After she left Planned Parenthood Indonesia, Ninuk worked independently and focused on training and supporting others to become counselors. She has done this work in Iran, Turkey, Azerbaijan, Ghana, South Africa, and other places as well. Among her trainees are many college students who were trained as volunteer peer educators who would talk to young people both in school and out of school about sexual and reproductive health.

Along the way, it became very clear that it was necessary to have a law in Indonesia that would protect women and make it possible for women to access abortion services. Eleven people–activists, psychologists, and ob-gyns–came together to create the YKP Womens’ Health Foundation. They decided to only focus on two things: fighting to have legal protections for reproductive health and especially access to safe and legal abortion services and empowering the community, especially the young generation, to access health services and information. When they first launched the organization, they realized that they needed to gather evidence to support their advocacy for better national policy and to understand the needs and demand for sexual and reproductive health services and information.

In 2009, a new health law was passed in Indonesia, with a section on reproductive health. The law says that abortion can only be accessed by women who are rape survivors or if there is a health risk for the woman. There are of course many shortcomings of the law, but it is big progress for Indonesia. Read our analysis of the law from just after it was passed. Today, YKP is working to ensure that the law is implemented in a useful way. Ninuk is currently working on implementing pre- and post-counseling support for women who need an abortion, to make sure that abortion care services are as comprehensive and woman-centered as possible under the current law.

Young people all over the world face a range of unique challenges to exercising their rights.  Barriers to age-appropriate health services, meaningful education, and viable livelihoods opportunities are among the most pressing impediments to youth empowerment.

The International Women’s Health Coalition is centrally concerned with the sexual and reproductive health and rights of young people.  We believe that working with both young men and women is critical to ensuring that the rights of all young people, particularly girls, are universally protected and realized. The following contribution focuses specifically on the challenges facing girls, who continue to experience systematic social, economic and political marginalization in every part of the world.

Given the global persistence of gender inequality, many of the issues disproportionately affecting young people also tend to disproportionately affect girls. In 1997, UNAIDS reported that 60% of new HIV infections in sub-Saharan Africa were among young people (aged 15-24), with a 2:1 ratio of infected girls to infected boys.  This ratio continues to grow increasingly lopsided, with girls representing 74% of new infections among young people in 2009.

Additionally, girls face extraordinarily high rates of violence.  The experience of violence, the perceived threat of violence, or the stigma associated with being a victim of violence hinder access to entitlements, opportunities for social participation, and employment.

In developing countries, 40% of girls have their first child before the age of twenty, many before the age of 18. Not only does this mean that more girls are dropping out of school, but girls are also more likely than adults to die, experience complications, or suffer chronic injuries related to childbirth. Because they have less access to contraceptives and are less sexually experienced, adolescents are more likely than adults to seek out unsafe (often late-term) abortions.  Each year, it is estimated that 2 million to 4.4 million adolescents in developing countries have abortions, 70,000 unsafe abortions are carried out, and 13% of all maternal deaths occur as a result of unsafe abortion.

Early pregnancy is often associated with child marriage, a practice which also puts girls at increased risk of HIV infection.  Female genital mutilation, infanticide, nutritional bias—these and other harmful traditional practices disproportionately affect girls, infringing on their fundamental rights and opportunities for development.

The short answer to why these inequalities exist is that girls, especially the most vulnerable girls, continue to remain invisible. Despite the aforementioned figures, policymakers have consistently masked the specific needs of girls within “male-focused and male-dominated community-based activities and generic ‘youth’ prevention initiatives, all of which widely miss the mark” (Bruce, Temin, & Hallman, 2012).  This generic youth programming disproportionately benefits boys over girls overall, but it also favors unmarried to married girls, well-connected to socially marginalized girls, urban to rural girls, girls belonging to an ethnic majority to migrant or indigenous girls, and so on.

Girls also remain invisible because of how we measure progress.  Primary education enrollment figures, for example, are based on one day of the school year; even if there were genuine parity on this particular day, these figures fail to account for the reality that girls often miss multiple days of school each week because their domestic and reproductive responsibilities take priority.  Moreover, data on young people is rarely disaggregated, resulting in measures of participation which fail to report gender, age, marital status, and other critical factors.

