By: Mary Beth Hastings, Center for Health and Gender Equity (CHANGE) Vice President
It’s not that we can’t do it. We have the ability to save the lives of almost every one of the 290,000 women who die each year as a result of pregnancy and childbirth, in addition to millions of children. A new report – released with little fanfare – by the UN Commission on Life-Saving Commodities for Women and Children details how we can save 6 million lives over five years simply by improving access to 13 vital products.
Using standard UN language, the report focuses on tearing down barriers that limit access to these products by solving regulatory and supply chain issues. The solutions it proposes aren’t simple, but they’re also not controversial.
Yet for me, what is screaming from in between the lines of the report is controversial, or should be. Why aren’t many of these products more available now? The politicization of women’s bodies is often at the core.
Take emergency contraception (EC), for example – highly effective in preventing pregnancy when taken in the first few days immediately after unprotected intercourse. It’s the equivalent of being able to protect yourself by putting on your seatbelt after a car crash. Widespread access would prevent countless unintended pregnancies, and by extension, maternal deaths. The report cites “low awareness among women” as a key barrier to greater use – but why is that? In many countries, Catholic Church officials, conservative groups and policy makers have battled – in many cases successfully -- to make EC illegal and/or unavailable, because they claim (against solid scientific evidence) that EC could potentially interfere with implantation of a fertilized egg. By making this argument, they are restricting access to a life-saving drug and placing women’s lives at risk. It seems maternal mortality is considered more acceptable than the vague and unproven possibility of expulsion of a fertilized egg.
EC has finally made it to the U.S. commodities list, meaning U.S. missions can procure it. But few have, reflecting both lack of awareness on the part of mission staff and host country counterparts and the political tension that makes U.S. missions sensitive to anything accused of being abortion related. From what I’ve seen, programs to promote EC are usually run by small NGOs with small budgets – resulting in limited access.
Misoprostol suffers a similar fate. Postpartum hemorrhage is the leading killer of birthing women. By helping the uterus contract, misoprostol saves lives, like oxytocin (also on the list). Unlike oxytocin, misoprostol does not have to be refrigerated – key in places (where MM is highest) that have no reliable source of electricity, and can be taken as a tablet, rather than having to be administered via injection or IV. But misoprostol can also be used to induce abortion, and while that’s not the only obstacle to access, it is certainly a top one. It too is a commodity that the U.S. government favors for its public health importance, yet does not provide in country.
Female condoms have not been tarred as an abortifacient, yet they have languished as a dual method to prevent HIV and other STIs and unintended pregnancy due to lack of investment. The report cites the fact that users must be trained to use female condoms as a major barrier (unlike male condoms, which people come out of the womb knowing how to put on correctly?). This in itself is driven by gender inequality, as women are generally taught not to touch their genitals and many face challenges to introducing a condom into a relationship – including, but not limited to a risk of violence. Programming has successfully overcome these personal/political barriers – we just need many more programs to help couples do just that. Anemic donor investment in female condom procurement, distribution and programming means the vast majority of women are left without the only woman-initiated method that simultaneously protects them from HIV and unintended pregnancy.
Maybe it’s good that the report ignores the political battles over women’s bodies that these commodities ignite. Maybe we can proceed as if country governments can just prioritize these products and all will be well. But I fear that – without confronting the political dimensions – women will still encounter barriers to these life-savers at the health clinic, the pharmacy, and in the home. We cannot continue to interfere with women’s power over their own bodies. The U.S. must have the political courage to invest robustly in tools women and girls can use to save their lives.
Read the full report here.
Flickr photograph via Seema K K.