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.

After two weeks of fierce negotiations at the United Nations’ annual Commission on the Status of Women, on March 15 more than 130 governments committed to ending violence against women and girls, and reached strong agreements to promote gender equality and ensure access to sexual and reproductive health services.

The International Women’s Health Coalition and our amazing partners from around the world came out in force to the UN for the negotiations. Our agenda was clear: push governments to commit to concrete strategies to empower women and girls and end gender-based violence.

We met with instant opposition from conservative governments. Countries such as Iran, Russia, Egypt, and Syria joined with the Vatican in what The New York Times called “an unholy alliance.” IWHC staff and our women’s rights caucus of more than 100 activists worked around the clock to support progressive delegations to stand strong and not to cave in to pressure. We would not let a small but vocal minority use culture and religion as excuses to deny women their rights.

Our efforts prevailed and consensus was finally reached to loud applause from supportive governments such as Argentina, Brazil, Denmark, Mexico, Norway, the Philippines, South Africa, Switzerland, Turkey, United States, Uruguay, and even the small island of Tonga! As the “agreed conclusions” document was adopted, hundreds of women’s rights activists streamed into the negotiating room to join in the cheers.

For the first time at the UN, governments reached consensus that survivors of rape are entitled to emergency contraception to prevent unwanted pregnancy, and to timely and respectful forensic exams to support prosecution. They called for an end to child marriages. They agreed women’s right to control their sexuality is essential to preventing further violence. And they recognized the role that evidence-based sexuality education can play in reducing the harmful gender stereotypes that lead to violence.

In a sign of just how much was at stake, this year’s meeting received an unprecedented amount of media coverage after the Muslim Brotherhood condemned (and mischaracterized) the negotiations. IWHC featured prominently in many news articles, including in The Washington Post, The Guardian, Associated Press, ABC News, The Globe and Mail, Radio Free Europe, O Estado de S. Paulo, and Reuters.

Once again, we women have shown we’re an irresistible force. But our work is far from over. Now we must be vigilant to ensure that the agreements made at the UN are put into practice in local communities worldwide.

For that to happen, we must continue to support women’s groups to hold their own leaders to account.

Best regards,

One proposal on the table would group all these concerns under the objective of “universal health coverage.” In my two-part blog series, I will discuss why this proposal falls short when it comes to women and adolescents.

Universal health coverage is defined in the draft discussion paper for Botswana as “two inter-related components: coverage with needed health services (prevention, promotion, treatment, and rehabilitation) and coverage with financial risk protection, for everyone.” Universal health insurance is considered critical to achieving universal health coverage because of the protection it can provide against catastrophic health costs and its contribution to sustainable financing. But is it enough?

Economic barriers (“financial risk”) certainly pose formidable obstacles to women and adolescents seeking sexual and reproductive health care; universal health insurance can help to address this.  But alone, it is not sufficient. In fact, health insurance schemes may contain their own barriers to care, particularly for marginalized women and adolescents.

For example, core sexual and reproductive health services, such as family planning counseling and contraceptives and maternity care, are often excluded from benefits packages that determine what is and is not covered by insurance schemes.

Abortion services are largely excluded from coverage, despite the fact that abortion is legal (on one or more grounds) in a majority of countries worldwide. Coverage of contraceptives and sexual health services for adolescents may be likewise constrained due to political sensitivities.

The level of financial protection provided by health insurance can also vary and may not be sufficient to insulate women against economic hardship.  Women consistently experience a higher burden of out-of-pocket costs for health care services than men who have similar levels of insurance coverage, largely due to non-coverage or limits on coverage for sexual and reproductive health services. Even nominal co-pays, common in many insurance programs, may pose a significant barrier if women do not have access to or control over cash.

Concerns about confidentiality and privacy may also impede access for adolescents and women when their own insurance coverage is tied to their parents’ or spouse’s coverage.  In the United States, adolescents and young women and men enrolled as dependents under their parents’ health insurance policies often choose not to use their insurance coverage to pay for sexual and reproductive health services, for fear that their parents will receive notification that they sought such care. Women covered as dependents under their husbands’ insurance policies may likewise be hesitant to seek much-needed care, such as contraceptives or treatment for violence.

Finally, the most marginalized women often fall through the cracks of so-called “universal” health insurance schemes for a number of reasons including lack of autonomy and decision-making power, or lack of information.  Women who are employed in the informal sector, women living in poverty, adolescent girls, and older women are often those least able to obtain good quality health insurance.

How do we make sure what is recommended at the Botswana meeting addresses these concerns?

I suggest a way forward in my next post.

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?

Researchers estimate that 35,000 pregnancies occur every year in Peru as a result of rape. Women and girls in this situation are faced with two options: seek an illegal abortion and risk going to jail or carry the pregnancy to term and suffer the psychological and physical trauma that go along with giving birth to your rapist’s child. Women who can prove that a pregnancy is the result of rape receive a “reduced” sentence of three months in jail (the standard prison sentence for illegal abortions in Peru is two years). Perversely, this reduced sentence does not apply to married women who are raped by their husbands, even though marital rape is a crime under Peruvian law. Doctors who perform abortions in cases of rape face up to six years in prison.