The disproportionate burden that girls share for maternal morbidity and mortality, the time burdens that girls shoulder, the staggering inequalities in girls’ educational outcomes—these are all reversible realities. To tackle these disparities, we need to begin by making girls visible.  We must call for the post-2015 agenda to pay particular attention to girls and the challenges that they face.  The risks facing girls are well documented and the next step is to match the research with the necessary resources.

We need to make girls visible.

Making girls visible begins with how we count them.  By properly counting girls and disaggregating data by age and gender, we can target youth programming at specific subsets of youth—like adolescent girls.  We can also measure whether programs are actually reaching the girls who are most at risk.

We need to invest in girls.

We must invest in programming aimed specifically at girls, with an emphasis on the most at-risk populations of girls—those who engage in transactional sex, those who are forced into early marriage, those who fluently speak their native language but cannot communicate in their national language, and so on.  These programs must include the following features.

• Comprehensive Sexuality Education (CSE) must be thorough, scientifically sound, and culturally appropriate.  It should take place in a safe and healthy learning environment and it should explicitly address gender norms and gender equality.  When young people are educated about human rights, gender equality, and the role of power in relationships, they are not only equipped with the tools to negotiate their own health relationships, but they are also able to educate and influence power-brokers in their communities.
• Comprehensive services must be universally available and accessible.  This means, access to high quality sexual and reproductive health care, all forms of safe and effective contraception, safe abortion and post abortion care, maternity care, and prevention and treatment of sexually transmitted infections including HIV.
• Education is foundational to girls’ empowerment. We must ensure that all girls, no matter how poor, isolated or disadvantaged, are able to attend school regularly and without the interruption of early pregnancy, forced marriage, etc.  Education—for both girls and boys—must go beyond academics and equip young people with life skills so that they are prepared to think critically and challenge discriminatory and repressive policies and practices.
• Empowering spaces ensure girls have the opportunity to feel secure, be themselves, and plan for their safety and development.  Even if only for a few hours a week, accessing safe spaces allows girls to frame their own agendas, receive training on sexual and reproductive health and rights, and develop their social and economic capital. These participatory social spaces also foster opportunities for community-building and networking, mitigating the isolation that many girls experience.

We need to support young leaders.

We must continue to support both young women and young men to be advocates for change. Ensuring that reproductive rights are protected and promoted rests in the hands of young women and men, particularly young people throughout the global South.  Young people should be involved in all types of decision making on sexual and reproductive health and rights.  Seasoned advocates must be willing to pass the torch, share best practices, and work alongside—sometimes even be led by—a new generation of SRHR leaders.

As advocates, we can listen to one another and work in tandem to repeal legislation that legitimizes discrimination against girls and press for new protections that ensure equality of access to health services, jobs and earnings, education, property and all the rest.  Addressing the profoundly complex root causes of gender inequality (and accordingly the inequalities experienced by girls) is not a simple challenge.

As we begin to develop a tangible action plan for the post-2015 development framework, we must remain mindful that shifting the social and cultural norms that permit and promote discrimination against girls is not a simple box-ticking task. We cannot continue to view gender equality as a singular aim, but rather as both an explicit goal and an issue that needs to be mainstreamed throughout the post-2015 development agenda.

As I reported previously, the ICPD Global Youth Forum in Bali earlier this month brought passionate engagement by young people committed to securing a healthy and just life for youth worldwide. The Forum closed on December 6 with a celebratory reading of the key recommendations from the various multi-stakeholder consultations that took place related to five themes: Staying Healthy, Education, Decent Work, Youth Leadership and Participation, and Families, Rights, and Sexuality.

The key recommendations are included in a public declaration. Please take a look and share your thoughts with us. We here at the International Women’s Health Coalition are thrilled that young people and adult allies from governments, civil society, the private sector, multilateral agencies, and other stakeholders from around the world spoke out in support of a bold and progressive vision for what the global community must do in partnership with youth to achieve the largest generation ever of educated, empowered, safe, and healthy young people.

Only by working together as a global community and as individuals can we realize this bold and achievable vision of what young people want, need, and deserve. UNFPA Executive Director Dr. Babatunde Osotimehin rightly described the process of meeting the sexual and reproductive health and human rights of young people as “a journey of 1,000 miles [that] starts with the first step.”

