Recently, the highest court in Italy allowed a couple to remain legally married after one had sex reassignment surgery. In a surreal twist, the Catholic Church recognizes the couple as still married also, because it does not recognize gender reassignment. While it is hard to call this confluence the best of all possible worlds, it might be for now. The rights and freedoms of transgendered persons in other parts of the world, such as Latin America, are decidedly less clear.
Some countries, like Cuba, Brazil, and Uruguay, lead the way and allow people to legally change their gender in official documents after varying conditions are met. Places like Brazil and Chile are even ready to foot the bill for sex reassignment surgery. One of the most progressive laws in all of Latin America, however, is that of Argentina, which allows people to change their gender by filing some paperwork without surgery or a diagnosis.
The law was used immediately, even by children as young as six, such as in the case of Luana. Lulu, as she likes to be called, was originally named Manuel and was born with the body of a baby boy. Her mother noticed something was different about Luana when she started identifying herself as a girl the moment she started talking. When the law took effect, Luana's mother stood by her daughter while she requested that the government officially change her gender to female. Luana is now the youngest Argentinian to take advantage of the law, and she will be followed by many more.
These progressive laws offer hope for the future, but they belie a harsher reality that many transgendered people face. Latin America accounts for nearly 80 percent of reported murders of transgendered individuals. While legal progress has been made, homophobic and transphobic violence continues in the region, with people regularly being attacked or murdered for their gender identity. In Colombia alone, there were 60 reported murders of transgendered individuals between 2005 and 2012 and no convictions. It is not unheard of for police to deliberately ignore violence, or even to refuse to help a transsexual in the middle of an attack.
Many transgendered people, whether by their own volition or because of a lack of familial support and employment opportunities, become sex workers. Transwomen in the trade are particularly vulnerable. Clients, police officers, and medical professionals are far more likely to abuse and ignore them, so transwoman sex workers are highly at risk for HIV and are less likely to get any treatment once they have contracted the disease. As recently as 2006, 62 percent of deaths in the Buenos Aires transgendered community were attributed to HIV/AIDS.
The violence and preventable diseases are discouraging, but we shouldn't lose hope. The people who volunteer for us and our Member Associations work tirelessly -- in their advocacy and the provision of services -- to uphold the tenets of our Declaration of Sexual Rights. Among the rights laid out in our Declaration is the right to equality and freedom from discrimination based on sex, sexuality, or gender; the right to security of person and bodily integrity; the right to the benefit of modern medicine; and the right to accountability and redress in the case of wrongdoing.
IPPF/WHR and our Member Associations in the Caribbean and Latin America, work every day to guarantee these rights and educate people about, and provide services for, the prevention and treatment of sexually transmitted infections and HIV, reaching the most vulnerable populations and educating them about their options. In the beginning of our efforts to reach marginalized communities in Lima's red light district, for example, sex workers were liable to grab free condoms and run away from our health promoters for fear of abuse. Now, with the help of kindness and acceptance from our staff, they feel safe and trust us with their healthcare and sexual education.
The battle for sexual rights must be waged in the legislatures and courts and in the streets. We will not rest until every person is guaranteed and enjoys their sexual rights and freedoms.
A special thank you to Julia Redden, for her collaboration in the creation of this piece.
I have dedicated my life to ensuring that all women -- young and old, poor and wealthy, married and unmarried -- would be able to say that those two words and have them ring true.
It seems simple enough. When women have the power to decide if and when to have children, their families become healthier, stronger and more economically solvent. Yet even today, in 2014, the right to decide the size of one's family remains out of reach for far too many: worldwide, At least 200 million women want to avoid pregnancy yet lack access to modern contraception.
What would it take to shrink this number to zero? A mere $8.1 billion -- or about 1 percent of what Americans spent during the 2013 holidays. But the world spends less than half that. And the root of the problem lies not only in funding, but rather, in the fact that women have not achieved real equality with men.
Last month, I had the pleasure of traveling to Bolivia, one of Latin America's poorest countries, to meet with our local Member Association CIES. In addition to the breathtaking vistas of the world's highest capital city La Paz, we traveled through mud and across rivers to reach small, largely indigenous communities nestled in majestic -- and sometimes nearly impassable -- hills of Central Bolivia.
