REPRODUCTIVE RIGHTS, GENDER EQUALITY AND REPRODUCTIVE HEALTH IN DEVELOPING COUNTRIES

A Human rights approach to health had its beginning in the 1948 Universal Declaration of Human Rights. Perhaps due to 'gender blindness' the fact that women suffer from several human rights violations because of their societal and sexual roles was not recognized for several decades. In the eighties, improving reproductive rights gained recognition as a viable strategy with the recognition of women's reproductive rights as human rights. 

Why are reproductive rights a human right?  An answer to the question depends upon the definitions of the two concepts, reproductive rights and human rights. Of the two, human rights as a concept emerged during the period of colonization and industrialization in societies which experienced brutality, poverty, chaos and social disorganization. Industrialization led to unprecedented explosion of economic opportunities and generation of surplus capital (Arrighi, 1999). The competition for economic resources resulted in accumulation of power and wealth in the hands of a few relegating the rest of the society to a life of poverty, powerlessness and misery (Heron, 2008).  The experience of social and economic inequality was replicated in almost all countries during the course of modernization. Economic prosperity was indeed a desirable outcome of industrialization, precisely because it made possible almost universal demand for long life and improvements in material consumption (Negoita, 2006). However, for many who were excluded  from gaining access to economic opportunities , there was a manifold increase in the risk of feeling worthless, and losing their identity as a human being.  In a dynamic market the risk of poverty swept over different groups (especially powerless groups) at different times and different locations (Oswell, 2012). It was necessary to seek security against losing human identity in the face of recurring economic and political calamity. This gave impetus to the development of a set of social, economic, political and inalienable individual rights, now referred to as human rights (Harrelson-Stephens and Callaway, 2007).

The concept of reproductive rights emerged only during the later half of the last century (United Nations, 1968). Just as industrialization ironically stripped citizens of their human identity, women’s control over their own bodies became political and contentious because of the demand for labor, fear of population explosion, and the almost universal presence of a patriarchal system which bestows selected males in a family with power and privilege.  Women’s lack of power within the family and exclusion from labor markets (and from the public in general) not only left them stripped of their identity as human beings but also made them vulnerable to the control and exploitation of their bodies (Kelly, 1989). It became necessary to protect women at two levels: reinstate their control over their bodies, and their identity as human beings.  Reproductive rights are human rights because they confer upon women the right to attain reproductive well-being as human beings first and as women second. 

In order to acquire a meaningful social space for reproductive rights, they have to be widely understood within the population and used selectively to protect and meet current and potential needs and desires with respect to reproduction all through a woman’s life course (Risman, 2004). However, the ability to assert rights is contingent on two essential pre-conditions: the presence of freedom and autonomy.  Though there are many definitions of freedom, Sen (1999) proposes a liberal and inclusive view of freedom as involving  improvements in individual level capacities (for example education)  to meet one’s wants and desires in the presence of institutional support structures that  are supportive (Spijkers, 2009). Autonomy on the other hand implies an environment free of coercion in which individuals are free to make decisions. In the context of reproductive rights, autonomy is indicated by a capacity for self determination as well as the ability to control one’s own body (Degener, 1990). However, the capacity to make decisions may depend upon access to valuable resources. Such dependencies point to the importance of interrelationships among socio-economic factors, resources and individual level attributes such as autonomy. In general then, reproductive rights cannot be sustained in the long run unless there are institutional level transformations that are designed to provide services to individuals, efficiently and unbiasedly (Blum, 1991).

About a decade after its origin at the International Meeting on Women and Health in Amsterdam (1984), the scope of the term ‘reproductive rights’ remained limited to state actions against women's reproductive well-being. The 1993 World Conference on Human Rights held in Vienna, and the 1995 Fourth World Conference of Women in Beijing, initiated a search for the structural basis for reproductive rights (Cook, 1993; Cook, 1995).. At a theoretical level, discussion on the structural causative factors of reproductive rights has focused on the influence of political and economic development. More recently, using Sen's (1999) perspective on development, few have suggested that social development through community organization and community development may facilitate reproductive rights. It is found that social development plays a significant role in promoting reproductive rights. This finding has implications for right-based approaches toward improving reproductive health. Reproductive health issues such as susceptibility to HIV infection qnd maternal and infant mortality can be tackled only when women are empowered to demand and utilize their rights to protect their children and themselves.  Programs that target lessening social inequality and improving telecommunication are likely to promote levels of reproductive rights in developing countries.