We look forward to working with and on behalf of young people to realize the key recommendations contained in the Bali Declaration, including with UNFPA which did an exemplary job ensuring that the process remained youth-led and youth-driven. We simply cannot progress as communities and nations without continuing to make these important leaps forward on our collective journey of 1,000 miles to secure an educated, empowered, safe, and healthy future for all.

Will you join us?

Although the final Outcome Document “The Future We Want” (PDF) is weak overall, and in the last days of the negotiations was significantly weakened in the section dealing with the social pillar of sustainable development, women stayed the course and ensured that language around women’s and young people’s health and human rights was maintained and agreed upon as critical elements to achieve sustainable development.

Since the inter-governmental negotiations began in December 2011, feminist organizations were told by key countries, including Brazil and South Africa, that the Group of 77 (a group that represents “developing countries” in United Nations negotiations) would not break over differences of position on “controversial issues” such as gender equality and sexual and reproductive health and rights because “more important issues were at stake”.

Disappointingly, this was Brazil’s consistent position throughout the process as it sought to affirm its leadership within the Economic South and obtain gains on other issues such as the green economy and trade. Our allies remained vocal throughout the process and helped secure the language that we will use for enshrining reproductive health and human rights in future development agreements. These critical positions came from: Peru, Bolivia, Uruguay, Argentina, the United States, Iceland, Norway, Switzerland, New Zealand, Australia, Israel and Mexico.

Among other things, the Outcome Document urges governments to fully implement their previous commitments “leading to sexual and reproductive health and the promotion and protection of all human rights in this context” and emphasize the “need for the provision of universal access to reproductive health, including family planning and sexual health and the integration of reproductive health in national strategies and programmes.”

Governments also committed to “reduce maternal and child mortality and to improve the health of women, men, youth and children” by achieving “gender equality and protecting the rights of women, men and youth to have control over and decide freely and responsibly on matters related to their sexuality.” Finally, governments committed to “promote the equal access of women and girls to education, basic services, economic opportunities and health care services, including addressing women’s sexual and reproductive health, and ensuring universal access to safe, effective, affordable and acceptable modern methods of family planning”.

These words did not appear in the final document easily. Women worked day and night, through speaking with the media, taking to the streets and protesting, lobbying governments, and educating other civil society actors. to have our voices heard and hold our governments accountable.

The overall assessment by social movements and organizations that participated in the Rio+20 process is that it fell short of making any real progress and commitments for addressing pressing and critical sustainable development needs. Against the backdrop of an unwieldy process, multiple and often competing agendas, it is unsurprising that the outcome lacked content and clarity.

Moving forward as the post-2015 development discussions take shape, and if Rio+20 is to serve as an indication of how this process will unfold, it is critical that women’s and young people’s voices are heard in this process, and that social movements continue to pressure their governments to uphold their commitments to achieving sustainable development, gender equality, poverty eradication, and the realization of human rights for all.

A “can-do” atmosphere prevailed. Hosts Melinda Gates and Andrew Mitchell, the UK Minister for International Development, made significant new pledges of funding for family planning in the poorest countries. For Gates, this was an additional 560 million USD over 8 years, and for the UK’s international development arm, DFID, an additional 800 million USD over the same period.  Prime Minister David Cameron gave by far the most rousing speech outlining his personal commitment to women’s rights and to ensuring that the fight for women’s empowerment is at the core of the post-2015 development framework that will replace the current Millennium Development Goals.  Importantly, Cameron co-chairs the UN Panel of Eminent Persons tasked with developing this new framework.

High-level government officials and heads of State, from India to Uganda, announced increased support, financial and programmatic. Some couched this support in terms of “Family Planning,” given the topic chosen by the organizers. Many, particularly from African governments, mindful of national programs and their own commitments to the now 18-year-old agreement reached at the International Conference on Population and Development, insisted on “sexual and reproductive health and reproductive rights” and a full package of services and information rather than a stand alone investment that would reinforce siloed approaches. Providing adolescent girls with information and services was highlighted as a key intervention; when 2/5 of girls in Sierra Leone have their first child between the ages of 12 and 14, that is indeed an urgent need.

