On Mar. 22, 2023, dozens of people watched a live broadcast from San José, Costa Rica, on a large screen at the University of El Salvador, in San Salvador, of the open hearing of the Inter-American Court of Human Rights, listening to the testimony of witnesses in the Beatriz v. El Salvador case. The screenshot shows Beatriz's mother giving her testimony. CREDIT: Edgardo Ayala/IPS

By Edgardo Ayala
SAN SALVADOR , Mar 24 2023 (IPS)

An open hearing in the Inter-American Court of Human Rights in the Beatriz v. El Salvador case is raising hopes that this country and other Latin American nations might overturn or at least mitigate the severe laws that criminalize abortion.

That will happen if the Inter-American Court rules that El Salvador violated the right to health of Beatriz, as the plaintiff is known. In 2013 she sought to have her pregnancy terminated because it was high risk and her life was in danger."I hope that in the end my daughter's name will be vindicated, and that what happened to her will not happen again to any other woman.” -- Beatriz´s mother

But she was not given an abortion, only a tardy cesarean section, which affected her already deteriorated health and, according to the plaintiffs, eventually led to her death in October 2017.

The hearing on the emblematic case was held Mar. 22-23 at the Inter-American Court in San José, Costa Rica. Beatriz’s case builds on similar ones: the cases of Manuela, also from El Salvador, Esperanza from the Dominican Republic, and Amelia from Nicaragua.

The seven judges heard the arguments of the plaintiffs, the representatives of the Salvadoran State and the witnesses on both sides.

After the hearing, the parties have 30 days to deliver their written arguments and the magistrates will then take several months to debate and reach a resolution.

The open hearing held by the Inter-American Court of Human Rights on the Beatriz v. El Salvador case is the first time that the complete ban on abortion has been tried, and the verdict will have implications for Latin America, a region that is especially restrictive in terms of women’s sexual and reproductive rights. CREDIT: Inter-American Court of Human Rights

A historic case

“I hope that in the end my daughter’s name will be vindicated, and that what happened to her will not happen again to any other woman,” Beatriz’s mother said when testifying on the stand. Her name was not revealed in court.

The hearing has drawn international attention because it is considered historic for the sexual and reproductive rights of women in a region that is especially restrictive with regard to the practice of abortion.

“This will be the first case where the Court will rule on the absolute prohibition of the voluntary interruption of pregnancy, particularly regarding the risk to health and when the fetus is nonviable,” Julissa Mantilla Falcón, from the Inter-American Commission on Human Rights (IACHR), told the Inter-American Court.

Beatriz turned to the IACHR when the Constitutional Court of El Salvador denied, on Apr. 11, 2013, her request for an abortion.

On Apr. 19, the IACHR issued a precautionary measure in favor of Beatriz, and on May 27, 2013, it asked the Inter-American Court to adopt provisional measures which would be binding on the State.

In its November 2020 Merits Report, the IACHR established that the Salvadoran State was responsible for the disproportionate impact on various rights of Beatriz, by failing to provide her with timely medical treatment due to the laws that criminalize abortion.

The IACHR identified the disproportionate impact of this legislation on Salvadoran women and girls, especially the poor.

The Commission stated that it did not expect full compliance by the State with the recommendations of the report, and therefore referred the case to the Inter-American Court, which now, ten years later, is a few months away from handing down a resolution.

Anabel Recinos, from the Citizen Association for the Decriminalization of Abortion, one of the Salvadoran organizations that are co-plaintiffs in the Beatriz v. El Salvador case, hopes that the Inter-American Court sentence will set a legal precedent and pave the way for the modification of the 1998 law criminalizing abortion under any circumstances in El Salvador. CREDIT: Edgardo Ayala/IPS

For her part, Anabel Recinos, from the Citizen Association for the Decriminalization of Abortion, one of the Salvadoran organizations that are co-plaintiffs in the case, told IPS that she hopes that the Inter-American Court ruling will set a new precedent.

She said her hope is that the court will rule that laws in El Salvador and the region banning abortion under all circumstances must be modified.

In addition to El Salvador, Honduras, Nicaragua and the Dominican Republic are the countries in the region where abortion is completely prohibited in their penal codes. It is only legal in five countries in Latin America, while it is allowed only in strict circumstances in the rest.

“Or at least it should be allowed for specific reasons or exceptions, such as safeguarding health and life, or the incompatibility of the fetus’s life outside the womb,” Recinos said.

Twenty Latin American and Caribbean countries recognize the jurisdiction of the Inter-American Court: Argentina, Barbados, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname and Uruguay.

The IACHR and the Court make up the inter-American human rights system. They are independent bodies and in the case of the Court the sentences are final and binding, although they are not always enforced.

Recinos spoke to IPS at the University of El Salvador, in the country’s capital, where dozens of people gathered to watch the hearing, broadcast live from San José, on a large screen.

The activist added that it is likely that the Court will rule against the Salvadoran State, backing the IACHR’s conclusions.

The Court is made up of judges Ricardo Pérez Manrique (Uruguay), Humberto Sierra Porto (Colombia), Eduardo Ferrer Mac-Gregor (Mexico), Rodrigo Mudrovitsch (Brazil), Nancy Hernández López (Colombia) and Verónica Gómez (Argentina).

In March 2003, Beatriz requested an abortion during her second pregnancy, because she suffered from lupus, an autoimmune disease in which the body’s immune system mistakenly attacks healthy organs, and preeclampsia, a dangerous increase in blood pressure during pregnancy, as well as other health problems.

In other words, her life was at risk. In addition, the fetus had malformations and would not live long at birth.

However, the medical personnel, although they were aware that an abortion was indicated to save Beatriz’s life, did not carry it out due to the fear of prosecution.

Beatriz was forced to continue with a pregnancy that continued to harm her health as the days went by.

But after the Inter-American Court granted provisional measures, Beatriz underwent a cesarean section on Jun. 3, 2013, almost three months after requesting an abortion.

The child, who was born with anencephaly, missing parts of the brain and skull, died just five hours later.

Activists for the sexual and reproductive rights of women in El Salvador demonstrate on Mar. 22 outside the Inter-American Court of Human Rights in San José, Costa Rica, during the hearing for the emblematic case of Beatriz v. El Salvador. Many carried green balloons, whose color is a symbol of the fight for the right to abortion in Latin America. CREDIT: Collaborating Organizations

Misogyny on the part of the State

Since 1998 El Salvador, this Central American country of 6.7 million inhabitants, has been the most drastic in the region in the persecution of abortion, punishing women who terminate their pregnancies with sentences of up to 30 years, in all cases, even when the life and health of the pregnant woman is at risk or in cases of rape.

The legislation mainly affects poor women in rural areas. According to data from women’s rights organizations, 181 such cases have been prosecuted since 2019.

Guillermo Ortiz, a gynecologist and obstetrician who specializes in high-risk pregnancies, testified before the Inter-American Court: “Yes, I saw many women die because they did not have access to a safe abortion, despite my having requested it.”

In her testimony, Beatriz’s mother said that the many doctors who treated her daughter had recommended that the pregnancy be terminated, but did not dare to perform an abortion or c-section to remove the fetus, for fear of going to prison.

“They told my daughter that they couldn’t, because in El Salvador it’s a crime, and if they did, they could go to jail,” said the mother.

“The State failed Beatriz twice,” said the mother, before breaking down in tears.

She was referring to the failure to carry out an abortion promptly, despite her daughter’s serious health conditions. She also was talking about a motorcycle accident that the 22-year-old suffered later.

“She had an accident that shouldn’t have been fatal, she was in stable condition” when she was admitted to the hospital in Jiquilisco, a municipality in the eastern department of Usulután.

But a storm caused a flood in some parts of the hospital, so they transferred her to the hospital in Usulután, the capital of the department.

“The doctor who treated her there didn’t even know what lupus was,” she said. In the hospital, Beatriz caught pneumonia.

The mother’s testimony and that of the other witnesses at the hearing has been closely followed in El Salvador and other nations by feminist and human rights organizations that have been monitoring and criticizing the country’s strict anti-abortion law.

A teenage mother and her toddler in Bonpland, a rural municipality in the northern province of Misiones in Argentina. Latin America has the second highest regional rate of early pregnancies in the world, after sub-Saharan Africa. Credit: Fabiana Frayssinet/IPS

By Fabiana Frayssinet
BUENOS AIRES, Jul 8 2016 (IPS)

In plain and simple language, an Argentine video aimed at teenagers explains how to get sexual pleasure while being careful. Its freedom from taboos is very necessary in Latin American countries where one in five girls becomes a mother by the time she is 19 years old.

“For good sex to happen, both partners have to want it and this is as much about being sure they want it, as about being in the mood or ‘hot’ with desire,” said psychologist Cecilia Saia who made the video “Let’s talk About Sex” (Hablemos de sexo), aimed at adolescents and preadolescents and posted on social networks.

The video was produced by Fundación para Estudio e Investigación de la Mujer (FEIM – Foundation for Women’s Studies and Research) as part of a Take the Non-Pregnancy Test campaign. It was also distributed to teenagers so they “would be able to take free and informed decisions about becoming mothers and fathers.” “Keeping children in the education system or bringing them back into it would be effective interventions to prevent teenage pregnancy. In the same way, creating conditions within the education system to ensure that pregnant teenagers or adolescent mothers can continue their education, would be another intervention with a positive impact” - Alma Virginia Camacho-Hübner.

During the campaign, teenagers of both sexes were given boxes similar in appearance to pregnancy test kits, containing information about teenage pregnancy and the myths surrounding how it is caused, as well as condoms and instructions on how to use them, Mabel Bianco, the president of FEIM, told IPS.

The campaign was broadcast on YouTube and other social networks, with candid messages in the language used by adolescents. “This meant we could reach a large numbers of 14-to-18-year-olds, an age group that such campaigns usually find hard to reach,” she said.

According to FEIM, in Argentina 300 babies a day, or 15 percent of the total, are born to mothers aged under 19.

“This percentage has shown a sustained increase over the last 10 to 15 years, and the proportion of births to girls under 15 years of age has also risen,” Bianco said.

Argentina exemplifies what is happening in the rest of Latin America, which is the world region with the second highest teenage fertility rate, after sub-Saharan Africa. The national rate in Argentina is 76 live births per 1,000 women aged 15-19 years, according to United Nations’ demographic statistics.

In order to call attention to this problem and to the general need to promote the equal development of women, Investing in Teenage Girls is the theme of this year’s World Population Day, to be celebrated July 11.

The United Nations Population Fund (UNFPA) states that one in five women in the Southern Cone of South America (Argentina, Brazil, Chile, Paraguay and Uruguay) will become a teenage mother, in an area where over 1.2 million babies a year are born to adolescents.

“Early pregnancy and motherhood can bring about health complications for mother and baby, as well as negative impacts over the course of the lives of adolescents,” says a UNFPA report about fertility and teenage motherhood in the Southern Cone.

The report says that “when pregnancy is unplanned, it is a clear indication of the infringement of teenagers’ sexual and reproductive rights and hence of their human rights.”

Alma Virginia Camacho-Hübner, UNFPA sexual and reproductive health adviser for Latin America and the Caribbean, told IPS that teenage pregnancy has implications for individual patients, such as maternal morbidity and mortality associated with the risks involved with unsafe abortions, among other factors.

Prematurity rates and low birthweights are also several-fold higher, especially among mothers younger than 15.

For health services, the costs of prenatal care, childbirth, postnatal care and care of the newborn are far higher than the cost of interventions to prevent pregnancy and promote health education.

