by Kimberly Whipkey, Center for Health and Gender Equity
“At Colectiva Mujer y Salud, we view each woman as a complete person. If a woman comes seeking an HIV test, we will make sure she also receives information about contraception, screening for gender-based violence, education about her sexual health and a better understanding of her rights.”
– Sergia Galván, Executive Director, Colectiva Mujer y Salud, Dominican Republic
Reproductive health care that is comprehensive, accessible and woman-centered is far from a common reality — anywhere in the world. Global women’s health advocates are campaigning for a more holistic approach that better serves women and their families.
In mid-October, the Center for Health and Gender Equity (CHANGE) invited reproductive health experts from the Dominican Republic, Ethiopia and Botswana to participate in CHANGE’s Reproductive Justice Ambassadors Tour. The tour made stops in Boston, Philadelphia and Washington, D.C., to meet with NGO leaders, activists and key decision-makers.
At each venue, experts discussed why investing in comprehensive sexual and reproductive health and rights is critical at this moment, and they offered suggestions on how the United States can strengthen human rights-based care overseas that breaks down the divisions among HIV/AIDS, reproductive health, and maternal and child health.
The three health experts — Dr. Fisseha Mekonnen Alemu, Grace Sedio and Sergia Galván — offered hope that it is possible to provide comprehensive and rights-based care, even in the face of poverty, a weak health infrastructure and social, political and legal environments hostile to reproductive rights. The obstacles, however, are formidable.
Dr. Mekonnen, executive director of the Family Guidance Association of Ethiopia, discussed his country’s dire maternal health statistics. Only 6 percent of pregnant women have a skilled attendant at delivery, and an estimated 100,000 Ethiopian women suffer obstetric fistula — an entirely preventable condition. Rural women have little or no access to modern health care. And 30 percent of women who die as a result of pregnancy or childbirth do so as a result of unsafe abortion.
Women living with HIV in many countries face layers of stigma and discrimination. Grace Sedio, project officer at Bomme Isago Association in Botswana and member of the International Community of Women Living with HIV/AIDS, spoke about HIV-positive women — especially those who are pregnant— being blamed by public officials in Botswana for spreading the virus. They are often treated as vectors of disease rather than as women with reproductive health needs and rights.
While Sergia Galván, executive director of Colectiva Mujer y Salud in the Dominican Republic, provides comprehensive care through her feminist health center, serious challenges to attaining critical reproductive health services remain. Legislators recently ratified an article within Constitutional reform that prevents liberalization of abortion laws, which currently prohibit abortion under any circumstance. The Constitutional changes were largely influenced by ideological opposition to abortion from conservative factions, including the Catholic Church.
“One Cardinal said he would rather see two deaths [the woman and the embryo or fetus] than one abortion,” Galván said at a Congressional briefing in Washington, D.C.
For eight years under President Bush, the global gag rule stifled NGO advocacy around safe and legal abortion, creating a vacuum in the Dominican Republic that helped enable the Constitutional reform. So, whether a woman is raped, a victim of incest, or suffering life-threatening complications of an ectopic pregnancy, she cannot legally access abortion care, and the situation is unlikely to change anytime soon.
The Ambassadors often highlighted how decisions made in the United States have had major impacts in their countries. They also offered suggestions for how people in the United States can promote reproductive justice globally. For example, Congress is in the early stages of re-writing the Foreign Assistance Act of 1961, which governs how foreign assistance is spent.
One immediate action step is to contact your members of Congress and urge them to support the inclusion of comprehensive reproductive health. For more information, we encourage you to read CHANGE’s new report: “Investing in Reproductive Justice for All: Toward a U.S. Foreign Policy on Comprehensive Sexual and Reproductive Health and Rights.”
At an NGO breakfast meeting in Philadelphia with the Ambassadors, a participant said, “At our health center in Philadelphia we view every woman as an opportunity.”
So, too, should U.S.-funded domestic and international programs see each woman as an opportunity to provide comprehensive and rights-based health services — and an opportunity to improve the health of women worldwide.
Kimberly Whipkey is a senior associate for advocacy and outreach at the Center for Health and Gender Equity in Washington, D.C.