All well and good — but for those of us trying to discern whether the rights of women will truly be at the center of this Family Planning Initiative, as promised by DFID and the Gates Foundation in response to our months of advocacy, there were moments of disquiet.  Several speakers made it clear that their national plans involved hard targets for increasing the number of users of contraception, rather than simply making contraception available and accessible, which the ostensible goal of the Summit. For example, the representatives of Indonesia and Bangladesh spoke in terms of achieving certain ambitious contraceptive prevalence rates and total fertility rates – thus raising the very real possibility that coercion might result without safeguards. The Additional Secretary of Health of India outlined her government’s plan for post-partum IUDs for the 12 million women who deliver in institutions. These women are routinely discharged very quickly after childbirth – how much time will they have to decide whether to “accept” an IUD in these conditions?

Then, at the side session on Monitoring and Accountability in late afternoon, we heard for the first time that something about this Initiative was going to be hard to do: providing 120 million women with access to services in some of the poorest countries on earth? No. Ensuring a reliable supply of contraceptives in faraway places? No. What was going to be hard to do was “measuring human rights.” Evidently, the members of the Initiative’s Monitoring & Accountability Working Group at work need to familiarize themselves with the extensive quality of care and human rights literature on the subject, notably that produced by the Population Council and the World Health Organization. It would certainly help if representatives of women’s groups and of human rights groups were invited to join this Working Group, for a start.

The human rights of women must be measured when one is spending $4.6 billion on an initiative that is supposed to, precisely, uphold their rights. Measuring whether there is coercion in services is not hard to do. Measuring whether this is a wide range of methods available is not hard to do. Measuring whether women are satisfied with the services they receive is not hard to do. If programs do not measure these and other aspects of human rights and quality of care, however, they will send a clear message that the human rights of women are a distraction, and that something else is more important – controlling that pesky African fertility, perhaps? Let’s see whether the Initiative measures up to its claims.

Brazil, a country that in the past has championed women’s human rights, including reproductive rights, at the global level, has failed women in both Brazil and the world over.

During meetings to finalize the Rio+20 document, Heads of State will adopt in the next few days at Rio+20, delegates agreed on a plan short on vision and big on compromises. After three days of long, drawn-out negotiations, marked with lack of clarity about the process, a document to be signed off by heads of government was presented. Quickly gaveled through by the Brazilian chair, one after another government thanked Brazil for facilitating this document and largely expressed how this was the best they could do. By all accounts, despite the attempts to spin the outcome as a success, this document is neither “the future we want” nor what future generations deserve. In an effort to get consensus at whatever cost, Brazil forgot Rio: the vision and commitments of the Rio Earth Summit held 20 years ago.

From the start of the negotiations, gender equality and women’s human rights, including reproductive rights, have continuously been challenged by a few governments, claiming that [these] had “nothing to do with sustainable development.”

This debate continued until the last few hours of the negotiations. In the end, the text includes a re-affirmation of both the Cairo and Beijing agreements, but it falls short by failing to recognize that reproductive rights are also critical to the achievement of sustainable development. If a woman cannot decide if and when to have children and if she is not provided with the reproductive health care that is her human right, it is challenging to contribute to sustainable solutions for the planet.

Opposition to women’s human rights per se was concentrated among a few countries, with the un-holy alliance of the Holy See and oppressive governments such as Syria and Egypt insisting on marginalizing women. And since there was so much at stake for “more important issues,” such as trade, financing for sustainable development, and the green economy, other governments in the end traded away women’s reproductive rights, giving the Vatican what it wanted in the first place. But even if reproductive rights had been reaffirmed, the lack of real commitment by the international community to eradicate poverty, address urgent environmental concerns, and to chart a clear path for implementation of sustainable development, makes it difficult for women– and for the world — to  achieve gender equality and women’s empowerment in this context.

Norway, the United States, Canada, Australia, New Zealand, Peru, Bolivia, Uruguay, Mexico, Iceland, Switzerland, Israel and many others fought to the end to retain the reference to reproductive rights and expressed disappointment that this was not incorporated in the final text. However, it is expected that they will speak of their continued commitment through their leaders during the High Level Segment that begins today.

