6: Reproductive Freedoms
- Page ID
- 153104
Overview
Population Control and the Birth Control Movement
The Women’s Health Movement
Linda Gordon’s “Woman’s Body, Woman’s Right” and Bonnie Mass’s “Population Target” analyze the history of the birth control movement and trace the elements present in the current debate to their origins in the conflicts and contradictions of the movement’s history. They have written about the women’s health movement and noted that it positively influenced gynecological practice. They have also described problems with the first generation of oral contraceptives.
by Sophie Brodish
Across the globe, contraception use has reached a record high. Modern forms of contraception globally include, but are not limited to, female sterilization, male sterilization, pill, injectables, implants, intrauterine devices, and male condoms. Within Ethiopia, Kenya, and Tanzania the most popular contraception method are injectables, while sterilization is more common in other places, such as Guatemala.* In countries where there is a strong skew toward one or two contraception methods, however, questions about equal access arise. Data suggest that women may not have a choice when choosing contraceptive methods or are limited from the full array of existing options. Existence does not guarantee access in the world of reproductive freedom.
In countries where women with unmet needs are not using contraception despite not desiring a pregnancy, they cite concerns related to contraception side effects, postpartum amenorrhea (also known as postpartum infertility), and lack of necessity as a result of infrequent sex. But one of the most significant concerns is the lack of knowledge itself. Within the Democratic Republic of Congo, nearly 19 percent under the age of 25 and 10 percent above the age of 25 cite their reason for not using contraception as being a lack of knowledge surrounding the method and the method’s source, the main concern still being postpartum and breastfeeding effects from the use of contraception. Complications related to postpartum breastfeeding are a primary concern for many women under the age of 25, leading to a decreased use of contraception by this population, increasing their chances of an unintended pregnancy. Improving knowledge surrounding contraception will decrease the risk of not just unintended pregnancy, but also the spread of sexually transmitted infections, which can be transmitted further without proper knowledge.
*One organization that seeks to spread awareness is WINGS Guatemala (Women’s International Network for Guatemala Solutions), an organization founded to improve the education and access to reproductive and family planning services for rural Guatemalan youth, women, and men. They provide free contraceptives to those under 19 years of age and offer a wide array of methods to choose from, as well as offer counseling pertaining to sexual and reproductive health.
Reproductive Rights Are Human Rights: Progress from 1945 to 1994
by Ramona Flores
MaternityAction.org defines pregnancy discrimination as “treating a woman unfavourably because of her pregnancy or pregnancy-related illness.” Many countries have laws and regulations in place that serve to legally protect pregnant people from pregnancy-based discrimination, like New Zealand, Sweden, the United Kingdom, and the United States. However, there are still many countries with policies that fall short of being effective or exclude women who aren’t citizens, such as migrant workers.
The Fair Labor Association published a report in 2018 that highlighted the struggles of pregnant migrant workers in Malaysia, Taiwan, and Thailand. The study not only identified the problems in each country’s treatment of pregnant migrant women, but also outlined possible solutions. Some connecting themes across all three countries were a push for civil rights education for expectant mothers, improving health care access for both mothers and their children, and access to pre- and postnatal care regardless of citizenship status.
A 2021 study published in the Qualitative Report found that more than 800,000 women in Italy reported being forced to resign after becoming pregnant and had undated resignation letters used against them. Alternatively, some Kenyan women were made to sign contracts for their employer pledging that they would not get pregnant during their employment. Human Rights Watch found that several girls who were still enrolled in Kenyan schools and became pregnant were routinely told they had to leave and not return until after their delivery.
While there are some protections in place for pregnant women globally, they are rarely implemented in countries with the most vulnerable populations and consistently fall short of protecting women and girls.
