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No sharp distinction can be made between aﬄuent and developing nations with respect to the evolution of the concept of reproductive rights. The notion developed through intense dialogues involving feminist communities in Northern and Southern nations. The concept of sexual rights developed concurrently. The two concepts occasioned theoretical controversies within the feminist community and opposition from national and global conservative political forces.
The two concepts are now enshrined in United Nations documents. In 1994, the Program of Action of the International Conference of Population and Development (ICPD Cairo, 1994) deﬁned reproductive rights as:
[Embracing] certain human rights that are already recognized in national laws, international human rights documents and other consensus documents. These rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. It also includes their right to make decisions concerning reproduction free of discrimination, coercion and violence. … (Paragraph 7.3)
A year later, the Platform of Action of the IV World Women Conference (IV WOW Beijing) reaﬃrmed the ICPD principle and spelled out the substantive contents of women’s sexual rights:
The human rights of women include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. 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.
1. Historical Background
Almost a century of North–South interactions concerning birth control preceded the recent establishment of the concept of reproductive rights. From the early twentieth century, eugenic societies, neo-Malthusians, the socialist movement, and advocates of sexual hygiene had developed connections with colonial territories and Southern independent nations. Beyond these intentional eﬀorts, ideas had been largely spread worldwide in a more incidental way, by labor migrants, colonial functionaries, and progressive political activists.
The expansion of eugenic societies and Malthusian networks has been extensively examined. The biography of Margaret Sanger, the North American birth control advocate, is a privileged subject of analysis. From the late 1920s, Ms. Sanger was involved in international advocacy in association with neo-Malthusian and eugenic networks. Research has revealed the close links between her eﬀorts, colonial administrations, and local ideologies of class, caste, ethnic, and racial domination. These networks would play a major role in the second wave of global advocacy for fertility control in the 1960s and 1970s. By then Ms. Sanger had sponsored research leading to the invention of the contraceptive pill which, together with the ﬁrst IUDs, were being disseminated in developing nations.
In contrast, the path through which Emma Goldman’s socialist views on women’s reproductive self-determination traveled south remains largely unexplored. The Cuban experience suggests a resonance far beyond the pioneering initiatives taken by Goldman in the early days of the Soviet Union, as abortion was legalized in 1959, immediately after the Revolution. Recent research has also drawn attention to some of the more progressive ramiﬁcations of Ms. Sanger’s endeavors. One illustration is provided by Mexico where, in 1916, in Mexico, after a Feminist Congress, a booklet written by Margaret Sanger, ‘Birth Regulation,’ was disseminated. In 1925, the same publication was distributed freely by the anticlerical Calles Administration.
Having originated from contradictory theoretical sources, birth control ideas were given diﬀerent meanings by diverse interpreters. In India, where the spread of neo-Malthusian ideas coincided with the intensiﬁcation of the independence struggle, they sparked harsh controversies within the Gandhian movement. In Mexico, contrasting with the climate of the previous decade, a pronatalist General Population Law was approved in 1936. In the same period, mother and child care programs and family beneﬁts were adopted in Brazil, Argentina, Chile, and Uruguay. These initiatives, which were conceived as accompaniments to early industrialization strategies, converged with the Catholic Church’s resistance to all variants of birth control advocacy. This climate silenced existing progressive strands and inspired adaptations of conservative eugenic streams. In Brazil, for instance, ideologies advocating racial and ethnic miscegenation to ‘whiten’ the population gained legitimacy.
This background determined the immediate post-Second World War environment. In Latin America, previous such policies gained leverage from the adoption of import-substitution industrialization strategies. In other regions, the acceleration of decolonization brought the idea that large populations were a positive element in the establishment of new nation states. Rapid economic growth favored a lowering of mortality rates worldwide. However, as industrialized nations entered a second cycle of fertility decline, in developing nations, where demographic transitions were taking place, fertility rates remained high. In the 1950s, Alfred Sauvy, the French demographer, conceived the categories First, Second, and Third World. The central parameters for this demarcation were the demographic diﬀerentials between the three zones.
