Women's rights to reproductive and sexual health are fundamental to women's health in the United States and abroad. Efforts concerning women's rights to reproductive health have been essential in expanding women's human rights. Adoption of a health and human rights framework encourages logical applications about the correlation between women's health and human rights, social justice, and respect for human dignity. Hindrance to reproductive health rights is political, legal, social, and financial in nature (Gruskin 1737).
The purpose of this paper is to detail the significance of human rights associated with women's reproductive health rights in the United States and the public health implications of these rights. This paper investigates health and human rights, as it relates to a woman's reproductive health in the United States, including the right to autonomy; the right to health care and information; and the right to equity in the distribution of health service resources, availability, and accessibility. The association of these rights to women's reproductive health in the United States has significant public health implications, discussed below.
Historical and Modern Application of Modern Human Rights Development after WWII
Human rights are standards that defend all humans from serious legal, political, and social abuses (Mann et al. 9). Historical and modern applications of modern human rights development after World War II include, the World Health Organization's (WHO) Constitution in 1946, the Universal Declaration of Human Rights (UDHR) in 1948, and The International Covenant on Economic, Social and Cultural Rights in 1966. Each of these doctrines spelled out the premise that all humans are equal and free with rights, including the right to health.
The right to health was first expressed in the World Health Organizations' Constitution (1946). The World Health Organization declared in the Constitution that the fulfillment of the utmost achievable paradigm of health is one of the essential privileges of every person (Mann et al. 9; Ross 55; Robinson par. 8). Conversely, the right to health continues to be neglected in many parts of the world. This neglect, while not as grossly, is extended to the United States. The United States has abstained from passing this and other international agreements. In reality, the United States has not ratified a single treaty that acknowledges an entitlement to health for its citizens. The United States' lack of ratifications of these treaties is challenging and will be elucidated later in this discussion.
Human rights were also expressed by the United Nations in the 1948 Universal Declaration of Human Rights. The Universal Declaration of Human Rights (UDHR) was implemented as a reaction to the Nazi holocaust and set a benchmark by which the human rights actions of all countries should be defined. The UDHR commences by setting forth the fundamental principle that all people are born uninhibited and equivalent in distinction and rights (Mann et al. 10). Also, it prohibits any division in the fulfillment of human rights on the grounds as race, color, sex, language, religion, political, national origin, birth status. In addition, the UDHR clearly spells out the rights to security, life, and liberty, as well as the entitlement to be liberated from slavery, servitude, torture or cruel conduct or retribution (Cook, Dickens, and Fathalla 90-91; Ross 55-56).
The International Covenant on Economic, Social and Cultural Rights (1966) further expanded on the issue of human rights by specifying socio-economic rights. These rights include, but are not inhibited to, the right to education, shelter, health, water and food, employment, social security, a healthy environment, and the right to advancement ("International Covenant on Economic, Social, and Cultural Rights" articles 10-12). The treaty exemplifies processes to be implemented by States parties to accomplish: maternal, child and reproductive health; healthy natural and workplace environments; prevention, treatment and control of disease; health facilities, goods and services. This treaty also states that all socio-economic rights must be declared without inequity (Cook, Dickens, and Fathalla 153)
The right to health is also acknowledged in various other documents world-wide including: 1961 European Social Charter, 1978 Declaration of Alma Ata, 1981 African Charter on Human and People's Rights, 1988 Additional Protocol to the American Convention on HRs in the Area of Economic, Social and Cultural Rights, and 1989 Convention on the Rights of the Child.
Women's Human Rights
Women's human rights are the freedoms and benefits given to women and girls. Women's human rights are categorized collectively and distinguished from comprehensive philosophies of human rights because they frequently vary from the self-determinations essentially held by men and boys. Themes regularly connected with the concepts of women's rights include, but are not restricted to, the right: to physical integrity and autonomy; to education; and to have marital, parental and religious rights.