1968: Final Act of the Tehran Conference on Human Rights | “Parents have a basic human right to decide freely and responsibly on the number and spacing of children and a right to adequate education and information in this respect.” The General Assembly endorsed the Final Act in December 1968. (UN 1968) |
1975: Declaration of Mexico on the Equality of Women and their Contribution to Development and Peace and Plans of Action | Principle 12, “every couple and every individual has the right to decide freely and responsibly whether or not to have children as well as to determine their number and spacing, and to have the information, education and means to do so.” (UN 1975) |
1993: World Conference on Human Rights adopted the Vienna Declaration and Programme of Action | Section 3 of the Programme of Action deals with women’s rights and their right to accessible and adequate health care and the widest range of family planning services, as well as equal access to education at all levels, including sexuality education. (UN Human Rights Council 1993) |
1994: ICPD and Programme of Action | The Programme of Action clearly affirmed and articulated that reproductive and sexual health is protected by the human rights already recognized by both national and international law. In addition, the Programme of Action contributed to the recognition of the complex links between population growth and gender equality. The generally acknowledged definition of reproductive rights is taken from the ICPD Programme of Action paragraph 7.3. (UNFPA 2014) |
1995: Beijing Declaration and Platform for Action—IV World Conference on Women | The conference reaffirmed the goals and standards on sexual and reproductive health and rights set out in the ICPD but elaborated on women’s interests, stating that “equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behavior and its consequences.” The 1995 conference also directly called upon UN member states to review their laws, especially those that still imposed punitive measures upon women who “have undergone illegal abortions.” |
2000: Millennium Summit and the Millennium Declaration and subsequent Millennium Development Goals (MDGs) |
In September 2000 the then-189 members of the United Nations in the Millennium Summit adopted the United Nations Millennium Declaration. Based on the Millennium Declaration, primarily Section III on development and poverty eradication, the eight MDGs were established. Four out of eight MDGs were related to reproductive and sexual health and rights. MDG 5 concerns maternal health and contains two targets: to reduce the maternal mortality ratio by three quarters between 1990 and 2015, and to achieve universal access to reproductive health by 2015. MDG 4 is to reduce the mortality of children under age five by two-thirds between 1990 and 2015. MDG 3 deals with promoting gender equality and empowerment of women. Finally, MDG 6 concerns the combat of HIV/AIDS, malaria, and other diseases. Based on current data, MDG 5 is considered the least likely of all the MDGs to be achieved within the timeline set. (UN Women 1995) |
2005: World Summit Outcome | The 2005 World Summit Outcome confirms the commitment to the Millennium Declaration and reiterates the “determination to ensure the timely and full realization of the . . . Millennium Development Goals.” In addition, the World Summit Outcome contains new commitments, four of which became part of the revised MDGs during 2006-7. One is the achievement of universal access to reproductive health by 2015 (that became an addition to MDG 5); another is universal access to HIV/AIDS treatment by 2010 (that became an addition to MDG 6). |
Systematic Global Attention toward Reproductive Rights (UN 2005), (UNFPA 2014, 7.3) |
ICPD Programme of Action 1994
References
by Victoria Keenan
People who have had a surgical birth in the past may have heard the saying, “once a C-section, always a C-section” (Enkin et al. 2000). This attitude can be reinforced through subtle negative language, such as when it is suggested that a woman or birthing person is being “allowed” a “trial of labor” by their doctor. Such phrasing suggests that the pregnant person is not in a position of authority in their own care, and they should not expect their labor will lead to a physiologic birth. This is in opposition to consistent high-quality evidence that shows vaginal birth after cesarean (VBAC) as a safe and achievable mode of delivery for many women.
Despite resistance, some pregnant people choose a VBAC, or even a home birth after cesarean (HBAC). Owing to lack of experience, ignorance of evidence-based practice, or fears of litigation, some medical providers may refuse to accept the pregnant person unless they abandon their VBAC and comply with a planned cesarean birth. Pregnant people can also feel coerced into having repeat C-section births as a result of threats to contact the police or child welfare services. Some obstetricians have even taken it upon themselves to override women’s human right to bodily autonomy by performing this major abdominal surgery without consent.
Such extreme actions are often based on misinformation about risks and obstructive hospital policies, rather than inherent risk or an individualized risk assessment.
References
Enkin, Murray, et al. A Guide to Effective Care in Pregnancy and Childbirth, 3rd ed. Oxford: Oxford University Press, 2000.
by Sarah Baum
In many places in the world, talking about sexuality and reproductive rights remains an unbreakable taboo subject. This is especially true in highly religious countries where abortion is banned and access to contraceptives is limited. It would be easy for an international organization to simply step in and try to enforce their beliefs onto another person’s culture, but that isn’t what groups like the International Planned Parenthood Federation (IPFF) do.
