‘Understanding Abortion as a Right’ ASAP workshop report

'Understanding Abortion as a Right'

The Asia Safe Abortion Partnership (ASAP) organized its first workshop on 'Understanding Abortion as a Right'. This was held from 18th -20th March 2009 at Hotel West End, Mumbai, India .

Why focus on Rights, Human rights, Gender, Ethics and Sexuality issues ? Each year, nearly 70 million women have unwanted pregnancies. The impact of these pregnancies varies immensely and depends upon factors such as a woman's health, family relationships, economic resources, and the availability of medical care. These and other factors influence her decision to either carry this pregnancy to term or seek an abortion. Given the complexity of this decision, the only person equipped to make it should be the pregnant woman herself. However, it is an unfortunate truth that that the women themselves as well as the service providers are rarely aware of rights of these women.

A woman who needs an abortion must have access to the appropriate facilities and care that will enable her to terminate the pregnancy safely. It is very important for the women and the Government to recognize and respect a woman's human right to make decisions regarding her reproductive life and make safe abortion services available to her. Many countries are signatory to various international convenants which are supposed to safeguard various human rights and reproductive rights for their citizens but in reality these rarely get effectively implemented.

There is a strong need for the capacity building of advocates at various levels to ensure that the gatekeepers can facilitate access to safe abortion services keeping the rights based framework in mind. Even in countries with restricted access due to the local law, there is always a provision for abortion to save the woman's life, or in case of rape. There is also a need to expand access to safe abortion in these countries, but the advocates should also find a way of optimal utilization of existing provisions by using the rights based approach.

The aim of this workshop was to unpack the relationship between human rights, women's rights, gender, sexuality and ethical issues related to and impacting upon safe abortion. We hope to gain a deeper understanding that reducing unsafe abortion is a complex multilayered process which includes not only increasing women's access to safe service delivery but also needs to address the more complicated issues of rights, gender power inequities, patriarchy and ethical dilemmas.

WORKSHOP OBJECTIVES

• To explore the concept and history of human rights, the evolution of women's rights and sexual and reproductive rights.
• To gain clarity on the basic international human rights instruments and their relation to human rights advocacy
• To understand the concept of the "human rights-based framework"
• To clarify values related to the issue of abortion
• To obtain an understanding of the way gender issues and sexuality issues impact on abortion
• To explore the dynamics of religious, social and political opposition
• To understand the impact of ethical issues and sex selection on safe abortion access

Some highlights and key discussion points emerging from the workshop:

Abortion is about a pregnancy that is unwanted and we need to understand what it is in society that makes a pregnancy unwanted:
• The pregnancy is not the problem, but the construction of society.
• We must understand the context within the society and the forces that do not allow the woman to have an abortion; and social context that forces a woman to have an abortion.( for e.g. an unwed mother cannot keep the child, her family will not accept her if she does so. )
• Social organization (Supremacy of the men / father)
• Legal dependence- Descent and inheritance in the male line.(Mother's name gets lost.)
• Male domination: all institutions ruled by men. Every institution governed by men. If a woman is raped she goes to a male policeman, a male lawyer, a male doctor.
• Gender roles may be transgressed at some point, but inheritance and descent belongs to the father, still patriarchy.

Human Rights are

• Universal
- But no one size fits all - abortion rights, contextualized.
- Cultural sensitive vs. cultural essentialist
• Intrinsic
• Inalienable
• Indivisible
• Inter-dependent
• Inter-related
• Non-hierarchical

Inter-sectionality exists even in human rights. One right strengthened or eroded impacts upon other rights. Also human rights are not exercised in a social, political, cultural or economic vacuum.
Needs and rights: needs and rights are inter-linked and inter-dependent, why then do need the rights-based approach?