In the late 1960s, fertility control premises became a ‘grand ideology,’ supported by United Nations agencies, public ﬁnancial institutions, bilateral donors, private foundations, and the International Planned Parenthood Federation and its national associates. Scientiﬁc evidence was collected to prove that rapid demographic growth had negative impacts on the economic development of Southern countries. Extreme positions went as far as to argue that population control would have the additional beneﬁt of preventing Revolutionary uprisings across the South.
Although pressured from outside, developing nations were not easily or immediately persuaded. Indeed, at the Population Conference of Bucharest of 1974, they counteracted by proposing a policy agenda that combined reform of the international economic order, domestic economic growth and investments in basic needs. This position became crystallized in the lemma: ‘Development is the best contraceptive.’ Yet, not all developing nations remained faithful to their Bucharest commitment. By the late 1970s, draconian population control was already in place in Asia, particularly in China and India. In the other regions countries resisted longer.
Feminist initiatives were also blossoming south of the Equator. Feminist groups initially supported the Bucharest critique of population control. Gradually, however, they came to perceive that women’s needs and rights were not being addressed by either pronatalist or antinatalist programs. In some settings, women’s fertility was targeted. In others, women’s ability to freely decide on reproductive matters was curtailed by pronatalist ideologies. In a few countries the two approaches were implemented in combination, the racial and ethnic origin of the client being the determining factor for selecting which approach was used for whom. Overall, the quality of information and care provided by both MCH and family planning programs was extremely poor.
The early feminist critique of population policies was preceded and surrounded by other relevant institutional processes. The 1968 International Human Rights Conference, held in Tehran, approved a principle ensuring couples the ‘basic human right to decide freely and responsibly on the number and spacing of their children and a right to adequate education and information in this respect.’ In Bucharest, it was rephrased to extend these rights to individuals (not just couples) and to ensure access to the means of exercising them. Nevertheless, until the 1990s, individual rights in regard to reproductive matters remained subordinated to the primacy of preventing the population crisis.
Bringing gender concerns into family planning frameworks evolved along with other eﬀorts aimed at women’s equality. In 1975, the First United Nations sponsored International Women’s Conference was held in Mexico City. Coercive measures of population control were debated and the ﬁnal document proclaimed respect for the bodily integrity of women as ‘a fundamental element of human dignity and freedom.’ This was followed by the approval of the Convention on the Elimination of All Forms of Violence against Women (CEDAW) in 1979. CEDAW aﬃrmed women’s rights to family planning, their equal right (with men) to decide on the number and spacing of their children, the right to maintain their jobs while pregnant, and to have access to maternity leave and child-care. In 1981, a UN Symposium on Population and Human Rights held in Vienna also declared that ‘Both the compulsory use of abortion and its unqualiﬁed prohibition would be a serious violation of human rights.’
Despite this emerging consensus, the climate of debates began to change. In the International Population Conference of Mexico in 1984, developing countries expressed a broader acceptance of family planning programs and reaﬃrmed women’s right of access to contraception. However, an alliance between the Reagan Administration and the Roman Catholic Pope made the subject of abortion a major controversy. The United States cut funding for international family planning activities, saying that the programs facilitated access to abortion. (This US policy remained in place until 1993.) Some family planning organizations openly contested this US policy and disseminated information about it among their Southern partners. Abortion was openly debated at the NGO Forum of the Women’s Conference of 1985 in Nairobi. In 1988, the meeting of the International Federation of Gynecology and Obstetrics in Rio de Janeiro was preceded by the Christopher Tietze International Symposium on Women’s Health in the Third World, a critical event in addressing abortion rights internationally. By the end of the decade, the World Health Organization adopted the notion of reproductive health that would be rapidly incorporated by other institutions and advocacy groups becoming an important conceptual adjunct to the idea of reproductive rights.
