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Women's health is a citizenship and democracy issue

Gabby De Cicco

FRIDAY FILE: May 28, 2011 was the International Day of Action for Women’s Health. AWID spoke to Nirvana Gonzalez Rosa, General Coordinator of the Latin American and Caribbean Women’s Health Network (RSMLAC), on their call to action and the status of the right to health in the region.

AWID: Why is the Network now launching an Ongoing Campaign for the Comprehensive Health, Sexual Rights and Reproductive Rights of Women and Girls while earlier campaigns were always single-issue ones?

Nirvana González Rosa (N.G.R.): Last year we held our second consultation meeting with members and one of the concerns discussed was that the Network had fragmented its work by choosing a different issue every year. Members proposed that we should go back to a more comprehensive and holistic approach to women’s health. The Campaign also responds to the multiplicity of social determinants of health and focuses on the different subordinate issues affecting women’s health.

The comprehensive approach reflects the processes taking place throughout women’s life cycles without focusing only on the reproductive years. Often we just stop there and, for instance, fail to address the issues affecting women over 60, who survive men because their life expectancy is higher. These women are the most lonely, aged and impoverished. These are the elements that we need to take into account, and where there are currently gaps in the women’s health movement.

Women’s health activism in LAC has also evolved from demanding services to demanding rights. As a rights issue it is also a citizenship and democracy issue.

AWID: What are the social determinants of health?

N.G.R.: It is one of the most comprehensive approaches being advanced by bodies like the World Health Organization (WHO), the Panamerican Health Organization (PAHO) and academia with regard to health as a whole. This approach emphasizes that it is impossible to speak of health without mentioning its social determinants, that is, those conditions that are cross-cutting to health and impact on it, like race, culture, age, socio-economic and educational status, sexual orientation and gender, among others. This analysis still lacks a gender perspective and it falls on the women’s movement to push for it.

Nirvana González Rosa

AWID: When you mention the holistic approach to health, how do you integrate the knowledge from different cultures into it?

N.G.R: For the last three years we have been involved in building alliances with different groups, including networks of women living with HIV, sex workers, indigenous and Afro-descendant women to integrate them into the follow-up and ratification of the Cairo agenda in the region. In this way we integrate, position and make visible their identities in RSMLAC’s work and actions towards a more holistic, comprehensive, egalitarian and inclusive approach.

AWID: What is the status of Sexual and Reproductive Rights (SRR) in the region?

N.G.R.: In spite of serious threats, well-orchestrated and better funded attacks coming from the Holy See and its conservative allies, we can point out some recent advances as a result of consistent activism and advocacy by women’s and feminist movements across the region.

Even with a conservative government, Costa Rica recently launched a national policy on sexuality with a human rights and diversity framework, and although abortion is not mentioned in it, it is nevertheless a very progressive policy. Other positive examples include the Reproductive Health Law passed by the Guatemalan government and the recognition of abortion rights in Mexico City.

Another step forward for our region is the decrease in fertility rates. There is a wider use and consumption of contraception, although not necessarily among the most impoverished women. Maternal mortality rates have gone down in some countries but not yet in others, like Bolivia, Guatemala and Haiti. Concepts like sexual and reproductive health, gender conditioning and identity are being integrated into health policies.

Brazil is taking two steps forward and one back. During the Lula da Silva administration, our colleague Maria Jose Araujo was the head of the Women’s Health Unit, through which she managed to implement a Comprehensive Health Program for Women. Now feminists are denouncing the new program being promoted by President Rousseff, focused mainly on maternal and child health.

In Nicaragua there were also setbacks as abortion was re-criminalized. If we recall what happened in the Dominican Republic a year ago, protection to life from the moment of conception was included in the Constitution, ruling out all possibilities of decriminalizing abortion.

Compared with other regions in the Global South (Asia or Africa) our region has progressive public policies in many cases, but our main problem is the lack of political will of States to allocate the necessary funds to implement these policies adequately and to ensure access for all. In addition to this, most donors are withdrawing from our region compounding the situation even further, particularly for the women’s movement and for progressive social movements in general.