Needs Based Approach Rights Based Approach

May or may not be met Enforceable by law

May fluctuate, can be arbitrarily decided or withdrawn Not arbitrarily but according to established principles and standards
Identified by provider - a client / patron relationship is established
Are negotiated and the bearer of rights has a say

May be reduced Dynamic and open to expansion - cannot reduce that right
Sense of benevolence Fulfilled because there is a "right"
No consequences to the provider if not met Consequences in terms of accountability to mechanisms and remedies for claiming rights

Non-fulfillment becomes crucial only when needs of a large section of society are affected Violation of a single individual's rights is a "wrong"

Reproductive rights are rights relating to reproduction and reproductive health. The World Health Organisation defines reproductive rights as follows:
"Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence.

The contentious issues evolved from the discussion related to Reproductive Rights were as follows:
• Worldwide, issues related to reproductive rights are some of the most vigorously contested, regardless of the population, religion or culture.
• Reproductive Rights may include some or any of the following rights:
- Safe abortion
- Control reproductive functions
- Access to quality reproductive healthcare
- Right to Education and access to make reproductive choices free from coercion, discrimination and violence
• Reproductive Rights may also be understood to include education about contraception and Sexually Transmitted Infection and freedom from coerced sterilization and contraception, protection from gender- based practices such as female genital cutting (FGC) and Male Genital Mutilation (MGM).

The ICPD Definition of Reproductive Health.

• Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes.
• Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.
• Implicit in this last condition are the right of men and women to be informed [about] and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant

From Reproductive Health to Reproductive Rights [Beijing Platform (4th World Conference on Women, 1995)]
• What is the difference between Reproductive Health to Reproductive Rights?
• Reproductive Rights established a broader context of reproductive health
• Approaching from a human rights discourse, not solely on health
• Reproductive Rights as "indivisible, universal and inalienable human rights"
• Not doing things allowed by law, but points out to things that need advocacy and may need to go ahead and change the law.
• Shared responsibility for sexual behavior and its consequences e.g male participation in family planning, condom usage; Men's role in reproduction

Control over reproduction is a basic need and a basic right of all women. It is linked to women's health and social status, as well as the powerful social structures of religion, state control and administrative inertia, and private profit. It is from this perspective that the right can best be understood and affirmed. Women know that childbearing is a social, not a purely personal phenomenon.
The thought that was put forward was "Under no circumstance, will you have a child without getting married; and once married, under no circumstances, should one not have children."

Declaration of Sexual Rights brought into light some important points.

• Sexuality is constructed through the interaction between the individual and social structures.
- Social structures: social norms about how social relationships are carried out.
- Lesbianism and homosexuality
- Caste, class, race, marital status
• Right to sexual freedom
- Sex with children - impinges on sexual freedom of children from sexual coercion
• Right to sexual autonomy, sexual integrity, and safety of the sexual body
• Right to sexual privacy
• Right to sexual equity
- Right of all people including those who are emotional disability.
- Dilemmas about intellectual disability
• Right to sexual pleasure, to emotional sexual expression, to sexually associate freely
• Right to make free and responsible reproductive choices, to sexual information based upon scientific inquiry
• Right to comprehensive sexuality education
- Children require different kinds of education at different times;
- Need not be told the whole truth, but only about the truth
- Sexuality education not wanted for many reasons
• Young people start talking about abuse
• Stay powerful is to keep the knowledge to yourself
• Right to sexual health care

Values session outcomes:

• Under no circumstance can we sacrifice women's right to safe abortion.
• Right gets more expansive rather than more restrictive.
• Rather than having a needs based approach we must have a right based approach
• Abortion cannot be seen in the absence of other reproductive and sexual rights.

Gender roles are reflected in the family structures, household responsibilities, labour markets, schools, health care systems, laws, public policies. The influence of gender is similar in strength to religion, race.

Power is a broad concept that describes the ability or freedom of individuals to make decisions and behave as they choose to behave. It is a person's access to resources and ability to control them.

Two Power types describe the inequities: "power to" and "power over".