“For society as a whole, from a strictly economic point of view, in countries that enjoy a demographic dividend, early motherhood represents an accelerated loss of that demographic dividend,” Camacho-Hübner said from the UNFPA regional headquarters in Panama City.

This is because “instead of increasing economic productivity by having a larger economically active proportion of the population, a rise in early motherhood causes a rapid rise in the dependency ratio, that is the proportion of the population that is not economically active and requires support from family or society,”she said.

The Southern Cone study found that dropping out of school usually preceded getting pregnant.

“Therefore, keeping children in the education system or bringing them back into it would be effective interventions to prevent teenage pregnancy. In the same way, creating conditions within the education system to ensure that pregnant teenagers or adolescent mothers can continue their education, would be another intervention with a positive impact,” Camacho-Hübner said.

In her view, teen pregnancy and motherhood are an issue of inequality which mainly affects women in lower socio-economic strata.

“It is teenagers from the poorest families and with the least education, living in underprivileged geographical regions, that are most prone to becoming adolescent mothers,” she said.

“Becoming mothers at an early age reinforces conditioning and the inequalities in the process by which teenagers who are, and who are not, mothers, effect the transition into adulthood,” she said.

“The main consequence of pregnancy is the interruption of schooling, although in many cases they have already dropped out by the time they become pregnant. But they do not go back to school afterwards because they have to look after the baby,” Bianco said.

“This makes for a poorer future, as these girls will have access to lower-paid jobs and will be able to contribute less to the country’s development. On the personal level, they will have to postpone their adolescence, they cannot go out with friends, go dancing and other typical teen activities,” she said.

Federico Tobar, another UNFPA regional adviser, said that “in addition to strengthening health, education and social services, there must be investment to promote demand, with interventions to motivate young people to build a sustained life project.”

“This involves incorporating economic incentives as well as symbolic remuneration, and also concrete childcare support for teenage mothers so that they can finish school and avoid repeated childbearing, which is frequently seen in these countries,” he told IPS.

Among other positive experiences, Tobar mentioned the Uruguayan initiative “Jóvenes en red” (Young People’s Network) which includes returning to school and work, and promotion of sexual and reproductive health.

“I believe it is important to invest in the education of teenage women, including comprehensive sex education and the capacity to decide whether or not they wish to have children. It is not a question of eliminating all pregnancy in adolescence, but of making it a conscious choice rather than an accident,” Bianco said. 

Edited by Estrella Gutiérrez. Translated by Valerie Dee.

In public hospitals in Costa Rica, like the Rafael Ángel Calderón hospital in San José, there is no protocol regulating legal therapeutic abortion, for doctors to follow. As a result, physicians restrict the practice to a minimum, leaving women without their right to terminate a pregnancy when their health is at risk. Credit: Diego Arguedas Ortiz/IPS

By Diego Arguedas Ortiz
SAN JOSE, Jun 24 2015 (IPS)

The lack of clear regulations and guidelines on therapeutic abortion in Costa Rica means women depend on the interpretation of doctors with regard to the circumstances under which the procedure can be legally practiced.

Article 121 of Costa Rica’s penal code stipulates that abortion is only legal when the mother’s health or life is at risk. But in practice the public health authorities only recognise risk to the mother’s life as legal grounds for terminating a pregnancy.

“The problem is that there are many women who meet the conditions laid out in this article – they ask for a therapeutic abortion and it is denied them on the argument that their life is not at risk,” Larissa Arroyo, a lawyer who belongs to the Collective for the Right to Decide, an organisation that defends women’s sexual and reproductive rights, told IPS.

“The problem isn’t the law, but the interpretation of the law,” said Arroyo.

She and other activists are pressing for Costa Rica to accept the World Health Organisation’s definition of health, which refers to physical, mental and social well-being, in connection with this issue.

Many doctors in public hospitals, unclear as to what to do when a pregnant woman requests an abortion, refuse to carry out the procedure regardless of the circumstances.

Illegal abortion in Costa Rica is punishable by three years in prison, or more if aggravating factors are found.

“It’s complicated because in the interactions we have had with doctors, they tell us: ‘Look, I would do it, but I’m not allowed to’,” said Arroyo.

Others say they have a conscientious objection to abortion, in this heavily Catholic country.

In Costa Rica, abortion is illegal in all other situations normally considered “therapeutic”, such as rape, incest, or congenital malformation of the fetus.

Activists stress the toll on women’s emotional health if they are forced to bear a child under such circumstances.

“Many women don’t ask for an abortion because they think it’s illegal,” Arroyo said. “If both women and doctors believe that, there’s no one to stick up for their rights.”

This creates critical situations for women like Ana and Aurora, two Costa Rican women who were carrying fetuses that would not survive, but which doctors did not allow them to abort.

In late 2006, a medical exam when Ana was six weeks pregnant showed that the fetus suffered from encephalocele, a malformation of the brain and skull incompatible with life outside the womb.

Ana, 26 years old at the time, requested a therapeutic abortion, arguing that carrying to term a fetus that could not survive was causing her psychological problems like depression. But the medical authorities and the Supreme Court did not authorise an abortion. In the end, her daughter was born dead after seven hours of labour.

The Collective for the Right to Decide and the Washington-based Center for Reproductive Rights brought Ana’s case before the Inter-American Commission on Human Rights (IACHR), as well as that of Aurora, who was also denied the right to a therapeutic abortion.

Her case is similar to Ana’s. In 2012, it was discovered that her fetus had an abdominal wall defect, a kind of birth defect that allows the stomach, intestines, or other organs to protrude through an opening that forms on the abdomen. Her son, whose legs had never developed, and who had severe scoliosis, died shortly after birth.

In 2011, the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) expressed concern that “women do not have access to legal abortion because of the lack of clear medical guidelines outlining when and how a legal abortion can be conducted.”

It urged the Costa Rican state to draw up clear medical guidelines, to “widely disseminate them among health professionals and the public at large,” and to consider reviewing other circumstances under which abortion could be permitted, such as rape or incest.

The international pressure has grown. Costa Rican Judge Elizabeth Odio, recently named to the San José-based Inter-American Court of Human Rights, said in a Jun. 20 interview with the local newspaper La Nación that “it is obvious that therapeutic abortion, which already exists in our legislation, should be enforced.”

“There are doctors who believe therapeutic abortion is a crime, and they put women’s lives at risk,” said Odio.

In March, Health Minister Fernando Llorca acknowledged that “there is now a debate on the need for developing regulations on therapeutic abortion – a debate that was necessary.”

Activists are calling for a protocol to regulate legal abortion, established by the social security system, CCSS, which administers the public health system and health services, including hospitals. But progress towards a protocol has stalled since 2009.

“For several years we have been working on a protocol with the Collective and the CCSS,” said Ligia Picado, with the Costa Rican Demographic Association (ADC). “But once it was completed, the CCSS authorities referred it to another department, and the personal opinions of functionaries, more emotional than legal, were brought to bear.”

The activist, a member of one of the civil society organisations most heavily involved in defending sexual and reproductive rights, told IPS that “the problem is that there is no protocol or guidelines that health personnel can rely on to support the implementation of women’s rights.”

Picado said the need for the protocol is especially urgent for women whose physical or emotional health is affected by an unwanted pregnancy and who can’t afford to travel abroad for an abortion, or to have a safe, illegal abortion at a clandestine clinic in this country.

Statistics on abortions in this Central American country of 4.7 million people are virtually non-existent. According to 2007 estimates by ADC, 27,000 clandestine abortions are practiced annually. But there are no figures on abortions carried out legally in public or private health centres.

Groups of legislators have begun to press the CCSS to approve the protocol, and on Jun. 17 the legislature’s human rights commission sent a letter to the president of the CCSS.

“We hope the CCSS authorities will realise the need to issue the guidelines so that doctors are not allowed to claim objections of conscience and will be obligated to live up to Costa Rica’s laws and regulations,” opposition lawmaker Patricia Mora, one of the authors of the letter, told IPS.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

Young girls in the village of Sonu Khan Almani in Pakistan's Sindh province perform most of the household chores, like making bread. Credit: Zofeen Ebrahim/IPS

By Preethi Sundaram and Fiona Salter
NEW YORK, Mar 16 2015 (IPS)

It is estimated that women account for two-thirds of the 1.4 billion people currently living in extreme poverty. They also make up 60 per cent of the world’s 572 million working poor.

Rapid global change has undoubtedly opened doors for women to participate in social, economic and political life but gender inequality still holds women back.If you can decide who you live with, what happens to your body and the size of your family, if you are free to make decision about these fundamental rights – only then are you able to participate fully in social, economic and political life.

Around the globe, women and girls continue to have subordinate status, fewer opportunities and lower income, less control over resources, and less power than men and boys.

Son preference continues to deny girls the education they have a right to. And the burden of care work that women face impinges and intrudes on their opportunities in terms of education and career.

Now a new report to be launched by the International Planned Parenthood Federation (IPPF) Mar. 16 in New York examines the links between SRHR and three core aspects of gender equality: social development, economic participation and participation in political and public life.

The report, Sexual and reproductive health and rights – the key to gender equality and women’s empowerment, provides specific recommendations to governments and to United Nations agencies to make sexual and reproductive health and rights and gender equality become a reality.

The reason for the report is to assess objectively what we have long suspected, namely that sexual and reproductive health and rights are critical to achieving equality.

Why? Because when women are able to maintain good health the trajectory of their lives can be transformed.

There are fewer maternal deaths and less reproductive illness; women and girls can realise their sexual and reproductive health and rights, they are free to participate in social, economic and political life.

Stark figures show that the denial of sexual and reproductive health and rights is a cause and consequence of deeply entrenched ideas about what it means to be a man or a woman.

Gender norms leave women and girls at risk and unable to reach their full potential. In some extreme cases, they can kill.

Women die because they cannot access the abortion services they need. Women die of preventable causes in childbirth. Women die at the hands of their violent partners. We see examples of this in all corners of the world.

Globally, one in three women experience either intimate partner violence or non-partner sexual violence during their lifetime. And, shockingly, women how have experienced intimate partner violence are 50 per cent more likely to contract HIV.

Sexual and gender-based violence is a major public health concern in all corners of the world. It’s a barrier to women’s empowerment and gender equality, and a constraint on development, with high economic costs.

And then there’s work. The percentage of women working in formal wage employment has increased over the last half century but a striking number of women are still likely to work in the informal economy due to gender inequality.

Across cultures and in all economies, women continue to do the bulk of unpaid care work. Women make up the majority of workers in the informal economy – 83 per cent of domestic workers worldwide are women.

Work in the informal economy can be more insecure and precarious, and can have specific impacts on the sexual and reproductive health and rights of women. For example, lack of regulations can make women more vulnerable to lower wages, limited access to health care, maternity leave or child care and workplace discrimination, including sexual assault.

In virtually every country, men spend more time on leisure each day while women spend more time doing unpaid housework. Women devote 1 to 3 hours more a day to housework than men; 2 to 10 times the amount of time a day to care (for children, elderly, and the sick), and 1 to 4 hours less a day to market activities.

Globally, female labour force participation decreases 10-15 per cent with each additional child for women aged 25-39.

Women also tend to have less access to formal financial institutions and saving mechanisms. While 55 per cent of men report have an account at a formal financial institution, the figure is just 47 per cent for women .

Here, too, women’s sexual and reproductive health and rights are key – true economic empowerment and stability comes from ensuring that regulatory frameworks across both the formal and informal economies take into consideration women’s reproductive lives.

