The
10th International Women’s Health Movement conference
Maryam Jap
Introduction:
The 10th International Women’s Health
Movement (IWHM) was held in New Delhi from the 21st to 26th
of September 2005. It brought together 800 participants from 70 countries
across the globe during eight plenary and sixty six parallel sessions
The autonomous women’s health movement started as a part of the growing women’s movement in the 1970s. During this time the focus of the women’s health movement has evolved the individual women’s procreation and maternity needs to one that acknowledges the relationship between women’s health and her role in production and reproduction and thus positions women’s health within the broader context of heteropatriachy, capitalism and the neo-liberal globalizing project. This progressive change since the reproductive health focus of the 1970s and 1980s are reflected in the more recent conference themes: Women’s health poverty and quality of life in 1997 and the impact of violence (State and family) and environment (natural and built) on women’s health in 2002. The tenth IWHM conference drew upon this past experience and discussed women’s health rights its links with violence and the environment in the context of the politics of globalization and increasing fundamentalism. The conference was organized around five focal themes: Public health sector reform and gender; reproductive and sexual health rights; the politics and resurgence of population policies; women’s rights and medical technologies; and violence (of State, Militarism, Family, and Development) and women’s health.
Form: The international
women’s health movement aims to create spaces, foster debates and share the
wealth of experience from the autonomous women’s movement. Consequently there
is no permanent secretariat or organizational structure, whilst a wide range of
organizations, networks and grass root organizations participate in the
conferences and constitute the global movement the conference aims to
represent. Many methods were used to improve participation of the more
vulnerable and marginalized, such as one third of the budget was spent on
scholarships for those who could not afford it and simultaneous translations
were provided throughout the plenary and parallel sessions. The conference in
India also introduced a unique format. They conducted zonal consultations
throughout the country in the year preceding the conference and so the issues
raised by over a 1000 women at the six zonal meetings was represented in the
conference enabling a much larger participation of grass roots organizations in
the process and proceeds of this conference. The daily publication of a summary
of the plenary and parallel sessions enabled participants to have an over view
whilst art, film and culture were alternative mediums used for the sharing of
experiences.
The context: World wide
healthcare is the focus of policy changes, the current trend being to institute
‘reforms’ that are characterised by privatization and scaling back subsidies
and other forms of welfare health care. The world today is also marked by
highly scaled up violence social, political, in armed conflict and within the
family. Other issues impacting on
women’s health is the conservative backlash and the rise of fundamentalism
throughout the world. Or to paraphrase Sonia Correa, these are indeed dark
times.
Public Heath sector reforms and gender: Trade liberalization and health sector reform were described as the
one of the greatest threats to world health. Eva Maria Otero presented a study
showing how the implementation of GATs and the free trade in services will
impact on women’s health both in the resource poor and rich settings. The
global health market is worth 3.5 trillion dollars and therefore a target for
large transnational health care companies. The process of health
commodification was described as impacting upon women at three different
levels: Increasing the workload of women as unpaid and informal care-givers in
the home, increasing the proportion of unorganized and non-unionised women
working in an increasingly privatized health care system; reduced access to affordable
healthcare for women as users of heath care systems.
It was argued that activists need to monitor and evaluate the impact of these reforms on the right to healthcare. Kausar Khan described a frame work to assess the impact of the reforms at a national level. She suggested that the site where pubic health care systems, reforms and gender intersect is the “space” that needs to be enlarged through activism and political struggle. Maria Zuniga suggested that this struggle should be through forging alliances with the people’s health movement that just had their second conference in Cuenca Mexico; to fight for a social justice approach to health and thus the Right to Health and the “Right to Healthcare”. She quoted Paul Farmer as saying that healthcare can either be a commodity or a right it cannot be both.
The violence of gender biased “economic development”: Padmini Swaminathan critiqued the artificial biurification of
economy from the social context. She argued that although women were
increasingly entering the labour force they remain invisible and amongst the
unorganized labour force. She described an urgent need to look at the
relationship between production and reproduction, women’s role particularly in
the latter and its impact on women’s health.
