3. Overview of the Presentation
• Ethical foundations for professional activities in the field of obstetrics and
gynecology
• The role of OBGYNs as advocates for women’s rights
• Contraception and abortion: The Ethiopian Medical Association’s Code of
Ethics
• Contraception and abortion: The International Federation of Gynecology and
Obstetrics Code of Ethics
• Ethiopia’s abortion law
• Legality of conscientious objection in Ethiopia
• The components of reproductive justice
4. Part One: Foundations of the Codes of
Ethics for OBGYNs
• ESOG (in the process of writing one)
• EMA- medical ethics for doctors in Ethiopia-
2010
• FIGO, ACOG, AMA
• Let us begin with ACOG’s Code of Ethics…
5. 1. The Patient-Physician Relationship
• The patient–physician relationship: The welfare of the patient
(beneficence) is central to all considerations in the patient–physician
relationship.
• Included in this relationship is the obligation of physicians to
respect the rights of patients.
• The respect for the right of individual patients to make their own
choices about their health care (autonomy) is fundamental.
• The principle of justice requires strict avoidance of discrimination
on the basis of race, color, religion, national origin, sexual
orientation, perceived gender, and any basis that would constitute
illegal discrimination (justice).
6. 2. Physician Conduct and Practice
• The obstetrician–gynecologist must deal honestly with
patients and colleagues (veracity).
• This includes not misrepresenting himself or herself through
any form of communication in an untruthful, misleading, or
deceptive manner.
• Furthermore, maintenance of medical competence through
study, application, and enhancement of medical knowledge
and skills is an obligation of practicing physicians.
• Any behavior that diminishes a physician’s capability to
practice, such as substance abuse, must be immediately
addressed and rehabilitative services instituted.
7. 3. Avoiding Conflicts of Interest
• Potential conflicts of interest are inherent in the
practice of medicine.
• Physicians are expected to recognize such situations and
deal with them through public disclosure.
• Conflicts of interest should be resolved in accordance
with the best interest of the patient, respecting a
woman’s autonomy to make health care decisions.
8. 4. Professional Relations
• The obstetrician–gynecologist should
respect and cooperate with other
physicians, nurses, and health care
professionals.
9. 5. Societal Responsibilities
• The OBGYN has a continuing responsibility to
society as a whole and should support and
participate in activities that enhance the
community.
• As a member of society, the OBGYN should respect
the laws of that society. As professionals and
members of medical societies, physicians are
required to uphold the dignity and honor of the
profession.
10. EMA’s Medical Ethics for Doctors in
Ethiopia XII: Abortion
Article 54: The first moral principle imposed upon the doctor is respect for
human life from its beginning.
Article 55: An abortion is justified only when it is performed for the purpose of
saving the endangered life or health of a woman.
Article 56: Abortion is justifiable if performed by a doctor in health institutions
where appropriate facilities are available.
Article 57: It is mandatory to treat a patient who is suffering from the effect of
an abortion induced by another person.
Article 58: The doctor must never disclose the cause of her/his patient's
condition to anyone else without the consent of the patient unless ordered to do
so in court of law.
Article 59: An abortion leading to death should be reported to the concerned
authorities by the treating doctor.
11. EMA’s Medical Ethics for Doctors in
Ethiopia XIII: Family Planning
Article 60: It is ethical for a doctor if she/he informs,
educates and communicates knowledge of family
planning to individuals, families or the general
public.
Article 61: It is the duty of a doctor to prescribe
scientifically acceptable means and methods of family
planning to individuals or couples who have attained the
age of 18 years and who freely and responsibly decide to
postpone or prevent pregnancy.
