The african women's protocol: Bringing Attention to Reproductive Rights and the MDGs


Published on

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

The african women's protocol: Bringing Attention to Reproductive Rights and the MDGs

  1. 1. Policy ForumThe African Women’s Protocol: Bringing Attention toReproductive Rights and the MDGsLiesl Gerntholtz1, Andrew Gibbs2*, Samantha Willan21 Human Rights Watch, New York, United States of America, 2 Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, SouthAfricaLack of Progress on All The Forgotten Millennium Goal: referring to them, it was in Cairo in 1994Millennium Development Goals Improving Women’s at the International Conference on Popu- lation and Development (ICPD) [9], andfor Women Reproductive Rights again in 1995 at the Fourth World The international community recently Underlying the failure to meaningfully Conference on Women in Beijing [10],reviewed 10 years of progress towards the progress towards achieving MDGs 3, 5, that reproductive rights and their relation-Millennium Development Goals (MDGs). and 6, particularly in Africa, is the failure ship to women’s rights and developmentThe outcome document of the High Level to protect and promote women’s human broadly was firmly established. The ICPDPlenary Meeting of the General Assembly, rights, including their reproductive rights. Programme of Action remains a founda-adopted by a consensus of the General The United Nations Population Fund [6] tional vision for women’s reproductiveAssembly of the United Nations on 22 outlines the three components of repro- health, committing the 179 participatingSeptember 2010, recognised the signifi- ductive rights: the right to control sexual nations to the achievement of universalcant steps made towards achieving many and reproductive lives, the right to non- and equal access to reproductive health byof the goals, but also emphasised the discrimination, and the right to reproduc- 2015. The definition of reproductiveuneven progress and that more must be tive health care. This creates a framework health in the ICPD Programme of Actiondone to ensure that the MDGs will be met that supports women’s rights to insist and was broad and inclusive and includedin 2015 [1]. engage in safer sex (including the right to family planning services and counselling, Significantly, the fifth goal—to improve be free from unwanted sex) and to access comprehensive sexuality education, andmaternal health—has made the least comprehensive and accurate information maternal and child health services. Theprogress, with 350,000 women still dying on HIV/AIDS and family planning and Beijing conference further amplified linksannually of pregnancy-related causes [2]; comprehensive reproductive health care, between women’s ability to participatethe MDG outcome document expresses which includes termination of pregnancy fully in all spheres of life and their re-‘‘grave concern over the slow progress and post-abortion care. Furthermore, re- productive rights, and reiterated the im-being made on reducing maternal mortal- productive rights are critical in ensuring portance of achieving the goal of universality and improving maternal and repro- that women can control their fertility and access.ductive health’’ [1]. While greater progress in supporting their participation in social, More recent international treaties, such ashas been made with regard to MDG 6, to economic, and political life. the Convention on the Rights of People withcombat HIV/AIDS, malaria, and other While earlier international treaties such Disabilities [11] and the Convention on thediseases, and MDG 3, to promote gender as the Convention on the Elimination of Rights of the Child [12], have built on andequality, progress in these two MDGs Discrimination of Discrimination Against reaffirmed a global commitment to achiev- Women (CEDAW) [7] and the Interna- ing reproductive rights. In 2010, the UNremains limited. tional Convention on Economic, Social Human Rights Council passed a second The lack of progress across MDGs 3, 5, and Cultural Rights [8] supported aspects resolution on maternal mortality that reaf-and 6 is linked; failure to progress in any of of reproductive rights without explicitly firmed the need to protect women’s humanthese three MDGs undermines progress inthe other two. Despite global progress inreducing maternal mortality, the impact of Citation: Gerntholtz L, Gibbs A, Willan S (2011) The African Women’s Protocol: Bringing Attention to Reproductive Rights and the MDGs. PLoS Med 8(4): e1000429. doi:10.1371/journal.pmed.1000429HIV/AIDS has slowed reductions inmaternal mortality and in some countries Published April 5, 2011increased maternal mortality [2]. One Copyright: ß 2011 Gerntholtz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,estimate suggests HIV contributed an provided the original author and source are credited.additional 64,100 maternal deaths globally Funding: This work has been funded through a Joint Funding Agreement (JFA) for the Health Economics andin 2008 [3]. Furthermore, both AIDS- HIV/AIDS Research Division (HEARD) of the University of KwaZulu-Natal, South Africa. The JFA comprises ofrelated morbidity and mortality and ma- SIDA, Irish Aid, RNE and