Investing in women: a human rights approach

At Women Deliver, a message is extolled throughout the dozens of sessions, plenaries, panels and press conferences: “Invest in women and girls, it pays.” This simple message, however, has several layers of subtext. Many of the conference’s attendees are emphasizing the broader concepts that underpin it – one of the great takeaways of this conference, at least in my mind, is that it will take more than an additional $12 billion to ensure that women and girls around the world are able to fully realize their rights. Among these concepts, is the notion that women’s s rights are, first and foremost, human rights.

I listened to Mary Robinson, the former President of Ireland, former United Nations High Commissioner for Human Rights and current president of Realizing Rights: The Ethical Globalization Initiative,  speak about the importance of framing maternal health with a human rights approach. She eloquently articulated the need for a holistic human rights approach towards the issues affecting girls and women. Robinson noted that so much of what we talk about when we talk about improving maternal health and reproductive rights is related to broader, human rights issues: access to health care and family planning, nutrition, religious and cultural dimensions, discrimination, domestic violence, early childhood marriages, to name a few.

And indeed, there is a very strong case to be made for envisaging maternal health as a broader human rights issue. Ever since the 1994 United Nations International Conference on Population and Development in Cairo and the 1995 Fourth World Conference on Women in Beijing, women’s rights are being increasingly framed as human rights. This is critical because it can help circumvent the barrage of opposition typically put up by conservative groups. Religious leaders, right-leaning or traditional family-oriented groups have all at some point or another been antagonistic to the notion of women having control of their bodies and fertility.

I attended two panels today where this point was driven home very vividly. First, was the panel entitled “Delivering Solutions at the Margin: Reaching the Hard to Reach”. The conversation, which was moderated by Mary Robinson, featured several activists and advocates for women’s rights in vulnerable environments. One speaker, Martha Sanchez, who works for organizations advocating the rights of indigenous women in Central America and Mexico, spoke powerfully on this issue. She explained that issues related to indigenous women’s rights and maternal health were often circumscribed by structural discrimination and stigma. Dealing with this marginalization requires a holistic approach: you cannot look at maternal health in a silo: it belongs to a much broader picture of persistent inequity and unequal access.

In the same vein, Malika Saada Saar, president of the Rebecca Project for Human Rights,  spoke of the oft-forgotten American women who are not able to avail themselves of their rights. Specifically, Saar discussed the case of pregnant women in U.S. prisons who are shackled when they begin labor, and until after they deliver their baby. Often, these new mothers have to breastfeed their newborns while still shackled, and then have to deal with the trauma of having their children taken away from them and put into foster care. She spoke movingly about how this “drachonian practice” is, in effect, depriving women of their rights and is tantamount to “cruel and unusual punishment”, thus establishing the link between women’s rights, human rights and legal protection.

Fulfilling Millennium Development Goal 5 (reducing maternal mortality by three quarters and ensuring universal access to reproductive health) is not just an issue of financing programs that build clinics, train health workers, and provide services. It is an issue of fair, transparent, equal and indiscriminate access. Maternal health and reproductive rights are also fundamentally part of a broader narrative of respecting and promoting human rights. There are several international legal instruments which should, in theory, guarantee women’s rights.

The Convention on the Elimination of Discrimination Against Women (CEDAW) is one of those treaties which, in theory, were it fully enforced, would ensure (among other things) that women would have safe and equal access to health care. Regarding maternal health specifically, Article 12 of CEDAW states that”States Parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.”

“Human rights are women’s rights and women’s rights are human rights” is the rallying call for those who advocate for a comprehensive approach that tackles the complex, multi-dimensional issue of maternal health and reproductive rights. In her concluding remarks at this afternoon’s panel, Mary Robinson spoke of the need to be proactive in dealing with the barriers that “dehumanize us.” She urged attendees to “go beyond the statistics”, to really look at whether people at the margins are being reached and their needs, addressed.

Poverty, inequality and discrimination are among some of the structural barriers that need to be done away with in order for not just MDG5 to be achieved, but also the full spectrum of women’s rights to be realized.

H1Nwhat?