In 1979, The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) was adopted by the United Nations. CEDAW affirms women equal rights with men in all realms of life, including education, employment, healthcare, nationality, and marriage (Cook, Dickens, and Fathalla 198-203; Ross 1-3).
In 1995, "The Fourth World Conference on Women: Action for Equality, Development and Peace," also popularly known as the United Nations Fourth World Conference on Women, was held in Beijing, China. The conference raised global knowledge of human rights, the inequalities and inequities between men and women, and bestowed the required motivation for accentuating gender-based violence as a precedence issue for engagement by the global community (Cook, Dickens, and Fathalla 79).
Human rights are being used to promote public health. Reproductive health rights become visible in the globally reputable structure of human rights through established rights to life, security, equal treatment, education, development, and to the maximum health standards. The rights include the privilege to emergency medical services and to the fundamental health determinants, such as sovereignty from discrimination, and adequate food, water, and sanitation (Gruskin and Loff 1880). The right to health is an essential human right that consists of free will and privileges (Hunt 1878). The freedoms consist of the right to contribute to apposite decisions about one's health, including those made about sexual and reproductive freedom (Germain, "Reproductive Health and Human Rights" 65).
Human Rights and Public Health Standards in Regards to Women's Reproductive Rights
The associations amid medicine, public health, and human rights are developing swiftly, in result of a multitude of actions, occurrence, and efforts. These are comprised of the ongoing efforts on various aspects of women's health.
To understand the associations between human rights and public health, it is fundamental to evaluate the important essentials of modern public health. Medicine and public health are two corresponding and interrelated methods for health advancement and protection through physical, mental, and social security. However medicine and public health must be separated because they serve different purposes (Germain 65). The primary disparity involves the population importance of public health, which varies with the individual center of medical care. Public health recognizes and measures health risks to the populations, composes legislative policies in reaction to these risks, and develops certain services contributing to the promotion of health and disease prevention (Gruskin and Loff 1880). Medicine, on the other hand, concentrates on the diagnosis and treatment of individuals.
There is a strong association between public health and human rights. In the article "Health and Human Rights", Jonathan Mann et al. describe a trinary outline of health and human rights and the impact and implications in health policies, human rights, and the connection between the two.
Health practices, policies, and programs have an effect on human rights. Public health liabilities are accomplished in considerable evaluation through programs and policies distributed, employed and implemented with assistance from the state. Public health functions are appraising health concerns and inadequacies, cultivating policies intended to manage health issues of precedence, and ensuring agendas to employ planned health goals (Mann et al. 13-17). For example, compilation of information on population health problems may be gathered on particular significant health problems opposed to others. This consequently creates inequity and other human rights violations by neglecting to contribute suitable health services.
Public health is concerned with the advancement and security of the health of populations. There is a correlation between socioeconomic circumstances and inadequate health on women's reproductive health and human rights. The themes of public health and human rights are each comprised of health promotion and clarifying standards for performance (Gruskin and Loff 1880).
The health and human rights framework is applicable to population issues concerning women's reproductive health. Human rights violations, such as gender inequalities, and lack of access to family planning, have a negative impact on women's health.
Encouraging gender equality, development and ascertainment of women's reproductive health services and the elimination of impediment to women's economic and educational contribution is essential to promote public health.
Gender disparities are a chief reason of disproportion in health status, including health care. Gender differentiations are evident in disease prevalence; access to preventive care; and reproductive health. Promotion of gender equality in other sectors can influence health status and have reinforced public health outcomes (Robinson par. 9). Unfortunately, there remains a considerable disparities among recognized allegiance to gender equality in reproductive health services within the United States and abroad. The foremost cause of death and disease in women globally age 15-44 are reproductive health issues. Globally, inadequacies in family planning access contribute to the chief aspect regarding the 76 million unplanned pregnancies each year; nearly 20 million result in unsafe abortions, and attributing to nearly 70,000 deaths yearly. In emergent countries, the primary reason of death and impairment among women of reproductive age is pregnancy and childbirth complexities. Less than a quarter of married women use contraception in Africa. Females contribute to half the people infected with HIV-nearly 100 percent live in emergent countries (United Nations, "Reproductive Health Factsheet").