UNAIDS. The funders had no role in study design, data collection and analysis, decisionternal mortality undermine women’s abil- to publish, or preparation of the manuscript.ity to realise their equality by excluding Competing Interests: The authors have declared that no competing interests exist.women from education and employment. Abbreviations: CEDAW, Convention on the Elimination of Discrimination Against Women; ICPD, InternationalWhile all women are ill-served by this lack Conference on Population and Development; MDG, Millennium Development Goal; OAU, Organisation of African Unityof progress, women in Africa, who areespecially vulnerable, will bear a dispro- * E-mail: burden of these failures [2,4,5]. Provenance: Not commissioned; externally peer reviewed. PLoS Medicine | 1 April 2011 | Volume 8 | Issue 4 | e1000429
  2. 2. Summary Points out such a right, women living with HIV/AIDS have a reduced ability to make reproductive decisions. N Despite overall progress on the Millennium Development Goals (MDGs), Goal 3 (promote gender equality), Goal 5 (reduce maternal mortality), and Goal 6 The many barriers to the promotion (combat HIV/AIDS, malaria, and other diseases) significantly lag behind other and protection of women’s reproductive goals, with women in Africa bearing the burden of this failure. rights in Africa undermines women’s abi- N Underlying this lack of progress is the failure to protect and promote women’s lity to take control of their sexual health, reproductive rights. fertility, autonomy, and participation in N The Protocol to the African Charter on Human and Peoples’ Rights on the Rights social and economic life. Technical, dis- of Women in Africa (or, the African Women’s Protocol) provides a strong, crete interventions to promote women’s African framework for women’s reproductive rights that goes beyond other health, tackle HIV/AIDS, and reduce binding international treaties in supporting and promoting reproductive rights. maternal mortality are unlikely to work if N Only 29 out of 52 countries in Africa have signed and ratified the African wider laws and policies continue to Women’s Protocol thus far, and there remain significant barriers to translating undermine women’s reproductive rights. the Protocol into national legislation and implementing its provisions. N If fully implemented and integrated into national legislation, the African The African Women’s Protocol Women’s Protocol offers a significant tool to support women’s reproductive rights in Africa, thereby supporting the attainment of MDGs 3, 5, and 6. The Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa [23] (therights as part of a comprehensive strategy to to disclose their HIV status to sexual African Women’s Protocol), which wasaddress maternal mortality and morbidity partners for fear of violence and adopted by the African Union in 2003[13]. abandonment. Criminalisation also and became legally binding for countries Despite recognition of the key role that reduces access to reproductive health that had signed and ratified the protocolreproductive rights plays in advancing services, especially for vulnerable on 25 November 2005, corrects thewomen’s health and empowerment, the groups of women such as sex workers weaknesses in the African Charter onMDGs originally failed to include a and adolescents; Human and People’s Rights (Africanspecific goal on access to reproductivehealth care or reproductive rights. Partly N Anti-abortion legislation [17]. Such Charter) [24] with respect to women’s legislation limits women’s ability to rights. While the African Charter pro-in response to lobbying by women’s determine whether and when to have vides an important human rights frame-rights activists, access to reproductive children; work, including reinforcing the righthealth was added as one of the targetsin MDG 5 at the 5-year review meeting N High levels of violence against women, to life, liberty, security and freedom often in contexts of weak or limited from discrimination, it is silent aboutof the MDGs in 2005. Indeed, target 5B legislative frameworks to support wo- women’s rights in general and reproduc-reaffirms the commitment made at the men’s rights [18,19]. Violence against tive rights specifically [25]. The protocolICPD to achieve universal access to women limits their autonomy and promotes women’s rights and equalityreproductive health by 2015. That the ability to make decisions about their broadly, including in marriage andimportance of women’s reproductive body and sex. Furthermore, violence divorce, land tenure, inheritance rights,rights to women’s health, autonomy, places women at greater risk of and in relation to ‘‘traditional’’ practices.and ability to participate fully in society acquiring HIV, and may make them The protocol contains specific protec-has been recognised for decades makes weary of accessing reproductive health tions for older women, disabled women,the absence of significant attention to services and HIV testing. The failure and women in distress, but fails tothese rights in the MDGs even more to criminalise marital rape in many include similar provisions for girls anddeplorable. African counties has increased the risk young women. of HIV transmission for married