In the political realm gender norms limit women’s opportunities to participate in decision making. As a result, women’s domestic roles are over-emphasised, they have less time to engage in activities outside of the home. This then restricts their influence to informal decision making, which tends to be hidden, or not respected.

Hardly surprising, then, only 1 in 5 parliamentarians is female.

One reason for women’s low participation in public and political life is because party politics and strategic resources are dominated by men.

In addition, women also have to overcome barriers that men don’t, such as poor networking, limits on whether they can travel.

Women voters are four times as likely as men to be targeted for intimidation in elections in fragile states. After all, would you vote if you faced threats on your way to the polling station?

What this report shows is that gender inequality prevents girls and women from reaping benefits and contributing to social, economic and political life.

So what’s the answer? Truth be told, no single approach will work. We have to look at solutions that work for women’s varied and complex lives.

But there is something that we can change – something that goes to the very heart of poverty eradication and development goals. We can uphold sexual and reproductive rights.

Because if you can decide who you live with, what happens to your body and the size of your family, if you are free to make decision about these fundamental rights – only then are you able to participate fully in social, economic and political life.

It’s the freedom from which all other freedoms flow.

Women and girls should have the right and ability to make decisions about their reproductive lives and sexuality, free from violence, coercion and discrimination.

That’s what equality is all about.

Edited by Kitty Stapp

Excerpt:

In most Latin American countries schools now provide sex education, but with a focus that is generally restricted to the prevention of sexually transmitted diseases – an approach that has not brought about significant modifications in the behaviour of adolescents, especially among the poor.

The international community made the commitment to offer comprehensive sexuality education (CSE) during the 1994 International Conference on Population and Development in Cairo.

“Although some advances have been made in the inclusion of sexual and reproductive education in school curriculums in Latin America and the Caribbean, we have found that not all countries or their different jurisdictions have managed to fully incorporate these concepts in classroom activities,” Elba Núñez, the coordinator of the Latin American and Caribbean Committee for the Defence of Women’s Rights (CLADEM), told IPS.

Teenage mom Maura Escobar with her baby María. Credit: Daniela Estrada/IPS

The 2010 CLADEM study ‘Systematisation of sexuality education in Latin America’ reports that Argentina, Brazil, Colombia, Mexico and Uruguay are the countries that have come the closest to the concept of comprehensive sex education, and they are also the countries that have passed legislation in that respect.

Others, like Chile, Costa Rica, El Salvador, Guatemala and Peru, continue to focus on abstinence and birth control methods, while emphasising spiritual aspects of sexuality, the importance of the family, and the need to delay the start of sexual activity.

But programmes in the region still generally have problems “with respect to the enjoyment and exercise of this right,” especially among ethnic minorities and rural populations, said Núñez from Paraguay.

Countries such as Argentina, Brazil and Mexico have also run into difficulties in implementing sex education programmes outside the main cities.

These shortcomings are part of the reason that Latin America is the region with the second highest teen pregnancy rate – 38 percent of girls and women get pregnant before the age of 20 – after sub-Saharan Africa, as well as a steep school dropout rate.

In Argentina, a law on comprehensive sex education, which created a National Programme of Comprehensive Sex Education, was approved in 2006.

Ana Lía Kornblit, a researcher at the Gino Germani Research Institute, described the programme as “an important achievement because it makes it possible to exercise a right that didn’t previously exist.”

But in some provinces the teaching material, “which is high quality, is not used on the argument that [schools] do not agree with some of the content and they plan to design material in line with local cultural and religious values,” she said.

“Children can see everything on TV or the Internet, but in school it isn’t talked about for fear of encouraging them to have sex,” Mabel Bianco, president of the Foundation for the Education and Study of Women (FEIM), told IPS.

“But in the media everything is eroticised, which incites them to engage in sexual behaviour. And the worst thing is they don’t have the tools to resist the pressure from their peers and from society to become sexually active,” she said. “CSE would enable them to say no to sexual relations that they don’t want to have.”“Children can see everything on TV or the Internet, but in school it isn’t talked about for fear of encouraging them to have sex.” -- Mabel Bianco

Lourdes Ramírez, 18, just finished her secondary studies at a public school in Mendiolaza in the central Argentine province of Córdoba. She told IPS that in her school, many parents of students in the first years of high school “kick up a fuss” when sex education classes are given “because they say their kids are young and those classes will make them start having sex sooner.”

“It’s absurd that you see everything on TV, programmes with girls in tiny thongs, but then in school they can’t teach how to use a condom or that people should only have sex when they really want to,” Ramírez said.

In her school, the Education Ministry textbooks and materials arrived, but they were not distributed to the students “and were only kept in the library, for people to come and look at.”

Carmen Dueñas, a high school biology teacher in Berazategui, 23 km southeast of Buenos Aires, said it was surprising that even when available birth control methods are explained to the students, “many girls want to get pregnant anyway.”

“They think that when they get pregnant they will have someone to love, that they’ll have a role to play in life if they have a family of their own,” said the teacher, who forms part of a municipal-national CSE project.

“There are conflicts and violence in a significant proportion of families, and teenagers don’t feel they have support; families are torn apart, and there is domestic abuse, violence, alcohol and drug use,” said Marité Gowland, a specialist in preschool education in Florencio Varela, 38 km from the Argentine capital.

“All of this leads to adolescents falling into the same cycle, and it is difficult for them to put into practice what they learn in school,” she said. “Many schools provide the possibility for kids to talk about their problems, but the school alone can’t solve them.”

A project in Berazategui is aimed at breaking the mould. Students are shown a film where a girl gets pregnant when she is sexually abused by her stepfather, but manages to stay in school after talking to her teacher.
“We chose this scenario because sometimes we have clues that there are cases like this in our schools,” Dueñas said.

Through games, the project teaches students how to use condoms. In addition, students can place anonymous questions in a box. “There are girls who comment that although they haven’t even gotten their first period, they have sex, because they have older boyfriends. Then the group discusses the case,” Dueñas said, to illustrate how the project works.

Another member of CLADEM, Zobeyda Cepeda from the Dominican Republic, said that what prevails in most of the region is a “biological approach, or a religious focus, looking at sexuality only as part of marriage.”

Until the focus shifts to a rights-based approach, experts say, Latin America will not meet its international obligations to ensure that “every pregnancy is wanted […] and every young person’s potential is fulfilled.”

This story originally appeared in a special edition TerraViva, ‘ICPD@20: Tracking Progress, Exploring Potential for Post-2015’, published with the support of UNFPA, the United Nations Population Fund. The contents are the independent work of reporters and authors.

Edited by Estrella Gutiérrez/Translated by Stephanie Wildes

Members of the Tropicana dance company animate a session of the conference of the International Association of Lesbian, Gay, Bisexual, Trans and Intersex People for Latin America and the Caribbean, in the Cuban resort town of Varadero. Credit: Jorge Luis Baños/IPS

By Ivet González
VARADERO, Cuba , May 10 2014 (IPS)

Although it might not seem to be, Latin America is the most active region in the world when it comes to the defence of the rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

That is due to the maturity and intelligent strategies that the LGBTI movement has come up with in a number of the region’s 33 countries, where the level of respect for sexual orientation and gender identity still varies a great deal, however, activists from around the region told IPS at a conference in the Cuban resort town of Varadero.

“The most progressive and interesting proposals are emerging in the Americas,” said Mexican activist Gloria Careaga during the sixth Regional Conference of the International Association of Lesbian, Gay, Bisexual, Trans and Intersex People for Latin America and the Caribbean (ILGALAC), which was held here this week.

Leading the changes are Argentina and Uruguay, said Careaga, the co-secretary of the global federation, which was founded in 1978 and has Consultative Status to the United Nations Economic and Social Council.

These two Southern Cone countries have passed laws against discrimination and legalising same-sex marriage and adoptions.

Careaga added that other countries that have taken major steps are Brazil, Colombia and Mexico. She also stressed the progress made in Cuba, where “public displays of homosexuality” were illegal until the 1990s, and which is now hosting the May 6-10 regional conference.

In general terms, the Caribbean is the part of the region that is lagging the most in terms of LGBTI rights.

Today, homosexuality is only criminalised in two Latin American countries, Belize and Guyana. That is compared to nine Caribbean island nations that penalise same-sex acts, especially male on male.

Antigua and Barbuda, Barbados, Saint Vincent and the Grenadines, Dominica, Grenada, Jamaica, St. Kitts and Nevis, St. Lucia and Trinidad and Tobago provide for prison sentences of between 10 and 50 years for people convicted of engaging in same-sex acts.

And since 1976, Trinidad and Tobago has barred homosexuals from entering the country.

For these and other reasons, the conference in the Plaza America Convention Centre in Varadero, 121 km east of Havana, is the first held in the Caribbean region. The gathering brought together representatives of more than 200 organisations belonging to ILGALAC, along with participants from Europe and the United States.

Rainbow flags, the global symbol of respect for free sexual orientation and gender identity, and signs with inclusive messages adorn the convention centre’s corridors and halls.

Despite the situation in the Caribbean, this region as a whole continues to gain ground in the fight against deep-rooted homophobia and sexism.

To explain the advances made, Careaga stressed that every country has outlined its own agenda, adapted to its specific context.

Argentine lawyer Pedro Paradiso, who has been involved in the cause for over 20 years, said the evolution of LGBTI activism has been a key factor.

“We have gradually changed. At first the struggle was much more about victimisation and protests. But our approach began to expand and to be renovated. Now we are subjects of rights,” the member of the Argentine Homosexual Community, an organisation that emerged over three decades ago, told IPS.

In his view, raising the self-esteem of the non-heterosexual population and taking an approach based on their rights as a collective were decisive, although he said there were many other factors involved.

According to Paradiso, the movement started out by empowering itself and gaining in visibility. Later it began to gain institutional status and to demand sexual and reproductive rights as human rights. It also started forging ties with other social movements, and alliances were forged with political parties and public and private institutions like universities.

In addition, the movement gained ground in international forums like the United Nations and the Organisation of American States, which can exercise pressure to some extent on governments and member states.

And to the extent that each legal system allowed, the LGBTI community has used the courts to forge paths, sometimes tortuous, towards equality.

That is the case of Colombia, where same-sex couples legalise their unions in the courts, while waiting for a law on same-sex marriage. “The process is like a long, painful birth,” said Anaís Morales of the Corporación Femm, which groups lesbian and bisexual women in that South American country.

The 25-year-old feminist activist said women are still outnumbered in the fight for sexual and reproductive rights. “Gay men are the most visible,” Morales told IPS.

In general terms, the women’s organisations present in Varadero agreed that women suffer from double discrimination because of their gender and sexual orientation, and said they needed greater access to assisted reproduction techniques, respectful treatment in health services, and better connections between the women’s and lesbian rights movements.

The first transgender city council member in Chile, Zuliana Araya, told IPS that the LGBTI movement needed to forge closer internal ties. “Among ourselves there can be no discrimination,” said the city councillor from Valparaíso, who is an activist in a local union of trans persons.

“Just because the majority of our [trans] community is involved in commercial sex work doesn’t mean we should be left out,” said Araya, 50, whose activism led her into a career in politics, in a country that passed legislation against discrimination in May 2012. “We are still in the stage of demanding our rights,” she said.

Bringing about a cultural and social shift towards respect for sexual and gender diversity is the big challenge, even in Argentina and Uruguay, whose legislation is among the most advanced in the world.

The hindering effects of religious fundamentalism and political conservatism are also felt, especially in the Caribbean. Although gay Dominican activist Davis Ventura told IPS that “there are many Caribbeans.”