Cultural and societal customs regarding reproductive health contribute to the variations among women's and men's health status. Acknowledgment of the dynamic gender roles and associations reliant on social perspectives where cultural, religious, economic, and political positions are mutual are necessary to promoting gender equality in healthcare.
Gender customs and discrimination within the United States, in addition to policies and laws influence women's access to health services and education can have a significant effect on women's reproductive health and their interrelated human rights (Germain, "Reproductive Health and Human Rights" 66). It is imperative to acknowledge the significant health outcomes attributed to a woman's capability of autonomy in controlling health and health decisions. The ability for a woman to have control over when and how many children she has is crucial to increasing women's economic abilities.
Family planning occupies the use of contraception to control the amount of children and intervals between births. An effective analysis of reproductive health allows women to establish informed decisions about their reproductive health and welfare (Cook, Dickens, and Fathalla 45-48). Family planning also encourages the preservation of women's freedoms and protects their health by precluding unplanned pregnancies and decreasing women's vulnerability to the health risks (Koop, Pearson, and Schwartz 190-191). All women should have the freedom to determine unconditionally and conscientiously the amount and proportion of children to have and to be able to acquire the education and information required to realize this right. Services include access to contraceptives, education, legal abortion, sexually transmissible infection (STI) screenings and treatment, pregnancy testing and counseling. In many parts of the world, including the U.S., these services remain unavailable. For example, between 1994 and 2001, impecunious women had increased number of unplanned pregnancies, rates of abortion, and unintended births contrary to more affluent women. Low-income women are less likely to use contraceptives, thus increasing the incidence of STI's and abortion (Finer and Henshaw 95).
High-quality family planning and the highest medical care aim to reduce abortion rates. Prohibiting access to superior reproductive health services and education amplifies the rate of abortion.
Reproductive health and human rights and social and economic development.
Population health is necessary for continuing economic advancement and overcoming poverty (Novick, Morrow, and Mays 20-24). Men and women should have a fundamental right to health and welfare, but significant infringements and disparities in health determinants and healthcare access continue to exist (Germain, "Reproductive Health and Human Rights" 65). In the United States, numerous relations among poverty and sexual and reproductive behavior exist. Being disadvantaged is related to first intercourse acts at an earlier age; less constancy with or no contraceptive usage; and reduced rationale to evade childbearing and rearing (Gruskin 1737). The prevalent concern is to surmount social cultural barriers and initiate family planning courses and assistances to women and girls. Supporting and promoting women's reproductive rights and encouraging family planning, enhances economic circumstances of women and families. Violence and discrimination against women continue to negatively impact their United States' economy.
The collaboration between public health and human rights transforms social and political structures that prevent women from fulfilling their highest human potential. The theory of a complex association between health and human rights has outcomes. Health professionals may supply beneficially to public acknowledgment of the remuneration and expenses related to the realization in respect of human rights and dignity.
Public health may encumber human rights. In the name of public health, gross misapplication of private health status information can, consequently, aid in harming individuals and violating rights. Mann et al. explains that mishandling of HIV information has resulted in limitations on human rights in such areas as marriage and family, education and work, and freedoms (14). When vital public health problems are delineated on the basis of religion, national origin, or sex, health issues of prioritization may cause bias and are assigned inferior precedence. Additionally, discrimination may arise when health services fail to consider economic and socio-cultural impediments to their access.
There are health effects consequent from human rights violations. The extent and scope of health consequences resultant from violation of rights and dignity continue to be disregarded. It is indisputable that human rights and dignity violations have poor effects on health. Recognition of these health influences connected with violations of rights and dignity can promote health and human rights fields (Mann et al. 17-19). For instance, the right to information may be violated when a woman seeks to attain a surgical procedure without appropriate procedural and health risk information available to her.