12. FIGO Code of Ethics
• ETHICAL ISSUES IN OBSTETRICS AND
GYNECOLOGY by the FIGO Committee for
the Study of Ethical Aspects of Human
Reproduction and Women’s Health,
OCTOBER 2015
13. The Role of OBGYNs as Advocates for Women’s Health
1. Our ethical obligation to be advocates:
1. Our knowledge on sexual and reproductive health
2. Women come to us first, so it is our duty to provide
care
3. A strong knowledge base and social standing is
helpful for advocacy for policy change
2. Women are uniquely vulnerable due to their
reproductive function and role, social discrimination,
GBV and lack of power, this increases our obligation!
14. The Role of OBGYNs as Advocates for Women’s
Health Continued…
3. Unequal exposure to violence, poverty, malnutrition and
denial of opportunity for education and employment will
lead to unjust SRH and access to health care.
4. When possible, monitor and publicize RH data and suggest
improvements.
5. Wrong policies deleteriously affect the care that we
provide.
6. We should inform the community about the problems of
SRH and promote a wide debate to improve policies and
legislation.
15. Definition of Pregnancy
• Natural human reproduction is a process which
involves the production of male and female gametes and
their union at fertilization.
• Pregnancy is that part of the process that commences
with the implantation of the conceptus in a woman, and
ends with either the birth of an infant or an abortion.
•Verification of this is usually only possible at the
present time at 3 weeks or more after implantation.
•WHO definition of a birth: 22 weeks’ menstrual age or
more
16. Safe Moterhood
• Maternity is a social function and not a disease.
Societies have an obligation to protect women’s right
to life when they go through the risky business of this
social function that ensures the survival of our species.
• Maternal health care is not only important for avoiding
maternal mortality and morbidity, but is also crucial for
reducing the high burden of perinatal mortality and
morbidity.
17. Safe Motherhood: Recommendations
1. Women’s mortality related to pregnancy remains
unacceptably high, particularly in resource poor areas.
Prevention of maternal death should be considered
worldwide as a public health priority.
2. Where abortion is not against the law, every woman should
have the right, after appropriate counselling, to have
access to medication or surgical abortion. The health care
service has an obligation to provide such services as
safely as possible. Family planning services and
information should be made available for the timing and
spacing of births.
18. Ethical Aspects of Induced Abortion for Non-
Medical Reasons
• Induced abortion may be defined as the
termination of pregnancy using drugs or
surgical intervention after implantation and
before the conceptus has become
independently viable (WHO definition of a
birth: 22 weeks’ menstrual age or more).
19. Abortion is Very Widely Considered to be Ethically
Justified when…
• Undertaken or medical reasons to protect the life or health
of the mother in cases of molar or ectopic pregnancies and
malignant disease.
• Most people would also consider it to be justified in cases of
incest or rape,
• when the conceptus is severely malformed, or
• when the mother’s life is threatened by other serious
disease.
20. The Use of Abortion for Other Social Reasons
• Remains very controversial because of the
ethical dilemmas it presents to both women and
the medical team.
• Women frequently agonize over their difficult
choice, making what they regard in the
circumstances to be the least worse decision.
• Health care providers wrestle with the moral
values of preserving life, of providing care to
women and of avoiding unsafe abortions.
21. The Use of Abortion for Other Social
Reasons Continued…
• Abortion should never be promoted as a method of
family planning.
• Women have the right to make a choice on whether
or not to reproduce, and should therefore have
access to legal, safe, effective, acceptable and
affordable methods of contraception.
• Provided that process of properly informed consent has
been carried out, a woman’s right to autonomy,
combined with the need to prevent unsafe abortion,
justifies the provision of safe abortion.
22. The Use of Abortion for Other Social
Reasons Continued…
• Most people, including physicians, prefer to avoid
termination of pregnancy, and it is with regret that they may
judge it to be the best course, given a woman’s
circumstances.
• Some doctors feel that abortion is not permissible whatever
the circumstances. Respect for their autonomy means that no
doctor should be expected to advise or perform an abortion
against his or her personal conviction. Their careers should not
be prejudiced as a result. Such a doctor, however, has an
obligation to refer the woman to a colleague who is not in
principle opposed to inducing termination.
