Reproductive Freedoms

It is the mission of the United Nations Fund for Population Activities (UNFPA), “to deliver a world where every pregnancy is wanted, every birth is safe and every young person’s potential is fulfilled.” (2014, 10).

Reproductive freedom is essential for all women and men to have self-determination over their bodies and sexuality. Reproductive rights for women are critical for the achievement of gender equality to ensure global progress toward fair and democratic societies. For decades, the decisions and choices related to bearing and nurturing children have been debated and discussed between spouses and their families in many societies. “Marriage,” the legally or formally recognized union of two people as partners in a personal relationship, has been traditionally considered as the only right time for giving birth to a child; some religions considered out-of-wedlock births to be a sin.

Studies have shown that in many societies, early marriage, giving birth to a child, space between children, and restrictions to the number of children borne are mostly decided by the spouse and by the family members based on their psychological needs and socioeconomic conditions of the family. Beyond that, global sociopolitical movements over the years have attempted to manipulate women’s lives, sexuality, and fertility for political purposes, fundamentalist revivals, or population control.

Overview

Gender norms often create a double standard with regard to men’s and women’s sexuality; for example, unmarried women who engage in sexual activity are shamed, whereas their male peers who do the same are celebrated. Social stigma can prevent unmarried women from seeking sexual and reproductive health care, especially contraception and abortion. Conversely, in societies with more equitable gender norms, men do support women’s autonomy and rights and facilitate women’s access to information and services (Blanc 2001).

Women have responded to repressive gender norms and resurgences of gender violence by building an internationally recognized legal framework for the universal defense of women’s autonomy, bodily integrity, and personhood. The framework identifies how human rights instruments may be interpreted to condemn abuse of women’s rights. It also proposes modifications to existing legal tools and social policies. With explicit provisions protecting women’s right to bodily integrity, the framework is a key instrument for guaranteeing that population programs respect women.

This chapter gives a historical overview of population and birth control and its essentiality by examining culture-specific myths regarding national and global growth. The chapter describes the historical reproductive rights movement that has promoted a human rights-based approach to reproductive health; laws relating to reproductive rights; institutions working toward reproductive rights; the international commitment to reproductive health; contraceptives and the impact of new technologies related to reproductive health; and cases explaining how the existing patriarchal system plays a role in reproductive behavior.

Population Control and the Birth Control Movement

Humans have attempted to control their reproduction since ancient times, using techniques such as abstinence, withdrawal, and abortion. Contraceptive methods such as vaginal sponges and cervical caps were used in the Middle East several thousand years before Christ. Population control as a major international development strategy is a phenomenon that dates only to the aftermath of World War II. Yet its origins reach back to the intellectual currents and social movements of the nineteenth and twentieth centuries, which culminated in an organized birth control movement in Europe and the United States (Hartmann 1997).

Eugenicists and racists attempted to use birth control for social engineering. Eugenics is a set of beliefs and practices that aim to improve the genetic “quality” of a human population, historically by excluding people and groups judged to be inferior or promoting those judged to be superior. The motive of eugenics was to limit “deviant” populations; the population control movement aimed to solve social and economic problems through fertility control. It was used again as a tool in a new era of social planning after World War II when it metamorphosed into “family planning.” The efforts of English radical neo-Malthusians (who believed that rapid population growth would lead to depletion of the Earth’s resources) that promoted birth control and emphasized poverty reduction somehow evolved into women’s rights. Initially, the US birth control movement reflected the emergence of family planning policy resulting from the efforts of Margaret Sanger, feminists, and the civil rights movement. By the twentieth century, changing views of sexuality and working-class militancy ignited the US birth control movement.

The Women’s Health Movement

Margaret Sanger

Linda Gordon’s “Woman’s Body, Woman’s Right” and Bonnie Mass’s “Population Target” analyze the history of the birth control movement and trace the elements present in the current debate to their origins in the conflicts and contradictions of the movement’s history. They have written about the women’s health movement and noted that it positively influenced gynecological practice. They have also described problems with the first generation of oral contraceptives.

Population control moved through three stages: from the cause of “voluntary motherhood,” to advance suffrage and women’s political and social status; to the concept of “birth control,” promoted by socialist feminists to help empower women and the working class; and, from 1920 on, to a liberal movement for civil rights and population control.

