Women’s Right to Health

Examining reproductive rights &

reproductive health thru the gender
justice lens

Fatima Alvarez Castillo

UP Manila
The case of Doris*
29 year old mother of 3
Tried mixed methods of rhythm &
contraception
Efforts failed

Pregnancy aborted, profuse bleeding

Scolded by doctor in hospital for
“killing” her baby
mas masakit pa yong panlilibak sa ospital
kesa sa pagdugo ko….
( *One of our key informants from Manila)

Drawing: Tanya Villanueva

Arrows for Change, 10 (1), 2004
 Repro Rights are basic rights of all couples &
individuals to decide freely & responsibly the
number, spacing & timing of their children, to
have the information & the means to do so
and to attain the highest standard of sexual &
repro health (WHO)
 Repro Health is physical, mental and social well
being - not merely the absence of disease or
infirmity - in all matters related to the
reproductive system, its functions & processes
(UN Conference On Pop & Development, 1994).
 Women’s rights are human rights:
obligations states are accountable for
 1945 UN Charter – obliges states to promote
universal respect for & observance of human
rights & fundamental freedoms without
discrimination as to race, sex, religion or
language.
 1948 UN Declaration of Human Rights
 1979 UN Convention on the Elimination of All
Forms of Discrimination Against Women
 Philippine government legally
accountable for: domestic laws
 1987 Constitution recognizes fundamental
equality of men & women
 Family Code
 Agrarian Reform Law
 Women in Dev & Nation Building Law
 What is the situation?
Abortions mostly unsafe
78,900 women hospitalized for post abortion care
(year 2000)
Large increases in abortion rate in Metro Mla (41
in 1994; 52 in 2000)
(Guttmacher,31(3), 2005)
 Maternal mortality: death due to
complications of pregnancy, pregnancy
related causes

230/100,000 (adjusted mortality

rate, Statwatch 2005) – 2nd highest in SEA;
10 women die/24 hours (PopCom, 2000)
MMR highest in ARMM
 Maternal mortality, access to reproductive
health services and MDG Targets

Indicators 1993 2001 2006 MDG

Target by
2015
Maternal 209 162* 52
Deaths/100,0
00 live births

Access to 49% 50.6% 80%

repro health
services (15-
49 age )

Source: NEDA & UN Country Team (UNCT). 2007. Philippine Midterm Program Report on the Millennium Development Goals.
 Global improvements in narrowing gender gap

INDICATORS 2006 2007

Educational Attainment 91.55% 91.60%

Political Empowerment 14.07% 14.15%

Economic Participation 52.25% 57.30%

Health 96.25% 95.8%

( World Economic Forum 2006 and 2007 Reports)

 Why is the situation for women’s
repro health like this? While other
global indicators are improving why
is the health gap worsening?
 Why is it that Doris has to resort to abortion to
limit the number of her children?
 Why did the doctor behave the way she did?
Why did she place the full burden of guilt on
Doris?
 What larger issues are implicated in this case?
 Gender refers to socially constructed identities, roles and
status that influence the allocation of
power, entitlements, opportunities and prestige to men
and women.
 Gender-based inequities are imbalances in
power, opportunities, and resources between
men and women irrespective of social class or
ethnicity or geographic location. These
imbalances are commonly suffered by women
more than men
Gender is a social stratifier, but unlike class, the
power differential is between men and women
although class and gender tend to correlate.

Example: poor women tend to have less access to

health care than rich women because of differences
in material resources, but poor women tend to have
less access to health care than poor men.

Thus poor women tend to have less access to health

care compared to rich women and to poor men due
principally to the combined impact of their poverty
and their gender.
 Ethnicity and age could worsen the impact of
gender & poverty as in the case of Muslim
women (ethnicity) who are adolescent (age)
 Gender-based discrimination:
norms, practice, policy, programs

 The problem is highly complex:

- Deep seated biases, norms of patriarchy
- Multiple factors that intersect at all levels
of social life
- Many aspects of discrimination are hidden,
unrecognized for what they are
Gender-based discrimination, inequities
found in
Open & hidden structures & practices in:
 Individual relationship

 household

 community

 health system & other institutions

 State & global programs

Most internationally binding Human Rights
instruments do not explicitly mention sexual and
reproductive rights;

No domestic law on RR & RH

Efforts to promote RR & RH demonized

Inquirer 1/31/2010
 Medical ideology & practice

 Patriarchy in medical practice

 Technical interest of doctors
…kaya I transferred from (private teaching hospital) to here (public
hospital) kasi for training, so that I can train on complicated OB
cases…e ang nagyayari nagiging raspa hospital ng mga
nagpapalaglag; nauubos oras naming residents sa kanila…
(one of our resident-key informants)
 Gender justice in Universal Health Care
To be truly just, universal health care must not only be
sensitive to class-based injustice in health care but also to
gender-based injustice.

Explicit protection of women’s full enjoyment of right to

health.

Why should it be explicit?

Because gender inequity tends to be obscured by or

conflated with other inequities such as those brought
about by class or ethnicity or religion.
Critique of gender mainstreaming
 Overall the international experience w/ gender
mainstreaming not positive:
-de politicized whereas social transformation is a
political project
-instrumentalist intent – mainstreaming becomes
end rather than means to redress inequality

Mukhopadhyay & Singh, 2007

 Gender Justice
Gender justice: the ending of, and the provision of redress
for, inequalities

It is both outcome & process:

As process, it has the element of ACCOUNTABILITY of those

who are supposed to protect women’s rights

As outcome, it implies ACCESS to & CONTROL over

resources, combined with AGENCY (the FREEDOM &
CAPABILITY of women to make choices).

(Anne Marie Goetz 2007)

 Realization of reproductive rights &
reproductive health linked to realization of other
human rights
 Political leadership required…
 So that women are not forced to abort their pregnancy
 So that health care providers respect women’s right to
the best possible care & to dignity
 So that families, communities, schools, churches, state
institutions, laws are not the sites of discrimination
against girls, women
 So that those responsible are made accountable
Thank you