The African Women’s ProtocolAn Enabling Environment for women and undermines their access emerged through extensive lobbying ofWomen’s Reproductive Rights to post-exposure prophylaxis; government by women’s rights organisa-in Africa N Limited rights to comprehensive sexu- tions across Africa and around the world. ality education and access to male and Since 1995, African women’s rights activ- Currently, there are a range of issuesthat undermine women’s reproductive female condoms, particularly for ists have recognised the limitation of therights in Africa. Specific issues include: young people [20]. The failure to African Charter and called on the Orga- provide comprehensive sexuality edu- nisation of African Unity (OAU) toN Criminalisation of HIV transmission cation and access to male and female condoms undermines women’s abili- address the rights of women with a specific instrument. In response, the OAU man- [14,15]. At present, in Africa and globally, a number of countries have ties to make fully informed reproduc- dated the African Commission on Human either passed legislation, or are con- tive choices and act on these decisions; and People’s Rights to develop a protocol. sidering legislation, that criminalises and A draft was circulated to non-governmen- the transmission of HIV. Criminalisa- N Failure in many national policies to tal organisations for comment in 1997 and tion does little to reduce HIV trans- realise the reproductive rights of wom- the Commission later endorsed the ap- mission [14,15] and disproportionately en (and men) living with HIV [21], pointment of a special rapporteur on affects women, who are often unable seen most explicitly in the emergence women’s rights to finalise the protocol. to decide how and when sex occurs of coerced or forced sterilisation of Following consultations with civil society, [16]. Women may also be less willing women living with HIV [22]. With- the text was revised and adopted in 2005. PLoS Medicine | 2 April 2011 | Volume 8 | Issue 4 | e1000429
  3. 3. The African Women’s Protocol is par- Table 1. African Union countries and the signing and ratification of the Africanticularly strong on women’s reproductive Women’s Protocol.rights, and is a tool for ensuring universalaccess to reproductive health and thecreation of an enabling environment. It Not Signed or Ratified Signed Onlya Ratifiedgoes beyond other binding treaties, such asCEDAW, in outlining reproductive rights Botswana Algeria Angola[25]. It contains the first references to Egypt Burundi BeninHIV/AIDS in an international treaty, and Eritrea Cameroon Burkino Fasothe first expression of a right to abortion, Tunisia Central African Republic Cape Verdealbeit limited to where a pregnancy is the Chad Comoresresult of sexual assault, rape, or where itendangers a woman’s mental or physical Cote d’Ivoire Dijboutihealth. It specifically recognises marital Equatorial Guinea Democratic Republic of Congorape as a form of gender-based violence. Ethiopia GambiaMoreover, the protocol ‘‘identifies protec- Gabon Ghanation from HIV and AIDS as a key Guinea Guinea-Bissaucomponent of women’s sexual and repro- Madagascar Kenyaductive rights’’ [25]. Articles 14(1&2) of the African Wo- Mauritius Libyamen’s Protocol set out three major com- Niger Lesothoponents of women’s reproductive health Sahrawi Arab Democratic Republic Liberiarights: Sierra Leone Mali1. Reproductive and sexual decision mak- Somalia Malawi ing, including the number and spacing Sao Tome & Principe Mozambique of children, contraceptive choice, and Sudan Mauritania the right to self-protection from HIV; Swaziland Namibia2. Access to information about HIV/ Nigeria AIDS and reproductive health; and Rwanda3. Access to reproductive health services, South Africa including antenatal services and abor- tion-related services. Senegal Seychelles Unfortunately, the vision offered by the TanzaniaAfrican Women’s Protocol is still to be Togorealised across Africa. Only 29 out of 52 ofthe African Union countries have current- Ugandaly signed and ratified the protocol (see ZambiaTable 1). While ratification is a significant Zimbabwestep, it is, however, only the first step in autilising the African Women’s Protocol to The signature of a treaty is evidence of the state’s intention to ratify the instrument at some time in the future, but is not legally binding for a state.realise women’s reproductive rights. doi:10.1371/journal.pmed.1000429.t001Countries must domesticate the proto-col—that is, translate the protocol intonational (domestic) legislation. This would Protocol and guaranteeing that they are Through the ratification, domestica-require a comprehensive legal review of replicated at a national level is crucial. tion, and transparent reporting on thethe provisions of the protocol in relation to Upon ratification, countries are bound to African Women’s Protocol, a frameworkcurrent legislation. Countries’ failures to report on steps taken to fulfil their can be implemented in Africa that createssign, ratify, and domesticate the protocol obligations when they report more widely contexts that support women’s reproduc-are major barriers in utilising this legisla- on the African Charter. Yet reporting by tive rights. In so doing, a