Physicians such as Robert Latou Dickinson legitimized the movement via formation of the Committee on Maternal Health in 1925, but the movement remained divided until 1939, when Sanger’s group merged with the American Birth Control League, the predecessor of Planned Parenthood Federation of America. A key US legal decision in 1939 allowed for the distribution of birth control devices by mail to physicians. After a brief retirement, Sanger formed the International Planned Parenthood Federation and supported research into the birth control pill. Eugenicists through the Committee on Maternal Health supported Christopher Tietze and others developing “The Pill.” Final constitutional access to contraception based on the right to privacy was granted in Griswold v. Connecticut (1965).^[1] The ruling in Eisenstadt v. Baird (1972)^[2] extended this right to unmarried persons. The right to privacy was further extended in the Roe v. Wade decision on legal abortion in 1973.^[3]

The argument for improving the “quality” of the population remained from the formation of the Population Reference Bureau in 1929 through the 1960s. US government support for national and international family planning proceeded slowly through the 1950s, 60s, and 70s. The US need for the resources of developing countries led to concerns about population growth fueling nationalistic fires. Thus private agencies began a postwar population control effort in developing countries. This received official US approval with the 1958 report of the Draper Committee,^[4] which identified world population growth as a US security issue. From 1967 to 1970, Congress enacted strong legislation in support of national and international family planning. The Bucharest Conference in 1974 highlighted the inadequacies of international population control that deemphasized economic development.

About $5 billion is spent annually on family planning in the Third World. Third World governments spend about $3 billion, with China, India, and Indonesia being the biggest spenders. More than $1 billion is donated by the governments of developed countries, multilateral institutions, and private agencies, and the rest is spent by individual contraceptive users.

While the level of population assistance has increased over time, it still accounts for only 1 percent of Official Development Assistance (ODA). This percentage is significant, however, since less than 7 percent of ODA is allocated to human welfare concerns and population aid, and the policies it helps to generate influence many other aspects of development planning. The organizations that comprise the population establishment have the common purpose of reducing population growth in developing countries, but they are nonetheless different entities with sometimes conflicting goals and strategies.

Reproductive Rights Are Human Rights: Progress from 1945 to 1994

The Universal Declaration of Human Rights was first ratified in the United Nations Charter in 1945. The declaration affirmed equality between the sexes as a basic principle in 1948. Yet inequality remained between men and women until the international body seriously examined women’s conditions in 1975. The United Nations (UN) then sponsored meetings to launch the women’s decade in 1975. The International Women’s Year Conference in Mexico City (1975) initiated the decadelong process that culminated in Nairobi in 1985 (Correa and Reichmann 1994).

The International Women’s Year Conference denounced coercive practices in contraceptive research and services as human rights abuses. Women activists were instrumental in ensuring that the women’s conference grounded its assertion of rights to reproductive choice on a notion of bodily integrity and control. The UN Decade for Women played the role of an international legal instrument for the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), ratified in 1979. CEDAW was a major victory in the battle to secure women’s equality with men, including the right to bodily integrity. But CEDAW failed to specify a number of women’s reproductive rights, except to affirm women’s rights to family planning information, counseling, and services, and to have equal rights with men to decide the number and spacing of their children. In addition, CEDAW confirms women’s rights to maintain their job during and after pregnancy, including maternity leave and childcare (UN Women 1979, Part I, Article 4, Appendix A).

Parallel to the women’s decade and the consolidation of internationally recognized women’s rights instruments, the United Nations held a series of international human rights and population conferences that also dealt directly with women’s reproductive rights. The concept of universal rights was first applied to family planning twenty years after the Universal Declaration, at the 1968 International Human Rights Conference in Tehran: “Couples have a basic human right to decide freely and responsibly on the number and spacing of their children and a right to adequate education and information in this respect” (Freedman and Isaacs 1993).

The various UN conference resolutions on women’s rights represented significant advances over the restricted civil and political human rights recognized by the previous UN covenants. But population and family planning provisions were consistently oriented to birth control rather than an integrated approach to reproductive health, and their gender neutrality disregarded women’s specific reproductive responsibility. The UN resolutions also utterly failed to address abortion rights (Dixon-Mueller 1990).

