"In the Chittagong Hills (in Bangladesh), giving birth to babies is like ensuring one's death. Women wait and wait for a doctor to arrive and eventually they die while delivering the child," declared a woman health worker at the 10th International Women's Health Meet (IWHM) recently. The health worker was describing what women in some parts of South Asia go through while delivering a child.
The Bangladeshi health worker was speaking at a special consultative meet organised by the Malaysia-based advocacy group Arrow. Arrow's meet aimed to share the various strategies deployed by the Women's Health and Rights Advocacy Partnership (WHRAP) in strengthening the women's health movement.
"In a house, if a man and woman are both suffering from an illness, it's the former who is rushed to the hospital. Women's health needs are rarely addressed. Why are women suffering, despite so much advancement in health, and so many leaders pushing for women's health rights," the health worker asked a group of experts at the Arrow meet. Her questions grew sharper: "There are over a 1,000 women leaders in the IWHM, yet even as the meet is on, several women are dying in the process of just giving birth."
In some ways, her posers were like a reality check on the women's health rights movement: What has been achieved and what still needs to be achieved? How far have we come and how far do we still need to go? The IWHM's broad theme: 'Health Rights, Women's Lives: Challenges & Strategies for Movement Building' included discussions on how globalisation is impacting women's health; gender politics of GATS; how violence against women is becoming a huge risk to their health and well being; and how women's perspectives need to be integrated in various policymaking processes.
Worldwide, post-globalisation, women are socially and personally more vulnerable and financially more insecure. Besides, new age medical technologies have, in some countries, have threatened the very existence of a female child.
The 10th IWHM had not only activists, grassroots workers and doctors debating about women's health, but also economists, poets and filmmakers, discussing how to take the movement forward.
A recurrent theme at the meet was inequity - why some people (women) are more vulnerable to diseases and death. As Pakistani activist Kausar Khan said during one of the meetings: "The role of inequity is so very relevant today."
The meet also had some 'old enemies' of the movement - resistance to women's right to sexual and reproductive health (SRH) - being discussed in the current context. For almost five years now, women's groups and health experts have been grieving over how and why the SRH issue got excluded not only from the agenda of the Millennium Development Goals (MDGs) but also from the priority list of most governments.
In a way, all the gains of the International Conference on Population and Development held in Cairo in 1994, and the UN Fourth World Conference on Women in Beijing in 1995, seem to have been lost, with SRH hardly a focus for governments and planners. The Bangladeshi health worker's example of the conditions prevailing in Chittagong was just one of the many illustrations of SRH not being a priority any longer.
Although, in the last two decades, feminists and activists have enlarged the entire concept of health and well being, not restricting women's health to just their maternal roles and reproductive rights, the ground reality demands that we revisit some of these core rights all over again.
In five South Asian countries - India, Nepal, Bangladesh, Pakistan and Sri Lanka - high maternal mortality rates (MMR) rates suggest that reproductive health is really not a goal for the policymakers. The media regularly reports shocking stories of negligence and of women suffering because basic health care is still unavailable to most.
Even the recently released 'State of World Population 2005' report by UNFPA says that every year over 500,000 women die due to pregnancy-related causes across the world. Lack of access to contraceptives in the developing world results in 76 million unwanted pregnancies and an estimated 19 million unsafe abortions worldwide every year. Ninety nine per cent of the maternal deaths occur in developing countries.
In recent years, most of the resistance to SRH has centred around abortion. According to the UNFPA report, unsafe abortions are a leading cause of maternal mortality and can result in permanent injuries. "Many women who seek abortions are married. They are usually poor and struggling to provide for children they already have. Research suggests that one in 10 pregnancies will end in an unsafe abortion, with Asia, Africa and Latin America accounting for the highest numbers," says the report.
Even though the UN recognises SRH as essential step to reduce MMR, infant mortality rates and the risk of acquiring HIV/AIDS, SRH has been excluded from the MDGs.
So how can SRH become the centre of the policymaking process? How can governments be held accountable to ensuring basic health services to women? How can women's groups and health rights workers ensure that there is no delay in treatment even in the most remote areas?
The WHRAP partners shared some wonderful experiences of how they have tried to push the SRH agenda in their respective countries. India partners, Sahayog (based in Uttar Pradesh) and Chetna (based in Gujarat), described how research-based advocacy had helped influence policymakers on SRH issues. In fact, advocacy based on grassroots research, conducted by local women themselves, made a deeper impact on the government planners.
Jashodhara Dasgupta from Sahayog said that the process of studying the system of service providers and producing evidence of negligence has itself been an empowering process for women in the villages. The women have now learnt how to access their rights.
A question from one of the participants in the Arrow meet - how personal issues like sexual and reproductive health needs can be discussed with village women - suggested how several biases about village women still need to be challenged. All WHRAP partners agreed that compared to urban women, village women were less inhibited when it came to talking about their reproductive concerns. Their experience showed that once women became aware of their rights, they became more determined to access it.
A gentle but firm appeal was made by some participants to see how men can be involved as partners. Their role, some felt, may give the movement that extra push it so badly needs.
The key to successfully push the SRH agenda lies in linking grassroots experiences with policy issues. Simultaneously, activists and pressure groups need to use every existing law and legal or representative body to demand for more SRH-related reforms and for more accountability within the government.
While the 10th IWHM may not have thrown up answers to all fundamental questions and concerns about the future of the women's health movement, it did help in indicating that the struggle for women's health rights will not only be a long one, but be full of new challenges and old obstacles.
It's time to take charge, all over again.