On September 28, 2012, a coalition of women’s rights groups launched a campaign to challenge this cruel violation of human rights. The campaign, Dejala Decidir (“Let her decide”), seeks to introduce a new law that decriminalizes abortion in cases of rape (currently, abortion is only permitted when the woman’s life or health is at risk). The groups, led by partners of the International Women’s Health Coalition—PROMSEX, Demus, Catholics for the Right to Decide-Peru, Manuela Ramos, CLADEM-Peru, and Flora Tristán—need to collect 60,000 valid signatures to petition Congress to consider the bill.

Photo courtesy of PROMSEX

This is no small challenge. The requirement for valid signatures means that people must be willing to provide their government ID numbers to verify their identities. This may be intimidating to many people in a country where the Catholic Church exerts a great deal of influence in the government and within communities. Consider also that many people in rural and indigenous communities—especially poor women who are disproportionately impacted by the abortion ban—do not have government IDs. Even if the campaign succeeds in obtaining 60,000 valid signatures, there is no guarantee that Congress members will risk controversy or the ire of the Catholic Church and support a change in the law.

The groups see the Dejala Decidir campaign as an opportunity to build a powerful and active movement on two important but neglected issues: abortion and rape. Every signature represents at least one more person informed about the harsh realities faced by rape victims in Peru, and mobilized to change the current abortion law.

George Liendo, Director of PROMSEX, says the time is ripe for a national dialogue. “It’s not always easy to build a coalition in Peru, but there is real energy for this campaign. People across the country want to put this on the political agenda.”

Peru is not the only country in the region rethinking its draconian approach to abortion. In October 2012, the Uruguayan congress voted to decriminalize abortion in the first twelve weeks of pregnancy.

Activists in Peru have until October 2013 to collect enough signatures to ask their own Congress to act. In the meantime, we can expect a rich and lively dialogue on rape and abortion. It’s about time.

This blog was cross-posted on RH Reality Check at http://www.rhrealitycheck.org/article/2012/12/19/double-jeopardy-rape-victims-in-peru.

The last couple of days of the ICPD Global Youth Forum in Bali, Indonesia, have seen a flurry of around-the-clock activity by nearly 1,000 young people, adult allies, NGO representatives, academics, government officials, and other stakeholders from around the world. Their hard work is already paying off.

Yesterday, forum participants developed a number of “Staying Healthy” recommendations to ensure that governments prioritize programs that empower vulnerable young populations, including young women and adolescent girls, LGBTQI individuals, persons with disabilities, and young people living with HIV and AIDS. These recommendations are progressive, measurable, and based on evidence.

The journey has not always been easy. A small, but vocal, opposition made up of non-youth participants have attempted to intimidate and censor young people during this forum. Many people could easily have been intimidated into silence by this group, but thankfully the youth at the Global Forum refused to back down. There is too much at stake.

The “Staying Healthy” recommendations were developed as part of a consultative process following a lively plenary. In his speech, UNFPA Executive Director Dr. Babatunde Osotimehin encouraged young people to continue questioning the status quo, stating that young people are not only the present but the future. He discussed a number of issues impacting the sexual and reproductive health and rights of young people, including meaningful participation, gender equality, ending early and forced marriage, unintended pregnancy, maternal mortality, and the needs of both married and unmarried adolescents. Osotimehin 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.”

Indonesian Health Minister Nafsiah Mboi also spoke at the plenary and was met with rousing applause when she stated that, “We have the responsibility to fulfill and promote the health and human rights of young people,” that, “Young people need to be empowered in all aspects of their life,” and that, “It is a fundamental human right of adolescents and youth to access comprehensive sexual and reproductive health education and services.” In Indonesia, there are more than 65 million young people aged between 15 and 24 years old and only 21 percent of them have comprehensive knowledge regarding HIV/AIDS. Sexual transmission of HIV accounts for the vast proportion of new HIV infections among young people and unmarried girls cannot access contraception. Despite these facts, Mboi stated she believes that “The government has an obligation to provide education and services on sexual and reproductive health that are equitable, affordable, and accessible.” For the tens of millions of Indonesian young people in need of information, services, and protection of their human rights, we are optimistic when she says that “You can count on me, I won’t let you down.”

I am thrilled that the final consolidated “Staying Healthy” recommendations articulate a clear, comprehensive, and human-rights based vision as to where the global community needs to focus attention and resources to secure the health and human rights of all young people, and in particular the most marginalized and vulnerable which include adolescent girls and LGBTQI individuals.

These young forum participants deserve our applause for remaining steadfast that this must remain a youth-led and youth-driven process. They stood strong as did UNFPA, which made it clear in various ways that this is indeed intended to be a youth-led and youth-driven process. Displeased with the final consensus recommendations consolidated from the 15 Staying Healthy breakout sessions, the vocal minority of non-youth unconstructively confronted forum participants, after the recommendations were presented during the plenary. During my own breakout session, this same minority consistently opposed suggestions concerning individual rights, and access to safe abortion and contraception.