At the time of the UN conferences (both the Decade for Women and the population conferences) the concept of reproductive rights had not yet been formalized in feminist discourse. The International Campaign on Abortion, Sterilization, and Contraception (ICASC), founded in Europe in 1978 to counter both pro-natalist and anti-natalist movements, may have been the first to formalize a concept that many women’s organizations around the world had come to define as reproductive rights: women’s right to decide whether, when, and how to have children—regardless of nationality, class, race, age, religion, disability, sexuality, or marital status in the social, economic, and political conditions that make such decisions possible (Petchesky and Weiner 1990).

The Amsterdam Conference is often cited as the birth of the international reproductive health and rights movement, bringing together individuals representing initiatives taken throughout the world. On that occasion the campaign changed its name to the Women’s Global Network for Reproductive Rights (WGNRR), under pressure from Global South activists, who felt that the explicit reference to reproductive rights would more appropriately encompass southern women’s health agenda.

One underlying principle that formed the basis for communication among the profusion of diverse women’s groups was the belief that women should be seen as the subjects and not the objects of population policies. In January 1994, women from all over the world issued a declaration to be delivered to heads of state and drafts of the International Conference on Population and Development (ICPD) Programme of Action (Correa and Reichmann 1994).

Systematic Global Attention toward Reproductive Rights
(UN 2005), (UNFPA 2014, 7.3)

1968: Final Act of the Tehran Conference on Human Rights	“Parents have a basic human right to decide freely and responsibly on the number and spacing of children and a right to adequate education and information in this respect.” The General Assembly endorsed the Final Act in December 1968. (UN 1968)
1975: Declaration of Mexico on the Equality of Women and their Contribution to Development and Peace and Plans of Action	Principle 12, “every couple and every individual has the right to decide freely and responsibly whether or not to have children as well as to determine their number and spacing, and to have the information, education and means to do so.” (UN 1975)
1993: World Conference on Human Rights adopted the Vienna Declaration and Programme of Action	Section 3 of the Programme of Action deals with women’s rights and their right to accessible and adequate health care and the widest range of family planning services, as well as equal access to education at all levels, including sexuality education. (UN Human Rights Council 1993)
1994: ICPD and Programme of Action	The Programme of Action clearly affirmed and articulated that reproductive and sexual health is protected by the human rights already recognized by both national and international law. In addition, the Programme of Action contributed to the recognition of the complex links between population growth and gender equality. The generally acknowledged definition of reproductive rights is taken from the ICPD Programme of Action paragraph 7.3. (UNFPA 2014)
1995: Beijing Declaration and Platform for Action—IV World Conference on Women	The conference reaffirmed the goals and standards on sexual and reproductive health and rights set out in the ICPD but elaborated on women’s interests, stating that “equal relationships between women and men in matters of sexual relations and reproduction, including full respect for the integrity of the person, require mutual respect, consent and shared responsibility for sexual behavior and its consequences.” The 1995 conference also directly called upon UN member states to review their laws, especially those that still imposed punitive measures upon women who “have undergone illegal abortions.”
2000: Millennium Summit and the Millennium Declaration and subsequent Millennium Development Goals (MDGs)	In September 2000 the then-189 members of the United Nations in the Millennium Summit adopted the United Nations Millennium Declaration. Based on the Millennium Declaration, primarily Section III on development and poverty eradication, the eight MDGs were established. Four out of eight MDGs were related to reproductive and sexual health and rights. MDG 5 concerns maternal health and contains two targets: to reduce the maternal mortality ratio by three quarters between 1990 and 2015, and to achieve universal access to reproductive health by 2015. MDG 4 is to reduce the mortality of children under age five by two-thirds between 1990 and 2015. MDG 3 deals with promoting gender equality and empowerment of women. Finally, MDG 6 concerns the combat of HIV/AIDS, malaria, and other diseases. Based on current data, MDG 5 is considered the least likely of all the MDGs to be achieved within the timeline set. (UN Women 1995)
2005: World Summit Outcome	The 2005 World Summit Outcome confirms the commitment to the Millennium Declaration and reiterates the “determination to ensure the timely and full realization of the . . . Millennium Development Goals.” In addition, the World Summit Outcome contains new commitments, four of which became part of the revised MDGs during 2006-7. One is the achievement of universal access to reproductive health by 2015 (that became an addition to MDG 5); another is universal access to HIV/AIDS treatment by 2010 (that became an addition to MDG 6).

