Framework Convention on Global Health (FCGH) – a blog in response to the May 18 Geneva meeting minutes
24/09/2013 Comments Off on Framework Convention on Global Health (FCGH) – a blog in response to the May 18 Geneva meeting minutes
A blog by Marge Berer, Editor Reproductive Health Matters. Originally posted on the blog of JALI – the Joint Action and Learning Initiative on National and Global Responsibilities for Health
I asked JALI if I could write a blog after I had read the minutes of the May 18 meeting in Geneva on the way forward for an FCGH, to raise some issues that I’ve been confronting in the seemingly endless consultations and statements circulating on the internet on the post-2015 world – to do with what an MDG replacement would look like, whether or not universal health coverage as currently conceived is the answer to how to address health, and whether and where my issues of sexual and reproductive health and rights might fit into the “Sustainable Development Goals”, the most likely successor to the MDGs, when they have had such short shrift in the MDGs.
I was particularly struck by the paragraph on the two animating principles of a Framework Convention on Global Health mentioned in the minutes, that is, ‘global health equity (within and between countries) – “global health with justice,” as offered by Larry Gostin – and the right to health… setting clear standards to make it more concrete, measurable, and enforceable… addressing global governance for health… shifting international law towards health. It would ensure for all people the conditions required for health, including health care, public health, and social determinants of health, setting standards and establishing a national and global financing framework to enable universal access to and coverage of health care and public health measures (e.g., clean water, sufficient nutritious food)… directly address domestic inequities…[and] promoting Health in All Policies.’ (pp.2-3)
Just as people in the meeting raised the fact that some participants in the FCGH process required more explicit attention, e.g. health workers and health worker unions, as did some issues, e.g. mental health, I would like to raise three aspects that I think need to be part of the FCGH discussions:
i. Gender issues – that is, the differences between men and women in their health needs, their access to health and health care, and the inequities in that differential access. Gender issues in relation to health are crucial to any convention. There has been a lot of work by women’s health advocates on gender issues in relation to women’s health but far less work by either men or women on gender issues in relation to men’s health. In the same ways as girls’ and women’s health issues were at one time almost invisible in the previous century, attention to boys’ and men’s health issues has not been developed in the past 30 years, in spite of the growing attention to women’s health issues and wide-ranging work on gender, both in academia, by the women’s health movement and even in WHO. In a recent paper I was considering for publication, for example, it was said that gender-based violence against women was the most common form of violence, when in fact men experience far more violence globally overall, but between each other, whereas women experience violence mostly from men. Thus, work is needed on how to address gender issues within an FCGH in relation to the right to health, the social determinants of health, health financing, etc, and how this might be approached needs much more thought and consideration.
ii. Religious, political and “cultural” opposition to what an FCGH would stand for, being used most vocally today to justify why access to crucial aspects of health and health care related to sexuality and reproduction are being withheld and denied, and many sexual and reproductive rights condemned and criminalised. Underlying this opposition are two forms of hate: misogyny and hatred of any form of sexuality that is not heterosexual and heteronormative.
One of the reasons I support a Convention is that it would give greater weight to all these issues by requiring not only non-discrimination and equality, but also regular examination, analysis and critique of country programmes, along with official recommendations for policy and programmes, and demands for accountability and action through interpretation of the implementation of the convention. We are beginning to see such a framework making a difference in relation to sexual and reproductive rights issues, particularly via the work of CEDAW. So I recommend studying CEDAW’s history, functions, and procedures particularly and how they might be applied more broadly across health. I would be interested in being involved in this in the future.
iii. The process of developing the successor to the MDGs may cut out the few specific aspects of health and health care that were allowed into MDG 5, where they were mostly reduced to their lowest common denominator and stripped of their complexity, e.g. universal access to reproductive health was a late add-in to MDG 5, which never moved beyond superficial attention to a few aspects of reducing maternal mortality, diluted heavily by tacking newborns, infants and children onto “maternal” health, and omitting the great majority of interlinked sexual and reproductive health problems.
Universal health coverage in my opinion may also succeed in shortcutting and eliminating the “controversial issues” in whatever is included under a “unified health goal” post-2015, and it may also make support for addressing specific aspects of health equally or even more difficult. Having devoted two recent issues of Reproductive Health Matters to privatisation in sexual and reproductive health services, where articles provided evidence of a resulting increase in inequity of access to health care among the 4th and 5th socioeconomic quintiles of many African and Asian countries, I am worried that the health goal that is eventually agreed is likely to be biased one way or another towards consumerism, commercialisation and privatisation of health and health services, and their financial underpinnings such as health insurance. I am very uncertain of the value of what has emerged so far as regards universal coverage from WHO, given the pressure on the agency from the World Bank, big pharma, world trade policies, and the influence of private/foundation donors, when measured against what we would like to see as the basis for the Framework Convention on Global Health.