23. The Use of Abortion for Other Social
Reasons Continued…
• Neither society, nor members of the health care team
responsible for counseling women, have the right to impose
their religious or cultural convictions regarding abortion on
those whose attitudes are different. Counseling should include
objective information.
• Very careful counseling is required for minors. When
competent to give informed consent, their wishes should be
respected. When they are not considered competent, the
advice of the parents or guardians and when appropriate the
courts, should be considered before determining management.
24. The Use of Abortion for Other Social
Reasons Continued…
• The termination of pregnancy for non-medical
reasons is best provided by the health care service on
a non-profit-making basis. Post-abortion counseling on
fertility control should always be provided
• In summary, the Committee recommends that after
appropriate counseling, a woman has the right to have
access to medical or surgical induced abortion, and
that the health care service has an obligation to
provide such services as safely as possible.
25. • Permits medical providers to refuse
to provide certain health services
based on religious or moral objections.
Conscientious Objection (CO)
26. Ethical Guidelines on Conscientious Objection
1. The primary conscientious duty of obstetrician-
gynecologists is at all times to treat, or provide
benefit and prevent harm to, the patients for whose
care they are responsible.
2. Any conscientious objection to treating a patient is
secondary to this primary duty. Practitioners who find
themselves unable to deliver medically indicated care
to their patients for reasons of their personal
conscience still bear ethical responsibilities to
them.
27. Conflict of Interest
1. When practitioners feel obliged to place their
personal conscientious interests before their
patients’ interests, they have a conflict of
interest.
Not all conflicts can be avoided, but when they
cannot, they can be resolved by due disclosure;
that is, practitioners must inform potential patients
of the treatments in which they object to participate
on grounds of their personal conscience.
28. Conflict of Interest
2. Provision of Benefit and Prevention of Harm require
that practitioners provide such patients with timely
access to medical services, including giving information
about the medically indicated options of procedures for
their care and of any such procedures in which their
practitioners object to participate on grounds of
conscience.
29. Conflict of Interest
3. Practitioners have a professional duty to abide by
scientifically and professionally determined definitions
of reproductive health services, and to exercise care
and integrity not to misrepresent or mischaracterize
them on the basis of personal beliefs.
4. Practitioners have a right to respect for their
conscientious convictions in regard to both
undertaking and not undertaking the delivery of lawful
procedures, and not to suffer discrimination on the
basis of their convictions.
30. Conflict of Interest
5. Practitioners’ right to respect for their choices in the
medical procedures in which they participate requires that
they respect patients’ choices within the medically indicated
options for their care.
6. Patients are entitled to be referred in good faith, for
procedures medically indicated for their care that their
practitioners object to undertaking, to practitioners who do
not object. Referral for services does not constitute
participation in any procedures agreed upon between patients
and the practitioners to whom they are referred.
31. Conflict of Interest
7. Practitioners must provide timely care to their
patients when referral to other practitioners is not
possible and delay would jeopardize patients’ health
and well-being, such as by patients experiencing
unwanted pregnancy
8. In emergency situations, to preserve life or physical
or mental health, practitioners must provide the
medically indicated care of their patients’ choice
regardless of the practitioners’ personal objections.
32. Conscientious Objection
• Should it be universal?
• Does it apply to resource limited countries?
• When does it become unethical?
• Is it legal?
33. The Limits of Conscientious Objection to Abortion in the
Developing World, Louis-Jaqcues van Bogaert, Developing
World Bioethics 2 (2), 131-143
• Although the right to conscientious objection is also a
basic human right, the case of refusal to provide
abortion services on conscientious objection grounds
should not be seen as absolute and inalienable, at
least in the developing world.
• This is because referral procedures are fraught with
major obstacles. Therefore … the right to conscientious
objection to abortion should be limited by the
circumstances in which the request for abortion arises.