Instead, they work with local communities and women’s rights groups to integrate into the region’s cultural history and system of beliefs, all without compromising their own dedication to women’s reproductive rights. They work with local volunteers everywhere, from Jamaica, to Colombia, to Indonesia, addressing the needs of the communities on a case-by-case basis. From starting men’s groups to offer “the other half” information on women’s rights and contraception, to confidential use of injectable birth control, each program is tailored to provide the best care possible while remaining sensitive to local traditions. With the help of groups like the IPPF and others, women now can learn about reproductive health in a supportive and understanding way.
Talking about sex and sexuality isn’t always a comfortable subject, but it’s a vital one to allow women to gain control over their own bodies. And while it’s never easy to venture into taboo subjects, family planning is a right all women should have access to, no matter where in the world they live.
Global Laws Relating to Reproductive Rights
by Lily Sendroff
Legal access to abortion varies significantly both between and within countries. It has long been known that regardless of the continent, country, or region, outlawing abortion does not stop abortion: it only stops safe abortion. Instead of sterile procedures performed by medical professionals, people with no other option turn to dangerous methods for self-managed abortion. According to the World Health Organization, an estimated 23,000 people die annually from unsafe abortion, and countless others suffer significant health complications.
Abortion access varies significantly across nations; 90 million women of reproductive age live in countries where abortion is not permitted for any reason. For example, El Salvador has some of the world’s strictest abortion laws. In that country, if found guilty of receiving an abortion, a woman can be imprisoned for up to eight years. Worldwide, 360 million women of reproductive age—accounting for 22 percent of the global population of women of reproductive age—live in countries where abortion is only permitted to save the life of the pregnant person. The majority of countries that fall into these two harshest categories of abortion policy are in the Global South.
A third category uses a broad interpretation of law that allows abortion in a variety of contexts based on social or economic reasons. If someone wants an abortion in these countries, the impact of pregnancy and child rearing on a woman’s livelihood based on her socioeconomic circumstance is evaluated. In all, 23 percent of the global population of reproductive-age women live in countries with these laws—roughly equal to the proportion of women living in countries where abortion is only permitted to save the parent’s life. Finally, the most flexible category permits abortion upon request without contingencies on maternal health outcome, social, or economic reasons. Globally, seventy-two countries fall into this legal category, accounting for the experiences of 601 million women of reproductive age.
Even in places where abortion is allowed on request, access still varies significantly based on geographic location. For example, in the United States, gestational limits are determined on a state-by-state basis. This means that someone who wants an abortion at 23 weeks into their pregnancy cannot legally receive one in Texas, where the limit is now about 6 weeks, but they can travel to Florida, where the limit is 24 weeks, and obtain a legal abortion. Globally, the average gestational limit for countries where abortion is available upon request is only 12 weeks.
Limits on abortion access have serious economic, social, and mental health implications for those who miss gestational limits or live in countries with legal restrictions. Tracking abortion around the world helps to show where and how women are treated, their level of physical autonomy, and in the most basic terms: their power to determine the course of their own lives.
International Commitment to Reproductive Health
by Victoria Keenan
Some people who experience or witness birth trauma may develop perinatal (just before or after birth) posttraumatic stress disorder. They might have distressing flashbacks or nightmares, avoid anything that could trigger negative memories, feel anxious or hypervigilant, or have feelings of unhappiness (Centre of Perinatal Excellence 2021).
If you are suffering, contact an organization like the ones below:
Australasia
Australasian Birth Trauma Association
Advocacy, education, research, peer support, and informative downloadable guides for Australians and New Zealanders
PANDA—Perinatal Anxiety and Depression Australia
Support for families affected by anxiety and depression during pregnancy and the first year of parenthood
PANDA National Helpline: 1300 726 306
International
Postpartum Support International (PSI)
Members all over the world, including volunteer coordinators in every one of the United States and more than thirty-six other countries
Helpline: 1-800-944-4773 #1 En Español or #2 English
Text in English: 800-944-4773
Text en Español: 971-203-7773
United Kingdom
For parents and health professionals
The PND Awareness and Support Helpline (PANDAS)
The free helpline provides information, support, and guidance
+44 (0)808 1961 776
Support for families and professionals through training, campaigning, and collaborative academic research
United States
Aims to empower consumers, community leaders, and care providers with tools to improve birth
Australasia
International
United Kingdom
United States
Reproductive Freedom and Justice Concerns in India
References
by Victoria Keenan
African American women give birth prematurely twice as often as any other racial population and die during pregnancy and childbirth at three to four times the rate of white American women (Davis 2019). In the United Kingdom, women of African descent are five times more likely to die than their white counterparts.