ICPD Programme of Action 1994

The ICPD Programme of Action revealed that reproductive health services should include safe contraception, abortion, and prevention as well as early diagnosis and treatment of sexually transmitted diseases, including HIV/AIDS. The United Nations and other donors and governments should recognize the right to safe and legal abortion as an intrinsic part of women’s rights, and governments should change legislation and implement policies to reflect such recognition. Better health services are one element of women’s rights. In addition, sexuality and gender power relationships must be addressed as a central aspect of reproductive rights (Correa and Reichmann 1994).

Reproductive rights are human rights, which are inalienable and inseparable from basic rights, such as the rights to food, shelter, health, security, livelihood, education, and political empowerment. The conference emphasized that women are entitled to bodily integrity (security from personal harm or control). Within this principle, violence against women and harmful practices like female genital mutilation must be recognized as major reproductive rights and health issues. Governments should be held accountable for taking measures to combat such practices. Women should be involved in decision-making processes national and internationally, where any laws or policies affecting their rights and health are designed and implemented (Correa and Reichmann 1994).

The Cairo document included concerns for gender equality, the right to physical integrity, security of the person, and reproductive rights. The ICPD Programme of Action declared that sexual and reproductive rights include certain human rights that are already officially recognized, including the basic rights of individuals and couples to decide on the number and spacing of their children and the right to information and accessible services to that end, the right to respect for security of the person and physical integrity of the human body, and the right to non-discrimination and freedom from violence. In this context the concept of reproductive health gained momentum, and abortion was considered a legal right of women.

In order to extend the struggle for abortion rights beyond the boundaries of the feminist movement, women must engage allies in dialogue to define advocacy strategies appropriate to diverse cultural and political contexts. In many settings the women’s movement has opted to pursue the health rationale, viewing it as more morally compelling than the argument in favor of individual rights. The two rationales should not be seen as opposing alternatives, but rather as lines of reasoning and argument that converge upon the same goal: women’s access to safe, legal abortion (Correa and Reichmann 1994).

Serious barriers to implement the reproductive health and rights framework in many countries are the persistent practices that are harmful to women but justified by customary legal systems. The gap between abortion laws and practices worldwide is probably the most striking example of the contradiction. In Brazil, for example, 1942 legislation permitted abortion in cases of rape or risk to the mother’s life. But the public health system provided services for women legally entitled to an abortion only in 1989, in response to an order from the São Paulo Municipal Health Department (Araujo 1993).

In many countries, abortion is illegal under any circumstances. In Kenya it is legally restricted but widely practiced with the full knowledge of public authorities. In some countries, such as Bangladesh, abortion is accepted by customary legal systems but is a crime under statutory law. Finally, before abortion had been fully legal for even two decades, as in Croatia, Germany, Poland, Russia, and the United States, neoconservative social forces began working to roll back women’s hard-won access to safe abortion (Correa and Reichmann 1994).

Global Laws Relating to Reproductive Rights

This section describes laws relating to reproductive rights around the world. The Center for Reproductive Rights (n.d.) reports the following as of 2019:

• New South Wales joined the rest of the Australian states in decriminalizing abortion, permitting abortion on request up to twenty-two weeks’ gestation.
• Oaxaca became the second state in Mexico to decriminalize abortion.
• The UK parliament voted overwhelmingly to adopt legislative provisions extending abortion rights to Northern Ireland and legalizing same-sex marriage.
• Kenya’s High Court ruled that the withdrawal of 2012 standards and guidelines on Reducing Maternal Mortality and Morbidity from Unsafe Abortion in Kenya was illegal, holding abortion lawful on both physical and mental health grounds.
• Iceland passed one of Europe’s most liberal abortion laws, permitting abortion on request up to twenty-two weeks’ gestation.
• North Macedonia removed regressive barriers to abortion and extended the gestational limit to abortion on request to twelve weeks, making abortion care more accessible.
• South Korea’s Constitutional Court ruled that restrictive abortion laws are unconstitutional, giving lawmakers until 2020 to pass new legislation that legalizes abortion.
• India recognized women’s reproductive rights as part of the “inalienable survival rights,” which are implicitly protected under the fundamental right to life. Article 51(c) of the Indian constitution and the judiciary have established that the government has a constitutional obligation to respect international law and treaty obligations (Supreme Court of India 1999).