Other contributions to the conceptualization of reproductive rights came from women’s organizations in Southern nations. Though small-scale, these grassroots organizations engaged in constant dialogue with their societies to transform sexist attitudes and practices. Sometimes they inﬂuenced legislation and policy to enhance women’s health. In all contexts, feminist organizations had to confront the powerful inﬂuence of international population policies or the resistance of pronatalist ideologies.
This blossoming of feminist advocacy coincided with the ﬁrst ripples of globalization. The debates evolving in industrialized countries ﬁltered into Southern societies through various communications streams. Feminist publications such as ‘Our Bodies, Ourselves’ were read in English speaking circles. Political exiles brought back home the stories of feminist struggles in relation to reproduction and sexuality and adapted innovative consciousness raising strategies, as in the case of gynecological self-examination. The mainstream media provided some information.
Local groups built connections with each other and with the Committee for Abortion Rights and Against Sterilization Abuse (CARASA) in the United States, and the International Campaign on Abortion, Sterilization and Contraception (ICASC) in Europe, which had spawned the very ﬁrst formulation of reproductive rights. In 1984, a ﬁrst Latin American Women’s Health Meeting was held in Colombia. The International Campaign on Abortion, Sterilization, and Contraception also hosted, in Amsterdam, the ﬁrst International Reproductive Rights Conference.
In Amsterdam, the International Campaign was renamed the Women’s Global Network for Reproductive Rights (WGNRR) and given a broad mandate to address all issues related to women’s reproductive health, not only those involving abortion, sterilization, and contraception. Reproductive rights were deﬁned as ‘women’s right to decide whether, when and how to ha e children—regardless of nationality, class, race, age, religion, disability, sexuality, or marital status—in the social, economic and political conditions that make such decisions possible.’
The next WGNRR conference held in San Jose, Costa Rica (1987) started an international campaign on maternal mortality and inspired the creation of the Latin American Campaign for the Decriminalization of Abortion. In 1988, in a feminist meeting preceding the Tietze Symposium in Rio, the debates concentrated on ethical aspects of population control policies, abortion, and new reproductive technologies. In Manila, in 1990, during another WGRRN Women’s Health Conference, the idea was raised that the international reproductive rights movement should conceptualize a feminist population policy. As globalization intensiﬁed, a clear acceleration occurred in the circulation of these ideas.
The United Nations Conferences of the 1990s were conceived as an interconnected series of global debates starting with Environment and Development (Rio 1992) and moving forward to address Human Rights (Vienna 1993), Population and Development (Cairo 1994), Social Development (Copenhagen 1995), Women (Beijing, 1995), Human Settlements (Istanbul, 1996), and Food Security (Rome, 1996). Whereas in the 1970s and 1980s, Southern feminist intellectual and political endeavors evolved largely in isolation from international policy arenas, in the 1990s, ‘they involved’ meant direct engagement in these negotiations. In Rio, access to reproductive health was added to conventional family planning language. Vienna’s deﬁnitions with respect to women’s human rights aﬃrmed that they applied to both the public and private realms, thereby creating the basis for the further developments of Cairo and Beijing regarding reproductive and sexual rights.
2. The Contents Of Reproductive And Sexual Rights In The Southern Feminist Perspective
The adoption of a reproductive rights framework by advocacy groups within developing nations entailed a broadening of its original focus—abortion, contraception, and sterilization—to include maternal mortality, prenatal and obstetric care, breast and cervical cancer, and adolescent and postmenopause health. The Southern perspective also underlined the need to incorporate attention to women’s economically productive roles in addition to their biologically reproductive functions. This required a better understanding of the correlation between sexual and reproductive health and endemic and chronic diseases, as well as occupational, environmental and mental health hazards, and aﬄictions.
In the 1980s, the scope and intensity of abortion related initiatives varied across regions, being more visible in Latin America (particularly Brazil), the Philippines, and South Africa. Abortion was always addressed as part of a broader reproductive health and rights agenda, never as a ‘single issue.’ Eﬀorts to decrease maternal mortality were prioritized by most countries and within these eﬀorts new venues for addressing abortion have emerged. Both ICPD and IV WCW ﬁnal documents recognize abortion as a major public health problem, aﬃrming that, in circumstances where it is legal, it should be safe. The Beijing Platform of Action recommends that countries review laws containing punitive measures against women who have undergone abortion.