Ever since I got back to France a couple of weeks ago, two hotly debated news stories have caught my attention. What I love about the French is that they take the gloves off when it comes to discussing issues, and listening to both sides has been rather fascinating. One of these issues is the “debat sur l’identite nationale” (“debate on national identity”), which is an attempt by the Minister of Immigration, Integration, National Identity and Solidary Development (a real mouthful) to (re)define the tenets of French national identity. That’ll be the topic of another post. For now, suffice it to say that it’s highly contentious and has opened the door and given credence to racist and intolerant comments in the media and the political arena.

The other issue that I’ve been following with a lot of curiosity is the kerfuffle around H1N1. After having spent two months in Liberia where H1n1 is not at all discussed, I came back to a country where the Minister of Health, Roselyne Bachelot, had made the decision to purchase 94 million doses of Tamiflu to innoculate the French population. First of all, given that there are only 63 million citizens, the 94 million figure seems excessive. Apparently, the French authorities were told that those who get vaccinated must get more than one shot, hence the incredibly large order of Tamiflu – except that, oops!, you actually only need one dose. France has apparently purchased 1/3 (one third!) of all Tamiflu stocks in the world, for a mere 870 million euros (1,250,000,000 USD). Now, the French are trying to cancel part of their order to four different pharmaceutical companies, hoping to save 350 million euros. The government is also selling off their overstock abroad – but given that the epidemic’s peak has apparently been reached, they are having a hard time finding customers for their second hand vaccine.

French Health Minister Roselyne Bachelot, having a jolly good time receiving her dose of Tamiflu

The government has come under fire for inflating the threat posed by H1N1, and responding inappropriately. Many opposition figures are calling the government’s handling of H1N1 “scandalous” and a waste of public funds. Sarkozy’s Foreign Affairs Minister, loud-mouthed Bernard Kouchner, claims that he is “scandalized by the scandal”, and that if the government had not taken the epidemic seriously and people had died of H1N1, then the criticism would have been (legitimately) much stronger. President Nicolas Sarkozy defended the Health Minister’s decision by saying that 219 people died of this flu in 2009, and that his government couldn’t make it a banal issue. Fair enough. But let’s do some simple math. First of all, 94 million vaccines for 870 million euros is unbelievably expensive – nearly 10 euros (15 USD) per dose. Really?! What’s the production cost of this vaccine? And if it’s critical to global public health, shouldn’t the pharmas make it slightly more affordable? (I know the answer to that question – I mean it rhetorically). Alternatively, couldn’t France have negotiated these prices a little bit more? Sweet deal for the pharmas.

219 deaths from H1N1 in 2009….and between 1,500 and 2,000 deaths from the “regular” flu every year, in France. 2.5 million people suffer from the flu each year in the country. In fact, the flu is the number one infectious disease in France. Now, are we spending even a fraction of what we’re spending on H1N1 to fight the “regular” flu? No. I honestly have no idea how the government can justify spending nearly one billion euros on this new strain of flu. The flu is a perennial disease, and it’s a constantly evolving infection. Perhaps we should spend a fraction of the 870 million euros on strengthening health systems, particularly prevention activities among the vulnerable: the young, the elderly, pregnant women and (gasp!) poor people.

Each year in France, HIV-AIDS kills 1,700 people and there are more than 5,000 new infections. Why aren’t we spending hundreds of millions of euros stopping the spread of this incurable disease? Infectious disease causes only 2% of deaths in France – why not focus on the real killers?

A recent motion in the European Parliament reads:

“In order to promote their patented drugs and vaccines against flu, pharmaceutical companies have
influenced scientists and official agencies, responsible for public health standards, to alarm governments
worldwide. They have made them squander tight health care resources for inefficient vaccine strategies and
needlessly exposed millions of healthy people to the risk of unknown side-effects of insufficiently tested
vaccines.

The “birds-flu“-campaign (2005/06) combined with the “swine-flu“-campaign seem to have caused a great
deal of damage not only to some vaccinated patients and to public health budgets, but also to the credibility
and accountability of important international health agencies. The definition of an alarming pandemic must
not be under the influence of drug-sellers.

The member states of the Council of Europe should ask for immediate investigations on the consequences at national as well as European level.”