WE ALL HERE AGREE ON HEALTH AS A BASIC HUMAN RIGHT, AS AGREED IN THE ALMA ATA DECLARATION AND HIGHLIGHTED IN THE PEOPLE’S HEALTH CHARTER. TO ENSURE HEALTH FOR ALL, WE NEED TO TAKE INTO ACCOUNT WOMEN’S ACCESS TO HEALTH, AND WOMENS SEXUAL AND REPRODUCTIVE HEALTH, IN PARTICULAR. HEALTHL SECTOR REFORMS ARE TAKING PLACE AROUND THE WORLD. PRIVATIZATION AND BUDGET CUTS IN ALL CONTINENTS.
- free from coercion, discrimination, violence - Apply throughout life cycle
MDGs: - 5-year review to take place at end of summer - no rights-based perspective - no mention of srhr - various related goals (maternal health, gender equity, education, poverty eradication) NOTE: ICPD - international conference on population and development Beijing - UN women’sconference MDGs - Millennium Development Goals
POVERTY: Women have less money to – for example – take a bus to go to a hospital. There is a growing inequality between rich and poor, related to globalization processes. LOW SOCIAL STATUS: In some places they women need to be accompanied by a man to go to a health clinic. Cultural barriers can include shame over menstruation, for example, and disrespect for sexual activity before marriage. WAR & CONFLICT: War on terror, increased millitarisation globally; breaking down health centers and transportation routes. FUNDAMENTALISMS: Vatican & Bush’ Global Gag Rule - 70.000 deaths/year AIDS: 60% new infections S-saharan Africa = women
Reproductive health services are regularly the first services cut when budgets are cut.
HSR can include: Privatization of public services Cost recovery mechanisms Decentralization Improving efficiency of ministries of health Health insurance systems PLUS now WTO and regional Trade Agreements continue in a similar process….
Assumption is that public health sector cannot be an effective health provider. Assumption is that competition in (private) health services will lead to enhanced access and quality of care. Efficiency and cost-effectiveness have led to: - selectiveness in services , no more holistic or integrated approach. SRH services often cut from services or limited again to family planning services . - return to vertical program (AIDS treatment and prevention separate from other health provision) In vertical, disease oriented programs, women don’t count or only if they are pregnant. HIV positive pregnant women get medication so baby won’t be hiv+, but they get no ARVs themselves.
HEALTH FOR THE POOR: Only those who can pay have access to certain services. 1. 3 billion people live on less than 1 dollar/day. 70% of the worlds poor are women. Health as a commodity -- about supply & demand, just like buying shoes or fish. How can people be expected to ‘shop around’ when they are sick? Unregulated market is not controlled on quality at all . More collaboration is needed. In Tanzania, use of traditional healers increased significantly after introduction of user fees. Especially among poorest of the population. Not always because it’s cheaper, also because they have more flexible payment schemes.
You can see this strongly in Africa with increased care for AIDS patients. AND In Europe you see it more and more with the care for elderly.
1. When you can get money off someone who is sick, why would you invest in preventing that person from getting sick? It doesn’t fit the privatized health market situation. Over 70.000 deaths / year as result of unsafe abortions. 500.000 women die / year during pregnancy and delivery, majority easily preventable.
Examples of the relevant countries: Sometimes exemptions are in place, but often women are not informed. TANZANIA Sometimes national health insurances are put in place, but women barely get to profit because: deliveries and abortions not included --LATIN AMERICA women of reproductive ages not included -- ECUADOR, CHILE only formal sector included --LIKE CAMEROON IN THE USA, THE LEADER IN NEO-LIBERALISM, ALMOST 20% OF WOMEN OF REPRODUCTIVE AGES ARE NOT INSURED. 1 IN 6 PERSONS DOES NOT HAVE HEALTH INSURANCE , MILLIONS OF OTHERS ARE UNDERINSURED.
Responsibility for women’s health -- health is a human right and must be guaranteed by the State. Women’s sexual and reproductive rights must be included in all health policies and women must be given the opportunity to participate in all levels of planning, implementation and monitoring. develop more gender sensitive policies. -- governments must put in place gender assessment instruments to alert them on the impact of new policies on women’s right to health. Governments officials, police and health service providers must be trained on gender issues and gender sensitivity. Health budgets: -- to enable this, IMF, WB and donor countries must drop all debt! Quality of health -- Communities (incl. Women) must participate in the process of monitoring the quality of services and extent to which they comply with women’s needs. Holistic & integrated -- must not be limited to bio-medical view of health, all sectors must collaborate.