The 40-year-old Ventura said the criminalisation of same-sex relations in the English-speaking Caribbean makes activism virtually impossible, or confines it to international forums, while a “mid” level of progress has been made in the Spanish-speaking countries – Cuba, the Dominican Republic and Puerto Rico – and the islands with French and Dutch influence are the most progressive.

Firm steps have been taken in Puerto Rico at the municipal level, while there are associations that have gained visibility in the Dominican Republic and Cuba passed the first anti-discrimination law in the Caribbean in 2013, when it approved a new labour code that explicitly protects the labour rights of non-heterosexuals.

However, there are voices arguing that there is no actual LGBTI movement as such in Cuba.

Manuel Vázquez, the head of legal advisory services in the National Sex Education Centre (CENESEX), a public institution, told IPS that “we are seeing groups that are actively asking for, demanding and discussing sexual rights.”

In the view of Maykel González, of the Proyecto Arcoíris (Rainbow Project), activism is still emerging.

Arcoíris, which describes itself as “independent and anti-capitalist”, the non-governmental Cuban Multidisciplinary Society for the Study of Sexuality, and initiatives supported by government institutions like CENESEX or the National Centre for the Prevention of STI/HIV/AIDS represented Cuba in the ILGALAC conference.

By Diana Cariboni
MONTEVIDEO, Aug 14 2013 (IPS)

Latin America and the Caribbean should play a central role in the construction of “sexual citizenship” – a concept that covers a series of population-related issues, rights and guarantees that this region helped build since the United Nations first emerged, says Brazilian expert Carmen Barroso.

Latin America has long been in the vanguard in the promotion of women’s rights, and still is today, Barroso, Western Hemisphere regional director for the International Planned Parenthood Federation, tells IPS in this interview.

Carmen Barroso doesn’t expect setbacks at the Montevideo conference. Credit: Courtesy of IPPF

Barroso, who was a key player in the negotiations for the 1994 International Conference on Population and Development in Cairo, says all innovations and creative solutions in this area come from civil society, where youth movements particularly stand out today.

For that reason she does not believe there will be any backsliding at the first session of the Regional Conference on Population and Development in Latin America and the Caribbean, running Aug. 12-15 in Montevideo, the Uruguayan capital.

In this week’s meeting, the region is assessing its progress and failures and hammering out a common position to take to the U.N. General Assembly.

Q: Do you expect setbacks in this first regional conference?

A: No, I don’t. The region has made great strides since the 1990s. Governments are aware that this is a development issue. There is no one here who wants to move backwards.

Furthermore, there are at least 12 government delegations here that have incorporated civil society – which sends a message that governments want to feel they represent different voices in their countries.

Civil society is essential; it gave rise to the rights agenda. Governments don’t have time to create things in that terrain. When they act in a creative manner, it is due to the influence of civil society.

I also think there will be a global impact. This region has always been in the vanguard. It was an extremely central actor in promoting women’s rights in the process of the United Nations charter and in the creation (in 1946) of the Commission on the Status of Women. That was a long time ago."There is still this terribly daft idea that sex education encourages 'sin'." -- Carmen Barroso

Now, the region is changing; there are many middle-income countries and Brazil is part of the BRICS group (along with Russia, India, China and South Africa). That means the world looks at us differently.

Q: What issues could stand in the way of a consensus?

A: The danger I see is that references to abortion could stay the same as they are in the Cairo Programme of Action: that it’s a public health problem; that when it is permitted it must be safe; and that it is necessary to act in line with national laws.

This will be a major focus of debate. The reality in the region has changed. Uruguay decriminalised abortion, the Mexican capital did so as well, and so did Guyana and Puerto Rico. Colombia adopted more flexible rules, and Brazil expanded the circumstances in which abortion is legal. In Cuba abortion has been legal since the 1960s.

It’s important for this to be reflected in the regional position, but that won’t be easy.

Another aspect is the demand for comprehensive sex education, particularly for young people. There is still this terribly daft idea that sex education encourages “sin”, or earlier sexual initiation.

The research shows that this isn’t true, and that the start of sexual activity is even sometimes delayed, because girls and young women are empowered and feel they can say no if they aren’t really sure.

There is also talk of explicitly including the right to gender identity and respect for sexual diversity.

But sexual and reproductive rights are broader. Women also have the right to not be harassed in the street or in their workplace. Many of these aspects have been forgotten.

To sum up, we are creating what we could call “sexual citizenship” – and comprehensive sex education is essential for that.

Q: How have the civil society groups that have formed part of this process in the last two decades evolved?

A: The most important thing is to look at young people. We have numerous delegations of very active young people here who also express and organise themselves as such. When I got involved in these issues I was young, of course, but I didn’t define myself as such. What defined me was being a feminist and a woman. This is new.

Q: Now that we’re talking about young people: one problem where there have been setbacks rather than progress is teenage pregnancy.

A: It’s true. A study by ECLAC (Economic Commission for Latin America and the Caribbean) shows that, in half of the countries where statistics are available, the figures have remained the same, and in the other half, they have gone up.

There are some new developments, however: many adolescent girls who have a first child don’t have a second child (in adolescence), which is what used to happen.

Q: What explains this?

A: That they only have access to birth control methods and information once they enter the health system because of the pregnancy and birth.

Q: It would seem that adolescents today enjoy greater sexual freedom than 20 years ago, but don’t have the tools to handle it…

A: Not all of them. There are class-based differences. In the wealthiest quintile of the population, there are no teen pregnancies, which are concentrated in the poorest quintile.

Q: What’s the solution?

A: Governments should start out by living up to their promises. In 2008, the region’s education and health ministers pledged to ensure comprehensive sex education mechanisms in schools. What we have seen so far are a few timid steps in a handful of countries.

Excerpt:

When the U.N. Population Fund (UNFPA) participates in a regional review conference in the Uruguayan capital of Montevideo next week, it will take stock of the successes and failures of a wide range of gender-related issues, including reproductive health, sexual violence, women’s rights, maternal mortality, and the spread of HIV/AIDS – all of them relating to Latin America and the Caribbean (LAC).

A young pregnant Argentine woman contemplates the risks and difficulties of pregnancy and motherhood. Credit: Carolina Camps/IPS

And the question lingering in the minds of most delegates will be how LAC has fared in implementing the landmark Programme of Action (PoA) adopted at the 1994 International Conference on Population and Development (ICPD) in Cairo.

The question appears even more relevant considering the fact that a high-level meeting of the General Assembly is due to take place in 2014 to review ICPD achievements – and shortcomings – over the last 20 years.

Maria Jose Alcala, director of the Secretariat of the High-Level Task Force for ICPD, insists the international community must build on the Cairo commitments.

She told IPS that Cairo was a landmark, placing the reproductive rights of women at the centre of sustainable development.

“Their implementation has brought tremendous benefits to individuals, families, economies and countries, though they remain unfulfilled for millions across the region,” Alcala said.

But at the Montevideo Conference, scheduled to take place Aug. 12-15 and organised by the U.N. Economic Commission for Latin America and the Caribbean (ECLAC), “We must also go beyond agreements made 20 years ago to make the promise of Cairo, and the sexual and reproductive rights for all, a reality regardless of who you are or where you come from,” she noted.

Speaking at the 30th anniversary of the UNFPA Population Awards ceremony last week, Secretary-General Ban Ki-moon underlined the fact that “population is not a matter of numbers”.

“It is all about people – the choices they make and the choices they are able to make,” he said. “We must empower individuals. We must protect their freedom, ability and right to make informed decisions. This will enable people to fulfil their potential. And that will advance whole societies.”

UNFPA Executive Director Dr. Babatunde Osotimehin concurs with Ban’s view that development is not sustainable unless it is equitable and serves all people.

“I couldn’t agree with him more. We at UNFPA continue to emphasise that people and the principle of equity must be kept at the centre of sustainable development,” he said.

Dr. Osotimehin says it means recognising the need to invest in women and young people and promoting human rights. “It means increasing equity to build a world of opportunity for all.”

Alcala said that among the issues to be discussed at Montevideo, a high priority would be fundamental human rights.

“Governments in the region need to make strong commitments to advance gender equality, the rights of women and girls, the empowerment of young people, and sexual and reproductive health and rights,” she said.

These are basic rights to make decisions about one’s own private life and free of any form of discrimination, coercion or violence.

“They include deciding if, when and how many children to have, if and whom to marry, decisions about one’s body, sexuality and health and to have the information and services to do so,” she noted.

But for too many women and adolescent girls in the LAC region – and for too many young people and communities living in poverty – enjoyment of these rights is still far from reality, she warned.

As the United Nations embarks on its post-2015 development agenda, described as a logical successor to its Millennium Development Goals (MDGs) with a 2015 deadline, population and reproductive health are expected to be an integral part of the new agenda, including the proposed Sustainable Development Goals (SDGs).

The Montevideo conference will include a general discussion on national experiences relating to population and development, prospects for the period beyond 2014, and the role of adolescents and youth.

Alcala told IPS a key issue is bringing more policy attention and investments to adolescents and youth.

She pointed out adolescent girls in Latin America and the Caribbean, have the second highest pregnancy rates in the world after sub-Saharan Africa. About 20 percent of all births in the region are to adolescent mothers between 10 and 19 years of age.

And young women in the Caribbean are 2.5 times more likely to be infected with HIV than young men, she added.

She said her task force is calling for universal access to comprehensive sexuality education for all young people, in and out of school.

Countries in the region are already taking concrete steps in this direction: this must be a priority of any common-sense 21st century education agenda, Alcala said.

She said more needs to be done to intensify prevention of violence against women and girls and bring perpetrators to justice. Some 36 percent of women in the LAC region have experienced sexual or physical violence in their lifetime and, despite increased efforts in various countries, impunity for these crimes remains rampant.

Alcala said governments meeting in Montevideo must also address ending unsafe abortion as a major killer of women and adolescent girls. Latin America and the Caribbean has the highest rate of unsafe abortions in the world: 4.2 million unsafe abortions every year.

Beyond ensuring every woman and adolescent girl has access to sexual and reproductive health information and modern contraception – including emergency contraception – this includes expanding access to safe abortion, which is one of the safest medical procedures available.

“We must put a stop to the fear unleashed upon women, and the cruel imprisonment and punishment of women and girls who have sought life-saving care after undergoing an unsafe abortion,” Alcala said.

“We must remember that even where it is illegal, in the region as across the world, wealthy women and couples will find a way to obtain a safe procedure; but it is poor women and girls who will be forced to risk their lives when they are left with no other recourse but an unsafe abortion.”

This issue is a fundamental matter of social equity, she said, adding that the need for abortion will not go away.

“So we have a choice: to continue standing on the sidelines as women and girls risk and lose their lives, or allow women and adolescent girls the basic right to make decisions about their own bodies, health and lives,” she said.

India’s matinee idol Shah Rukh Khan and his wife Gauri Khan announced recently that they had their third child through surrogacy. Gossip columns said that Gauri Khan, a mother of two teenagers, had tried to conceive for the last couple of years and at last resorted to surrogacy.

The announcement, coming after intense speculation by the media, caught fans by surprise; this is something not openly discussed in Indian society, least of all by a celebrity. But the veil of secrecy surrounding surrogacy was lifted earlier by another Bollywood celebrity, Aamir Khan, who with his director wife Kiran Rao went for a surrogate baby in 2011.

Doctors specialising in IVF (In Vitro Fertilisation) say that celebrity endorsement has suddenly made it fashionable among the swish set.

But to many in small towns and slums, surrogacy has become familiar for the possibility of earning money through carrying a child for another couple. The clients are usually non-resident Indians (NRIs) and white couples from western countries where commercial surrogacy is illegal.

