives of the women working as surrogates as they wait the nine months for the babies to be born.  They’re often separated from their families so that they avoid things like second-hand smoke and sex with their husbands, and many clinics house them in dormitories or hostels.

The baby business is booming.  The number of clinics in India offering surrogacy hastripled to 350 in the last five years.  The sector is predicted to generate $2.3 billion a year by 2010.  There have been a few high-profile cases of legal problems, and the Indian government is attempting to tighten the legal framework for surrogacy.  The Assisted Reproductive Technologies (Regulation) Bill is currently in draft form and would include restrictions on selling gametes, zygotes or embryos, and would explicitly lay out the “rights and duties” of surrogates and donors as well as the rights of the child.  The problem of “commodification of female reproductive organs,” as Rafia Zakaria puts it on the Ms. Blog, remains.

I’ll close with a quote from an Indian feminist sister.  Ranjana Kumari, president of a coalition of NGOs working on women’s issues, says in the Wall Street Journal, “They are using the vulnerability of the poor.  Making (a woman) a child-producing machine is not acceptable.”

Quoted and reported by IPPF

In Policy Blog on July 26, 2010 at 2:13 am

I’m very excited to see that the International Planned Parenthood Federation (IPPF) has pulled from my recent column on abortion in Kenya for a News Room article.

Here it is.

From the article:

Religious leaders campaigning against the Proposed Constitution have come under criticism from a global organization for their stand on abortion.

Ms Brook Elliott Buettner has accused the clergymen of favouring the life of the unborn child over that of the mother.

….

Buettner, a social justice worker and freelance human rights policy researcher, points out that 15,000 women die annually of pregnancy-related complications and more than a third in unsafe abortion.

“Maternal mortality rates in Kenya are among the world’s highest. Direct medical causes for maternal death include haemorrhage, infection, obstructed labour and unsafe abortion,” she cautions.

Maternal Mortality and Abortion in Kenya

In Policy Blog on July 12, 2010 at 2:04 am

This is a cross-posting of my monthly column, the Sexual and Reproductive Health and Rights Situation Report, on Gender Across Borders.  This month’s column focuses on the fight for abortion rights in Kenya during a period of constitutional reform.

The East African Caravan for Maternal Health launches in Kenya

Because of it’s relative stability, Kenya is a popular travel and study abroad destination, and has loads of international players working there– including USAID.  Contraceptive prevalence in Kenya hovers around 30%, and the fertility rate is between 4 and 5 children per woman. Maternal mortality rates in Kenya are among the world’s highest; a Kenyan woman has a 1 in 39 lifetime risk of dying because of pregnancy or childbirth.  Something like 15,000 women a year die this way– more than a third from unsafe abortion. Direct medical causes for maternal death include hemorrhage, infection, obstructed labor, and unsafe abortion.  As in all poor countries with high maternal mortality rates, the severity of these problems is driven by social factors.  In Kenya, health systems are lacking and infrastructure issues make it difficult to access existing resources.  Moreover, women often lack decision-making power during the entire spectrum of their reproductive lives.  Abortion is illegal, heavily stigmatized, and responsible for the deaths of thousands of Kenyan women every year.According to the Center for Reproductive Rights‘ report, “In Harm’s Way: The Impact of Kenya’s Restrictive Abortion Law,” 2,600 women die every year in Kenya due to complications from unsafe abortions.  More than half of them never sought medical care.  The in-depth report includes powerful stories of women denied the right to choose, including 14-year-old Sarah, who lost her life due to complications from an unsafe abortion; too afraid to go to a doctor as she suffered from a raging infection ” because of the risk of arrest and the fear of community condemnation.”  Make sure you watch this compelling video on the subject from CRR.After my piece last month criticizing the Gates Foundation’s refusal to fund abortion services, it’s interesting to note that the Foundation has recently announced that it will fund (to the tune of $23M) a family planning program in Kenya run by Johns Hopkins’ Jhpiego.  Jhpiego’s expertise lies in strengthening health systems, and the Gates-funded program seeks to “meet Millennium Development Goal 5 to reduce maternal mortality by increasing women’s access to and use of RH services…”  by shoring up public and private service delivery methods.  Jhpiego also works with USAID in Kenya on the Maternal and Child Health Project.  It’s worth noting that none of these programs specifically fund abortion services.With CRR’s report and an upcoming constitutional reform process, abortion has been brought to the forefront of the discussion on maternal mortality in Kenya.  Conservative religious leaders are campaigning for a “total rejection of the draft constitution” because it wouldn’t explicitly define life as beginning at conception.  I’m baffled again by the one-sidedness of trying to protect fetal life while turning a blind eye on the thousands of women who die seeking abortions every year.  As CRR’s report points out, making abortion illegal doesn’t make it less prevalent, just more dangerous.In Kenya we again see the imposition of draconian social ideas about women’s role and worth, institutionalized in the form of policies and systems design, causing the needless deaths of thousands of women.  This is why we are global feminists– all over the world women are so lowly-valued that we lose our lives by the millions.  It must stop.