Exploring the link between human rights and health is challenging. The most extensively established examination concentrates on higher socioeconomic status and enhanced health status. Lawrence Finer and Stanley Henshaw explain in the article, "Disparities in Rates of Unintended Pregnancy In the United States, 1994 and 2001" that the rates of unplanned pregnancies have elevated among American women, the most prevalent populations being: women aged 18-24, low-income women, and minority women (91). The socioeconomic model generates escalating consequences that further increases the public health issues and human rights violations (Mann et al. 19-22).
U.S. Healthcare Systems and Women's Reproductive Rights
Public policy plays a role in women's reproductive rights in the United States. Most of the policy options are related to health care policies. Public health policies, programs and practices can burden human rights because reproductive and gender equity and equality are not analogous.
Reproductive Rights are lawful rights and freedoms involving reproduction and reproductive health. The World Health Organization defines reproductive rights as the fundamental right of couples and individuals to choose without restraint and conscientiously the quantity and timing of their children. In addition, the rights also encompass the right to achieve the maximum paradigm of sexual and reproductive health and education/information devoid of inequity, force and aggression (World Health Organization, "Reproductive Health.").
According to the Center for Reproductive Rights in "Report on the United States' Compliance with Its Human Rights Obligations in the Area of Women's Reproductive and Sexual Health", a woman's access to inclusive reproductive healthcare in the United States is not standardized or definite. The United States Constitution does not unequivocally defend the right to health and, consequently, healthcare is obtained through public and private sectors (par. 2).
The United States is a new affiliate of the United Nations Human Rights Council. In the near future, the United Nations Human Rights Council will evaluate the United States' adherence with the human rights responsibilities as declared in the Universal Declaration of Human Rights; the United Nations Charter; and international humanitarian law (Center for Reproductive Rights; "Report on the United States' Compliance"). This relationship will influence United States public policy as it correlates to public health issues as it exemplifies the importance of freedoms and human rights afforded people in the United States, as well as in other nations.
Medical Ethics and Reproductive Health Rights
There are ethical principles involved with women's reproductive health rights. Essential to contemporary medical ethics is a value for patient autonomy and the basic principle of informed consent. Medical ethics deals with the selections by both medical professionals and patients and the responsibilities and commitments of medical professionals to their patients. In addition, medical ethics also comprises of choices developed by society, the allocation of supplies and health care access and the problems evolving from these.
Four elemental principles are feasible in modern medical ethics are: respect for autonomy, the principle of beneficence, the principle of non-malfeasance, and the principle of justice. Autonomy is respected when persons are considered ethical representatives with functions and responsibilities and the aptitude to comprehend and formulate ethical conclusions. The principle of respect for autonomy gives the power for the freewill of all people. In addition, the principle of beneficence attempts to promote the good of the person by doing good; the principle of non-maleficence attempts to evade producing injury; and the principle of Justice considers all people comparatively equal (Harman 40; "Key Ethical Principles").
Modern medicine considers the medical professional and patient reciprocally united in the treatment decision making process. Respect for autonomy, informed consent and confidentiality are also important for ethical performance.
In health care, respect for patient's autonomy is imperative. Occasionally, autonomy can clash with opposing principles of ethics, such as beneficence (Pozgar 360-361). Autonomy can be limited through the position of the capability to make decisions for oneself, as in the case of a person in a coma or severely brain injured person. The principles of human dignity and respect for people are embedded within autonomy. The principle of human dignity is the fundamental worth that resides in every human being. Respect for people as a principle purports that all people should be treated as capable as they are free and responsible people (Cook, Dickens, and Fathalla 69-70; "Key Ethical Principles").