AWID: What are some of the pending problems or challenges?

N.G.R: Unsafe abortions and harassment of women who have had abortions continue to be serious problems in the region. In Mexico, impoverished and indigenous women who have abortions outside Mexico City are being jailed. Two years ago in Mato Grosso, Brazil, about 20 women were prosecuted and imprisoned for having abortions. This happened under the Lula administration. There have been similar cases in Chile and Nicaragua. The demonization of everything related to freedom of sexual and reproductive choice in daily language, femicides and the daily increase in violence against women all have considerable impact on women’s holistic health and also on the health of society as a whole. The feminization of HIV/AIDS that is increasingly affecting heterosexual women and goes unaddressed from a gender perspective (in programmes and policies) also constitutes a challenge for us as a movement.

Also, at the recent UNCPD meeting, the World Bank (WB) proposed that women in developed countries should begin giving birth before they turn 30. As RSMLAC, we are very concerned about this, because for the last 30 years we have been telling women to empower themselves to access education, health, contraception, and to become professionals, etc. so they can have greater control over their lives, their bodies and life decisions. But now this WB report is telling them to begin giving birth at a younger age. Where is the human rights framework being dumped? So we are seeing a shift back towards population policies that have a demographic vision. It took us many years of work to change that vision into a rights-based one in which women are no longer regarded as objects but as subjects. We have also noticed this switch in framework at the Economic Commission for Latin America and the Caribbean (ECLAC) meetings and as feminists we need to be very alert about this.

AWID: How is the systemic crisis affecting health systems in the region?

N.G.R.: I think that the privatization of health systems is a violation of one of our most fundamental rights. Women are always the most affected as we are the main users of health systems. If we look at Chile - the first country to implement this model of privatizing health services in the region - now it is about to implement a reform to the reform, just like Puerto Rico. In the case of the latter, it has been a complete failure and what prevails is the scaling-down of all services. Education and health are the areas attracting the smallest investment by States and they were the most affected by the global financial crisis. The paradox is that health and education constitute the backbone of any society.

AWID: What is the situation in the countries with a more socialist model?

N.G.R.: There are differing stories. In the case of Venezuela, low-income persons have access to health services which they were previously unable to access and the same thing is happening in Bolivia. Countries like Brazil, Uruguay and Argentina have progressive policies aimed at social justice, which should translate into greater and equal access to health services for all. However, in practice, there is no guarantee that these policies will be implemented effectively and consistently.

In terms of policies related to the body, sexuality and reproduction, those countries with “socialist” models are as conservative as those on the right. Look at what the former Uruguayan President Tabaré Vázquez did when he vetoed the Reproductive Health Law that had been passed by a majority vote in Parliament with popular support and endorsement by doctors. Other examples are the outspoken opposition to abortion by President Correa, from Ecuador; the signing of a Concordat with the Vatican by the former Brazilian President da Silva and the refusal by Bachelet, the former President of Chile, to promote the decriminalization of abortion in the country.

AWID: What are the strategies to confront the Church hierarchies?

N.G.R: We need to keep maximizing our work in addition to looking for more resources. Nowadays, these hierarchies are well organized and have a much more articulated and convincing discourse than they had in the past, and they are also co-opting our own discourse. This is due to a serious injection of money precisely what the women’s movement lacks. But we have persistence, commitment and creativity, which are the trademarks of our movement that has been fighting for its rights and for social justice for quite a while.

We also need to support every campaign and action aimed at promoting and demanding secular states. This notion is present in most of our countries’ constitutions, but it is not put into practice. We must expose the violence being perpetrated by priests against boys, girls and women. We must expose their double moral standards to the whole world. Latin America is the only stronghold the Vatican has left, together with some Protestants allied to the Republicans in the USA. Let us remember that they are not pro-life but anti-rights.