significant steption. Countries frequently raise concerns governments lacks transparency and is can be made towards rolling back HIVabout the cost of reviewing legislation and limited. and maternal mortality and therebyimplementing reproductive rights. A fur- Learning from CEDAW, civil society supporting the attainment of MDGs 3,ther barrier is continued tension between has a crucial role to play in ensuring 5, and 6.human rights and customary laws. accountability and implementation, in- Finally, legislative change is meaningless cluding production of shadow reports Author Contributionsif it is not implemented, monitored, and and active lobbying of governments to ICMJE criteria for authorship read and met:enforced to ensure real change for women encourage further implementation. Civil LG AG SW. Agree with the manuscript’s resultsin Africa [26]. Strengthening and ensuring society may, however, remain constrained and conclusions: LG AG SW. Wrote the firstthe utilisation of accountability mecha- without significant resources being allocat- draft of the paper: AG. Contributed to thenisms contained in the African Women’s ed to this specific role. writing of the paper: LG SW. PLoS Medicine | 3 April 2011 | Volume 8 | Issue 4 | e1000429
  4. 4. References1. United Nations General Assembly (2010) Keep- on Population and Development, Doc A/CONF. legislation in sub-Saharan Africa: the need for ing the promise: united to achieve the Millennium 171/13. Cairo: United Nations. strengthened medico-legal linkages. Reprod Development Goals, A/65/L.1. New York: 10. United Nations General Assembly (1995) Report of Health Matters 17: 10–19. United Nations. the Fourth World Conference on Women, A/ 19. Watts C, Zimmerman C (2002) Violence against2. Hogan MC, Foreman KJ, Naghavi M, Ahn SY, CONF.177/20/Rev.1. New York: United Nations. women: global scope and magnitude. Lancet 359: Wang MR, et al. (2010) Maternal mortality for 11. United Nations General Assembly (2006) Con- 1232–1237. 181 countries, 1980-2008: a systematic analysis of vention on the Rights of Persons with Disabilities 20. Han J, Bennish ML (2009) Condom access in progress towards Millennium Development Goal and Optional Protocol. New York: United South African schools: law, policy, and practice. 5. Lancet 375: 1609–1623. Nations. PLoS Med 6: e1000006. doi:10.1371/journal.3. The PLoS Medicine Editors (2010) Maternal health: 12. United Nations General Assembly (1989) Con- pmed.1000006. time to deliver. PLoS Med 7: e1000300. vention on the Rights of the Child. New York: 21. Mantell JE, Smit J, Stein ZA (2009) The right to doi:10.1371/journal.pmed.1000300. United Nations. choose parenthood among HIV-infected women4. Kinney MV, Kerber KJ, Black RE, Cohen B, 13. Human Rights Council (2010) Preventable ma- and men. J Public Health Policy 40: 367–378. Nkrumah F, et al. (2010) Sub-Saharan Africa’s ternal mortality and morbidity and human rights: 22. Mallet J, Kalambi V (2008) Coerced and forced mothers, newborns, and children: where and why follow up to Council resolution 11/8, A/HRC/ sterilization of HIV-positive women in Namibia. do they die? PLoS Med 7: e1000294. doi:10.1371/ 15/L.27, 27. Geneva: United Nations. HIV AIDS Policy Law Rev 13: 77–78. journal.pmed.1000294. 14. Berer M (2009) Criminalisation, sexual and 23. African Union (2003) Protocol to the African5. UNAIDS (2008) Report on the global HIV/ reproductive rights, public health and justice. Charter on Human and People’s Rights on the AIDS epidemic 2008. Geneva: UNAIDS, WHO. Reprod Health Matters 17: 4–9. Rights of Women in Africa. Maputo: African6. UNFPA (2005) Rights Into Action: UNFPA 15. Jurgens R, Cohen J, Cameron E, Burris S, Union. implements a human rights-based approach. Clayton M, et al. (2009) Ten reasons to oppose 24. Organisation of African Unity (1981) African New York: United Nations Population Fund. the criminalization of HIV exposure or transmis- Charter on Human and Peoples’ Rights. Addis7. United Nations General Assembly (1979) Con- sion. Reprod Health Matters 17: 163–172. Ababa: Organisation of African Unity. vention on the Elimination of All Forms of 16. ATHENA Network, AIDS Legal Network (2010) 25. Centre for Reproductive Rights (2006) The Discrimination against Women, Resolution 34/ 10 reasons why criminalization of HIV exposure Protocol on the Rights of Women in Africa: an 180. New York: United Nations. or transmission harms women. Seattle: ATHENA instrument for advancing reproductive and sexual8. United Nations General Assembly (1966) Inter- Network. rights. New York: Centre for Reproductive national Covenant on Economic, Social and 17. World Health Organization (2004) Safe abortion: Rights. Cultural Rights, Resolution 2200A (XXI). New technical and policy guidance for health systems. 26. Palmer A, Tomkinson J, Phung C, Ford N, York: United Nations. Geneva: World Health Organization. Joffres M, et al. (2009) Does ratification of9. United Nations General Assembly (1994) Pro- 18. Kilonzo N, Ndung’u N, Nthamburi N, Ajema C, human-rights treaties have effects on population gramme of Action of the International Conference Taegtmeyer M, et al. (2009) Sexual violence health? Lancet 373: 1987–1992. PLoS Medicine | 4 April 2011 | Volume 8 | Issue 4 | e1000429