34. Conscientious objection to abortion provision: Why
context matters, Laura Florence Harris, Jodi Halpern,
Ndola Prata
• Conscientious objection to abortion–a clinician’s refusal
to perform abortions because of moral or religious
beliefs–is a limited right, intended to protect
clinicians’ convictions while maintaining abortion
access
• As the only legal way to refuse to provide abortions
that are permitted by law, conscientious objection can
become a safety valve for clinicians under pressure and
may be claimed by clinicians who do not have moral
or religious objections.
35. Physicians, Not Conscripts — Conscientious
Objection in Health Care
• The New England Journal of Medicine
engl j med376;14 nejm.org April 6,
2017 1380
Ronit Y. Stahl, Ph.D., and Ezekiel J.
Emanuel, M.D., Ph.D.
36. The Views of Professional Societies
•All tend to accept rather than question conscientious
objection in health care.
• The American Medical Association (AMA) is internally
inconsistent on conscientious objection.
• In its Code of Medical Ethics, the AMA insists that
• “physicians’ ethical responsibility [is] to place patients’ welfare
above the physician’s own self-interest” (Opinion 1.1.1).
Physicians must treat HIV pts for example.
• AMA forbids discrimination in selecting or rejecting patients on
the basis of “race, gender, sexual orientation, or gender identity,
or other personal or social characteristics that are not clinically
relevant to the individual’s care” (Opinion 1.1.2).
37. But…
• Conversely, it permits physicians to refuse to treat
patients who are seeking care that is “incompatible with
the physician’s deeply held personal, religious, or moral
beliefs”
• But the authors argue that physicians are professionals
• AMA argues that physicians should not participate in
executions, even if they personally accept the morality of
capital punishment (Opinion 9.7.3).
• Physicians also must care for wounded enemy soldiers and
refuse to participate in torture, regardless of their
personal political allegiance.
38. We Chose Our Profession
• No one is forced to be a physician, nurse, pharmacist,
or other health care professional or to choose a
subspecialty within their larger field.
• It is a voluntary, individual choice. By entering a
health care profession, the person assumes a
professional obligation to place the well-being and rights
of patients at the center of professional practice.
•Thus the Jehovah’s Witness surgeon cannot refuse to
allow blood transfusions during the surgery.
•The catholic nurse cannot refuse to treat alcoholics.
39. Remember: In a freely chosen profession, conscientious
objection cannot override patient care!
• No matter how sincerely held, objections to treating
particular classes of patients are indefensible —
regardless of whether the objections are based on race,
gender, religion, nationality, or sexual orientation.
• A health care professional cannot provide medical
services for a white, Christian person and conscientiously
object to providing the same services to a Hispanic,
Muslim.
40. Health care professionals who are unwilling to
accept these limits have two choices:
1. Select an area of medicine, such as
radiology, that will not put them in
situations that conflict with their personal
morality or,
2. If there is no such area, leave the
profession.
41. • Recognizes CO as a barrier to lawful abortion services, it can
impede women from reaching the services for which they are
eligible, potentially contributing to unsafe abortion.
• In its recent edition of guidelines on safe abortion, WHO notes
that health services should be organized in such a way as to ensure
that an effective exercise of the freedom of conscience of health
professionals does not prevent patients from obtaining access to
services to which they are entitled under the applicable
legislation.
• It recommends the establishment of national standards and
guidelines facilitating access to and provision of safe abortion
care, including the management of conscientious objection
WHO and CO
42. • While important, the right to conscience is not absolute.
• Article 18(3) of the International Covenant provides that: “Freedom
to manifest one’s religion or beliefs may be subject only to such
limitations as…are necessary to protect public safety, order, health,
or morals or the fundamental rights and freedoms of others.”
• The right of conscientious objection is an important freedom, but
those who invoke it must show the same respect for other’s rights
and freedoms as they require for their own.
• Referral does not constitute participation in any discussions that
referred physicians have with patients, or in any procedures upon
which such physicians and patients agree.