Gates Foundation setting the agenda again- no abortion.

In Policy Blog on June 14, 2010 at 12:11 pm

This is a cross-posting of a monthly column I write for Gender Across Borders devoted to international policy issues and current events around these critical rights called the Sexual and Reproductive Health Situation Report.

Ban Ki-moon and Melinda Gates discuss maternal health at Women Deliver. Care of AP.

At last week’s Women Deliver conference, Melinda Gates announced that the Bill and Melinda Gates Foundation would devote $1.5 billion to maternal and child health over the next five years.  They will not, however, fund abortion services.  Gates said in her remarks that she couldn’t imagine being denied the “basic right to decide how many children to have.” she also said that the Gates Foundation would focus it’s efforts “upstream,” explaining that with proper family planning abortion will not be necessary.  I don’t even think I have to address that little doozy, but if you’re interested, Columbia’s Gender and Sexuality Law Blog does a good job of taking on the problematic nature of that reasoning.

The Women Deliver Conference is part of  a swelling tide of awareness about maternal health.  Access to safe abortion is one of Women Deliver’s “Three Core Strategies to Save Lives.”  In the broader conversation, however, there is rarely an explicit recognition of the role of unsafe abortion in maternal mortality.  Because of the politicization of a public health issue, a major factor contributing to the deaths of hundreds of thousands of women every year is swept under the rug.  As The Lancet’s editor, Dr. Richard Horton, pointed out in response to the Gates Foundation’s pledge, “unsafe abortion contributes to one in seven maternal deaths across the world.”  Sadly, international donors are being allowed to turn  their faces from the issue because it is politically difficult.

The Gates Foundation’s decision not to fund abortion services goes beyond the simple failure to address a critical component of sexual and reproductive health.  The Gates Foundation, like US AID, is powerful and big enough to influence the global agenda.  If agencies that provide abortion services cannot get funding from a major funding body like US AID, some are forced to stop providing abortions so that they won’t be forced to close their doors.  This impacts the shape of the global health infrastructure by shoring up certain areas and allowing others to fall to the wayside.

This announcement is being called a “change in direction from funding specific vaccines and the fight against particular diseases,” specifically HIV/AIDS, tuberculosis and Malaria.  Several years ago, the Gates Foundation made a strategic decision to change their focus from building human capacity in the health sector.  I was working for a Gates-funded fellowship program at the time, which brought mid-career reproductive health professionals to the University of Washington for a year of study and research.  The year I worked for the program, we were invited to the Gates Foundations offices to hear about the foundation’s new strategic direction.

They talked about focusing on technologies like vaccine delivery, especially given their roots in technology, as their value-added.  I felt sad that the fellowship would end, but only grasped over time the impact of the change in direction.  When a power-player like Gates focuses on a particular issue, the rest of the world has no choice but to get on board.  NGOs all over the globe have shifted their programmatic focus toward projects that will be funded.  And while the causality is arguable, the brain drain of health professionals continues to decimate many countries’ ability to respond to health crises like maternal death.  I have seen many organizations shift their focus to HIV/AIDS projects to the detriment of other program areas because of the tremendous quantities of money available through the Gates Foundation.  In the case of a foundation as big as Gates, there is no such thing as value-added; its game-changing.

Gates’ and others refusal to fund abortion services also serves to create a separate silo for abortion, removing it from it’s rightful spot as one part of the suite of necessary services that make up holistic sexual and reproductive health care.  By categorizing abortion as different and separate from other services like prenatal care and birth control, it’s naturally going to get cut out of strapped projects.  It’s like putting an abortion rider on your health insurance plan– it sounds OK in theory to have abortion services funded separately but in reality you end up with abortion services getting shoved off the agenda and out of the clinics, and women continuing to die from the effects unsafe abortion procedures.

