When I give presentations about my class on "Critical issues in International Women's Health"
I often ask an audience what issues they think
should be covered in such a course. The first answer that the audience
always gives is "maternal health"
or "family planning" or "birth control." And I'm pleased that they respond that way
because then I can tell them that issues of maternal health
and birth control are what people always used to think of
when they thought about "international women's health,"
If you go to the text books on international or global health that we
used when I began teaching this course,
back in 2001, you may look in the index
under "women," and it will guide you to one section in the book:
the chapter on maternal and child health. For many people,
until quite recently, International Women's Health meant
maternal and child health. The terminology for the topics
that are included within this vast field has changed over the past 20 years.
An overview of the field of reproductive health and rights
illustrates how recently women's health and sexual rights
have been recognized as worth studying or including
on international policy agendas.
During the 1970s, reproductive health issues were part of discussions of
population control in the context economic development.
The term reproductive rights was not commonly used until the late 1980s.
A crucial moment in the shift from a development approach
to a human rights approach happened at the United Nations Conference on
Population and Development,
held in Cairo in 1994. At that conference
almost for the first time, the idea that women have the right to determine their
own reproduction
was clearly stated in international documents.
The idea of reproductive rights was further refined in Beijing at the fourth
United Nations Conference on Women
in 1995. The Beijing
document confirmed women's equal rights in sexual relationships.
This was the first instance in a UN document to mention women as sexual
as well as reproductive beings. Now our discussions of women's health include
many issues having to do with both reproductive health
and rights. This is a vast field.
Issues of maternal health and reproductive and sexual health are of prime
importance to women,
and we take these up during this week. A week is an impossibly short time to
cover such issues
but we will plunge in and try to highlight those that are critical
when we are speaking about reproduction and maternity. Keep in mind that the issues
that I highlight during this week
are those that women themselves were concerned about when they wrote to the
Global Fund for Women
about their work in their own countries. Harking back to last week when we were
speaking about adolescence,
let me first highlight a serious issue that affects young women in particular:
It is early marriage and early childbirth. Giving birth before the age
of 18, which many girls do around the world,
is not as safe as giving birth after that age.
Each year around the world about 350,000 women die
of almost completely preventable illnesses and injuries related to
pregnancy and childbirth.
Maternal mortality among girls under 18 is between
two and five times higher than among those over 20.
Motherhood has been glorified for centuries as a noble goal,
and yet the means to ensure that women can be healthy mothers
continues to be denied to the majority of women around the world.
This happens primarily in resource-poor countries,
among poor women. Ways to avoid maternal mortality are known
but not equally shared around the world. Mahmoud Fathalla, an obstetrician in
Egypt who has written eloquently on the subject of maternal mortality
and in his career has probably saved hundreds of thousands of women,
writes: "The basic reason why maternal mortality has been neglected
is that it is a woman's problem in regions where women
do not enjoy high social status.
It is a question of how much mothers are worth."
