Global Reproductive Justice in 2019: Our Very Survival Depends on It
With America choking off access state by state to reproductive health care for millions of women, it’s hard to think beyond these infringements on our own rights to think about the state of reproductive justice in the rest of the world.
Yet, globally, there’s much to celebrate. The prioritization of maternal health in the United Nations Millennium Development Goals galvanized the nearly 50-percent reduction of maternal mortality between 1990–2015, as the numbers of prenatal visits, births attended by skilled health attendants, and women using contraceptives rose worldwide.
Nevertheless, the world still has a long way to go before all women have equal access to reproductive care. Every 90 seconds a woman loses her life to preventable childbirth-related complications, including, most lethally, hemorrhage, hypertension, unsafe abortion, and sepsis. Ninety-nine percent of these deaths occur on the Global South, where contraception and safe abortions are often unavailable. Millions more women who survive childbirth endure serious complications, including infertility and fistula.
These gross inequities begin well before childbirth. Across the life cycle, infants, girls, and women in low-income settings are at a profound disadvantage. From infrequent prenatal, post-natal, and pediatric check-ups; to the lack of access at the onset of puberty to vital reproductive health information and menstrual health and hygiene products, to the continuing prevalence of child marriage, impoverished or otherwise vulnerable girls and young women are deprived of both medical attention and the information that can help them get the care they need.
Compounding these privations, women’s and girls’ freedom, too, is taken from them — the freedom to decide whether to continue with their own education and/or to pursue a career, when, whether, and whom to marry, whether and when to have children, and how many. Given their limited access to adequate information, health insurance products, and quality clinical care across their lifespans, maternal survival is by no means assured for low-income and otherwise marginalized women in the developing world.
To address these tough challenges, the international community has again prioritized reducing maternal mortality in the UN Sustainable Development Goals, a new set of global goals to be met by 2030. This may sound ambitious, but solving this global crisis is not rocket science. We know that comprehensive interventions have had remarkable results across the globe, from Cuba to Tunisia to Sri Lanka to China. Targeted programming needs to focus on access to affordable education, women-friendly health services, and nutrition, both before, during, and after childbirths that are attended by skilled birth attendants, with access to prompt, quality emergency obstetric care should complications arise.
The World Health Organization and the other international agencies that have helped design, fund, and advise the national-level implementation of such thoughtful and comprehensive programs have embraced the right to “safe motherhood” as part of their justification. But promoting “safe motherhood” as a human right is not sufficient. To achieve the SDG target of reducing maternal mortality worldwide, women need full human rights, including the right to own and inherit property, to quality nutrition and education, to equal pay for equal work, to have safe and affordable childcare, so that they can work, to be free of violence, to realize their full human potential.
To make this happen, we must engage a full array of partners across sectors — from local and national government, to the private sector, to bilateral and multilateral technical and financial assistance, to the local health sector, to each and every community. At the table, too, and at the heart of the conversation, must be women leaders in each community, who know best what they need and who can therefore inform all stakeholders duty bearers what’s going right and wrong — both as to their care itself, and to the requisite communications, health infrastructure, and transport required to provide that care.
Knowing what to do is not enough. The time has come for an “all-hands-on-deck” mobilization — with intention, action, and constancy as the keys to success. Many countries are not pulling their weight, with some even pulling in precisely the wrong direction: draconian U.S. cuts in aid to international health providers, for example, now risk raising both the death and abortion rates across the globe, as programs from Nigeria to Madagascar to Nepal are shuttered.
Yet the momentum behind the Sustainable Development Goals for informed, concerted action reassures us that a watershed has been crossed: decades of strenuous efforts on the part of national governments and multilateral institutions have been rewarded with the understanding that women’s survival is key to the survival of the planet. There can be no more excuse or impunity, therefore, anywhere, for letting mothers die.