These deaths are preventable (when performed properly abortion is one of the safest clinical procedures available).  These are women lost because the international community has allowed ideology to trump health.  With its size and budget, The Gates Foundation wields tremendous agenda-setting power in the realm of global health.  And by removing abortion services from its equation, it will cause a ripple effect that will create the conditions for even more wholly preventable deaths over the coming years.

Abortion in Ireland

In Policy Blog on May 13, 2010 at 11:49 pm

This is a cross-posting from a column I write for Gender Across Borders on sexual and reproductive health and rights policies and issues worldwide.

Anti-choice protesters in Dublin. Photo: Niall Carson for The Guardian

Abortion has been illegal in the Republic of Ireland since the so-called “Offenses against the Person” Act of 1860, and legislation has become increasingly restrictive over time.  Irish women now face life in prison if they have abortions, and the fetus is protected in the Irish constitution.  

There is a provision in the law for risk to the woman’s life, or if (in an astonishingly paternalistic twist) the woman can prove she is suicidal.  Recently a 16-year-old won a Supreme Court case allowing her to travel to England to abort an anecephalic pregnancy– a disorder in which the fetus is missing part of the brain and skull and would not survive more than three days outside the womb.

While there is strong, mostly Catholic, anti-abortion sentiment in Ireland, most people there do support at least some form of legalization of abortion.  And the need is there– About 7,000 women a year travel to England, where abortion has been legal since the sixties, at personal expense.  This means that once again abortion is effectively unavailable to poor women, sometimes forcing them to risk their lives with clandestine providers.

Three women are challenging the repressive law before the European Court of Human Rights (ECHR).  With the support of the Irish Family Planning Association and the British Pregnancy Advisory Service, A, B, and C are claiming that having been forced to travel to the UK to receive abortion services “stigmatised and humiliated.”  They’re arguing that the Irish law violates their rights to privacy and family life, rights protected under the European Convention on Human Rights, specifically he Articles 2, 3, 8 and 14 of the Convention: the right to life, the prohibition on torture, the right to respect family and private life, and the prohibition against discrimination.

The women have chosen to remain anonymous, and with good reason.  Not only are they at risk of imprisonment under the law, they would also undoubtedly become the targets of other Irish citizens.  The right in Ireland has resorted to nasty “baby-killer” rhetoric, and organizations which look suspiciously like “Crisis Pregnancy Centers” invite women in only to have them hold little models of fetuses and beg them not to murder their babies.

The right wing is successfully steering the conversation, and it’s not the only responsible party.  According to Human Rights Watch, the Irish government goes beyond endangering women’s lives through a legislative restriction, and has been spreading “grossly misleading information” on the nature and consequences of abortion.  Many have accused the government of uncomfortably close ties with the Catholic church, and the church has threatened ex-communication of any Irish public figures who support abortion.

The case before the Court is extremely significant for several reasons.  First, any time abortion comes before an international legal body it re-affirms the status of abortion as a human rights issue.  Second, Ireland may indeed need to re-think abortion law, as Poland has done in the wake of an abortion case recently heard by the ECHR.  Finally, each case that comes before the ECHR strengthens the imperative for liberalizing abortion law around the world, and builds jurisprudence on women’s right to decide under international law.

Interestingly, the Irish government is focusing it’s defense of the law around two key areas: the old “morality” bugaboo, and the implications of a ECHR decision for state sovereignty.  This tack fails to address the actual merits of the case, implicitly recognizing that it is very difficult to make a cogent case against a woman’s human right to access reproductive health services, including abortion.

I am hopeful that the Court will rule in favor of A, B, and C, and for the ongoing health and autonomy of Irish women.  I am also hopeful that the Court’s decision will prompt cases from other countries with repressive abortion policies and the liberalization of abortion law all over the world.

Radio News: Story on repro rights for WBAI

In Policy Blog on April 1, 2010 at 3:46 pm

I have been working with Fran Luck, one of the co-hosts of WBAI’s feminist program, Joy of Resistance, on news stories for several months.  Archives of the stories are available here.  The following is a suite of coverage on reproductive health setbacks- one story on Canadian foreign aid and updates from several U.S. states.  The stories ran Thursday, April 1, 2010.