"Power to" describes the ability of individuals to control their own lives and to use resources for their own benefit

"Power over" means that individuals can assert their wishes, even in the face of opposition, and force others to act in ways that they may not want to.

But one has to remember that the differences in power between men and women are not absolute or universal.

• Some poor, illiterate, unemployed, or homosexual men have little power and few resources.
• Women's gender roles are more limited and influenced by: her culture; age; income and education

Masculinities:
• The term relates to perceived notions and ideals about how men are expected to behave in a given setting
• The term conveys socially constructed definitions for being a man and that these can change over time and from place to place.
• Collectively constructed through interaction within cultures, groups and institutions such as classrooms, factories, the military, sports clubs and the mass media.
• Men believe that their privilege and power are natural, normal and just--simply the way the world works. for eg violence, extramarital affairs.

What is a value?

• Anything that we consider good or bad: Particularly for women, how they should conduct themselves, based on which the society will decide whether she has good or bad behaviour.
• Shared cultural standards: People from different cultures expect men or women to behave in a particular way as their culture demands.
• Internalised cultural ideas: concepts and beliefs about a particular culture get set because they are internalised.
• Common and specific morality: Norms about right and wrong that are so widely shared or appear to have social consensus.
• Some common values across the culture: Morality is a universal sense and that is how there are certain common values followed by every culture.

Ethics and ethical behaviour in our social structure is based on these set values and morality issues and how that affects the rights of women for safe abortion. The definition of ethics therefore is 'Ethics is a generic term for various ways of understanding and examining the moral behaviour or morality.' And hence, Ethics is a second order of systematic reflective consideration of our moral beliefs and practice.

Various standpoints related to abortion :

a. Conservative standpoints: religion does not support abortion. There may be people who may be opting for abortion and may still believe in the religious belief of aborting foetus is a murder. b. Liberal standpoints: Acknowledged that foetus in human biological sense but deny full moral status of it in the light of reproductive rights of the woman.
c. Moderate standpoints: Agrees with liberals that early abortion is not murder as foetus is not a living thing. Also discusses the issue of foetal viability and pressures on less second trimester abortions.

Concluding Statements:

The workshop helped us to link Human Rights (HR), Sexual and Reproductive Health (SRH) and rights to access to safe abortion. The workshop clarified for us that sexuality, power, patriarchy, gender and rights should be considered intrinsic to each aspect of programming, service delivery, education, communication and client- provider interactions and cannot not be compartmentalized.

Abortion cannot be made safe and legal without dealing with these issues. We understand that a rights based approach puts as much emphasis on the ethical and value-oriented aspects of a program as it does on technical skills.

We learnt that, most of the Asian countries have long standing cultural practices which abuse women's human rights and manipulate women's reproductive health and sexual rights and health for political purposes. We discovered that in some countries the Government may prosecute and punish women who have had abortions and penalize women for exercising their basic rights. Through various examples the resource persons explained to us how these rights are further compromised when a woman who decides to terminate a pregnancy, does so only by undertaking a serious risk to her life and health.

Finally we state : without respect for women's human rights, gender equality and ethical practice, a women will always be at the mercy of others in making fundamental decisions, like whether and when to have sex or to have children or under go an abortion .

Applying a rights- based framework to the abortion services takes us several steps further, and establishes means of ensuring the accountability of programs to the population, and means of redress for violations of rights mainly where abortion is concerned.

Messages to take home:
1. We must first ensure that women's human rights are understood and access to safe abortion as an integral part of it.
2. We should look for ways that the public health and human rights communities can work together to promote women's reproductive and sexual health as a matter of right.
3. From the human rights and gender equality perspective, this means that we need to develop enforceable reproductive health norms and not just raise the language of rights.
4. Finally, it means that as advocates, we need to do more to understand and address the social justice dimensions of dealing with abortion issues and not just technical and access aspect of it.

******************************

A detailed report will be uploaded in the files section soon.