Violence, Poverty, and Sexual & Reproductive Health

by Liz Borkowski 

Itâs International Womenâs Day, and the United Nations Commission on the Status of Women is holding its 51st session with the theme of âthe elimination of all forms of discrimination and violence against the girl child.â Elisha Dunn-Georgiou at RH Reality Check reports that this theme, which youâd expect to get broad support, is under attack from some groups because itâs linked to sexual and reproductive health.

For those who donât believe that itâs a moral imperative for women to have control over their reproductive lives, thereâs another compelling argument in favor of improving sexual and reproductive health (SRH) worldwide: We canât reduce poverty, violence, and disease without improving SRH.

The UN Millennium Project examines the relationship between SRH and global development targets in its 2006 report Public Choices, Private Decisions: Sexual and Reproductive Health and the Millennium Development Goals; they explain that SRH âat its core is the promotion of healthy, voluntary and safe sexual and reproductive choices for individuals and couples, including decisions on family size and timing of marriage, that are fundamental to well-being.â The report concludes that progress toward the Millennium Development Goals depends on attaining reproductive health goals. For instance, when it comes to the Goal 1, eradicating extreme poverty and hunger:

Recent analyses suggest that 25 â 40 percent of economic growth is attributable to the effects of decreased mortality (health affects productivity) and declining fertility (allowing deepening of human capital investment). ⦠High levels of fertility contribute directly to poverty, reducing womenâs opportunities, diluting expenditure on childrenâs education and health, precluding savings and increasing vulnerability and insecurity.

Families with a lot of children have fewer resources for each child, and girl children are most likely to suffer from these resource constraints. This leads us to Goal 2, achieve universal primary education:

Girls may be pulled out of school to care for siblings at any time during their education. This is more likely as family size increases. Pregnancy-related dropouts, too, may occur at any level of education, including the primary level⦠[There is evidence from many empirical studies] that the gender gap in education may be explained by parental preference for sending boys to school when a family has limited resources.

Universal education is important not only for economic development, but for reducing violence against women. Another UN Millennium Project report on education (PDF) explains:

Female education can play a critical part in reducing violence against girls and women and enhancing their control over their own bodies. As the evidence on female genital mutilation makes clear, secondary education may once again provide an important threshold.

Profiles of nine African countries found that female genital mutilation was more prevalent among uneducated women. Women with primary or no education are more likely to have been cut than those who have received secondary level instruction. In the Central African Republic, for example, 48 percent of women with no education and 45 percent with primary education have been cut, while only 23 percent of women with secondary education have been subjected to the practice (Population Reference Bureau 2001). Another study by the World Health Organization (WHO 1998) reports that in Côte dâIvoire, 55 percent of uneducated women had been cut, compared with 24 percent of women with a primary or higher level of education.

On Goal 3, promote gender equality and empower women, the SRH report highlights the problem of gender-based violence, particularly sex trafficking (80 percent of the 800,000 people trafficked across borders each year are women and girls, and theyâre mostly being bought and sold for commercial sex) and female genital cutting (FGC). Itâs estimated that 100 â 140 million women and girls - mostly in Africa, the Arab States, and Asia- have been subjected to FGC, which can cause hemorrhaging, infection, and death, and puts young women at risk for constant urinary tract infection and reproductive tract infection.

Goals 4 and 5, reduce child mortality and improve maternal health, are, of course, closely linked to SRH. Ensuring access to family planning services can reduce the number of children born to very young mothers and allow for wider spacing of birth, and thus improve childrenâs survival and health. Comprehensive basic and emergency obstetric care is essential to reducing the more than half a million deaths that occur from preventable complications of pregnancy and childbirth each year.

Improved access to contraception and safe, legal abortion would also allow women to prevent more high-risk pregnancies (e.g., those occurring at a young age or shortly after a previous birth) and the high rate of injury and death from unsafe abortions. A recent Lancet article entitled âUnsafe abortion: the preventable pandemicâ (free registration required) reported:

Every year, about 19â20 million abortions are done by individuals without the requisite skills, or in environments below minimum medical standards, or both. Nearly all unsafe abortions (97%) are in developing countries. An estimated 68, 000 women die as a result, and millions more have complications, many permanent. Important causes of death include haemorrhage, infection, and poisoning.

When it comes to family planning, condom use is particularly important because itâs key for Goal 6, combat HIV/AIDS, malaria and other diseases. (Iâm focusing on the HIV/AIDS part of goal, though the report notes that people with HIV are more susceptive to other diseases and that pregnancy reduces womenâs immunity to malaria.) According to the Millennium Project Report:

â¢Â Globally, 80 percent of HIV cases are transmitted sexually.

â¢Â Correct and consistent use of condoms has been found to reduce HIV incidence by 80 percent.

â¢Â Underlying power dynamics between women and men, particularly in many developing countries, prevent women from accessing condoms and then insisting on their use.

Mechanisms for ensuring mother-to-child transmission of HIV during pregnancy, labor, delivery, or breastfeeding will can also help reduce the number of new HIV infections â and, of course, giving HIV-positive women the ability to prevent unintended pregnancies can reduce the risk of mother-to-child transmission in the first place.

The world has gotten behind a series of laudable goals for improving prosperity, peace, and public health. Anyone who supports those goals needs to be supporting sexual and reproductive health.

Liz Borkowski works for the Project on Scientific Knowledge and Public Policy (SKAPP) at George Washington Universityâs School of Public Health and Health Services.