By Sivananthi Thanenthiran, Executive Director, ARROW (@SivananthiT)
Based on a speech given at a panel discussion organized by the Population Council at the International Conference on Family Planning (ICFP), in January 2016.
The World Health Organization (WHO) has issued a technical guidance document presenting the nine human rights principles and standards around the provision of contraceptives. These include:
- Availability, accessibility, acceptability, quality
- Informed decision-making
- Privacy & confidentiality
- Participation & accountability
Previous speakers touched on the issues of availability, accessibility, acceptability, quality (triple A,Q), and I’d like to take some time to focus on three key areas of non-discrimination, informed decision-making and accountability.
On non-discrimination – two WHO recommendations are available on this principle which cover access to comprehensive contraceptive information and services being provided equally and free of discrimination and that special attention be paid to the disadvantaged. Young people are on such key group – globally adolescents aged 10-19 comprise 18% of the population; and young people aged 10-24 comprise 26% of the population. Approximately 664 million young people live in the two regions of South Asia and East Asia, and the Pacific.
However, evidence shows that young people face greater discrimination in accessing contraceptive services. Studies in Kenya, Zambia, Lao PDR and China show that health providers believe that distributing contraceptives to young people encourages promiscuity. Young women are more affected by double standards on sexual behaviour. Young or nulliparous women are denied contraception because of provider beliefs that contraception is not for women without children. These are all provider beliefs.
When we bring the human rights approach there are three key aspects: to promote, to protect and to fulfil.
In this context of fulfilling the human rights of young people would also entail obligations to end early marriage, and fulfil young people’s rights to privacy and confidentiality from an agency perspective and to do away with parental and spousal consents for accessing SRH services. This is not going to be an easy task, and we have to ask whether we are prepared to take up this challenge? The other big question is that of integration – we have to deal with when we are talking about young people who are facing their entire life cycle ahead of them. We cannot say that we are going to give young people contraceptives for a certain number of years and that somehow equates with a human rights approach to young people’s SRHR.
The second principle we need to address is informed decision making. This is not a new thing, it has been there from time immemorial and yet we still can find that all around the world women are still not being given the three types of information – on the different methods of contraception available, the different side-effects, and what to do if side-effects occur. And yet year after year the DHS tells us that women are not using contraception, or are discontinuing use because of fear of side effects.
The solution seems so simple that if we are able to do this, it provides a win-win situation – women and men know how to use the method, they know how to handle the side effects or they can switch methods, they have a good relationship with the service provider, they trust the method and the provider, and they come back to continue. For me this is a critical for the success of the type of movement that we are trying to create with processes such as the ICFP. This is critical because I come from a region, which was known for coercive population policies as seen in China, India and Indonesia. If we do not do this, the negative perceptions of contraception that some people carry with them will keep growing and be detrimental in the long run.
We also have to recognise that our movement is under threat from fundamentalists who keep spreading that contraception causes cancer, causes infertility, and is a Western agenda aimed at keeping in check our race and our religion. And it is precisely providing informed decision-making, which will keep such negative discourse in check. So we have to understand that we need to work together on this aspect and it is absolutely vital to ensure that contraception is framed by rights and autonomy.
The third principle is that of accountability. We need to fund organisations on the frontline for advocacy and monitoring, because they will be able to keep their service providers and their governments, both local and national, accountable, and also keep up the rights discourse when battling the discourse of the fundamentalists. These are not easy things to do but we have to keep doing it and investing in it for the agenda to succeed.
We all have to uphold that sexual and reproductive rights are indivisible. We cannot say there is a right to family planning but not a right to safe abortion. We cannot say there are rights for married heterosexual women to access SRH services but not rights for LGBTIQ people to do the same.