International Commitment to Reproductive Health

The main aim of the reproductive health movement is to support physiological functions such as pregnancy and child health and reduce adverse outcomes of sexual activity and reproduction. It is meant to ensure that people of all ages, including adolescents and those of reproductive age, have safe and satisfying sexual relationships. The reproductive health movement helps tackle obstacles such as gender discrimination, inequalities in access to health care services, restrictive laws, sexual coercion, exploitation, and gender-based violence.

According to the United Nations Fund for Reproductive Activities (UNFPR), “reproductive healthcare is defined as the constellation of methods, techniques, services, goods, and facilities that contribute to reproductive health and well-being by preventing and solving reproductive health problems” (UN 2014). It also includes sexual health, the purpose of which is the enhancement of life and personal relationships, not merely counseling and care related to reproduction and sexually transmitted diseases. Sexual and reproductive health involve five key components (World Health Organization 2008):

1. Ensuring contraceptive choice and safety and infertility services.
2. Improving maternal and newborn health.
3. Reducing sexually transmitted infections, including HIV, and other reproductive morbidities.
4. Eliminating unsafe abortion and providing postabortion care.
5. Promoting healthy sexuality, including adolescent health, and reducing harmful practices.

Reproductive Freedom and Justice Concerns in India

In Indian society, women are under patriarchal control, and they are often compelled by their husbands to have sex and forced by the government to be sterilized. Women’s liberties are limited by religious practices and social traditions. The evolution of the movement for women’s rights in India gave birth to the movements for reproductive rights in the early 1980s. The slogan “the personal is political” gained prominence among women’s groups in India. The slogan came to represent much of what the feminist movement was discovering about women’s oppression and ultimately liberation. Oppression perpetrated on women’s bodies in their homes and bedrooms had a direct effect on their position and treatment in the public sphere (Hussain et al. 2015).

Access to needed health services and education about contraceptive methods are limited, and therefore women face unplanned pregnancies that carry higher risks of maternal deaths and injury, unsafe abortion, mental anguish, and agony. The Indian government and its agencies have not taken the steps necessary to avoid these problems. The absence of information about contraceptives and the inaction of government agencies has resulted in violations of women’s fundamental rights as guaranteed under the constitution of India (Hussain et al. 2015).

In 1971 the government of India passed an act related to medical termination of pregnancy, prescribing and regulating the matters connected to abortion and related medication (Hussain et al. 2015). Though this act legalized abortion in India, most women do not have access to safe abortion services. Sometimes, women who approach government facilities for abortion are forced to accept contraception or sterilization. The government population policy and two-child norm often clash with reproductive rights and the right to safe sterilization (Hussain et al. 2015).

After the ICPD conference in 1994 at Cairo (popularly known as the Cairo Conference), reproductive health issues gained importance in various parts of the world. The Cairo Document includes concerns for gender equality, the right to physical integrity, security of the person, and reproductive rights. Similarly, the ICPD Programme of Action declares that sexual and reproductive rights include certain human rights that are already officially recognized: the basic right of individuals and couples to decide on the number and spacing of their children; the right to information and accessible services; the right to respect for security of the person and physical integrity of the human body; and the right to nondiscrimination and freedom from violence.

India recognizes women’s reproductive rights as part of the “inalienable survival rights” that are implicitly protected under the fundamental right to life. India is a signatory to international conventions like CEDAW, the International Covenant on Civil and Political Rights (ICCPR), the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the Convention on the Rights of the Child (CRC), which all recognize reproductive rights. Reproductive health rights are reflected in Indian policies and laws. For example, the National Population Policy 2000 affirms the right to voluntary and informed choices in matters related to contraceptive use. There are many nongovernmental organizations committed to work on the reproductive rights of women. But a large segment of women continues to face constraints and pressures that limit their ability to make reproductive health decisions. In particular, the continued pressure of son preference is widespread in Indian culture. The National Family Health Survey reveals that 18.8 percent of women and 18.7 percent of men would like to have more sons, compared to 3.5 percent of women and men who would like to have more daughters.