In health care contexts, the rights to informed consent and confidentiality are influential to assure decisions are made under the patient's own free will. The principle of informed consent gives every capable woman the rights and responsibilities to progress her own health (Cook, Dickens, and Fathalla 86; "Key Ethical Principles"). These rights oblige certain associated obligations upon health care providers. To obtain informed consent of the patient, healthcare providers are obligated to divulge information of anticipated treatments and their alternatives, and they must revere her right to treatment refusal. In addition, healthcare providers are obligated to maintain privacy to permit the patient to make private decisions independent of others, including healthcare providers and family (Pozgar 278-279). Informed consent is an issue of determination. The most important characteristic is that it is patient enabling therefore providing the patient the information she requires in order to make a logical decision for her healthcare needs to be met.
In U.S. health care, confidentiality is regulated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Privacy Rule, and many state laws (Miller 440-446). Confidentiality is generally used for discussions that occur between medical providers and patients in the course of treatment and/ or consultation. Legally, medical providers cannot disclose patient-provider discussions. In turn, the health care provider has a duty to respect the patient's trust and keep sensitive medical information confidential (Miller 447-450; Pozgar 267-268). This necessitates the health care provider to respect the patient's privacy by inhibiting others access to the patients private health care information thus, producing a trusting atmosphere supporting patient candidness with the health care provider.
Technology and Challenges Unique to the U.S. and Developed Countries
Technological advances play a role in women's reproductive rights in the United States. Reproductive technology includes contemporary and projected uses of technology for human reproduction, including facilitated reproductive technology, such as in-vitro fertilization; contraception; and abortion. The principles of integrity and totality assert that the wellbeing of the total person should be recognized when determining technology or therapeutic intervention usage (Harman 40; "Key Ethical Principles").
Assisted Reproductive Technology
In the U.S., there has been an increase in assisted reproductive technology (ART). In the United States, the first baby conceived through ART was born in 1982. Each year since, there has been a remarkable increase in the amount ART procedures performed, from 64,681 to 134,260 between 1996-2005 (Wright et al. 9). Assisted reproductive technologies pertain to a number of alternatives to assist a woman in becoming pregnant (Cook, Dickens, and Fathalla 305). Because assisted reproductive technology procedures are very costly and invasive, they are frequently employed as a final recourse for conception. These medical procedures, when employed, are frequently used along with more conservative treatment to amplify the success of the procedure.
Assisted reproductive technology methods include in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT) (Wright et al 3-5). Donor egg or embryo and surrogacy are also considered forms of assisted reproductive technology (Cook, Dickens, and Fathalla 305-307).
Recently there has been an increase in assisted reproductive technologies and in-vitro fertilization (IVF) in particular. In-vitro fertilization is the method where the ovum is fertilized by sperm outside the womb or in vitro. The fertilized ovum is then relocated to the woman's uterus with the intention of producing a pregnancy. In-vitro fertilization is the principal remedy in infertility to other unsuccessfully facilitated reproductive technology approaches.
There are examples of women's health rights being violated with in-vitro fertilization. Women who are single, overweight, or of significant age past child bearing years may be denied the same rights as a married, normal weight, younger woman.
Contraception is the utilization of a variety of techniques to inhibit pregnancy as well as thwarting sexually transmitted diseases (STD) and human immunodeficiency virus (HIV). While, for the most part, the United States exemplifies elevated concentrations of contraceptive use as a method to prevent pregnancy, it is not uniformly dispersed within the United States. Certain populations, mainly urban and rural communities, contraceptive alternatives are restricted and access is complex, ensuing an unrealized necessity for contraceptive technology. (Guttmacher Institute, "Facts on Contraceptive Use in the United States").
In spite of evolvement of contraceptive technologies, method selection is individual. Classification of contraceptive technologies is based on the length of defense. These classifications are permanent, long-term, and short-term methods.
Permanent methods of contraception have a very high success rate and include male (vasectomy) and female sterilization (tubal ligation). Both procedures are invasive and increase the risks of infection and other health complications and do not prevent against HIV and STD's.