Contraception has always been a cross-regional concern, often involving United States and European advocacy eﬀorts. Research has been devoted to sterilization, IUDs, injectables and implants, methods privileged by fertility control programs. Long before the feminization of the HIV-AIDS pandemic, Southern feminist organizations emphasized the disease-preventing advantages of barrier methods, such as the diaphragm.
In the 1990s, campaigns were launched against speciﬁc technologies: Norplant, the contraceptive vaccine, and Quinacrine (a method of chemical sterilization). Advocates engaged in dialogues with researchers, pressuring for better ethical standards and redeﬁned research priorities. One critical outcome of these eﬀorts was the investments aimed at developing microbicides to protect women against HIV-AIDS and pregnancy. Concern arose regarding the expanding use of prenatal sex-selection techniques in India and China.
In their eﬀorts to address reproduction as a right, not merely a woman’s obligation, Southern advocacy groups very early challenged gender inequalities in the sexual domain. Issues such as early marriages, rape, forced prostitution, traﬃcking, and female genital mutilation have been raised under the umbrella of violence against women. Sexuality, as such, however, gained enormous visibility under the impact of the HIV-AIDS pandemic. The inadequacy of contraceptive methods used in most Southern countries became clear, as they oﬀered no protection against infections. Research in Africa showed the association between HIV and other sexually transmitted infections.
The World Health Organization coined the notion of sexual health, and initiated preventive strategies that required a better understanding of sexual behavior. Most Southern governments resisted recognizing the impact of the pandemic, partly because it was initially portrayed as aﬀecting only certain risk groups (homosexuals, sex workers, and drug addicts). Among Southern feminists, some time elapsed before the feminization of HIV-AIDS became a priority. An important recent political development is the multiplication of gay and lesbian rights advocacy groups in developing nations. The concept of sexual rights presently encompasses nondiscrimination on the basis of sexual orientation or HIV-AIDS status. Other ideas have diﬀused that promote responsibility by men in sexual matters and transforming notions of masculinity.
Thus, although the emphases do vary, the content of reproductive and sexual politics within aﬄuent and developing nations are similar. The concepts exemplify an ‘ideascape’ which, having broken through national and cultural boundaries, has gradually crystallized in a globally accepted discourse. These ideas are present in Southern national and regional advocacy groups and among Southern academic and research initiatives, particularly in Latin America and South and South East Asia.
3. Conceptual Debates
A number of inter related controversies developed as reproductive and sexual rights were conceptualized in developing nations. A ﬁrst one can be retraced back to the global debates around abortion in the 1980s. In developing countries, should abortion be addressed as a single issue, as in the United States advocacy strategies, or part of a comprehensive reproductive health and rights agenda? A theoretical and political problem underlay this early controversy. In aﬄuent societies, where women’s basic needs had been largely met, restrictions in the access to abortion strikingly expresses gender inequality with respect to the individual right to decide. However, women’s exercise of reproductive rights in developing regions (and among marginalized groups in aﬄuent societies) is primarily curtailed by economic disadvantages that aﬀect men and women.
A related controversy arose from the critique of the intrinsic individualistic and contractual nature of the Western concept of rights. Feminist thinkers recognized that any approach to sexual and reproductive politics must take into account political, economic, and cultural constraints on individuals. The full exercise of these rights is dependent upon an enabling environment including democratic conditions that allow citizenship rights, women’s empowerment, and material support, such as transportation, childcare, jobs, and education. Examples of the importance of such support are easily found. In all developing nations, women die because they do not have transportation or because basic equipment is lacking in health facilities. In rural India and China, vaginal infection results from precarious sanitation. Poor women die of botched abortions, while rich women can pay for safe procedures. In India, abortion has been legal since the 1970s, but the quality of care remains poor. Young women are infected by HIVAIDS by having sex to get money to survive.