Contraceptives and the Impact of Reproductive Technologies on Women’s Health

Gender discriminatory practices with respect to contraceptive usage are an important concern. Contraceptives in the medical market are targeted toward women. Contraceptives can be divided into temporary and permanent methods. There are many temporary contraceptives for women, like pills and injections. To add to the burden, permanent sterilization methods tend to focus on women. Discriminatory practices are built into the attitudes of both males and females in such a way that they appear “natural.”

A partial range of birth control options. Others include tubal ligation (female sterilization), vasectomy (male sterilization), nonreproductive sexual activities, and abstinence from sexual activity

Birth control pills (female)	Condom (male)	Condom (female)	Emergency contraception (female)	Injectable contraceptive (female)

India’s National Population Policy guarantees women voluntary access to the full range of contraceptive methods. In practice, however, state governments continue to introduce schemes that promote female sterilization, leading to coercion, risky substandard sterilization procedures, and denial of access to nonpermanent methods. India has legalized abortion on multiple grounds until twenty weeks of gestation under the Medical Termination of Pregnancy Act of 1971. But 56 percent of the 6.4 million abortions estimated to occur in India annually are unsafe and result in 9 percent of all maternal deaths (Stillman et al. 2014, 14).

The advent of new reproductive technologies as a solution to infertility has oppressed women to an extent, with women—especially poor Indian women—being used as biological laboratories to bear children. Childbearing is the most significant social protection for women’s respectability. For instance, Chatterjee and Janwalkar (2014) reported on a woman in Tamilnadu who was pressured to sell her eggs. Sakunthala, 27 years old, had approached a political party office with her neighbor to file a complaint against her abusive husband, Navaraj. In the eight years of her married life, Sakunthala was forced by Navaraj and his mother to donate her eggs eighteen times at various hospitals in Tamilnadu and Kerala. (Police officials also revealed that she was forced to sell one of her kidneys soon after her wedding in 2006.) When Sakunthala finally resisted donating, she was attacked by her husband.

After Sakunthala’s attack, 17-year-old Sushma Pandey of Mumbai died of “brain hemorrhage and pulmonary hemorrhage due to ovarian hyper-stimulation shock syndrome” (Chatterjee and Janwalkar 2014) after donating eggs three times in ten months. This incident was a severe violation of the Indian Council of Medical Research guidelines, which restricts the age of women donating eggs to between 18 and 35. In another incident, Yuma Sherpa, a 23-year-old shop assistant, died in New Delhi following an oocyte (immature egg) extraction procedure (Chatterjee and Janwalkar 2014). These incidents gained national attention and raised questions about the legal and ethical aspects of assisted reproductive technology (ART). The Ministry of Health and Family Welfare introduced the Assisted Reproductive Technology (Regulation) Bill in 2020 in Lok Sabha, the Parliament of India.

Despite the legal measures introduced to protect women from various societal pressures, patriarchal pressures on women making reproductive decisions continue. It also shows that women do not have control over their bodies, even with the advent of new reproductive technologies. In fact, ART treats women’s bodies as commodities, where all of a woman’s reproductive organs are for sale. What a sad commentary.

Finally, the noninvolvement of men and boys in matters related to reproductive rights contributes to “the poor preparation of men for adulthood, contraceptive use, and safe sex” (Kumar 2007). Men have a stake in reproductive rights through their multiple roles as sexual partners, husbands, fathers, family and household members, community leaders, and gatekeepers to health information and services. In addition, not all men live in traditional families but still have needs related to their sexual and reproductive health.

To be effective, reproductive health programs need to address men’s behavior in these various roles as well as their reproductive rights and needs as human beings. Involving men can enhance equity and gender equality, share the burden of preventing diseases and health complications, and promote satisfying sexual lives for men and women. The right to legal and safe abortion; to control one’s reproductive functions; to be able to make reproductive choices free of coercion, discrimination, and violence; to access education about contraception and sexually transmitted diseases and freedom from coerced sterilization and contraception; to be protected from gender-based practices such as female genital cutting and male genital mutilation should all be high priorities of any government.

References

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