Several studies (Pillai and Wang, 1999a; Pillai and Wang, 1999b) have found that increases in levels of reproductive rights have a positive effect on reproductive health. The importance of reproductive rights for reproductive health has recently been highlighted by consequences of the 'gag rule' promulgated by the Bush administration. The 'gag rule' restricts non-governmental organizations in developing countries where legal abortion is permitted from receiving US assistance for reproductive health services if they perform abortions. Consequently, several health clinics which provided reproductive health in countries such as Bangladesh, Kenya, Zambia and Tanzania have closed their doors. In Uganda, the consequences of the rule have been felt in terms of the deceleration in the rate of decline in HIV prevalence rates during the last decade. The importance of reproductive rights as a component of human rights for health has also been more recently promoted by several gay and lesbian groups.

Among the several social structural factors that influence reproductive rights, gender equality is of great importance (Pillai and Wang, 1999c; Pillai and Wang, 1999d; Pillai and Wang, 1999e).  The role of gender equality in improving women's reproductive health has been widely recognized both at the theoretical as well as policy level. The third Millennium Development Goal is to "Promote gender equality and empower women.” Improving reproductive rights is an aspect of empowerment. But in order to assert reproductive rights, a number of other rights which enable women to exercise their reproductive choices have to be present. They have to be presented with realistic opportunities to gain access to social and economic resources. Improving gender equality and lessening power imbalances with men is an integral part of achieving reproductive rights. Thus the Millennium Development Goal explicitly recognizes the relationship between reproductive rights and gender equality. The Millennium Development Goal aims at achieving gender equality and reproductive rights, even though the term 'reproductive rights ' is not explicitly used. It is couched in the term 'empowerment'. Several studies have found that gender equality has a positive and significant effect on reproductive rights (Pillai and Wang, 1999d; Pillai and Wang, 1999e).  Even though the Millennium Development Goals bundles up both gender equality and empowerment, gender equality is not only associated with empowerment but also has a causal effect on reproductive rights.

Two broad social-structural factors influence the level of gender equality. Economic development and democracy have significant positive effects on levels of gender equality. Pillai and Gupta (2011) suggest that equality is not possible until women are empowered to recognize their needs as democratic citizens. One of the most important preconditions for the growth of gender equality is the emergence of democracy (Wang and Pillai, 2001a; Wang and Pillai, 2001b).  Development of democratic institutions facilitates the process of institutionalization of the activities of interest groups advocating for gender equality and gender mainstreaming. Subsequently, democratic societies are more likely to seek reproductive health goals through cooperative strategies (Sen, 1997). Research on Africa and Latin America indicates that the democratization process generally facilitates a broad-based gender equality agenda and opens avenues for women to negotiate for independence and initiatives for social change (Pillai, Gupta and Jayasundara, 2005; Pillai and Sunil, 2002).

Economic development appears to influence reproductive health through gender equality. Gender equality is an important outcome as it is mediates the relation between economic development and economic rights (Pillai and Johnson,  2007; Pillai and Gupta,  2006). Improvement in economic opportunities through economic development improves women's access to jobs. As women acquire a large share of the jobs, parents are more likely to invest in their daughter’s education (Acholla and Pillai, 2000). Economic development is also likely to improve basic infrastructure such as availability of water, transportation, and electricity which increases the time available for a girl’s education (Pillai and Sunil, 2004). Economic development also improves people's attitudes toward gender equality. As economic development increases, the proportion of the population that considers gender inequality as undesirable also increases (Pillai and Gupta, 2011; Pillai and Johnson. 2010).
 
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Vijayan K. Pillai, Ph.D. &  FangHsun Wei, Ph.D
School of Social Work, 211 South Cooper Street, University of Texas at Arlington, Arlington, Tx 76019, U S A.