Long-term methods, while not as invasive as permanent methods, also have a very high success rate. Intrauterine devices (IUD), oral contraceptives, and hormonal injections are forms of long term contraceptive methods. This method, like permanent methods, can increase the risk of health complications and do not prevent against HIV and STD's.
Short-term methods of contraception are to some extent less successful than long-term and permanent methods. Short-term contraceptives methods include condoms, spermicides, vaginal barriers, and emergency contraceptive pills. While side effects of this method are fewer than previously mentioned methods, only the condom prevents conception and HIV and STD's simultaneously when used appropriately (Guttmacher Institute, "Facts on Contraceptive Use in the United States").
Access to reliable, safe contraceptives is an essential component of a woman's reproductive health and public health as a whole, with significant emphasis on the aspect of reproductive rights. It is imperative for healthcare providers to emphasize confidentiality and empower the woman's autonomy regarding decisions about contraceptive methods.
Abortion is a pregnancy that does not result in a birth (Pozgar 309). Therapeutic and elective abortions are the most common types of abortions in the United States. Therapeutic abortions are executed when there are fetal anomalies or when pregnancy endangers the mother's health. Elective abortions are the intended disruptions of pregnancy for basis exclusive of fetal irregularities or maternal threat. These types of abortion to end unintentional pregnancies are not uncommon (Guttmacher Institute, "Facts on Induced Abortion").
Access to reliable, legal abortion is a fundamental element of a woman's reproductive health and an important factor of reproductive rights (Germain, "Women's Health" 193). Women must have significant procedure accession where abortion is legal. In the U.S. Supreme Court's 1973 Roe v. Wade decision, the constitutional entitlement to abortion was acknowledged but failed to give women attainment to abortion services because of the escalating amount of limitations. Consequently, numerous state laws constrain a woman's ability to obtain an abortion thus increasing the number of illegally obtained abortions. These laws are intended to make it more complicated for an abortion to be attained. A woman's capability to access abortion services is additionally threatened by public persecution of abortion providers and confines on federal and private resources has produced a scarcity of services (Center for Reproductive Rights, "Report on the United States' Compliance" par. 16-23; Guttmacher Institute, "Facts on Induced Abortion").
A resolution cannot ensue without corroboration for alteration. A considerable portion of the issues with women's health are mortality of mothers in addition to the fetus due in part to little education and little or no maternal health care available.
The association of human rights with regards to women's reproductive health in the United States is a significant public health issue. The overall importance of women's health and human rights is to advance the health of women and girls throughout the lifetime. Future optimal balance should be negotiated between public health goals and women's health and human rights approaches.
The extensive historical impact of women's health and human rights emphasizes the need for endorsement and defense of health through respecting; protecting and fulfilling of women's human and health rights that are inextricably linked. It is imperative for public health officials and law makers to understand the serious health consequences and implications of defiance of women's health and human rights can have. The creation of universal health policies and programs to promote women's health and human rights in their design can facilitate the support of rights to autonomy, participation, privacy, and information in health care. Finally, susceptibility to illness can be abridged by adopting measures to appreciate, defend and accomplish human rights through autonomy from inequity of race, sex, and gender roles, as well as a fundamental right to health, nutrition, and education.
The focal point for women's health issues is to remedy the inequities in research, health care services, and education that have positioned the women's health in danger. By organizing women's health research, health care services, and public policy new programs and ideas required to advance women's health in the United States and internationally can increase (Gruskin, "Reproductive and Sexual Rights"). Expansion of improved women's health practices by recognizing and duplicating thriving women's health programs, advancement of public health education by expanding the involvement of women and girls in health education courses, and increasing access to women's health services by involving professionals, such as health care professionals and public health officials, on women's health issues will attempt to close the disparity gap between equality and equity of health care in and across the United States thus decreasing its public health implications.