UN Role in Reproductive Healthcare and Female Empowerment
By Corey Risinger
Restricted:
Demanding Reproductive Healthcare for the 21st Century
• Tenuous state of internationallyaccessible reproductive
healthcare
• History of UN involvement in
female empowerment and the
provision of healthcare
• Shortcomings of current tactics
• Potential Solutions
Fundamental Problems
• Developing regions are trending
towards decentralization of
healthcare
• A lack of knowledge and
accessibility to contraception
yields millions of unintended
pregnancies a year
• Infants delivered without
sufficient medical care are
predisposed to additional health
risks
Part of a UN Millennium Dev. Goal
Series of Advertisements
• Funding does not meet needs
for reproductive healthcare or
preventative education
Today’s Reality
• Over 60 million girls become
child brides
• 1/4 women experience sexual
or physical violence during
pregnancy
• 603 million women live in
countries where domestic
violence is not yet considered a
crime
• Strides have been made...
Previous UN Intervention
• 1975 Mexico City Conference
• 1980 Copenhagen Conference (First significant exposure for RHC)
• 1985 World Conference in Nairobi
• 1994 International Conference on Population and Development
• Millennium Development Goals (1990-2015)
• 1995 Beijing Conference
• 2005 World Summit
• ICPD Beyond 2014
Mexico City Conference
• First formal international exposure for the topic of women’s health:
• Discussed female safety and empowerment, especially in the context
of domestic violence and gender prejudices
• Incentive for bill aimed to curb discrimination against women,
establishing more prominent roles for all genders in the workplace
and home
June 19, 1975
June 19, 1975
World Conference,
Copenhagen
December 1979- UN passed Convention on the
Elimination of all forms of Discrimination against Women
- “Bill of Rights” for Women, binds 165 states
- 3 priorities: 1) education; 2) employment; 3) accessible
health services
World Conference, Nairobi
Violence against women ought to be acknowledged as a
worldwide issue:
-effects more than the direct parties involved
-must be addressed as a matter of human rights
International Conference on Population and Development
Cairo, Egypt- 1994
• Explicitly dealt with the provision of healthcare
• 179 participating member states of the UN
• Continuation of theme of women’s empowerment
• Added emphasis on the reduction of STIs
• Recognized preventative healthcare and family planning’s crucial role in
preventing maternal and infant mortality
• aimed to provide family planning by 2015
Millennium Conference
• UNFPA’s Master Plans for Development
• Goal 3: Promote gender equality, women’s empowerment
-address gender disparities in education (primary and secondary) by 2005, all
levels of education by 2015
-sub-points dealing with empowerment: level ratios of girls to boys in education,
in wage employment in nonagricultural sectors, in number of seats held in
parliament
• Goal 5: Improve maternal health
-Target 5.A- Reduce maternal mortality ratio by 3/4 between 1990-2015
-Target 5.B- Offer universal reproductive healthcare access by 2015
• Goal 6: Combat HIV/ AIDS
-halt the spread of HIV/ AIDS and begin to reverse it by 2015
Beijing Conference 1995
-largest of the World Conferences on Women
-180 government delegations/ states present
-created the “Beijing Plan for Action”
-identifies “Women and Health” as one of twelve “strategic objectives”
World Summit, 2005
Section 12) “We reaffirm that gender equality and the promotion and protection
of the full enjoyment of all human rights and fundamental freedoms for all are
essential to advance development and peace and security. We are committed to
creating a world fit for future generations, which takes into account the best
interests of the child.”
12a) “Eliminating gender inequalities in primary and secondary education
by the earliest possible date and at all educational levels by 2015.”
ICPD Beyond 2014
• Established the ICPD Programme of Action
-introduced to the UN Conference on Population and Development in 2014
-states declared “progress for women is progress for all”
Remaining
Dilemmas
• Need for professional medical
training that is regionally
sensitive
• Antenatal care lacking
• Family Planning requires
improvement
• Adolescent Childbirth
Medical Gaps to be Met: Delivery
• 26 million/ 135 million live births
in 2011 were delivered alone, without
adequate medical-care
• 55% (1990) to 66% (2011)
• Percentages vary according to region:
E. Asia (100%), C. Asia (97%), S.
Asia and sub-Saharan Africa (~50%)
• Rural areas are particularly
vulnerable
• Because of lackluster medical
care
A rural pregnancy in Nepal
Antenatal Care
• World Health Organization
minimum recommendation for
pregnant women= 4
visits
• Tetanus Toxoid
vaccination, screening for
infections, indicators of
warning signs during
pregnancy
• Adapted to include
regional illnesses (ex.
malaria)
Only 1/2 women in developing regions
meet the WHO standards.
Family Planning
• Includes counseling, provision of supplies, etc.
• 1990: 15% unmet vs. 2011: 12%
• ***By 2015, total demand for family planning among married is expected to
exceed 900
million women.
• 62% of women in developing regions- in a partnership or marriage- using
contraception (2011)
• Developing regions/ rural areas: 1) female sterilization; 2) Intrauterine
devices (IUD)
Factors in the movement to provide reproductive
healthcare
• Social Dictates
-Cultures may idolize pregnancy
-Perceived as becoming an adult, gaining status, or a
method for escape from abusive families
Case Study (Guttmacher Institute, 2010): 67% of married adolescents in sub-Saharan
Africa desired pregnancy or were intentionally pregnant
Gap to be filled: Need to instill an identity beyond motherhood to young adults
• Peer and Educational Influence
Women who remained in school were less likely to be adolescent brides or mothers
“The first step is to analyse not only why adolescent girls suffer from high rates of maternal
morbidity and death, but also why they are becoming pregnant... Amidst many other
factors, adolescent pregnancy might be due to a lack of comprehensive sexual education;
gender norms that reinforce early pregnancy; early marriage; high levels of sexual violence;
a lack of youth-friendly health services; lack of affordable and accessible contraception; or
a
combination of the above.”
