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."
