Latifah, a 14-year-old girl from Indonesia, was accused of adultery by the local police when she went to report she had been raped.
Louisa, a young woman from Burkina Faso, was verbally abused and slapped during childbirth at a local hospital.
Marta, a 30-year-old domestic worker from Indonesia, was refused contraceptives at a Jakarta health centre because she hasn’t had children yet.
Elena, a ten-year-old girl raped by a priest in Nicaragua, was pressured not to file a complaint and to keep quiet about the abuse, before her rapist was finally prosecuted and sentenced to 30 years in prison.
These women’s names have been changed but their stories show the consequences of the entrenched discrimination faced by millions of women and girls around the world simply because of their gender.
According to human rights organisations, including Amnesty International, there are often catastrophic consequences when women and girls lack effective health services and related information. In many countries, a lack of autonomy and decision-making power usually amounts to a further disadvantage for women and girls.
The UN recently reported that some 800 women die every day during pregnancy and childbirth and for each of these deaths, another 20 women endure lifelong suffering because of injury, infection, disease or disabilities stemming from pregnancy, childbirth or an unsafe abortion.
“From Indonesia to Peru, Sierra Leone to the USA, millions of women and girls are paying with their lives for failed health policies, inadequate care, and discriminatory laws. Many face discrimination and violence in their communities and families, with little or no hope of justice or support from governments,” said Marianne Mollmann, senior policy advisor at Amnesty International.
The cost of discrimination
In many countries, women and girls find it almost impossible to access basic sexual and reproductive health services and information.
In some cases, this is due to governments’ failure to make this a priority or to invest resources. In others, where health services exist they tend to be concentrated in more affluent areas, restricting access for many women who live too far away or cannot afford the cost of getting there.
Amnesty International found that even when they make it to the health centres, women who live in poverty are sometimes ill-treated by health staff who don’t understand their needs or, sometimes, even speak their language.
In the USA, for example, many migrant women said they were turned away from health centres just before giving birth as they did not have enough money to pay for treatment.
“Every year, millions of women and girls face almost insurmountable barriers to accessing the most basic health care, in particular when it comes to their sexual and reproductive health. They are consistently denied access to information, contraceptives, emergency obstetrics services, and even remedies for substandard care,” said Mollmann.
“The tragic reality is that many deaths and injuries connected with pregnancy and childbirth can be prevented.”
Lack of information
After looking into the availability and quality of health care access in more than a dozen countries, Amnesty International found that a leading cause of women’s deaths is the lack of information on available health care services.
In Indonesia, for example, women interviewed by the organisation said they were not given proper information about their right to access contraceptives.
Lack of information coupled with restricted access to abortion means that many young women are left with no choice but to carry on with an unwanted pregnancy or seek a clandestine abortion, usually in unsafe conditions.
According to UN estimates, adolescents account for 2.5 million of the approximately 19 million unsafe abortions carried out every year in the developing world, and girls aged between 10 and 19 years account for 70 per cent of hospitalisations due to unsafe abortions.
In 2011, UNAIDS reported that only 34 per cent of young people in developing countries were able to answer correctly five basic questions about HIV and how to prevent it. The same demographic currently accounts for 41 per cent of all new HIV cases.
A global plan
In 1994, at a groundbreaking conference in Cairo, leaders of 179 countries reaffirmed the human rights of women and girls to make choices about sexuality, pregnancy and motherhood, and pledged to put women’s empowerment at the centre of policies on population and development.
During the International Conference on Population and Development, world leaders also adopted a Programme of Action aimed at transforming how population policies and programmes were formulated and implemented.
The idea was to ensure that sexual health and reproductive rights – including issues such as preventing and responding to the discrimination faced by women when trying to access health care – featured strongly in any policy on population adopted by countries around the world.
The Programme included measures focusing on reducing infant, child and maternal mortality; population and the environment; internal and international migration; preventing and controlling HIV/AIDS; information, education and communication; and technology, research and development.
Amnesty International believes some important steps have been taken since the Cairo conference to realise the commitments it set out. But such progress has been slow in coming – and, in some areas like sexual and reproductive health, it has been patchy at best.
“These past decades, we have seen increased investment in prenatal care, in particular. And while that leads to necessary improvements in infant care, it does little to tackle underlying inequalities in access to health information and care,” Mollmann said.
“Women obviously have healthcare issues that are unrelated to childbirth. The fact is that governments are reluctant to prevent discrimination and remedy abuse.”
The future of women’s rights
Representatives of UN member states will gather again in 2014 to review progress on the Programme of Action adopted two decades earlier in Cairo. In particular they will scrutinise countries’ efforts to implement their commitments.
“We hope this review will help move these issues forward. Our demands are basic – everybody should be able to make independent and informed decisions about their health, bodies, and lives, and live free from violence,” explained Mollmann.
“As a minimum, this requires access to comprehensive sexuality education for all.”