Birth-givers of color also experience more prenatal issues and interventions like induction and cesarean births than white women. These disparities have historically been attributed to biological racial differences and/or socioeconomic or educational status, but research has now demonstrated that it is systemic racism, not race, that affects perinatal health outcomes. Well-educated and affluent professional Black women also experience disproportionately poor outcomes (Oparah and Bonaparte 2015).
Doula care is one cost-effective way to mitigate these systemic global health inequalities. Doulas provide nonclinical physical, emotional, and informational support before, during, and after birth. Those using doulas have fewer low-birth-weight babies, complications, cesarean births, and maternal distress. Doulas facilitate communication between clinicians and pregnant women, bridge linguistic and cultural barriers to appropriate care, and recognize and protect against conscious and unconscious bias in medical practice.
References
Davis, D. A. 2019. Reproductive Injustice: Racism, Pregnancy, and Premature Birth. New York: New York University Press.
Oparah, J. C., and A. D. Bonaparte. 2015. Birthing Justice: Black Women, Pregnancy, and Childbirth. New York: Routledge.
I have a few friends who went for a third child in order to have a boy baby. In my childhood, I had a relative who had five girl-children one after the other, a year and a half apart, in strong hope of having a boy baby. They were strongly criticized for having five girl-children and were economically poor.
The south Indian Tamil culture has a proverb that says, “If a man has five daughters even a king would become a pauper.” My relatives struggled a lot to get all five of their daughters married. This example shows that the strong son preference still prevails in India. In all these instances, women did not have decision-making capacity; it was their husbands and in-laws who made the decisions. So, although reproductive rights are technically conferred on the couples, in an Indian context it is a collective decision of the family.
Contraceptives and the Impact of Reproductive Technologies on Women’s Health
Birth control pills (female) | Condom (male) | Condom (female) | Emergency contraception (female) | Injectable contraceptive (female) |
A partial range of birth control options. Others include tubal ligation (female sterilization), vasectomy (male sterilization), nonreproductive sexual activities, and abstinence from sexual activity |
by Victoria Keenan
Obstetric violence is institutionalized gender-based medical violence against pregnant women and birthing people. It includes overt physical abuse and more nuanced forms of violence, such as verbal abuse, humiliation, coercion, medical procedures without informed consent (including vaginal examinations, episiotomies, and sterilizations), confidentiality breaches, withholding pain relief, privacy violations, refusing admission to facilities, neglectful care, use of restraints, and detaining women and infants unable to pay for treatment.
Although their experiences are shaped by their circumstances, women worldwide experience obstetric violence. In poor and marginalized communities, medical care might be best described as “too little too late,” as opposed to the “too much too soon” approach in wealthy populations. Obstetric racism reflects the differential reproductive outcomes that result from the intersection of medical racism and obstetric violence faced by Black, Indigenous, and other People of Color (BIPOC), irrespective of their socioeconomic or educational status.
Patriarchy has historically silenced women’s voices, and those who are giving birth and caring for infants can be particularly vulnerable to an oppressive medical system. There is a growing movement to challenge this dehumanizing treatment, however. ImprovingBirth.org supported the #breakthesilence campaign, and many pregnant people and birth workers are using the hashtag #metoointhebirthroom to spread awareness.
Learning Activities
References
Araujo, M. J. 1993. “Report from Population Round Tables.” In Placenta Femea, edited by R. D. Oliveira and T. Corral. Rio de Janeiro: Brazilian Women’s Coalition.
Blanc, A. K. 2001. “The Effect of Power in Sexual Relationships on Sexual and Reproductive Health: An Examination of the Evidence.” Studies in Family Planning 32, no. 3, 189-213. https://pubmed.ncbi.nlm.nih.gov/11677692/.
Center for Reproductive Rights. n.d. “The World’s Abortion Laws: Recent Developments.” Accessed September 19, 2021. https://maps.reproductiverights.org/worldabortionlaws.
Chatterjee, Pritha, and Mayura Janwalkar. 2014. “The Great Indian Egg Bazaar.” Indian Express, February 9, 2014. https://indianexpress.com/article/in...an-egg-bazaar/.
Correa, Sonia, and Rebecca Reichmann. 1994. Population and Reproductive Rights: Feminist Perspectives from the South. London: Zed Books.