The Canadian Foreign Affairs ministry has reported that it will no longer support family planning supplies, or even services, in its aid funding to developing countries.  The country has chosen to focus its foreign aid instead on water, vaccinations and nutrition, and ostensibly on improving maternal and child health.  When questioned about the exclusion if contraception and family planning services, Canadian Prime Minister Stephen Harper simply repeated, “We are going to focus on saving lives.”  
Ironically, hundreds of thousands of women die every year all over the world because of lack of access to contraception of family planning services.  Critics believe that the exclusion is basically equating family planning with abortion, and that the Foreign Affairs committee has caved to international anti-abortion pressure. 
 
The International Planned Parenthood Federation previously received $6 million annually from the Canadian International Development Agency.  Says its executive Director-General, “The evidence is indisputable: Family planning saves lives… No country has made significant inroads to improving maternal, newborn and child health without also ensuring widespread access to family planning.”
 
Reproductive health foes have been active in the U.S. as well.  In addition to restrictions on insurance coverage for abortion in the healthcare reform package, several states are considering legislation that would further limit a woman’s right to choose. 
 
In COLORADO, a so-called “personhood” initiative will be on the November ballot.  The proposed legislation would define personhood as starting “from the beginning of the biological development of that human being.”  A similar but less-stringent ballot measure was defeated in 2008 by a large majority. 
In better news for women, however, Colorado’s governor signed a law on Tuesday banning gender-rating, a practice whereby insurance companies charge women more for their coverage than men. Colorado joins a dozen other states which ban the practice, effectively closing a gender-rating loophole present in the federal health-care reform package. 
 
The KANSAS State Legislature is debating a law that would restrict abortion after 21 weeks.  The bill could require doctors to report the medical reasons for any abortion taking place after that time, threatening women’s right to confidentiality.
 
In SOUTH CAROLINA, abortion foes are taking a different tack to make abortion services increasingly difficult to access by increasing the waiting period
of 24 hours after either having an ultrasound or printing information from the website of the Department of Health and Environmental Control.  This print-out must be time-stamped, which women can have done at sites which offer free ultrasounds.  These sites include Crisis Pregnancy Centers, which have made news recently because of their aggressive tactics and blatant misinformation designed to dissuade women from choosing to have abortions.
 
State reports taken from the Feminist Majority website

Haiti: Repro Rights After Disaster

In Policy Blog on March 9, 2010 at 12:20 pm

This is a cross-posting of the Sexual and Reproductive Rights Situation Report, a monthly column I write for Gender Across Borders. 

 

Since the devastating  7.0 earthquake shook Haiti on January 12, 2010, Haitians have dealt with shortages of basic needs like water and food; flooding; and even churchy American do-gooders coming for their children.  As in any humanitarian crisis, the women of Haiti have been struck harder and in different ways than men because of existing inequality and gender disparities.   As the humanitarian community continues to formalize and learn from its major challenges, it is paying increasing attention to women’s rights and gender issues in the post-disaster setting.  I’m going to focus more specifically on women’s reproductive and sexual rights and the ways in which they are threatened in humanitarian crises.     

 The situation for reproductive health in Haiti was already dire before the earthquake.  The country had the highest maternal death rates in the region by far, with 670 of every 100,000 deliveries resulting in the death of the mother, according to the United Nations Population Fund (UNFPA).  This PBS documentary, available on Family Care International’s website, chronicles the tragedy of maternal death in Haiti, pre-quake.  The 63,000 pregnant women in Haiti when the earthquake struck are at even greater risk in the aftermath of the disaster.  According to CARE, a humanitarian relief and anti-poverty NGO active in Haiti, “breastfeeding mothers and young children are at greatest risk” after the quake.    Soon after the earthquake, Sophie Perez, CARE country director in Haiti, said:     

There are a lot of pregnant women in the streets, and mothers breastfeeding new babies.  There are also women giving birth in the street, directly in the street… the situation is very critical.

Pregnant women and other vulnerable populations may be less able to fight for scarce resources, and their unique health needs may not be met.  There are many sexual and reproductive health issues that are intensified in a humanitarian crisis.     