Limits of Conscience
43. • Failure to provide referral, information
• Failure to provide service when referral is not possible
• Actively place additional obstacles to the provision of
safe and legal abortion services
• Facilities cannot have CO
• Claiming conscientious objection to hide personal
convenience as a reason for refusing to provide safe
abortion care
When CO Becomes Unethical
44. The Ethiopian Law in Abortion
• Articles 14, 15, and 16 under Section I (Human
Rights) of the Constitution refer to the rights
to life, liberty, and security of the person.
• Article 35 refers to women’s equality with men
and their rights to information and the capacity
to be protected from the dangers of
pregnancy and childbirth.
45. Article 551 of the Penal Code Allows Termination of
Pregnancy Under the Following Conditions:
a. The pregnancy is a result of rape or incest; or
b. The continuation of the pregnancy endangers the life of
the mother or the child or the health of the mother or where
the birth of the child is a risk to the life or health of the
mother; or
c. The fetus has an incurable and serious deformity; or
d. The pregnant woman, owing to a physical or mental
deficiency she suffers from or her minority, is physically as
well as mentally unfit to bring up the child.
e. In the case of grave and imminent danger which can be
averted only by an immediate intervention.
46. Abortion: Technical and Procedural Guideline
in Ethiopia, FMOH, 2014
• Ethiopian women carry a disproportionately high morbidity and mortality as
compared to their counterparts in other parts of the world.
• Although we are witnessing a slow but steady change in the reproductive health
status of women, improvement in the status of women desires much more
focused attention investments, political commitment, and intersectoral
collaborations.
• Pursuant to its national and global commitments to improve the well being of
its citizens and changing social and gender dynamics, the Government of Ethiopia
had taken several policy and legal measures over the last decade.
• The revision of the Criminal Code of the Ethiopia that came after more than
five decades is among such notable measures. As an instrument for change and
a tool for the security of the individual and the society, the Criminal Code would
undoubtedly contribute to the overall development intentions of the nation.
47. This Guideline Translates the Law into
Actionable Measures
• And envisages to inform women, health
professionals, law enforcement agencies and all
sectors of the society who care for well-being of
women and their families.
• It is worthy of note here that this Guideline
follows the launch of the National Reproductive
Health Strategy that provides the framework for all
our RH services and programs.
48. Hence…
• Health care providers at all levels are expected to
not only have a good grasp of this Guideline, but
also prepared to discharge their professional
responsibilities as outlined in the document.
• The FMOH provides unreserved support and
guidance to the implementation of the Guideline as
an essential component of the strategy to reduce
maternal morbidity and mortality.
49. Details - needs reading it
• No need for consent for minors
• Three working days
50. The Ethiopia Law on Conscientious Objection
• FEDERAL NEGARIT GAZETTE
20th year No 11, Addis Ababa, 24th
January, 2014
Regulation number- 299/2013
• FMHACA council of ministers regulation
51. Part Six: Health Professionals
• Chapter two: health professional code of
conduct
• Article 84 -የግል እምነትና አገልግሎት የመስጠት ግዴታ
‘ማንኛውም የጤና ባለሙያ የግል እምነቱን
ምክኒያት በማድረግ እንደ ወሊድ
መቆጣጠሪያ፡ህጋዊ ውርጃ ና ደም ማስተላለፍ
የመሰለ የህክምና አገልግሎት አልሰጥም ማለት
አይችልም’
53. Successful Examples of Disallowing ‘Conscientious
Objection’ in Reproductive Health Care
• Christian Fiala, Kristina Gemzell Danielsson, Oskari Heikinheimo,
Jens A. Gumundsson
• Reproductive health care is the only field in medicine where health
care professionals (HCPs) are allowed to limit a patient’s access to a
legal medical treatment – usually abortion or contraception – by
citing their ‘freedom of conscience.’
• However, the authors’ position is that ‘conscientious objection’
(‘CO’) in reproductive health care should be called dishonorable
disobedience because it violates medical ethics and the right to
lawful health care, and should therefore be disallowed.