"Many of the women you will meet have never had a menstrual period," said CIES Executive Director Jhonny Lopez as we set out on our journey. He explained that many women living in these rural communities had given birth to as many as twelve children. A lack of access to birth control and health education was not the only problem. Many women remained pregnant at the insistence of their husbands. For many of the men in these small communities, who rely on migrant labor for their sparse incomes, pregnancy means guaranteed fidelity during the times they are away from their families.
During the two days we spent in Central Bolivia, I saw the change that CIES had brought to these rural communities. In addition to providing doctors and health supplies to these communities -- for many, their only contact with the health system -- a key component of CIES' approach is education. That means breaking down the myths associated with contraception and other reproductive health issues. That means slowly chipping away at traditional gender norms and convincing husbands to let their wives be seen by a male doctor--and often, convincing women themselves. But more than anything, it means giving women the right to decide- and the right to demand a different kind of future for herself, for her family.
There are also larger political and religious forces at play in the fight for a woman's right to decide. In the region where I work, Latin America and the Caribbean, conservative forces have for years blocked efforts to ensure universal access to low-cost reproductive health services for all who seek them. In our region, these efforts have primarily been led by the Catholic Church. While we had great hope that the Church may begin to soften given its new leadership, we have yet to see signs of retreat when it comes to our issues. Just last year, our Dominican Member Association PROFAMILIA was sued by the Catholic Church over its mass media campaign around sexuality education, contraception and sexual abuse. In the end, the court rejected the Church's claim that the ads were in violation of the Constitution. The public and media support for PROFAMILIA during and after the meeting was massive. But it was not an easy battle.
While the battle for sexual and reproductive health and rights continues today, you can take action now to ensure that women throughout the world -- from New York City to rural Bolivia -- have access to the information, services and rights they need to live healthy and empowered lives.
The Commission was convened at the UN headquarters in New York to address the challenges and achievements of the Millennium Development Goals (MDGs) in improving the lives of women and girls in developing countries. While the MDGs resulted in a reduction of poverty in some respects, the goals furthest from being achieved are those focused on women and girls -- particularly on achieving gender equality and improving maternal health. With the MDGs set to expire in 2015, the Commission's outcome document will help shape priorities for the next global development framework.
The Commission specifically called for a stand-alone goal on gender equality, a move that was applauded by women's rights activists.
A stand-alone goal on gender equality signals that gender equality and women's rights are important in and of themselves, as well as a priority for governmental investment. It recognizes that sustainable and meaningful development must address the root causes of gender inequality, which deny women and girls an education, the right to make decisions about their bodies and childbearing, to decent employment -- and equal pay for equal work -- and to live free of violence.
The Commission also stated that the post-2015 development agenda must include gender-specific targets across other development goals, strategies, and objectives -- especially those related to education, health, economic justice, and the environment. It also called on governments to address the discriminatory social norms and practices that foster gender inequality, including early and forced marriage and other forms of violence against women and girls, and to strengthen accountability mechanisms for women's human rights.
The Agreed Conclusions reaffirmed the Cairo Programme of Action as well as theBeijing Platform of Action, which called for investments in "quality comprehensive sexual and reproductive health care" including emergency contraception, information and education, safe abortion where allowed by law, and prevention and treatment of sexually transmitted infections and HIV. Furthermore, the Conclusions called for the recognition of the human rights of women to "decide freely and responsibly on matters related to their sexuality... free from coercion, discrimination, and violence."
Member States also recognized that progress toward achieving the Millennium Development Goals -- which include eradicating poverty and expanding access to health services such as reproductive health -- has been held back due to persistent "unequal power relations between women and men," particularly discriminatory laws, social norms, and gender stereotypes.
The governments expressed concern that several critical issues related to gender equality were not adequately addressed by the MDGs, including violence against women and girls; harmful practices such as early and forced marriage and female genital mutilation; women's and adolescents' sexual and reproductive health and reproductive rights; women's and girls' disproportionate share of unpaid work, particularly unpaid care work; the gender wage gap; women's equal access to and control of resources including land; women's inheritance rights; and women's full participation in decision-making at all levels.