Dixon-Mueller, Ruth. 1990. “Abortion Policy and Women’s Health in Developing Countries.” International Journal of Health Services 20, no. 2, 297-314. https://doi.org/10.2190/V08N-UE7N-TNBH-RA4P.
Freedman, Lynn P., and Stephen L. Isaacs. 1993. “Human Rights and Reproductive Choice.” Studies in Family Planning 24, no. 1, 18-30. https://doi.org/10.2307/2939211.
Hartmann, Betsy. 1997. “Population Control I: Birth of an Ideology.” International Journal of Health Services 27, no. 3, 523-40. https://doi.org/10.2190/BL3N-XAJX-0YQB-VQBX.
Hussain, Rubina, Chander Shekhar, Ann M. Moore, Harihar Sahoo, and Rajib Acharya. 2015. Unintended Pregnancy, Abortion and Postabortion Care in Madhya Pradesh, India—2015. New York: Guttmacher Institute. https://www.guttmacher.org/report/un...esh-india-2015.
Kumar, Anant. 2007. “Role of Males in Reproductive and Sexual Health Decisions.” Bihar Times. April 16, 2007. http://www.bihartimes.com/articles/a...oleofmales.htm.
Petchesky, Rosalind P., and Jennifer A. Weiner. 1990. Global Feminist Perspectives on Reproductive Rights and Reproductive Health: A Report on the Special Sessions Held at the Fourth International Interdisciplinary Congress on Women, Hunter College, New York City, June 3-7, 1990. New York: Hunter College Women’s Studies Program.
Stillman, Melissa, Jennifer J. Frost, Susheela Singh, Ann M. Moore, and Shveta Kalyanwala. 2014. Abortion in India: A Literature Review. New York: Guttmacher Institute. https://www.guttmacher.org/report/ab...erature-review.
Supreme Court of India. 1999. “Apparel Export Promotion Council vs A.K. Chopra on 20 January, 1999.” Indian Kanoon. https://indiankanoon.org/doc/856194/.
UN. United Nations. 1968. Final Act of the International Conference on Human Rights. Teheran, 22 April to 13 May 1968. New York: United Nations. https://undocs.org/pdf?symbol=en/A/CONF.32/41.
———. 1975. Report of the World Conference of the International Women’s Year Mexico City, 19 June–2 July 1975. New York: United Nations. https://digitallibrary.un.org/record/586225.
———. 2005. 2005 World Summit Outcome. New York: UN General Assembly. https://www.un.org/en/development/de...A_RES_60_1.pdf.
———. 2014. Reproductive Rights Are Human Rights: A Handbook for National Human Rights Institutions. New York: UN Population Fund, Danish Institute for Human Rights, and Office of the High Commissioner for Human Rights. https://www.unwomen.org/en/docs/2014...e-human-rights.
UNFPA. United Nations Fund for Population Activities 2014. Programme of Action of the International Conference on Population Development. New York: UNFPA. https://www.unfpa.org/publications/i...ogramme-action.
UN Human Rights Council. 1993. Vienna Declaration and Programme of Action: Adopted by the World Conference on Human Rights in Vienna on 25 June 1993. Geneva: UN Human Rights Office of the High Commissioner. https://www.ohchr.org/en/professiona...es/vienna.aspx.
UN Women. 1995. Beijing Declaration and Platform for Action: Fourth World Conference on Women. Geneva: UN Women. https://www.un.org/womenwatch/daw/beijing/platform/.
———. 1979. “Convention on the Elimination of All Forms of Discrimination against Women.” Accessed November 4, 2021. https://www.un.org/womenwatch/daw/ce...convention.htm.
World Health Organization. 2008. Integrating Poverty and Gender into Health Programs: A Sourcebook for Health Professionals. Module on Sexual and Reproductive Health. Geneva: World Health Organization, Western Pacific Region.
Image Attributions
6.1 Photo by Andre Adjahoe on Unsplash
6.2 “Margaret Sanger” by buttonknee is licensed under CC BY-NC-SA 2.0
6.3 “Pro-Choice Demonstrator” by Janet Lockhart is all rights reserved, used with permission
6.4 Photo by Reproductive Health Supplies Coalition on Unsplash
6.5 Photo by Reproductive Health Supplies Coalition on Unsplash
6.6 Photo by Reproductive Health Supplies Coalition on Unsplash
6.7 Photo by Benjamin Moss on Unsplash
6.8 Photo by Reproductive Health Supplies Coalition on Unsplash