54. Countries that Prohibit ‘CO’
• Three countries – Sweden, Finland, and Iceland – do not generally permit HCPs
in the public health care system to refuse to perform a legal medical service for
reasons of ‘CO’ when the service is part of their professional duties.
• The purpose of investigating the laws and experiences of these countries was to
show that disallowing ‘CO’ is workable and beneficial.
• It facilitates good access to reproductive health services because it reduces
barriers and delays.
• Other benefits include the prioritization of evidence-based medicine, rational
arguments, and democratic laws over faith-based refusals. Most notably,
disallowing ‘CO’ protects women’s basic human rights, avoiding both
discrimination and harms to health. Finally, holding HCPs accountable for their
professional obligations to patients does not result in negative impacts.
55. • It is legal and ethical to do abortion in Ethiopia, and
FMOH recognizes it as one method of decreasing maternal
death.
• HCPs should ALWAYS prioritize the patient’s interest
ahead of their interest.
Summary
57. Part Two: Reproductive Justice
Definition: The complete physical, mental, spiritual,
political, social, and economic well-being of women and
girls, based on the full achievement and protection of
women’s human rights
(1) the right to have a child;
(2) the right not to have a child; and
(3) the right to parent the children they have,
• Necessary enabling conditions to realize these rights
58. The Reproductive Justice Framework
• Analyzes how the ability of any woman to determine her own
reproductive destiny is linked directly to the conditions in her
community—and these conditions are not just a matter of individual
choice and access.
• Reproductive Justice addresses the social reality of the inequality
of opportunities.
• Moving beyond a demand for privacy and respect for individual
decision making to include the social supports necessary for women’s
individual decisions to be optimally realized.
• This includes obligations from government for protecting women’s
human rights to make options safe, affordable and accessible.
59. Reproductive Oppression
• The control and exploitation of women, girls, and
individuals through their bodies, sexuality, labor, and
reproduction.
• There are three main frameworks for fighting reproductive
oppression defined:
1. Reproductive Health, which deals with service delivery
2. Reproductive Rights, which addresses legal issues, and
3. Reproductive Justice, which focuses on movement
building.
60. The Reproductive Justice Analysis
• Offers a framework for empowering women and girls
relevant to every family.
• Instead of focusing on the means—a divisive debate on
abortion and birth control that neglects the real-life
experiences of women and girls—
• The Reproductive Justice analysis focuses on the ends:
• better lives for women,
• healthier families, and
• sustainable communities
61. The Key Strategies for Achieving this
Vision Include:
• Supporting the leadership and power of the most
excluded groups of women, girls and individuals within a
culturally relevant context.
• Directly addressing the inequitable distribution of
power and resources within the movement
• Building the social, political and economic power of
low-income women, indigenous women, women of color,
and their communities so that they are full participating
partners in building this new movement..
62. 10 Reasons to Rethink Overpopulation
• Central requirement for reproductive justice is
not only for women to have the right not to have
children, but to also exercise the right to have
children.
• Women have been denied this right through
population control programs that care more about
reducing birth rates than empowering women to
have control over their reproductive health and
right.
63. Here is Why
1. The population ‘explosion’ is over- the era of rapid growth is over.
birth rates have fallen in almost every part of the world and now
average 2.7 births per woman.
2. A narrow focus on human number places the blame on the people
with the least amount of resources and power rather than on
corrupt governments and rich elites as a cause for poverty and
inequality.
3. Hunger is not the result of ‘too many mouths’ to feed. Global food
production has consistently outpaced population growth. People
go hungry because they do not have the land on which to grow
food or the money with which to buy it
64. 4. Population growth is not the driving force behind
environmental degradation. Blaming environmental
degradation on overpopulation lets the real culprits off
the hook. The richest fifth of the world’s people
consume 66 times as many resources as the poorest fifth.
