In this guest post Maria Pawlowska presents the story and ideals behind the use of a human rights framework in health. Maria establishes the importance of using a human rights framework to guide reproductive health policies by tracing its implications from the global to the individual level.
In the early 1990s the late Jonathan Mann and Daniel Tarantola left the WHO Global Program on AIDS. They helped establish the unit just a few years before, however they now felt they disagreed with the way the program was run and the philosophy that motivated its actions. Tarantola and Mann found academic “refuge” at Harvard and began thinking about the most effective framework for dealing with the AIDS epidemic. The epidemic is now known as the one “that changed public health forever”. One of factors behind this dramatic sea change was the framework Mann and Tarantola developed. Although they were both qualified physicians, it didn’t take long for them to realize that HIV/AIDS needs to be treated with new drugs, but equally importantly the patients need to be guaranteed respectful treatment and honoured of their dignity as human beings. After some trial and error Mann and Tarantola decided that the Universal Declaration of Human Rights (UDHR) is the best theoretical basis for an effective fight against AIDS forward.
And so the discipline of health and human rights was born. Today it is a thriving area of research and clinical as well as legal practice with increasing numbers of institutions and countries incorporating a rights-based approach to health.
The core idea behind health and human rights is that the best public health programs respect the human rights of the population involved. Unfortunately, I do not have the space here to go into too many details, but the WHO provides a good introduction for those who may want to know more. In just a few words, incorporating a rights-based approach to health means treating patients with the dignity they deserve and respect for their choices and decisions. I’ll take a closer look at this now, with the example of a rights-based approach to reproductive rights and health.
It is important to realize that these concepts are not just subjects of academic discussion and taglines from WHO leaflets. They are the forces driving policies and ultimately the healthcare we are delivered in the doctor’s office. This may be hard to believe: probably the first things that come to mind when discussing human rights violations in the context of reproductive rights are coercive reproductive policies such as China’s one-child rule. Governments which force citizens into unwanted abortions are obviously violating a number of human rights. Similarly, it is clear to most of us that countries which delegalize homosexuality or criminalize it are also guilty of human rights violations. But the situation really isn’t always that obvious. What about governments which delegalize abortion (e.g. Malta)? And governments which do not provide access to evidence-based sexual education (e.g. Poland but also the US)? Governments which force mandatory HIV/AIDS status tests on sex workers (discussed in a number of countries and regions)? What about doctors who do not want to prescribe contraceptives to under-18s (again, many places around the world)? Or on a more personal level, has any doctor ever performed an examination – including (for those readers who have given birth) a vaginal examination during delivery – without your explicit informed consent? All these are in fact human rights violations according to a number of binding human rights instruments (the UDHR is not the only basic human rights document, although it is the only one with the term ‘human rights’ explicitly embedded in it – a full list of the important international documents can be found here).
We tend to imagine that breaking human rights involves wars, refugee camps, power-obsessed dictators and lunatic warlords. In fact, human rights violations may be happening in your oby/gyn office or at the GPs. For example, The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted in 1979 by the UN General Assembly, clearly states that access to evidence-based sexual education and contraception is a basic human right. CEDAW should be informing policy-makers around the world. However, as is too often the case we lag far behind the ideal. I’ve recently written about the pretty bad condition Polish citizens’ reproductive rights are in. But we needn’t look to emerging post-communist countries to find examples of human rights violations in regards to reproductive health. For example, the U.S. Department of Health and Human Services announced only last month that insurance will now have to cover several women’s preventive services, including birth control and voluntary sterilization. Prior to that contraceptives required a considerable co-pay, which barred many lower income women from accessing them. Moreover, according to the leading reproductive health research body The Guttmacher Institute: A total of 36 states require that sex education include abstinence, while only thirteen states require that the information presented in sex education classes be medically accurate and factual. And just a reminder: access to contraception and evidence-based information about sex is considered a human right according to CEDAW!
In this (very brief) outline I hope to have communicated that human rights really aren’t a bunch of idealistic phrases written down for the benefit of victims of violent conflicts. Human rights come into every aspect of our lives and definitely with regards to health – particularly an issue as intimate and politically charged as reproductive health. The take-home message really is this: the human rights framework guarantees that we should be the ones making choices, and they should be informed ones. The role of the state is to aid us in this and not encroach on our decisions about our sexuality and reproductive activity.