A range of the gender consequences of the rapid restructuring of the economy in India such as migration, rapid urbanization and slum creation, increasing impoverishment of the rural communities, tourism and its environmental effects, and the comeback of diseases such as malaria and TB were presented during the parallel sessions. It was also noted that ignoring gender issues in socioeconomic policy making leads to the kind of paradox wherein one of the richest Indian States, Punjab, has one of the highest declining female to male sex ratios.
Marginalization: Adetoun
Illumoka described Rights as a process of making claims and then legitimising
those “claims”. Groups can be disempowered through a history of exploitation,
domination and marginalisation. Thus their rights cannot be viewed in isolation
from the context that rendered them disempowered in the first place. This she
called the politics of remembering. This idea of cumulative trauma and
reclaiming history through story telling was revisited by other participants.
This conference placed much emphasis on creating spaces for the disempowered,
marginalized and excluded population. Plenary sessions included representations
from youth and disables groups. Other marginalized groups presenting data were
refugees and non citizens, gay women, prisoners and sex workers.
Reproductive and sexual health rights and population
politics: The
conference emphasized how far we still were from achieving the goals of the
1994 international conference on population and development in Cairo which
prioritized women and health over population control. The main barrier to
achieving these goals was described as the nexus between the neo-liberal
agenda, privatization of healthcare and the rise in fundamentalism.
There have been major ideological setbacks with the republican administration in Washington placing its considerable might behind the religious forces that oppose Cairo’s agenda. One consequence of this was that universal access to comprehensive reproductive healthcare did not find a place in the millennium development goals. Other insidious moves by the current US administration have been pulling back funding for reproductive services that include abortion, insisting on abstinence as the primary HIV prevention message and making fund recipients sign a gag clause on sex work. The real impact of this in Uganda has been dramatic reductions in condom availability and usage. Dorothy Roberts also described a reproductive caste system in the USA where the rich are opting for preferred genetic traits and the poor are being given welfare conditional to behavioural modification.
The rise in fundamentalism elsewhere has also contributed to this failure. Wanda Nowika described the increasingly reduced access to reproductive technologies and sexual rights in Eastern Europe with rising STIs and HIV rates. She warned of potential setbacks to the relatively progressive reproductive and sexual health policies of Europe with the “enlargement” project and the entrance of the more conservative forces of “new Europe”.
Another issue that was discussed was that the discourse on sexual rights is wider than that of reproductive rights and can articulate and connect a more diverse set of goals such as reproductive health, sex work, identity, sexuality, and sexual violence. As Manisha Gupte asked, why is it that women are seen as reproductive and men as sexual when women do not produce an ova every time they have an orgasm? Or as Dorothy Akenova said at the end of the day it is also about bringing pleasure back into sex.
Militarisation and violence: A particular theme developed was a
critique of sexual violence used against women in war, laying the
responsibility at the door of the perpetuators of the war. The experiences
described ranged from that of the 200,000 comfort women taken as sex slaves by
the Japanese military during the Second World War, to gang rape in places as
diverse as Kurdestan and Rwanda. In the context of the ever increasing
militarization and permanent “war on terror” other effects of war such as the
breakdown of civil society, infrastructure and consequently access to health
care were described. Anna Maria Whelen presented a report on the health status
of 9.2 “silent, voiceless” million refugees around the world the bulk of which
were living in the poorest nations. There was also a report of the adverse
mental health effects of being a refugee in the Australian detention centre.
The devastating effects of the growing nuclear militarization were brought home
to the conference through a presentation about the extreme reproductive health
consequences of nuclear testing on the women living in the Pacific.
Medical technology and research There were diverse opinions expressed with some women opposing all
form of medical technology and other emphasizing the importance of making
technology accessible to all women. There were concerns about the ethics of
conducting research on women and one solution suggested was to involve women’s
rights from priority setting, to resource allocation to participation and the
right to information.
Culture and women’s health: A variety of parallel sessions explored the impact of culture and religion on women’s rights. Two themes emerged one the dangers of cultural relativism and the second the need for a secular women’s movement. From the extreme conditions of women in Afghanistan to the conflict between constitutional rights and custom in India, religion and customs were seen to work counter to women’s reproductive and sexual rights. Multiculturalism was described as a way to enhance patriarchal domination and for the state to abdicate responsibility for its (usually) female citizens. Cultural relativism was critiqued in particular where the right to self-determine “culture” or “religion” is given precedence over the rights of the women.