The Brazilian failure: selling out women’s human rights in this negotiation, has not gone unnoticed. Brazilian feminists quickly mobilized and demanded an explanation from their government. In an interview with local media following the agreement on the text, the Brazilian Foreign Minister expressed disappointment that “reproductive rights” had been kept out of the document, but went on to explain that this was done out of the need to reach a compromise. Immediately following the adoption of the text, women gathered and protested at Rio Centro, the main venue for the conference, chanting “reproductive rights are not for sale”, “governments have failed women and the planet” and “women’s rights are human rights.” Finally, in a meeting with Michelle Bachelet, the head of UNWomen, and the Brazilian Minister for the Environment, Brazilian women presented their declaration to Rio+20 which fittingly ended with these words:

“We defend women’s rights to equality, autonomy and freedom in all the territories where we live, particularly in our bodies, which are our first territory.”

For now, governments attending Rio+20 have failed both territories.

Women wave scarves at Rio+20 protest. Photo courtesy of the Asia Pacific Forum on Women, Law and Development (APWLD).

Turkey’s Prime Minister Recep Tayyip Erdogan has announced plans to proceed toward a ban of abortion services in the country. In response, Turkish feminists are rallying to support pro-choice policy.  They have launched a website, Say No Abortion Ban, that is gathering electronic signatures to protest.

Here is some more information, direct from the Turkish activists:

According to data from the World Health Organization, thousands of women across the world die every year as a result of unsafe abortions. In Turkey, establishing the legal grounds for women to end unwanted pregnancies on demand has contributed to the decrease in maternal mortality, which dropped from 250 to 28 in every 100,000 live births from the 1970s to the mid-2000s. There is no data indicating that abortion is on the rise in Turkey; on the contrary, while 18 pregnancies out of 100 ended in abortion in 1993, this ratio was down to 10 percent in 2008. In an era where 26 countries have taken steps to remove obstacles that hinder access to abortion between 1994 and 2011, efforts to ban or restrict it in Turkey are unacceptable. Restricting the right to access safe abortion services and making them available only when required by medical conditions or instances of rape works to marginalize women’s fundamental bodily and sexual rights, and reduces the enjoyment of this right to circumstances of necessity.

We object to risking women’s rights to health and life by restricting or banning abortion instead of encouraging free, easily accessible, high quality birth control methods. Abortion is not only a freedom of choice, but a vital social right. The right to abortion that is on demand, free-of-charge, accessible, safe, and legal, is also a right to life. Forcing women to take life-threatening risks is nothing short of murder.

THE RIGHT TO SAFE ABORTION IS AN INDIVISIBLE PART OF WOMEN’S RIGHTS TO MAKE DECISIONS ABOUT THEIR BODILY AND REPRODUCTIVE RIGHTS!

Women’s right to sexual and reproductive health includes having control over their own bodies and access to safe abortion; limiting these rights is an open violation of fundamental human rights and women’s human rights. In accordance with its domestic legislation and the international conventions it is party to, Turkey is under obligation to provide adequate, comprehensive, and accessible sexual and reproductive health services. In Turkey, child marriages, forced marriages, women’s murders, rapes, and morality-based repression mechanisms have all become normalized. The responsibility for birth control has been left primarily to women. However, in a country where contraceptives are not easily accessible, withdrawal is the most prevalent form of birth control, female employment rates continue to drop and female poverty is rapidly increasing, restricting or banning women’s right to on demand pregnancy termination is an act of blatant discrimination that will push women to seek unsafe abortions.

WE REJECT THE ATTACKS ON HUMAN RIGHTS THROUGH MILITARIST AND DISCRIMINATORY DISCOURSES AND PRACTICES!

By saying “Every abortion is an Uludere,” PM Erdogan equated women’s enjoyment of their bodily rights with killing people in a bombardment attack. This is a discriminatory and militarist statement that calls to question the human rights of both Kurds and women, whereas the primary responsibility of any state should be to ensure its citizens lead a decent life, and to guarantee equal rights and freedoms to all.

According to Article 16.1.e of the Convention on the Elimination of All Forms of Discrimination against Women-to which Turkey is a proud signatory-women have the right to “decide freely and responsibly on the number and spacing of their children.” The current governmental initiative to ban abortion is simply another manifestation of the ongoing misogynist mentality that ignores women’s right to make decisions on matters that concern their bodies, sees women’s primary reason for existence as the continuation of the species, and constructs neoliberal population policies based on women’s bodies.

Sign their petition here!