The Commission called for measures to ensure universal access to primary education, especially for girls and vulnerable youth, as well as measures to strengthen the ability of women to participate in formal and informal labor sectors. The governments also called for efforts to ensure that women's rights and health obtain the prominence they deserve in the next global development framework.
Women's health and rights organizations applauded governments who stood up for the rights of all individuals to live free of violence, discrimination, and barriers to accessing sexual and reproductive health services, particularly for girls. However, advocates expressed disappointment that a small minority of conservative governments spurred on by the Holy See--which holds special observer status at the UN -- held up negotiations by objecting to concepts as fundamental as gender and the human rights of women throughout the two weeks of negotiations.
In particular, advocates noted that, despite a 20-year legacy of UN prohibition of discrimination and violence based on sexual orientation and increasingly on gender identity, government delegates gave in to pressure to exclude recognition of these violations in the final agreed conclusions.
A Resolution for 2014: Eliminating Health Care Inequality
A Resolution for 2014: Eliminating Health Care Inequality
As we ease into 2014, many of us are continuing to make good on New Year's resolutions to better ourselves and appreciate the good in our lives in an increasingly unpredictable world.
I have the fortune to experience this hope and inspiration each time I walk through the doors of the International Planned Parenthood/Western Hemisphere Region offices. From lawyers to doctors to human rights advocates, my colleagues are remarkable. They work hard and long hours, often spending weeks away from their families to lend their expertise and passion to ensuring the most rural and marginalized communities in Latin America and the Caribbean -- one of the most unequal regions in the world -- have a voice and a choice.
Recently, I had the opportunity to chat with Jessie Clyde, our Youth Program Officer, about her work. Given the recent news about the decline of the Argentinian economy and the murder of Miss Venezuela, protecting the health and rights of the region's 106 million youth is one of the most crucial and impactful investments we can make. I hope you enjoy her guest post on how inequality impacts sexual and reproductive health:
Compared to other regions of the world, Latin America seems to be doing well at first glance. Health indicators show progress: maternal and child mortality numbers have dropped, contraceptive use is up and abortion was even legalized in Mexico City in 2011. But as a public health professional in the region with a focus on the sexual and reproductive health of adolescents, I'm not so quick to celebrate these victories: My fieldwork has taught me that national averages often tell a very different story than the reality found on the ground.
All it takes is a quick detour from the urban capitals and glossy tourist havens to see the large number of people in the region who still desperately need quality health services. On a recent trip to Venezuela, it took only a few minutes to leave the sparkling city behind and find ourselves in the slums of the surrounding hills. On these steep streets, I encountered a pregnant 15 year-old girl who didn't have the information or access to services to prevent unintended pregnancies. A short boat ride away from the famous turquoise waters of the Belize cayes, young people speak to me about high levels of violence, HIV and adolescent pregnancies. And in Argentina, I have spoken with undocumented immigrants in public hospitals who struggle to get their basic health care needs met because of discrimination.
A recent study by the Guttmacher Institute backs up my observation that while the region as a whole is doing well, there are still pockets of extreme poverty that leave women unable to access basic services. The report begins by telling us the good news. Approximately seven out of 10 married Mexican women of childbearing age currently use a contraceptive method (a level similar to the United States), family size has declined from about six children in the 1970s to just over two, and maternal mortality has fallen significantly.
However, despite these impressive achievements, large disparities by population subgroups remain. The services, supplies and human resources that allow women in wealthier urban areas to plan their families are not always available to all. Poorer states such as Chiapas, Guerrero and Oaxaca still have large populations living in homes with no indoor plumbing or electricity, let alone access to sexual and reproductive health care. Not surprisingly, the indicators in those regions aren't quite as rosy. For example, abortions in Mexico City are safe and accordingly, just 0.5 percent of these procedures were associated with mild complications in 2009. However, of the abortions obtained by poor rural women, 45 percent led to complications. This figure is even more striking when you consider the fact thatnearly half of Mexico's population lives in poverty.
The first step in closing these gaps is to have the data that proves they exist. The Guttmacher study is a great step forward, but comparable data for other countries in the region is largely unavailable, leaving health professionals without the quantitative data needed to shift policies and budgets.