The mothers are often ignorant and illiterate, and prone to exploitation in this ‘unorganised sector’. There is no legal framework to protect them.

The 2012 report ‘Surrogacy Motherhood: Ethical or Commercial’ by the Delhi-based Centre for Social Research (CSR), found that about half of the surrogate mothers surveyed were paid between Rs 300,000 (4,900 dollars) and Rs 400,000 (6,500 dollars). Of those interviewed, 68 in the capital, Delhi, and 78 in the financial capital Mumbai said they were working as domestics earning around Rs 3,000 (50 dollars) a month.

“But often that’s half the story,” CSR director Ranjana Kumari told IPS. “The woman gets a small instalment at conception. If she has an abortion, she doesn’t get anything. In case of unhealthy pregnancies, abortion pills are given by doctors to terminate the pregnancy, and surrogates often think it is a miscarriage. In absence of any regulation, poor women often get exploited.”

“Commissioning parents” – as they are known in the business – pay on average a total of Rs 1.2 million (20,000 dollars) for a surrogate baby (more if twins are born). Much of this money goes to the Assisted Reproductive Technologies (ART) clinic, agents and lawyers. “Most often the woman gets about half of what is promised,” Kumari says.

Another study last year by SAMA – Resource for Women and Health, a Delhi-based NGO – corroborates Kumari’s observation. “The surrogates were not given information regarding the various procedures or tests conducted in the course of the treatment,” said the report conducted in Delhi and Punjab states.

By way of contracts, the report says, surrogates said that “they had `signed papers’… without any negotiation or discussion…the document, in English in all cases, was not read by the surrogate or her husband; nor was it read out to them and they were told only verbally what it states.”

But ART clinics are now mushrooming. According to CSR, the surrogacy business in India is worth more than 500 million dollars a year.

Unemployment or low-paying jobs and the resulting struggle to run households were cited to SAMA as some of the reasons behind ‘renting the womb’. Women felt that “along with their husbands they bore the responsibility of paying off debts, or buying a house,” SAMA found.

“We are not against surrogacy but against the rampant commercialisation of surrogacy which leaves the woman getting the short shrift,” Kumari told IPS.

She added that though doctors warn against it, mothers who already have had two or three children go for more IVFs than recommended, and this affects their health. “Are they just production machines?”

Activists and health professionals have been demanding regularisation of ART clinics to ensure better monitoring. The first draft of an updated bill was drawn up back in 2008, R.S. Sharma, deputy director of the Indian Council for Medical Research (ICMR), told IPS.

A new Assisted Reproductive Technologies Bill 2010 is under the consideration of the health ministry, he said. The bill has to be approved by various ministries before going to the cabinet.

“The bill will oversee the registration of IVF clinics. Clinics operating as banks (which source surrogates) often lead to vested interests. Now one will have to make a choice between a clinic and a bank,” Sharma told IPS.

Among guidelines to safeguard the mother’s health and stop commercialisation is the requirement that “the surrogate mother has to be between 21-35 years and be a mother already of one. Only two deliveries will be allowed through IVF, and that too at two years’ gap between each.”

ICMR is also preparing a national registry with details of the clinics, Sharma said. He has proposed creation of state boards to better monitor functioning of the clinics.

Kumari told IPS that a new study by her centre in collaboration with the Jawaharlal Nehru University in Delhi is in the offing.

“Next, we will launch advocacy campaigns. We need a proper law to stop exploitation of these women by various sections. Sometimes even the family members are involved, coercing them to conceive for monetary benefit.”

Brazilian President Dilma Rousseff signed a law guaranteeing treatment – including emergency contraception – for rape victims in public hospitals, in spite of strong opposition from religious conservatives who believe it will lead to the decriminalisation of abortion.

“In future when a victim of abuse goes to a hospital, the staff must follow the protocol,” said Health Minister Alexandre Padilha, announcing the president’s ratification of the law Thursday, which will enter into force in 90 days.

The new Law 3/2013 only introduces regulations for authorised procedures for multi-disciplinary care in the public health system for female victims of sexual violence, without actually modifying the country’s law on abortion.

In Brazil, abortion is only legal in exceptional cases: when the mother’s life is at risk; when the foetus has been confirmed by three doctors to be anencephalic (lacking a large part of its brain and skull); or when the pregnancy is the result of rape.

“The novelty is that the law establishes compulsory care in the health services for all cases of sexual violence,” said Beatriz Galli of the Brazilian chapter of Ipas, an international NGO that works for women’s health and reproductive rights, including safe abortions.

“At present, we know that some referral services for the care of victims of sexual violence are not working properly, especially when it comes to guaranteeing access to abortions in cases of sexual violence provided for by law,” she told IPS.

Galli said moral or religious objections by health professionals to practicing abortions were common.

She said there was even resistance in state public prosecutors’ offices, which sometimes request the seizure of records to make sure that the abortions carried out were within the limits of the law.

But the new federal law “will guarantee that health professionals can do their job with the requisite legal backing, putting an end to attempts to backslide on the reproductive rights of women, teenagers and girls who are victims of sexual violence,” Galli said.

Sociologist Angela Freitas of the Provincial Council on Women’s Rights, meanwhile, responded to conservative critics by saying that the law’s goal was not to legalise abortion but to guarantee the rights of women who suffered sexual violence, many of whom were teenagers.

“What bothers critics is that Brazil has begun to create public health services to provide care in cases of legal abortion, which is a victory for women’s movements,” Freitas, who also represents the Articulaçao de Mulheres Brasileiras (AMB – Brazilian Women’s Network) in the organisation’s Rio de Janeiro regional office, told IPS.

“Violence against women, especially sexual abuse, is on the rise, and this bill is important for guaranteeing victims access to healthcare and medical attention. People who are pro-life ought to support it,” said Galli, who added that one million illegal abortions a year are carried out in Brazil, often in conditions that put the mothers’ lives at risk.

Religious resistance

Thursday was the constitutional deadline for ratifying law 3/2013, which was based on a bill presented in 1999 by Iara Bernardi, who at the time was a congresswoman for Sao Paulo from Rousseff’s left-wing Workers’ Party (PT).

But doubts had arisen as to whether it would be signed into law, due to rising pressure surrounding Pope Francis’ Jul. 22-28 visit to Brazil, even though the bill had been unanimously approved in both chambers of Congress.

Three days before the pope’s arrival, representatives of the Brazilian Catholic bishops’ conference and other religious bodies visited Rousseff at the government palace to ask her to partially veto the law.

They were lobbying for the removal of an article referring to “pregnancy prevention” and another requiring “victims to be informed of their legal rights and all the health services available to them” – that is, the right to abort, or to take emergency contraception pills, in cases of rape.

Emergency contraception, also called the “morning-after pill”, delays ovulation or prevents implantation of a fertilised egg up to 72 hours after sex, but does not terminate an already established pregnancy.

But Catholic Church leaders fear these provisions will allow abortions to occur even when sexual abuse has not been proven – in other words, that women may “invent” reports of rape to obtain legal abortions.

“It is despicable to think a priori that women are dishonest liars,” Freitas complained. “And it also shows a lack of respect for the knowledge of the health professionals who talk to and examine patients.”

Freitas pointed out that legal abortions are not easy to obtain in Brazil. “A multi-disciplinary team made up of doctors, nurses, social workers and psychologists decides how to proceed in each case.”

So, “if a woman was inventing her story, she would be found out. But first she must be listened to and not condemned in advance,” she said.

Freitas highlighted that the new law compels the health services to follow regulations in force since 1999, “confronting the legal obstacles that anti-abortion sectors put in the way of rape victims when they decide to terminate a pregnancy and making it possible to penalise health professionals who fail to comply.”

She pointed out that, although emergency contraception and abortions are legal in certain cases, they are frequently not provided.

“There is a general lack of information and of referral services for this kind of care. Brazil is huge and hospitals with this kind of services only exist in the state capitals and other large cities,” Freitas said.

“There are doctors and hospital directors who refuse to talk about the issue and do not provide the service because of conscientious objections,” she said.

Latin American demographers and government delegates analyse the region's population and development challenges in Rio de Janeiro. Credit: Fabiana Frayssinet/IPS

By Fabiana Frayssinet
RIO DE JANEIRO, Jul 17 2013 (IPS)

Nearly 20 years after the landmark U.N. conference on population and development, the countries of Latin America have an opportunity to make headway with a new agenda on these issues, thanks to the favourable economic context that has made it possible to reduce social inequalities.

The situation in the region was debated at the preparatory meeting in Rio de Janeiro for the first session of the Regional Conference on Population and Development in Latin America and the Caribbean, to be held Aug. 12-15 in Montevideo under the auspices of two specialised United Nations agencies.

Demographers and government representatives from the region were convened by the Economic Commission for Latin America and the Caribbean (ECLAC) to a Jul. 15-17 meeting that took stock of pending challenges from the International Conference on Population and Development (ICPD), held in Cairo in September 1994, which approved a plan of action to 2014.

The current context of economic growth and improvements in income distribution opens an opportunity for progress in the elimination of socioeconomic imbalances and improvement in quality of life, says the basic document by the United Nations Population Fund (UNFPA).

Conference speaker Juan José Calvo, of the Uruguayan government’s population commission, agrees with this analysis of a Latin American population that over the last six decades has expanded from 167 million people to 596 million, according to 2010 figures.

“In the last 20 years we have seen extremely significant progress, in some cases giant strides, which does not mean that we do not still face big challenges, even in the same areas. In other words, we have lifted dozens upon dozens of Latin Americans out of poverty and extreme poverty, but that does not change the fact that it is still the main problem to be solved,” Calvo told IPS.

The ICPD programme of action recommended a set of interlinked quantitative goals, such as universal access to primary school education, with a special emphasis on girls; the promotion of health and reproductive rights, including family planning; the reduction of maternal and child mortality and morbidity rates; gender equality; and an increase in life expectancy.

In the framework of “sustainable development,” it took account of more general issues such as reduction of poverty and social, generational and ethnic inequalities.

In some countries these indicators improved, along with others that can help interrupt the cycle of inequality, like education. In Argentina, Chile and Uruguay, for instance, nearly all children and teens under 15 are in school, while on average in El Salvador, Guatemala, Honduras and Nicaragua, one-quarter of young people in that age range are out of the system, Calvo said.

Another stride forward was a rapid fall in fertility that began in the first half of the 20th century. Latin America and the Caribbean had some of the highest fertility rates in the world, at nearly six children per woman.

Four decades later, fertility in the region was below the world average of 2.9 children per woman, and in recent decades it has dropped to 2.17.

Since 1950, average life expectancy in Latin America and the Caribbean has increased by 23 years, to 75 years. During the same period, infant mortality plunged from 138 to 18 per 1,000 live births.

But these improvements are not evenly distributed among countries, regions or ethnic groups. “Latin America and the Caribbean remains the most unequal region on the planet, and that is probably its top priority challenge,” said Calvo.

“While we have made significant advances in most of the indicators that measure improvements in living conditions, there are still unacceptable gaps in sexual and reproductive health, poverty and education,” he added, referring, for example, to indigenous peoples.

Calvo said the basic problems could be traced back to the 1990s, when “the neoliberal governments that were predominant in the region gave up government planning as an instrument of public policies.”

At present, “several progressive governments have resumed planning, including demographic planning,” he said.

“Many have created social development ministries and institutes for young people and for women, for example, which are effective mechanisms for implementing more advanced regulatory frameworks,” he said.