 

 Although each disaster is unique, the humanitarian community, including NGOs, government agencies and multilaterals, has begun to attempt to learn from previous disaster response efforts to improve upon outcomes.  After the earthquake in Haiti, dozens of NGOs coordinated to write a letter to Secretary of State Clinton and the head of USAID encouraging a gender perspective in the US’ relief efforts, and pointing to the lessons learned and documented in a seminal document- the Gender Handbook in Humanitarian Action.    

In the last decade, several working groups on reproductive rights in post-conflict and post-disaster settings have formed, including the Inter-agency Working Group on Reproductive Health in Crises.  One of its theoretical initiatives is something called the Minimum Initial Service Package (MISP), which sets out to prioritize interventions at the outset of a humanitarian crisis to maximize positive reproductive health outcomes.  The Inter-agency Working Group is advocating for the MISP to be “provided within the context of other critical priorities, such as water, food, cooking fuel, and shelter,” which emphasizes the basic nature and life-or-death importance of reproductive health services.   

Another such group is the Reproductive Health Response in Conflict Consortium (RHRC Consortium), made up of academia and NGOs including the Women’s Refugee Commission.   Much of the work on gender in humanitarian crises is based on work that these and other agencies did on the reproductive health issues for refugees and displaced persons; many of the issues are the same.   Here’s a video from the Women’s Refugee Commission on the reproductive health situation in Haiti since the earthquake:     

RHRC Consortium released a statement following the Haiti earthquake demanding that disaster response address the health needs of women and girls.  The statement brought up a number of sexual and reproductive health issues in the post-disaster period that I hadn’t thought of before.  In addition to the needs of pregnant women and new mothers, a holistic view of sexual and reproductive health includes access to contraceptives, responsive treatment for survivors of sexual violence including emergency contraception and post-exposure prophylaxis for HIV, and continuity in ART therapies for HIV positive individuals. UNFPA and the International Research and Training Institute for the Advancement of Women (UN-INSTRAW) point out other issues including “limitations on accessing prenatal and post-natal care… greater risk of vaginal infections, pregnancy complications including spontaneous abortion, unplanned pregnancy and post-traumatic stress.”      

INCITE! Women of Color Against Violence explains in a statement on Haiti:    

Women experience the most negative consequences of catastrophic events, particularly with regards to higher rates of injury and death, displacement, unemployment, increased incidents of HIV rates, sexual and domestic violence, increased poverty, and the disproportionate responsibility for caring for others. This is especially true for women marginalized by race, sexual orientation, gender identity, class, health, ability, age, housing, and legal status.     

All of these issues highlight how existing vulnerability is magnified and intensified during a humanitarian crisis.  Women are already in a position of vulnerability due to the “interaction of biological and social risk factors.”  The World Health Organization (WHO) identifies among these risk factors gender roles, social taboos around menstruation and appropriate behavior for women and girls, existing economic and social marginalization and vulnerability to domestic and sexual violence.      

 

Although women’s lives and health are often threatened in the post-disaster period, they are a tremendous resource for reconstruction.  International women’s rights NGO MADRE, along with Haitian partner Zanmi Lesante, has written on women’s expertise and the marginalization of women’s experience in reconstruction.  “When relief is distributed by women, it has the best chance of reaching those most in need.”  It’s also more likely that real reproductive health needs will be met.      

The issue of participatory planning is front-and-center these days as NGOs plan Haiti’s future.  Oxfam has been campaigning  to push world leaders to include Haitian organizations and voices in the decision-making process during reconstruction (sign on to the campaign here).      

The Gender and Disaster Network has summed up the need for an even more nuanced view of participation that includes populations often left out of the process in their Six Principles for Engendered Relief and Reconstruction.  First, they point out, Gender analysis is “integral to plan for full and equitable recovery.”  Part of engendering reconstruction is basing program development on the true needs of women, based on gender-disaggregated data, and not on stereotypes. 

They advocate working with grassroots women’s organizations- the women who know what needs to happen to create a more just society and ensure future resilience.  GDN also points out that the act of participation, based on a human rights approach, builds conditions for empowerment and develops capacity among women. 

If disaster is not to disproportionately endanger women and girls and further entrench their social inequality and vulnerability, women’s unique needs and perspectives must be respected, accounted for and implemented in every stage of the after-disaster process of response and recovery.    

Take action: Support International Planned Parenthood Federation‘s partner in Haiti, PROFAMIL, in rebuilding and providing reproductive health services; or the Global Fund for Women‘s Crisis Fund which will support Haitian women’s organizations as they rebuild.