The emphasis on enabling conditions does not imply ignoring gender inequality and how it restricts women’s ability to protect their bodily integrity and personhood. Research that explored ordinary women’s perceptions of sexual and reproductive rights found that few women use these terms, but they do understand that the principles refer to being able to make decisions about procreation, to be free from harassment by men, to protect themselves against domestic violence and preventable illness, and to have access to adequate health care. When these rights are not in place, women cannot exercise civil and political rights. The framework implies both positive rights, such as reproductive health care and employment, and negative rights, such as protection against rape and discrimination, regardless of sexual orientation or marital status.
Some have criticized the emphasis on sexual and reproductive health as being too narrow when compared with the broad women’s health agenda deﬁned in the 1980s. To address this limitation requires understanding links between gender, social inequality, and health. One priority is to ensure that health reform policies improve women’s access to health services. Another concern is to understand how men’s violence against women aﬀects women’s health and mount policies to confront this. Exploring this topic may also lead to addressing the adverse eﬀects on women of cultural constructs of masculinity.
4. Policy And Political Challenges
A human rights approach to sexual and reproductive politics still faces major obstacles to eﬀective implementation. The deﬁnitions of related rights as enshrined in United Nations documents are not binding. Even if these new principles are translated into binding instruments, international human rights mechanisms have little power to enforce them, especially if violators are private parties rather than states.
Additionally, the eﬀective implementation of women’s reproductive and sexual rights must challenge a rigid and persistent ‘public’–‘private’ distinction in international human rights law and national legal systems. This breaking up of boundaries is crucial for women, whose lives in many cultures are still locked within domesticity. To help women, human rights claims must penetrate the ‘private sphere’ within which marital rape, female genital mutilation, virginity codes, and repudiation of birth control occur. On the other hand, public actions of the state and its agents also very often violate women’s sexual and reproductive self-determination.
Greater challenges may lurk in globalization. Poorly understood and poorly regulated, globalization is creating growing inequalities of income within and across countries. Women are entering labor markets everywhere. Earning more income often raises a woman’s value, but can also result in even tighter controls over her life. Earnings sometimes provide women with greater physical mobility, increased personal autonomy, and the possibility of breaking through gender barriers and patriarchal or other mechanisms of male control.
Concurrently—in reaction to the negative eﬀects of globalization—political, national, religion-based, ethnic, or other identities are being strengthened which revive traditional gender systems and controls. There is a proliferation of both antiabortion and ‘profamily’ groups associated with religious fundamentalists—Catholic, Protestant, Islamic—and of conservative politics that systematically oppose women’s reproductive and sexual freedom on behalf of ‘fetal rights,’ womanly duty, and the defense of hierarchical power within the family. These forces are at play in the United Nations, and other global policy arenas, whenever gender related issues arise. Moreover, racism, nationalism, and ethnic hatreds also pose threats to women’s reproductive and sexual health. Chronic violence, genocide, ‘ethnic cleansing,’ and military occupation have often meant mass rape, abandonment, refugee status, increased vulnerability to forced prostitution, traﬃcking, unwanted pregnancy, and sexually transmitted diseases.
The promoters of a globalized economy often support the breaking down of traditional gender systems and greater freedom for women. Nevertheless, they remain largely unconcerned with growing economic inequality which, in most cases, lies at the root of fundamentalist trends, patriarchal revivals, and ethnic strikes. For developing countries, globalization has led to large-scale debt and trade inequities. Fiscal austerity, imposed through structural adjustment programs, has negatively aﬀected the availability and quality of public social services.
The fulﬁllment of the twentieth century promise of women’s sexual and reproductive freedom requires these contradictory trends to be challenged and eventually tamed. Redeﬁning development policy priorities to create an enabling environment that will both provide a ﬁrm basis for individual self-determination while restraining the appeal of moral conservative forces remains a daunting task for the early years of the new millennium. The historical experience in both the South and the North also suggests that such fulﬁllment additionally demands sustained intellectual and political eﬀorts aimed at promoting and enhancing the acceptance of all forms of diversity and tolerance within and across societies.
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