However, not even these governments have been able to overcome internal conservative positions that hinder progress on issues like sexual and reproductive rights, regarded as “fundamental” by Brazilian demographer George Martine.

According to Elsa Bercó of Brazil, “fundamentalist” concepts blocked free discussion in Cairo of issues like sexual orientation, abortion and teenage pregnancy.

These issues “were not materialised in public policies or in the decisions of higher courts,” said Sonia Correa, the founder of the Brazilian women’s group SOS Corpo.

Martine told IPS that “In Cairo progress was made in terms of development, gender equity and reproductive rights, but not all of the agenda was discussed, and some touchier issues were left out of the debate for ideological reasons.”

He attributed this to “religious opposition, which is even capable of influencing governments whose own agenda is more progressive.”

Meanwhile, Magdalena Chu, the founder of the postgraduate course on Demography and Population at the Cayetano Heredia University in Peru, highlighted the region’s advances in sexual and reproductive rights.

“Nowadays there is more of a sense that people are free to plan their families, and to use this or that method of family planning,” she said. But she also blames conservative sectors for the fact that many governments have not been able to openly implement these policies.

Speakers at the meeting in Rio de Janeiro brought up other pending issues, like urbanisation processes and their consequences for the environment.

These are “inevitable” processes, but “there is a lack of policies on the part of administrators,” according to Martine.

“We have made advances on the road to development, but we still have a great deal to do,” Calvo summed up.

"I'm happy being a prostitute," says the HIV/AIDS prevention campaign poster that was subsequently withdrawn. Credit: Beijo da Rua

By Fabiana Frayssinet
RIO DE JANEIRO, Jun 12 2013 (IPS)

Happiness, the subject of endless philosophical discussions, has now become the focus of controversy in an HIV/AIDS prevention campaign aimed at prostitutes in Brazil. The campaign chief has been booted out and a further question has been raised: What are the limits of popular participation in the definition of public policies?

Before the Health Ministry campaign was even broadcast, shocked conservative sectors complained that it condoned prostitution.

As part of a strategy against HIV/AIDS, the slogan “Sou feliz sendo prostituta” (I’m happy being a prostitute) arose from national debates and workshops involving the targeted participants.

“(The slogan) expresses the dignity of our profession. To remove that phrase is a violation of our rights, especially because of the social stigma we suffer,” said Leila Barreto, of the Group of Women Prostitutes in the northern state of Pará.

The campaign, run by the department of sexually transmitted diseases (STD), AIDS and hepatitis, resulted in the dismissal of the head of department, Dirceu Greco, and the resignation of two assistant directors.

“It was a great disappointment,” Barreto told IPS. “The stronger we are, the less vulnerable we will be to diseases, unless society says: these women do not exist. But they do exist, and their work contributes to society,” she said.

The anti-AIDS campaign, which had not been authorised by the ministry’s advisory office for communications, included other statements such as “O sonho maior é que a sociedade nos veja como cidadãs” (Our greatest dream is for society to see us as citizens). It had barely gone out over the internet on Jun. 2, International Sex Workers Day, before it was withdrawn.

The version that replaced it reverted to the old-fashioned style: advice to sex professionals about the importance of using condoms and encouraging them to seek preventive measures in public hospitals.

“Prostituta que se cuida usa sempre camisinha” (Prostitutes who take care of themselves always use condoms) says the new campaign, which seeks to “strengthen tolerance” and “eliminate prejudice”.

In Brazil, AIDS is concentrated in the big cities, where most of the at-risk groups are to be found. Prevalence is 5.9 percent among drug users, 10.5 percent among men who have sex with men and 4.9 percent among women professional sex workers.

Each year there are on average 37,000 new HIV/AIDS cases in this country of more than 198 million people, where an estimated 530,000 people are HIV-positive, 150,000 of whom do not know that they are infected.

“The preventive measures we advocate work for any person, whether they are ‘happy or sad.’ It is not the Health Ministry’s business to make assessments of the state of mind of individual persons,” a communiqué from the ministry said.

Some people complain of a “regression” in Brazil’s anti-HIV/AIDS strategy, which was considered one of the boldest and most effective in the world.

“Brazil taught the world, with the concept of AIDS prevention, that at-risk and historically excluded populations like homosexuals, prostitutes and drug addicts are citizens who have rights, and that this is the stance to take when speaking of prevention,” Agustín Rojo, an Argentine expert on communications and HIV, told IPS.

But in this country, where conservative evangelical churches have great political clout, “there is a risk of ‘killing the programme off’ by mixing religion with public health,” said George Gouveia, of the Grupo pela VIDDA, an HIV/AIDS patients self-help group.

That risk is already a reality in the view of Greco, who attributes his dismissal to disagreements “over a policy based on human rights and valuing the populations that are most at risk,” due to a conflict with “the conservative policy of the present government” of centre-left President Dilma Rousseff.

He mentioned other cases as examples, such as the banning of a carnival video that showed a relationship between two men, and a cartoon strip for schools on homophobia and sexuality.

“They can’t treat us as if we were in the closet. If they don’t grant us visibility, we will continue to feel that our rights are curtailed,” Julio Moreira, the president of the gay rights group Arco Iris, told IPS.

In Rojo’s view, the issue is that the state “should allow sectors that are discriminated against to have a voice and visibility, in order for society first to recognise their existence and then to listen to them – but it is not for the state to take on each and every one of their positions.

“When a woman who is paid for sex publicly says that she feels happy, she is expressing more than a personal feeling. To be perfectly clear, she is stating a political position,” said Rojo, a sociologist who has coordinated official policies in Argentina on AIDS and other STDs.

In this case, “being happy” with what one does, like being “proud” of one’s sexual orientation, is a legitimate vindication of a social group, he said.

But the expression “cannot be transferred automatically to a government-run mass media campaign, because it will not be easily understood by everyone. The state has no business telling prostitutes they cannot be happy, but it shouldn’t applaud, or not applaud, their choices,” Rojo said.

“On the other hand, if any citizen, whether a prostitute, transvestite or drug addict, does not have access to condoms to take care of his or her health, or does not know how to use them or where to go for help – this is a problem for the state to address, whether in the case of a sex worker or a homemaker, a homosexual or a heterosexual,” he said.

Brazilian Health Minister Alexandre Padilha made similar comments. “I respect the groups and movements who wish to send that message (about being happy), but that is their role,” he said.

Now discussions are centred on the scope of a call for social participation in real politics.

“Designing a campaign for gays, prostitutes or prisoners is in itself a recognition that grants dignity to these persons,” Rojo said.

“It puts them on a level with the rest of the citizenry…which is a powerful political decision. It confronts stigma from the heights of power, with the message that ‘we do not care only about rich heterosexuals, but also about poor gays, prostitutes, transsexuals and so on, because to us they are all equal’,” he said.

“By selecting only one particular message among those created by the workshops, the government is rejecting the concept of equality, because prostitutes are denied the right to express their dreams and ideals of citizenship, and the affirmation of their identity and social visibility,” said Gabriela Leite of Davida, a sex workers’ group.

She said it was “arrogant to believe that a prostitute can’t be happy.”

A profile of Brazilian prostitutes drawn up by the Health Ministry contributes to the quantification of this relative happiness.

The majority of female sex workers are between the ages of 20 and 29, have not completed primary school, and are proud of being able to support their children. They do not suffer discrimination in the public health service, they like the freedom of their work, and they consider that it pays better than other jobs.

However, they feel humiliated and discriminated against, they avoid telling others what they do, especially their children, and they are forced to put up with unpleasant clients and those who refuse to wear condoms.

Every three years since 2007, a global advocacy organisation called Women Deliver has convened an international conference to talk about issues relating to the health and well-being of girls and women.

UNFPA, the United Nations Population Fund, has been privileged to participate in these conferences, and looks forward to joining multilateral organisations, NGOs and global leaders for the third Women Deliver conference in Kuala Lumpur this weekend.

Dr. Babatunde Osotimehin. Credit: UNFPA

Our focus this year will be on two issues that affect not just women and girls, but development in general, because research shows that voluntary family planning and maternal health are two key vectors for lifting developing nations out of poverty.

We will unveil new initiatives for each and seek to galvanise the world community for both programmatic and financial support. UNFPA has promoted voluntary family planning since it began operations in 1969, and if we have learned anything in the decades since, it is that the ability of women to plan when and at what intervals they will have children is essential to national progress in everything from education to health to economic prosperity.

Equally important, we have learned that family planning is about more than just condoms and other family planning commodities. It’s about human rights, information and education.

At the Women Deliver conference, UNFPA will launch a new partnership with the International Planned Parenthood Federation (IPPF) to increase access to family planning in some of the world’s most hard-to-reach areas. In cooperation with IPPF, we will seek to galvanise political commitments from 13 nations with statistically low contraceptive prevalence rates in order to increase support for programmes to educate women and men about the benefits of family planning.

UNFPA’s second major initiative will actually take place in the days leading up to Women Deliver, when we will co-host a symposium on the crucial, frontline role midwives play in lowering maternal deaths, reducing disabilities related to childbirth, and improving overall national health indicators.

More than 230 midwives will be joined by leading U.N. agencies, civil society representatives, policy makers and officials from donor nations to discuss ways to increase the numbers and improve the skills of midwives in developing countries.

At the symposium, UNFPA, alongside its partners from Intel, the World Health Organization and Jhpiego, the NGO affiliated with Johns Hopkins University, will roll out a new online training module for frontline maternal health workers to help train them to deal with issues such as pre-eclampsia, excessive post-birth bleeding and prolonged and obstructed labour. These medical complications can be matters of life and death for women giving birth in the developing world, so this is a critically important initiative.

But it is clear that these family planning and maternal health initiatives will succeed only if they are embraced by government leaders in a position to fund and support them. And there are often obstacles to that embrace.

The first obstacle, of course, is money. Governments struggling to meet the basic needs of their citizens face severe competition for scarce resources. But family planning and maternal health are so critically important to long-term development that they should be among the top spending priorities for developing nations’ governments.

And because helping underdeveloped nations rise out of poverty is so vital to international security and the global economy, voluntary family planning and maternal health should be investment priorities for developed nations as well.

The second obstacle standing in the way of family planning initiatives, in particular, are some cultural practices. The sad fact is that some societies still deny the human rights of half of their populations in the name of cultural traditions that do physical, social and psychological damage to women and girls.

As UNFPA sees it, the time has long passed when men can or should be allowed to dictate the reproductive rights of women. Young girls should not be forced into marriage. Sex should always be un-coerced. And every woman should have the means to enjoy her human right and freedom to choose if or when she will have children, and how many she will have.

We will be raising these issues at Women Deliver in Kuala Lumpur, and I hope all who attend will come away from the conference with a re-energised commitment to the central role these issues play in humanity’s future and to address the challenges of family planning and maternal health forthrightly.

*Dr. Babatunde Osotimehin is a United Nations Under-Secretary-General and Executive Director of UNFPA, the United Nations Population Fund.

Young women on a Damascus street. Credit: Rebecca Murray/IPS

By Thalif Deen
UNITED NATIONS, May 21 2013 (IPS)

When thousands of participants from around the world gather in the Malaysian capital of Kuala Lumpur next week, the primary focus will be on health and empowerment of girls and women.

The meeting, scheduled for May 26-30 under a banner titled Women Deliver, will zero in on a longstanding unanswered question: how does the international community meet the massive unmet needs for contraception by over 222 million women in the developing world?”

The U.N. Population Fund (UNFPA) points out that increased contraceptive use and reduced unmet needs for contraception are central to achieving three of the U.N.’s Millennium Development Goals (MDGs) – improving maternal health, reducing child mortality and combating HIV/AIDS – heading towards the 2015 deadline.