5. Population pressure is not a root cause of political
insecurity and conflict. youth bulge’ of too many young
men whose numbers supposedly make them prone to
violence. Blaming population pressure for instability takes
the onus off powerful actors and political choices.
65. 6. Population control targets women’s fertility and restricts
reproductive rights. All women should have access to high quality,
voluntary reproductive health services, including safe birth control and
abortion.
7. Population control programs have a negative effect on basic health
care. Under pressure from international population agencies, many poor
countries made population control a higher priority than primary health
care from the 1970s on. Reducing fertility was considered more
important than preventing and treating debilitating diseases like
malaria, improving maternal and child health, and addressing
malnutrition.
66. 8. Population alarmism encourages apocalyptic thinking
that legitimizes human right abuses.
9. Threatening images of overpopulation reinforce racial
and ethnic stereotypes and scapegoat immigrants and
other vulnerable communities. For example: Third
world, Muslims…
10. Conventional views of overpopulation stand in the
way of greater global understanding and solidarity.
Fears of overpopulation are deeply divisive and harmful.
67. Abortion Rights and Reproductive Justice
• Because a woman’s ability to control her reproduction
is fundamental to her ability to control her life,
reproductive autonomy is a core aspect of reproductive
justice.
• Achieving this goal requires access to safe abortion,
comprehensive sex education, freedom from coerced
sex, and birth control appropriate to each woman’s
health and life.
• It also requires that women have all that they need to
have and raise children.
68. Abortion Rights and Reproductive Justice
Continued…
• While abortion rights are central to women’s freedom, they are only
part of the picture.
• Within the reproductive rights movement, there has been
frustration over the mainstream pro-choice movement’s singular
focus on abortion, and its use of the framework of individual choice.
• The inadequacy of “choice,” the failure to disassociate abortion
politics from population control, and reducing reproductive rights to
the issue of abortion, alone, have divided feminists for decades.
• In contrast, the framework of reproductive justice is rejuvenating
the meaning and practice of reproductive rights with an expansive
multi-issue perspective and agenda for action.
69. Abortion is a matter of…
•Racial inequity
•Economic justice
•Youth issues
•Violence: When a woman is coerced into an
abortion by her abusive husband or partner
•Religious intolerance
•Rights for people with disabilities
•Imperialism
70. Conditions of Reproductive Justice
• Reproductive Justice recognizes women’s right to reproduce as a
foundational human right
Women’s right to manage their reproductive capacity
1. The right to decide whether or not to become a mother and when;
2. The right to primary culturally competent preventive health care;
3. The right to accurate information about sexuality and reproduction;
4. The right to accurate contraceptive information;
5. The right and access to safe, respectful, and affordable contraceptive
materials and services; and
6. The right to abortion and access to full information about safe, respectful,
affordable abortion services;
7. The right to and equal access to the benefits of and information about the
potential risks of reproductive technology.
71. Women’s Right to Adequate Information, Resources,
Services and Personal Safety While Pregnant
1. The right and access to safe, respectful, and affordable
medical care during and after
2. The right of incarcerated women to safe and respectful
care during and after pregnancy, including the right to give
birth in a safe, respectful, medically-appropriate
environment;
3. The right and access to economic security, including the
right to earn a living wage;
4. The right to physical safety, including the right to adequate
housing and structural protections against rape and sexual
violence;
72. 5. The right to practice religion or not, freely
and safely, so that authorities cannot coerce
women to undergo medical interventions that
conflict with their religious convictions;
6. The right to be pregnant in an
environmentally safe context;
7. The right to decide among birthing options
and access to those services.
73. A Woman’s Right to be the Parent of
Her Child
1. The right to economic resources sufficient to be a parent,
including the right to earn a living wage;
2. The right to education and training in preparation for earning a
living wage;
3. The right to decide whether or not to be the parent of the child
one gives birth to;
4. The right to parent in a physically and environmentally safe
context;
5. The right to leave from work to care for newborns or others in
need of care;
6. The right to affordable, high-quality child care.
74. Sexual Rights
• Embrace human rights that are already recognized in national laws,
international human rights documents and other consensus
statements.