An unholy alliance: religion, neo-liberal economics and good old fashioned patriarchy – restricting women’s abortion rights in Eastern Europe
11/05/2012 Comments Off on An unholy alliance: religion, neo-liberal economics and good old fashioned patriarchy – restricting women’s abortion rights in Eastern Europe
A report from guest blogger Charlotte Gage on ‘How much does abortion cost?’ a session organised by ASTRA Central and Eastern European Women’s Network for Sexual and Reproductive Health and Rights at the AWID Forum in Istanbul.
I attended this session where speakers from Poland, Romania, Hungary and Slovakia outlined the economic dimension of sexual and reproductive rights in their countries, and the increasing restrictions on access to abortion.
Provision of abortion and other reproductive health services are under threat from neo-liberal economics which is increasingly restricting state-funded services throughout the region. This is being fuelled, by ideological opposition to abortion from both the Catholic and Orthodox Churches, sometimes with funding and support from US anti-choice organisations which is thought may include the US-based Human Life International and Opus Dei.
Most countries in the region have experienced reforms to health systems following democratic transition from Communism, but the results of these vary. The restrictive abortion laws in countries such as Romania and Albania under Communism were seen as a social experiment to increase the population and provide new generations of workers, and have since been relaxed. More recently however, Ukraine and Russia have tried to implement restrictive laws, to reverse a decline in population.
The influence of religion varies throughout the region. In Poland the Catholic Church still has a strong influence, and as its access to public resources increases, through provision of adoption services, it has a vested financial interest – as well as ideological one to opposing reproductive rights. In other countries it is the influence of, and funding from, the US anti-choice movement that is driving forward an anti-choice agenda.
The increasing reluctance by governments to pay for contraception and abortion services is also having an impact.
In Hungary, an advertising campaign in which images of fetuses asked not to be murdered was funded by PROGRESS EU funding – a fund aimed at supporting equality. The Government was forced to stop the campaign after feminist organisations complained to the European Parliament.
In tandem with ideological tactics aimed at creating attitudinal change, the budget for reproductive health in Hungary, which supported women who could not afford to pay for an abortion, has been significantly reduced with no explanation. Women seeking home birth are subject to unaffordable insurance premiums and in one case a midwife has been imprisoned for supporting a woman to give birth at home. For PATENT – People Opposing Patriarchy these were all cited as examples of the continued repression of women’s reproductive rights in Hungary, patriarchy in action, and the denial of women’s autonomy.
Freedom of Choice, Slovakia, has campaigned against the lack of unbiased and accurate information on family planning. It also takes on the influence of the Catholic Church hierarchy which is opposing progressive policies such as inclusion of more information in school textbooks and making contraception more affordable.
The Polish Federation for Women and Family Planning described how in 1993 Poland became the first country in Eastern Europe radically to restrict abortion and is now, regrettably, serving as a model for other Governments in the region. Official figures show just 600 abortions were performed in Poland in 2010 (compared to 8,000 in 1989), but this figure hides the large number of privately performed abortions and those provided to Polish women abroad.
In many of the countries it is the actual cost of abortion for women that creates the main barrier to accessing services. Women on low wages sometimes pay the equivalent to the average monthly wage for an abortion. In Slovakia, where there are no state controls on the maximum price of contraception, prices are rising and contraception is becoming unobtainable for many women. Moreover, across the region professional resistance to medical abortion combined with high costs means women are denied the option of choosing this extremely safe method of abortion.
An interesting response to the economic and ideological squeeze on abortion access came from a speaker from the Romanian organization European Centre for Public Initiatives (ECPI) which said that Romania has not yet fully learned the lessons from its past. Though the liberalisation of abortion in Romania has led to significant reductions in maternal mortality there have been recent attempts to restrict and limit abortion in Romania, including proposing mandatory (biased) counselling and a three day waiting period before a woman is able to have an abortion.
ECPI believes that calculating the financial benefits of providing reproductive health care may be a powerful tool in opposing further restrictions. To this end, it is attempting to estimate the full cost of unsafe abortion including: the health care costs following unsafe procedures; social costs including sick leave and disability benefits if the woman is injured; the costs of childcare if the woman dies; and violence against women services for those who experience violence following abortion.
It may ‘leave a bad taste in the mouth’ to try to put a monetary value on women’s lives, but in the face of ideological opposition to women’s reproductive autonomy, and governments’ focus on cutting budgets, it might be the most powerful argument we can make.
With thanks to Katarzyna Pabijanek – ASTRA Network Coordinator