Sivananthi Thanenthiran, executive director at the Malaysia-based Asian-Pacific Resource & Research Centre for Women (ARROW), told IPS the ability to decide the number, timing, and spacing of their children is one of the most fundamental rights individuals and couples can have.

Currently, she said, it is estimated 222 million women have an unmet need for family planning, and in many countries most women still continue to have more children then they desired.

“Investing in reproductive health and reproductive rights requires investment in a number of interventions by U.N. agencies, governments and donors,” she added.

Since UNFPA began operations back in 1969, the average global fertility has been cut in half. UNFPA says it has been a “critical catalyst” in this success by responding to requests by developing countries.

Asked how best the contraceptive needs could be met, Dr. Purnima Mane, president and chief executive officer of Pathfinder International, told IPS the United Nations and the international community need to continue advocating for increased funding – domestic and international – for access to contraception and for the integration of family planning into universal health coverage in all possible forums and through broader partnerships across sectors.

While it is true that investments in women’s education are essential to this effort, she said, much more needs to happen to change the situation of women.

Community-oriented work to change social norms around gender and enabling social and economic policies are essential to prevent early marriage, to keep girls in school, and to help women to space their births and give birth safely, when they want to bear children, said Dr. Mane, who heads an organisation described as the global leader in sexual and reproductive rights.

She argued that based on historical evidence, political will is, and will be, the most critical element of success for strong family planning programmes.

“However, we need to be vigilant about the voluntary nature of such programmes and the quality of the care provided,” Mane added.

At this time, she said, the most critical priority is for the global community to come together to address the contraceptive and sexual and reproductive health information and service needs of the growing youth population of over three billion under the age of 25.

“There is no easy fix and we all know that. What we need is to address the multiple factors that impact on this issue rather than focus on any one aspect alone,” she said.

The Kuala Lumpur meeting, the third Women Deliver conference launched originally in 2007, is touted as the largest global event of the decade – primarily of government leaders, policymakers, healthcare professionals, representatives of non-governmental organisations (NGOs), corporate leaders, and global media outlets.

The event will include a Youth Pre-Conference, a Minister’s Forum and a Parliamentarians Forum.

Asked about investments in reproductive health, Thanenthiran told IPS these include interventions around delaying the age of marriage and the age of first pregnancies, which include investments in girls’ education especially at the secondary and tertiary levels.

Interventions such as making available a range of contraceptive methods and ensuring women receive the right information so that they can make informed choices about the method that best suits them, and that health service providers treat women with kindness and provide quality care and service are essential in increasing trust towards family planning programmes, she added.

Naturally this requires funding and political commitment, but the health of women and girls is well worth safeguarding, Thanenthiran added.

Asked how the U.N.’s post-2015 economic agenda could underline reproductive health, Dr. Mane told IPS human rights principles of the International Conference on Population and Development (which took place in Cairo in 1994) can be embedded constructively in a variety of ways in the new set of development goals, but given that the relevant MDGs are especially lagging, “more explicit attention to the unfinished agenda is needed as we go forward.”

Population dynamics are also often left out of important discussions about future needs and development scenarios. For example, population growth may be mentioned but not in relation to access to contraception as a solution, she added.

She said universal health care is a start, if coverage of the broadest range of sexual and reproductive health care is explicitly included to move the unfinished agenda forward.

“Only then will we achieve sustainable development,” she said.

“My organisation, Pathfinder International, stands behind confronting inequality by advocating with other civil society partners for better governance which not only addresses inequality but holds policymakers accountable for failing to address preventable deaths among women and children,” Dr. Mane declared.

Thanenthiran said it is essential that access to comprehensive, quality sexual and reproductive health services, as promised to women and committed to by governments in the Cairo ICPD Programme of Action, is prioritised in the post-2015 development framework.

The ICPD Programme of Action (PoA) is going to be 20 years in 2014, and women are yet to enjoy in full the promises made to them during that time, she pointed out.

In the MDGs, some attention was given to the agenda under MDG 5 (on improving maternal health), and those working in the field of sexual and reproductive health and rights are hoping to see a more comprehensive approach with more reproductive health issues and indicators being covered in the new goal on reproductive and maternal health.

This would be the best way to go about to ensure government commitments to the ICPD are fulfilled, and initial investments made during the MDGs are continued and fully realised in the new development framework, she declared.

LGBT activists, human rights observers and police officers wait outside a courtroom in Uganda's constitutional court. Four activists had brought a case against Minister of State for Ethics and Integrity Simon Lokodo. Credit: Will Boase/IPS

By George Gao
UNITED NATIONS, Apr 26 2013 (IPS)

Ishita Chaudhry spent the past 36 hours listening to U.N. delegates discuss population growth and development. She noticed that on “controversial” topics, such as sexual and reproductive rights, young people’s voices often get lost.

“For us as young people, it’s really not as controversial as it is for governments,” said Chaudhry, a member of the High-Level Task Force for the International Conference on Population and Development (ICPD), at a press briefing Thursday.

“We know that we need to be empowered to claim our human rights… And we understand that access to sexual, reproductive health and birth services, and comprehensive sexuality education is a key aspect of that empowerment,” she explained.

Joaquim Alberto Chissano, a former president of Mozambique and co-chair of the task force, added, “Fulfilling sexual and (reproductive) health and rights is not only a human right… it also offers solutions to many of today’s global problems.”

Chissano – often credited for ending civil war and strengthening democracy in Mozambique – cited the links between sexual and reproductive health and national progress.

He explained that by promoting sexual and reproductive health, the international community can “fully unleash human potential, energies and talents… to nurture the human capital that countries need to reduce poverty and inequality”.

If sexual and reproductive rights are not addressed, “those who will feel the pinch more are the coming generations”, he warned.

The task force’s work – entitled “Policy Recommendations for the ICPD Beyond 2014: Sexual and Reproductive Health and Rights for All” – reaffirms values established almost twenty years ago in Cairo, where 179 governments gathered to adopt a Programme of Action that placed the human rights of women at the centre of international development goals.

The task force calls on the governments to address Cairo’s “unfinished agenda” by: ensuring sexual and reproductive rights through law; working towards universal access to sexual and reproductive health services; providing sexuality education for all young people; and eliminating violence against women and girls.

It argues that governments should expand access to safe abortion and to services for victims of gender-based violence, and that the international community should adopt a definition of “comprehensive sexuality education”.

The task force’s work will inform U.N. negotiations for a new development framework, to replace the expiring Millennium Development Goals (MDGs) post-2015.

According to the task force, the sexual and reproductive health of young women and girls are particularly compromised. It cites that one in three girls in developing countries are married without their consent; 2,400 young people are infected with HIV every day; and up to 50 percent of all sexual assaults are committed against girls under the age of 16.

Asked if sexual and reproductive rights are often barred by social or cultural norms, Chaudhry – founder of The YP Foundation, a non-profit organisation in India – said, “I come from a country that has a broad representation, both in terms of religion (and) culture. It has a lot of sensitivities.”

She emphasised the importance of providing information and sexuality education to approach such sensitivities. “You’re not telling the young person that they should or shouldn’t do something, you’re giving them access to evidence-based information, which means that they are in the best place to decide (for themselves).”

She said, “Because there’s such a broad lack of understanding… the fear and stigma and discrimination around issues of sex and sexuality therefore remains very high.”

Chaudhry argued that some of the most effective cases in achieving sexual and reproductive rights are when governments invest at community levels in reducing levels of related stigma.

She explained, “One of the biggest misconceptions of sexuality education is that if you provide sexuality education to an adolescent, you’re going to decrease the age of first sex.”

She added, “Once you start breaking the stigma and the silence around issues of sex and sexuality, you find that even parents and religious leaders themselves have questions… They (just) haven’t had anybody else to ask.”

Tarja Halonen, former president of Finland and co-chair of the task force, posed a question of her own: would you want to perpetuate socially rooted injustices, “or would you like to be the founding father or mother with a new way of (doing things)”?

She explained that while it is important to respect traditional values, it is also important to abide by the Universal Declaration of Human Rights. She emphasised the need to work with experts from schools, health centres and religious communities.

Halonen noted that social stigmas on sexuality are prevalent even in Finland – ranked the second happiest country by the U.N.’s World Happiness Report. These stigmas discourage victims of sexual abuse from seeking the help they need, while providing impunity for perpetrators.

Halonen told IPS, however, that there has been some progress. She shared her experience fighting for sexual and reproductive rights, which started over four decades ago when she was a young lawyer.

“In the late 1960s, when I spoke on behalf of young Finnish students… I said that (students) need more information for these issues,” said Halonen.

“I remembered how they answered me in Parliament. They said, ‘(Students) are in the university in order to study, not to have sex’.”

Despite social stigmas and Parliament’s neglect, Halonen was able organise sexual and reproductive health services and information for the university’s health care centres.

Her national progress for sexual and reproductive rights continued from there.

“We changed the legislation in 1970s concerning minorities (and) homosexuals. Then we changed the abortion law, little by little. Now when we look at statistics, we see afterwards that it has worked well. We have less abortions, we have better birth rates, we have fewer HIVs,” she said.

“So what are we afraid of?” she added.

Nafis Sadik, renowned women's right advocate, and Cathleen Miller discuss Miller's book about Sadik, "Champion of Choice". Credit: Joan Erakit/IPS

By Joan Erakit
UNITED NATIONS, Mar 24 2013 (IPS)

Once dubbed “the most powerful woman in the world” by the London Times, Nafis Sadik learned at an early age that persistence leads to opportunities for change – and backlash from the Pope.

“Champion of Choice”, a book by acclaimed author Cathleen Miller, details the life and times of Sadik, the extraordinary women’s advocate who served as executive director of the United Nations Population Fund (UNFPA) from 1987 to 2000.

A dynamic collaboration between Miller and Sadik, “Champion of Choice” stands as an example of dedication and the power of the human spirit. The journey began 12 years ago in a quest for a story that led Miller all over the world.

“The main thing that connected me to her was my tremendous respect for her,” Miller told IPS about her decision to write a book about Sadik. She emphasised the importance of spending time with Sadik’s family, the local communities with whom she had worked and the women whose stories remained poignant contributions to “Champions of Choice”.

“People are not going to open up and tell you their life’s story over the telephone, to a stranger,” said Miller. “It was just about spending time with people and getting them to trust you, getting them to tell you things that were personal and sometimes very painful.”Sadik fought tirelessly for women's rights and opened a global conversation on family planning.

On Mar. 20, UNFPA, Friends of UNFPA and the International Planned Parenthood Federation (IPPF) hosted a book launch at the Ford Foundation in Manhattan to celebrate both author and subject.

The importance of advocacy

Sadik’s work focused heavily on the health of women and girls. She fought tirelessly for women’s rights in sexual and reproductive health and opened up a global conversation on family planning.

As an undersecretary general at the United Nations, Sadik noted that her position gave her “a platform to really say what I always wanted to say about the rights of women, about sexual and reproductive health – including family planning – and how important it was and is for women to be able to exercise those rights”.

Not to be outdone by her male counterparts, Sadik became well known for her outspoken views and disarming clairvoyance. Advocating for her fellow women to advance themselves within the UNFPA, Sadik changed how the organisation was set up.

When she joined, she set up a task force to examine how women could advance in the organisation. “I let it be known in the office that if a position was open for advancement, I would consider both women and men,” Sadik described. “For a while, if they were equal, I would promote the woman.”

Advancing not only UNFPA but also the conversation surrounding global health, Sadik defied stereotypes and set out on a historic mission that fought to give women control over their bodies.