Latin America is a diverse region that spans the peaks of the Andes to the tributaries of the Amazon to the Panama Canal. That is a diversity that we should continue to celebrate. However, when it comes to access to health care and sexual and reproductive health indicators, we want to see fewer differences across those mountains, rivers and canals.
Ken Edelin died last week at age 74. In addition to his distinguished career as a physician, Ken served as Chair of the Board of the Planned Parenthood Federation of America for three years, 1989-1992. I had the honor of sharing a podium with him in San Francisco when we were both honored by the local Planned Parenthood affiliate. He spoke passionately about his trials and tribulations serving women who had no other choices or access. He was an example for physicians everywhere in his dedication and willingness to put his patients first. Women have access to safer abortion procedures now because of his example and trial. I am glad to have know him.
As we reflect on the events of 2013, I can't help but think of the Clint Eastwood classic The Good, the Bad, and the Ugly.
When it came to women's rights, there was indeed ugliness: more and more states tried to restrict women's access to basic reproductive health care, and in El Salvador, Glenda Cruz was sentenced to 10 years in prison for miscarrying.
Despite these setbacks, there is reason for hope. Here's my wrap-up of the top five wins for sexual and reproductive rights in 2013:
1. The rape and murder of a 23 year-old woman in New Delhi set off widespread protests throughout India. In September, an Indian court sentenced the four perpetrators to death, stating that the crime "shocked the collective conscience of India."
2. In the Dominican Republic, the Catholic Church filed a legal complaint against our local partner Profamilia, claiming that its ad campaign on sexual rights violated the Constitution. In May, the Fifth Civil and Commercial Chamber of the National District rejected the Church's complaint as a violation of freedom of expression, adding that campaigns like Profamilia's help to promote comprehensive sexuality education and responsible parenthood. The public and media support for Profamilia during and after the case was massive, but it was not an easy battle.
3. As more states sought measures to tighten abortion laws, some fought to make it more accessible. In June, Texas senator Wendy Davis rose to national prominence during a 13-hour filibuster protesting SB5, a bill that would further restrict abortion access in Texas. While the legislation ultimately passed, a vigorous protest from Davis -- and supporters throughout the country -- was heard loud and clear. In California, Gov. Jerry Brown signed a measure into law that allows nurse practitioners, certified nurse-midwives and physicians' assistants who complete specified training to perform abortions.
4. On August 15, the first session of the Regional Conference on Population and Development concluded as representatives of 38 countries in Latin America and the Caribbean adopted an historic agreement:the Montevideo Consensus on Population and Development. At this meeting to assess progress towards implementing the Cairo Programme of Action, governments recognized the important connections between sexual and reproductive health and rights and the global development agenda. More than 250 members of civil society -- including IPPF/WHR and our Member Associations -- helped forge this victory. The Consensus is the first UN agreement to include a definition of sexual rights, "which embrace the right to a safe and full sex life, as well as the right to take free, informed, voluntary and responsible decisions on their sexuality, sexual orientation and gender identity, without coercion, discrimination or violence." With governments poised to adopt a new global development framework, this agreement will help ensure that sexual rights and reproductive rights remain at the center of efforts to reduce poverty and improve the well-being of individuals, communities and nations.
5. Perhaps the greatest "good" is the fact that despite fierce opposition, millions of women, men and young people throughout the world continue to fight to ensure that all people have access to quality healthcare and protection of their human rights. In 2012, we provided nearly 33 million services throughout the Americas and Caribbean with more than 75% of those services reaching poor and vulnerable populations. In a region where an estimated 95% of abortions take place in unsafe circumstances, the importance of access to contraception and accurate health information cannot be underestimated.
With reproductive freedom in jeopardy, Alexander Sanger, grandson of renowned family planning advocate Margaret Sanger and a longtime leader in the reproductive rights movement, has taken an urgent, fresh look at the pro-choice position—and even the pro-life position—and finds them necessary, but insufficient. In Beyond Choice he offers the first major re-thinking of these positions in thirty years.
“Well researched and readable, Beyond Choice should be required reading for both pro-choice and pro-life supporters.” —Governor Christine Todd Whitman