-2012 report from the Office of the High Commissioner for Human Rights
Adolescent Childbirth
• Psychological impact: 90% of adolescents who give birth are married,
depression, coerced sexual relations, stress from being unprepared for
the identity transformation of marriage
• Response to aforementioned social dictates
Sub-Saharan Africa
Nepal
Causal Analysis of
Adolescent Pregnancy
Perspectives on Teenage Pregnancy
• “The reality is that people are very judgmental, and that’s how human
beings are. To hear that even after all your accomplishments. . .all the
stuff you’ve gone through to pass these hurdles, to become a better
person. . .people can be very unforgiving because they are going to
remember ‘Oh, she had a baby when she was 15’.” -Tonette, 21,
pregnant at 15, Jamaica
• “Things are gradually changing.
Hopefully customs like atta-satta
(exchange marriages) and child
marriages will be totally gone by the
time my daughter grows up, and she
will get to complete her education and
marry only when she wants to.” -Komal,
18, India
Inspiring Change with Social Media: Madagascar
• 1/3 women become pregnant before 18
• 1/2 of the population is under 20 years-old
• Manantsoa Ratsarazaka (23 year-old) founded “Tanora garan ‘Tenen”
(Guarantee for Youth)- social media project
• “Malagasy people are generally shy when talking about sexual matters. Most
questions or concerns are ascribed to a ‘friend’ or a ‘cousin.’
Tanora garan ‘Tenen
Program explained to UN representative
“The impact of emotional, physical, and
sexual abuse on contraceptive method
selection and discontinuation”
by Allsworth JE, Secura GM, Zhao Q, Madden T,
Peipert JF
1) Hormonal IUD
2) Copper IUD
3) Implant
4) Shot
5) Birth Control Pill
6) Contraceptive Patch
7) Contraceptive Ring
8) Condoms
Choose Your Future Program in Nepal
• UNFPA-supported
• Instructors personally visit in-laws and parents to explain the empowerment program
rooted in education
• Personal hygiene and reproductive health lessons; encourage the delay of
pregnancy and the re-enrollment of girls in school (free through grade 10 as of 2009)
Choose Your Future
• “Early marriage is our custom, and we didn’t know it was wrong before the teacher
explained things to us,” said Malati Sebat.
Potential UN Solutions
1) New legislative body under the UNFPA
2) Development of RHC facilities
3) Education of local medical
professionals through UNsponsored conferences
4) Expanded sexual educationthrough schools and RHC centers
5) Media Campaigns
Application of the
WHO’s 6 building blocks
• Safe health services
• Trained health workforce
• Reliable health information
system/ infrastructure
• Equitable technologies
• Health financing system
• Legislative leadership
Particular target: migrant/ religious communities
Sexual Education
• Local educators/ grassroots
programs can better serve
regional cultures
• In Nepal, teachers were
first faced with staunch
opposition, but they were
able to relate to mothers.
• Sexuality education DOES NOT
hasten initiation of or increase
sexual activity (UNESCO 2009)
• In and out of school educational
opportunities (out-of-school
ones facilitated by RHC centers)
Promise of Media
Campaigns
• Tailored to specific regions (as
far as identifying most effective/
accessed forums and methods
of presentation)
• As seen by Ratsarazaka’s
successful program in
Madagascar, social media
projects may be a lasting
solution in the 21st century.
Translated UN poster for July 11
(World Population Day)
Restricted:
Demanding Reproductive Healthcare for the 21st Century
Metaphorical significance of the
wire, caution tape- confined torso
1) Resolution from the
Mexico City Conference,
2) Secretary General’s Report
from the Nairobi Convention
Bibliography
ICPD Beyond 2014, Resolution 65/234:
http://icpdbeyond2014.org/uploads/browser/files/ungass_res_65_243.pdf
ICPD Beyond:
http://www.un.org/ecosocdev/geninfo/populatin/icpd.htm.
United Nations Population Fund:
http://www.unfpa.org/public/home/about/pid/4629
http://www.unfpa.org/rh/planning.htm
United Nations Women:
http://www.unwomen.org/about-us/about-un-women/
Millennium Development Goals:
http://www.un.org/millenniumgoals/
“New Study Finds Little Progress in Meeting Demand for Contraception in Developing World”
http://www.unfpa.org/public/cache/offonce/home/news/pid/11239;jsessionid=EA3CEE93763805D1D3328C4E45C4BA74.jahia0
2
Taskforce on Women, Peace and Security:
http://www.un.org/womenwatch/ianwge/taskforces/wps/history.html
http://www.un.org/millenniumgoals/pdf/report-2013/mdg-report-2013-english.pdf
http://www.unfpa.org/webdav/site/global/shared/swp2013/EN-SWOP2013-final.pdf
http://www.choiceproject.wustl.edu/METHODS
http://www.flickr.com/photos/tanoragaranteen/7844239480/in/photostream/
Study: http://www.ncbi.nlm.nih.gov/pubmed/23948012
http://www.unfpa.org/public/home/news/pid/15473