In 1994, Sadik was appointed secretary general of the International Conference on Population Development (ICPD) in Cairo that brought together world leaders, non-governmental organisations (NGOs) and activists to discuss population development and human rights. She called her work there “my best achievement”, describing, “what I did was get people to the negotiating table”.

Spearheading an initiative for marriage equality and the empowerment of women, Sadik believed that when a woman has the right to reproductive health and the power to decide what’s best for her and her family, population management and sustaining global development become possible.

“Of course couples should make decisions together, but in the end it should be the woman who should be able to decide about her own life and about her own health and about her own needs,” Sadik said. This, however, “is not the case for the majority of women in the developing countries”.

A special narrative

With her many contributions and the occasional controversy – the Vatican opposed Sadik’s stand on sexual and reproductive health – Sadik’s story found its own special voice through Miller.

“This kind of narrative story that’s very much about storytelling – and very intimate – had the power to affect people in a different way than a book that’s historical or policy driven,” Miller told IPS.

Asking tough questions and relying on Sadik to recount stories, Miller wrote from a place of learning. The outcome was an incredible account of advocacy. In a era when the world is driven by instant gratification and immediate results, Sadik remains one of the most dedicated activists for women’s health and rights, an inspiring story and legacy in her own right.

“The main thing I learned from Dr. Sadik is that you have to have courage,” Miller shared. “Not just courage, but the determination to keep after a task or a change for decades.”

Argentina is set to become the first country in Latin America to legalise surrogate motherhood as an option for heterosexual and homosexual couples or single people who cannot conceive but want to have a child who is biologically their own.

“It’s been one of the hardest topics in family law,” Marisa Herrera, a lawyer who participated in a thorough reform of the civil code created in 1869, told IPS. Groups of experts worked on redrafting it under the direction of the Supreme Court, following a proposal by President Cristina Fernández.

The project was presented to Congress in early March, and if approved as expected it will make Argentina the first Latin American country to legalise this practice, also known as “rent-a-womb.”

Brazil and Mexico* have laws on surrogacy, but they lack the breadth of scope and the innovative nature of the Argentine bill, experts from those nations told IPS.

The reform bill puts forward a civil code that is much more open in terms of family law. It incorporates the already established right to marriage between persons of the same sex, as well as no-fault divorce, while replacing the concept of parental authority with that of parental responsibility.

But gestational surrogacy was the most complex issue for the experts, Herrera said, mainly because of the criticisms – “some extremely valuable” – from feminists and other groups that fear women who act as birth mothers will be “objectified,” or will be motivated by profit, especially in the case of poorer women.

There are a large number of ads on the internet posted by women from Latin America offering to act as surrogate mothers for a fee, as well as by couples looking for a healthy woman capable of carrying a baby to term in return for health care and economic support.

In Argentina surrogacy is practised, but it is unregulated, as in all other countries in the region. Some couples prefer to travel to countries where the practice is legal, and come back with their baby, but that implies heavy costs that not everyone can afford, resulting in discrimination, Herrera said.

The practice is legal in Australia, Greece, India, Israel, Russia, South Africa, some states in the United States and Canada, and is under consideration in Belgium, Bulgaria, Finland, Iceland and Ireland. In some countries where it is permitted within limits, like Brazil, flexibilisation of the law is being debated.

This information appears in an essay titled “Por qué sí a la regulación de la gestación por sustitución a pesar de todo” (Why gestational surrogacy should be regulated, in spite of everything), by Herrera and two other lawyers who drafted the reform bill, Eleonora Lamm and Aida Kemelmajer.

In it, the experts put forward the reasons for regulating the practice and essential precautions for making it safer.

“I don’t know if this method is ideal, but it exists,” Herrera said. “It is frequently used a lot abroad, and we cannot ignore it. It is better to have a law to regulate and control it, protecting the child above all, but also the surrogate mother and the intended parents who want to have their biological child this way.”

The bill stipulates that gestational surrogacy must be approved by a judge before the embryo is implanted. The judge will require medical and psychological health certificates for the birth mother and her “free, full and informed” consent.

A multidisciplinary team from the court will advise the surrogate mother about the risks and implications of the pregnancy. She will not be able to use her own eggs, and one or both of the intended parents must provide reproductive cells (eggs or sperm). This is to ensure there is no dispute over parentage.

In the view of the experts, “the intended parents must have demonstrated they are incapable of conceiving or carrying a pregnancy to term.”

They also say that in order to avoid becoming a form of “labour imposed by poverty and tolerated by the state,” the surrogate mother can only bear a child for others twice. She should also have at least one child of her own before entering into a surrogacy agreement “to ensure that she understands the seriousness of the commitment.”

The surrogacy agreement must be free of charge. Medical expenses, health care and food may be paid for but they do not alter the altruistic nature of the contract. And even if financial payments are involved, it is anticipated that the limit of two pregnancies will curtail the “business.”

Doctors will not be able to carry out embryo implantation without prior legal permission in every case, according to the bill.

In this way, legal safeguards are provided to all the parties. The child’s parentage is not changed at birth, because the intended parents are legally its parents from the moment the judge authorises the surrogacy, and they are responsible for the child from pregnancy on.

Brazil has no legislation on surrogate motherhood, but the Federal Medical Council has regulated it since 2010. It is allowed only when a couple cannot have a child of their own, and the surrogate mother must be a first- or second-degree relative (such as mother, sister or aunt).

The president of the Commission on Bioethics and Biorights of the Brazilian Bar Association, Bernardo Brasil, told IPS that the constitution forbids traffic in human organs, and “that includes the uterus.” So the regulations prohibit paying a fee to the substitute mother.

The Federal Medical Council allows the payment of medical expenses and the costs involved in the pregnancy, “but a contract cannot be entered into for financial gain. The person who lends her uterus cannot seek to cash in on the arrangement,” he said.

In his view, the Council’s resolution “is limited in nature because it only involves medical practice, but says nothing about the relations between the surrogate mother and the intended mother,” who is a relative, so that litigation about parentage may arise between them.

“There are profound ethical implications and there is still a great deal of resistance from religious groups in Congress. Brazil is experiencing a legal vacuum, because the Medical Council resolution is a provisional measure, but legal guidelines are lacking,” he said.

Mexico, too, lacks a national law on the question. Only the southern state of Tabasco has regulations for surrogate gestation since 1998, without addressing the issue of financial gain.

In 2010 the Mexico City government approved a surrogate gestation law restricted to married heterosexual couples, but it was vetoed. Another bill is currently under debate, although it would only apply in the capital.

Angélica García, the head of the non-governmental Mexican Foundation for Family Planning, told IPS that surrogacy should be “regulated in accordance with sexual and reproductive rights and freedom of choice; scientific information should be provided, the mental and physical health of the surrogate mother must be cared for, and there must be no coercion or blackmail.

“The financial aspects are not the most important. Without clear legislation, we would be left in doubt as to whether surrogacy should be profitable or not. It would be very difficult to decide whether or not a fee should be charged,” García said.

* With additional reporting from Fabíola Ortiz in Rio de Janeiro and Emilio Godoy in Mexico City.

Women's sexual and reproductive rights are at the heart of sustainable development, experts say. Credit: Fahim Siddiqi/IPS

By Becky Bergdahl
UNITED NATIONS, Oct 2 2012 (IPS)

Gathered at the Ford Foundation in New York Monday, international luminaries, family planning experts and women’s rights activists repeatedly expressed a common sentiment: “I cannot believe that we are still having this discussion today.”

They were there to mark the launch of a new 26-member high-level task force to galvanise support behind the goals of the International Conference on Population and Development (ICPD).

That conference took place nearly two decades ago, in Cairo, Egypt in 1994. It resulted in a Programme of Action that become the guiding document for the United Nations Population Fund, UNFPA.

The Programme of Action contains four global goals. First, universal access to education for all, including women and girls. Second, reduction of infant and child mortality. Third, reduction of maternal mortality. And fourth, access to reproductive and sexual health services, including family planning.

The ICPD goals will celebrate their 20th anniversary in 2014. None have been reached so far, especially the last.

“I would not say that the goals have not been fulfilled, but that they have only been partially fulfilled. There are a number of reasons for this,” Gita Sen told IPS.

Sen is a professor of public policy at the Indian Institute of Management in Bangalore, and has worked on population policies for 35 years. She is a member of the new task force, and attended the conference in Cairo in 1994.

“One thing that has definitely happened in those 18 years is that there is a language of sexual and reproductive rights, which was never there before,” Sen said.

“A part of what we are seeing is that this language has scared some people in governments, some very religious people, some social conservatives, who see this as a zero-sum game,” she said.

“They think that if women are empowered, if young people get autonomy and choice, they are going to lose out in terms of their ability to control them. Which is probably true, to some extent. But in the end it is for a better life for everybody.”

According to Sen, the rise of conservatism, hindering achievement of the ICPD goals, has its roots in the United States.

“For example, the spread of evangelical conservatism in Africa is funded heavily from this country. It is funded by very rich people who are pouring their millions into very poor countries, in order to ensure that they turn their agenda away from sexual and reproductive rights, against gender equality. And with that much money pouring in it is hardly surprising that we have faced so much trouble as we do.”

Yet Sen maintains a positive attitude. “We are going to win this one. You can not keep young people and women back forever. This is not the dark ages,” she concluded.

Much remains to be done. A staggering 200 million women worldwide still lack access to effective contraception. This results in 80 million unintended pregnancies each year, with 40 million ending in unsafe abortions, many with life-threatening consequences.

And 800 women who carry out their pregnancies, wanted or unwanted, die every day in childbirth – 99 percent of them in developing countries.

“We know that our response has been inadequate,” Ishita Chaudhry, a member of the new task force and the leader of the youth organisation TYPF in India, working for sexual and reproductive rights, said at the event.

Chaudhry highlighted the importance of banning child marriage in order to achieve the ICPD goals.

Child brides, girls married before their 18th birthday, run especially high risks of unwanted pregnancy and also of abuse. And there are currently over 60 million child brides worldwide.

Chaudhry told the audience about how she grew up in a middle-class family in India, with her mother working as a teacher in the slums. When Chaudhry befriended some of her mother’s students, she was shocked to learn that the most common topic of discussion was if the girl’s parents were planning to marry them off.

“I lost some of my closest friends… They got married and their husbands wanted them to stay home to cook and clean and have babies,” Chaudhry said.

On top of that, marital rape was not considered a crime in India at the time, and it is still legal in a great number of states.

“How do you say no when your government do not recognise your right to do it?” Chaudhry asked.

One in seven women experience domestic or sexual violence in their lifetime. Up to one in four women experience abuse during pregnancy. This has ravaging consequences for the women and for their babies, and for the society as a whole.

“Women’s sexual and reproductive rights are at the heart of sustainable development,” said Tarja Halonen, a former president of Finland and co-chair of the new high-level task force.

“Pregnancy should be one of the happiest times in our life… Girls pay the price of taboos and double standards,” she said.

Crown Princess Mary of Denmark also appeared at the launch of the new task force, of which she is a member.

“We are here today because… the Cairo agenda is an unfinished agenda,” Princess Mary said.

A famous feminist slogan is that the personal is political. And Princess Mary did go on to talk about day-to-day life in the Danish royal family.

“My oldest son is soon that age when he will start to ask how babies are made. He will receive answers from us, and education in school… With knowledge comes the opportunity to make informed decisions,” she said.

According to Princess Mary, talking about sex may very well be uncomfortable. “But not talking about these issues might have a much higher price.”