Implications for progressive forces and women: Given the impact on women’s health rights of the neo liberal
globalization paradigm, the rise in fundamentalism and the subservience of all
to war on terror the movement has to bring back economics and politics into the
equation.
Women are not a monolithic force and thus the notion of global sisterhood is meaningless. Women from the global south are differently affected than their sisters in the north. In many ways reproductive roles are increasingly being “outsourced” to the South. However this diversity is important in other ways and in particular the movement can be built from within by including hitherto marginalized women into the process of movement building.
Women’s reproductive health demands are incorporated into global agreements but in the meantime become stripped of content. Words and terms need constant redefinition and vigilance. The effect of social, political and economic policies on women’s health needs to be constantly re-examined.
Right to health is coming of age and can be a powerful tool to expose gender discrimination. As the special rapporteur for health, Paul Hunt, suggested avoidable maternal health becomes a violation of woman’s human right.
One particular achievement of this conference was to engage with not only the ideology and policies pertaining to women’s health rights but to make the women’s health movement responsible for engaging critically with health sector reform, the organizing, financing and management of health services and how this impacts on women’s health. In spite of an increasingly conservative social and political and economic climate the vast majority of countries have consistently reaffirmed their commitments to implement the progressive 1994 international conference on Population and Developments program of action. This is an arena within which activists can collate the evidence and hold their governments accountable.
What
are the implications of these findings for progressive forces in Iran?
The negative effect of Islamic fundamentalism on sexual and reproductive rights is well documented and so the danger of cultural relativism is a particular pitfall that needs to be avoided by the women’s movement in Iran.
To date the combination of a post revolutionary state and oil money has protected Iranian health sector from the worst ravages of trade liberalization and health sector reform. However within the current political climate this is unlikely to be sustainable and it will be important for the women’s movement to be prepared to assess and critique the impact of health sector reform on women and their access to services when it comes.
There is a very real possibility that the current US military adventure in the Middle East may engage Iran directly or indirectly with all the potential adverse effects on women’s health.
Clearly to be able to engage with all these existing factors and potentialities there is an urgent need for a secular and autonomous women’s movement which is locally active and internationally connected.
I was particularly struck by the level of technophobia and science phobia that dominated the thinking of many of the participants. Whilst I agree that science like all tools is often appropriated by the hegemonic forces, however nothing that I saw and heard in the conference suggested an alternative to the scientific method that was anything other than hocus pocus harking back to some sort or other of retrogressive religious, experiential or animist thinking. There was a sizable minority articulating the need to re-appropriate the scientific method, democratize it and use it to collect evidence to support the rights of women however they were still not the majority.
This glorification of the past and tradition is not the only remnant of cultural relativism that echoed throughout the conference walls, despite the many critiques of cultural relativism in the plenary sessions. The inclusiveness and diversity so celebrated in this forum sometimes bordered on the ridiculous with every woman scrambling for her place on the platform and all “Rights” and all “oppressions” becoming an indistinguishable homogeneous mass.
This inclusiveness was also extended to the “enemy” wherein although fundamentalism was denounced by one and all there was no distinction made between the different fundamentalisms. The qualitative difference between the marriage of the religious right and the neo liberal US administration with its current nemesis Islamic fundamentalism and the differing effects of these two regressive forces on the rights of women was not dissected. Although the neo liberal globalizing project was well critiqued, Islamic fundamentalism was barely touched upon.
The only plenary session from the Middle-east and countries in the throes of the war on terror came from Afghanistan. Afghanistan has the third highest maternal mortality on the world with 1600 out of 100 000 women die during childbirth. Both presenters from Afghanistan revealed the inability of the women’s movement from the Middle East to critique Islamic fundamentalism without embracing neo liberal globalization project or vice versus. Both Afghani presenters broadly welcomed the new regime in Afghanistan when compared with the Taliban. The more nuanced critique of global capitalism coming from South Asian and South American participants was absent from these presentations.
Whether or not the conspicuous absence of women from the Middle East is the consequence of this failure of the secular women’s movement to effectively engage with the dual threat of Islamic fundamentalism and the neo liberal militarization is a matter of speculation. Suffice to say that it is an urgent need for progressive forces in the Middle East to critically engage with the effect of this dual danger on women’s right to health.