In February, I was honored to become the third president in the International Women’s Health Coalition’s 28-year history.  My first 100 days are soon coming up, and I am simply awed by the work of the Coalition and its courageous and visionary partners in Africa, Asia, Latin America and the Middle East.

Let’s take, for example, our work to end early and forced marriage. This is one of the many battles we fight to support women’s and girls’ rights and health, often in the face of regressive forces aligned against women’s rights and health.

At the local level – In Cameroun, almost half of the girls under 18 are married off by their fathers, often against their will. These early marriages usually end girls’ education and put them at very high risk of complications and death in pregnancy and childbirth. IWHC supports APAD (Association for the Promotion of the Rights and Autonomy of Women and Girls), a local organization that educates communities about the intrinsic human rights of girls, including the right to choose when and whom to marry. Led by young women who escaped or avoided early and forced marriage, APAD empowers survivors and works to stop these marriages before they occur. They do this by building skills for young women, changing cultural values through collaboration with religious and traditional leaders, and educating parents.

In Washington, DC – As a leader of Girls Not Brides: The US Partnership to End Child Marriage, IWHC commends the United States Senate for passing the International Protecting Girls by Preventing Child Marriage Act, which is a rare victory for women and girls. This is a critical step in upholding the rights of adolescent girls around the world, and in shielding them from the harmful practice of child marriage, which often has devastating consequences for girls, their families and their communities. We now look to the Administration to ensure that sufficient attention and resources are directed to girls most in need to prevent more marriages from occurring and to support married adolescents. Ending early and forced marriage is key to ensuring the health and rights of girls and women and a higher standard of living for them, their families, and their country.

At the global level – With women and youth from around the world, IWHC is fighting to ensure that international agreements include funding for important programs that save women’s and girls’ lives and protect their rights and health. These include contraceptives; maternity care; access to HIV services; and age-appropriate sexuality education, which teaches gender equality and provides accurate health information to young people aged 10 to 24 who often have little, or no, understanding of their bodies.

Leading IWHC is a great responsibility and I am indebted to its former presidents, Joan Dunlop and Adrienne Germain, for their vision and dedication to women’s rights and health.  In the upcoming year, I look forward to building on their legacy and that of our partners.

Controlling one’s body and fertility is key to everything else in a woman’s life.  Please support us generously, so we can do even more.  Thank you.

Sincerely,

Françoise Girard
President, International Women’s Health Coalition

Senators Dick Durbin (D-IL) and Olympia Snowe (R-ME) are steadfast champions on this issue and deserve immense praise for their leadership to ensure this bipartisan legislation passed. Please take a moment and thank them for their work to end early and forced marriage. We now look to the Administration to do its part to ensure that sufficient attention and resources are directed to girls most in need to prevent more marriages from occurring and to support married adolescents. Together, we can all do our part to end this practice and secure the basic human right of all people to decide if, when, and whom they marry.

Working on the funding bill for the State Department and U.S. foreign assistance programs, today the Senate Appropriations Committee repudiated the negative action recently taken in the House.  The overall funding levels in the Senate bill for family planning and reproductive health programs were set at $700 million (an increase of about $125 million from last year’s levels – in an attempt to make up for disproportionate cuts in the past).  And, rather than seeking to defund UNFPA, as the House bill does, the Senate committee included $44.5 million for reproductive health services in more than 140 countries.

In direct opposition to House action, the Senate Committee included a provision to prohibit a futurePresident from unilaterally imposing the Global Gag Rule. The amendment was offered by Senator Frank Lautenberg (D-NJ) – a stalwart supporter of reproductive rights – and passed by a vote of 18-12. Committee Democrats (with the exception of Senator Ben Nelson (D-NE), supported it and were joined by Republicans Susan Collins, Lisa Murkowski and Mark Kirk (by proxy, as he is absent from the Senate due to health issues). Please take a moment to call or email Senator Frank Lautenberg and thank him for his continued commitment to women and girls’ basic human right to access the information and services they need to promote their health and well-being.

Additional good news: the bill contains language to allow abortion services for Peace Corps volunteers in cases of rape, incest, and life endangerment of the woman.  This is progress of sorts – and if enacted would give Peace Corps volunteers the same right federal employees already have in other federal programs.

Next step is action by the full Senate – and then the House and Senate will need to work out differences between the two versions of their bills before sending to the President for signature into law.