Women’s Global Network for Reproductive Rights (WGNRR)
Health Sector Reforms: Women Pay the Price <ul><li>Sexual and Reproductive Rights </li></ul><ul><li>Women’s Access to Health </li></ul><ul><li>Health Sector Reforms What? Why? Women paying the price... </li></ul>
Sexual and Reproductive Health and Rights <ul><li>Series of basic human rights which enable women to “have a safe, responsible and fulfilling sex life, and the freedom to decide if, when and how often to have children” (WHO) </li></ul>
Sexual and Reproductive Health and Rights <ul><li>Examples: </li></ul><ul><li>safe pregnancy and childbirth </li></ul><ul><li>safe, legal and voluntary abortion </li></ul><ul><li>sexuality education and information </li></ul><ul><li>safe and voluntary contraception </li></ul><ul><li>good quality health services </li></ul><ul><li>sexual self determination </li></ul><ul><li>protection against sexual violence </li></ul>
Sexual and Reproductive Health and Rights <ul><li>ICPD (1994) - governments must make reproductive health accessible through PHC system before 2015. </li></ul><ul><li>Beijing (1995) -autonomy, empowerment and self-determination of women are cornerstone of all health and population programs - life-cycle approach </li></ul><ul><li>MDGs (2000) </li></ul>
Sexual and Reproductive Rights <ul><li>Without the fulfilment of sexual and reproductive rights, the right to health cannot be fulfilled . </li></ul>
Women’s Access to Health <ul><li>Specific health needs of women: - sexuality and reproductive system - violence - position in society (cultural, religious, economic, political) - less opportunities to access health services - care takers of others in family and society </li></ul>
Women’s Access to Health <ul><li>Limited by: </li></ul><ul><li>Growing poverty (70% women) </li></ul><ul><li>Low social status of women (last to eat food in family) </li></ul><ul><li>Wars and conflicts, increased violence </li></ul><ul><li>Religious fundamentalisms </li></ul><ul><li>Lack access to essential services like water (result of privatization) </li></ul><ul><li>Rise of communicable diseases like AIDS (most new infections with women) </li></ul><ul><li>Population policies (targets) </li></ul>
Women’s Access to Health <ul><li>Limited by: </li></ul><ul><li>lack of (access to) health services - no SRH & maternal services - lowering health budgets - privatization - user fees - lack quality of services (no control system) - no women-friendly / youth friendly services </li></ul>
Health Sector Reforms <ul><li>Since 1980s (reaction to debt crisis) </li></ul><ul><li>Part of neo-liberal agenda of international institutions (World Bank, IMF, regional development banks, donor governments) </li></ul><ul><li>Introducing market-mechanism into health care provision ( private sector & competition) </li></ul>
Health Sector Reforms: Why? <ul><li>Reasons behind HSR: </li></ul><ul><li> cost-effectiveness of health sector </li></ul><ul><li> efficiency of health sector </li></ul>
HSR: What’s the price? <ul><li>- health as a commodity instead of a right, leading to less access for the poor </li></ul><ul><li>- Lack of mechanisms to control quality of care </li></ul><ul><li>- unregulated health market is largely ignored by HSR (in parts of Africa 80% of pop. uses traditional medicine for PHC). Results differ / unknown. </li></ul>
HSR: Women pay the price <ul><li>As health services are decreased, much of the work is transferred from the formal health-care system to the informal (and usually unpaid) care system = women </li></ul><ul><li>HSR lead to less services / clinics = women are less mobile (time, culture, money) so have less access </li></ul>
HSR: Women pay the price <ul><li>HSR lead to decrease in preventive and promotive care, especially SRH services (abortion, violence prevention, sexual health services for adolescents) </li></ul><ul><li>User fees limit access to maternal health services: in Nigeria maternal deaths increased by 56% after introduction of user fees (1983-1998) </li></ul>
HSR: Women pay the price <ul><li>Sometimes exemptions are in place, but often women are not informed. </li></ul><ul><li>Sometimes national health insurances are in place, but women rarely profit (deliveries and abortions not included, women of reproductive ages not included, only formal sector included) </li></ul>
What to lobby for? <ul><li>Demands on governments: </li></ul><ul><li>take responsibility for women’s health </li></ul><ul><li>develop more gender sensitive policies </li></ul><ul><li>Health budgets be increased with earmarked budgets for women’s sexual and reproductive health </li></ul><ul><li>Quality of health services be prioritised over targets </li></ul><ul><li>Health is recognized in a holistic and integrated manner (incl. preventive, promotive, curative) </li></ul><ul><li>Participation of women in all levels </li></ul>
Time for Action! <ul><li>Put people first, not profit! </li></ul><ul><li>HEALTH FOR WOMEN; HEALTH FOR ALL. </li></ul><ul><li>Thank you </li></ul>