• They include the right of all persons, free of coercion,
discrimination and violence, to: the highest attainable standard of
sexual health, including access to sexual and reproductive health
care services; seek, receive and impart information related to
sexuality; sexuality education; respect for bodily integrity; choose
their partner; decide to be sexually active or not; consensual
sexual relations; consensual marriage; decide whether or not, and
when, to have children; and pursue a satisfying, safe and
pleasurable sexual life.
75. Reproductive Rights
• Embrace certain human rights that are already recognized in
national laws, international human rights documents and other
consensus documents.
• These rights rest on the recognition of the basic right of all
couples and individuals to decide freely and responsibly the
number, spacing and timing of their children and to have
the information and means to do so, and the right to attain
the highest standard of sexual and reproductive health.
• It also includes their right to make decisions concerning
reproduction free of discrimination, coercion and violence,
as expressed in human rights documents.
76. And…
• Further, the right to reproductive health requires
that reproductive health care goods and services, as
well as programs, are widely available,
economically and physically accessible, culturally
acceptable, and of high quality.
• The right to reproductive autonomy also includes
the rights to information, privacy and
confidentiality when making decisions about
one’s reproductive capacity and life.
79. EDHS 2016
• Polygyny: Eleven percent of currently married women
report that their husband has multiple wives.
• Age at first marriage: Marriage is nearly universal in
Ethiopia, although women marry about 6.6 years earlier than
men on average. Median age at first marriage is 17.1 years
among women and 23.7 years among men age 25-49.
• Trends: Age at first marriage has dramatically changed for
women and girls. More than 30% of women born in the
seventies married before age 15, while for those born in the
nineties, this indicator is around 10 percent.
80. •Teenage pregnancy: Among women age
15-19, 10% are already mothers and 2% are
pregnant with their first child.
• Age at first birth: The median age at first
birth among women age 25-49 is 19.2 years.
81. Women Empowerment
• Employment and earnings: Forty-eight
percent of currently married women age 15-49
were employed in the 12 months before the
survey, compared with 99% of currently
married men age 15-49
• Decision to marry: The majority (61%) of
ever-married women say their parents made
the decision that they would get married the
first time.
82. Sexual Violence
• Experience of violence: Among women age 15-49, 23% have experienced physical
violence and 10% have experienced sexual violence. Four percent of women have
experienced physical violence during a pregnancy.
• Marital control: Sixteen percent of ever-married women have experienced at least three
types of marital control behaviors by their husbands or partners. Forty-three percent have
never experienced marital control behaviors by their husbands or partners.
• Spousal violence: Thirty-four percent of ever-married women age 15-49 have experienced
spousal physical, sexual, or emotional violence. Physical and emotional violence were
experienced by 24% each, and sexual violence by10%.
• Injuries due to spousal violence: Twenty-two percent of ever-married women who
experienced spousal, physical, or sexual violence reported injuries, including 19% who
reported cuts, bruises, or aches and 10% who reported deep wounds and other serious
injuries.
• Help seeking: About one-quarter of women who have experienced physical or sexual
violence has sought help.
83. Marital Control
• Percentage of women whose current husband/partner
(if currently married) or most recent husband/partner (if
formerly married) demonstrates at least one of the
following controlling behaviors:
• is jealous or angry if she talks to other men;
• frequently accuses her of being unfaithful; does not
permit her to meet her female friends;
• tries to limit her contact with her family; and
• insists on knowing where she is at all times.
84. • Reproductive justice links reproductive rights with the social,
political and economic inequalities that affect a woman’s ability to
access reproductive health care services. Core components of
reproductive justice include equal access to safe abortion,
affordable contraceptives and comprehensive sex education, as
well as freedom from sexual violence.
• Reproductive health care requires reproductive justice.
In Summary