In contrast to this small group, many other government and non-youth forum participants from around the world stood out as great allies to the youth participants in support of this set of recommendations. The final “Staying Healthy” recommendations will be released as part of a consolidated set of recommendations including the other forum themes: “Decent Work,” “Sexuality, Family and Rights,” “Education,” and “Leadership and Meaningful Participation.” We at the International Women’s Health Coalition look forward to sharing the final recommendations with you when they are released. Stay tuned!

The fall is in full swing and so are we at the International Women’s Health Coalition!

We continue to push the U.S. Government to take greater, concerted, and strategic action to prevent the early and forced marriage of millions of girls in key countries and to support the more than 60 million girls who are already married. It goes without saying that global development goals will not be achieved without women and girls, and that women and girls cannot thrive when they are married off as children, against their will, and often to much older men. Yet in a number of countries around the globe today, more than 40% of girls are married before the age of 18. Our colleagues at the Ford Foundation put together a fascinating report on the situation around the world.

On October 11, 2012, the world marked the first International Day of the Girl with many events around the world, including Too Young to Wed, a haunting exhibition by photographer Stephanie Sinclair. IWHC, as co-chair of the U.S. chapter of Girls Not Brides: the Global Partnership to End Child Marriage, collaborated with organizations around the world to raise the profile of this issue.

A day before, on October 10, I participated in a small closed door meeting at the State Department in Washington, DC that included Secretary of State Hillary Clinton, Archbishop Desmond Tutu of the Elders, Dr. Babatunde Osotimehin, Executive Director of the UN Population Fund (UNFPA), and Luis Ubiñas, President of the Ford Foundation. It was a special thrill to meet Tutu – such a humble and inspiring man! Shortly thereafter, Secretary Clinton announced some welcomed steps, such as a USAID-funded project to get girls into schools in Bangladesh and a one-year program to keep girls in schools in the Democratic Republic of the Congo. Still, we had hoped for quicker and more decisive action from the U.S. Government – these girls should not and cannot wait! Other commitments were also announced on that day – $25 million from the Ford Foundation and $20 million from UNFPA to prevent child marriage, and $39 million from the MacArthur and Mastercard Foundation for girls’ education. There is still time for the U.S. government to do its part. We will keep pressing the Administration to provide the leadership and resources these girls needs to live healthy and just lives.

We’ve also received positive news from our partner and grantee MYSU – Mujer y Salud en Uruguay (Woman and Health in Uruguay). After a 12-year battle, the Uruguayan Congress passed a bill last week that will allow abortions on any ground in the first trimester of pregnancy, and President Mujica just signed it into law. True, the law continues to stigmatize abortion and contains odious provisions that will force women to “explain the circumstances that surrounded the conception…”(!) to their doctor, go before a hospital committee to hear about “alternatives to abortion,” and endure a five-day waiting period. Nevertheless, this is a very significant step in Latin America, where women still face severe legal restrictions to safe abortion except in Mexico City, Guyana, Cuba, and Puerto Rico. IWHC first gave a grant to MYSU for this work in 1999, and we have supported them steadfastly through the many twists and turns along the way. Two years ago, for example, a more liberal law passed the Uruguayan Senate, only to be vetoed at the last minute by then President Tabare. MYSU and their allies have their work cut out for them to make certain the new law is implemented in such a way that barriers to safe abortion are removed, not reinforced. Social and policy change does require patience and staying the course!

For more news, follow IWHC and me on Twitter at @IntlWomen and @francoisegirard, or go to our website www.iwhc.org

Best regards,

The bill is far from what many Uruguayans had hoped for. For one, it does not take first-trimester abortions out of the criminal code. Instead, it allows a woman to terminate her pregnancy only after she has appeared before an interdisciplinary panel of professionals to outline her reasons for requesting an abortion. The panel is required by law to tell her about alternatives to abortion, such as adoption. Moreover, it must “create an environment of psycho-social support to the woman, to contribute to overcome the factors which may be driving her towards pregnancy termination, and ensure that she has the information to make a decision that is conscious and responsible.”

In addition, the woman must wait five days to “reflect on her decision.” These requirements will most certainly discourage many women, and in particular young and poor women, from accessing safe services for fear of stigma and humiliation. They also mean that a woman who self-induces an abortion, for example with misoprostol, without going through these procedures, would still face penalties.

Finally, the bill contains allows for conscientious objections by individual providers and by hospitals, without spelling out what obligations providers and hospitals have to ensure that these objections do not deny women the safe abortions they would now be entitled to.

The debate in the House was fierce.  For those in favor of making first-term abortion available without restrictions, this bill fell far short of what women need. Álvaro Vega, a member of the majority governmental coalition, the Broad Front, lamented: “Is this an advance?  No, this is not advancing anything.  We should…fully eliminate the articles (of the Criminal Code) that criminalize abortion. Abortions are not going to end in 2012.” It is estimated that in Uruguay every year there are 30,000 abortions, most of them unsafe.

Representatives on both sides of the debate were forced to leave the Chamber so that their alternates could take their places and vote the party line.  A member of the opposition Colorado Party, who vacated his seat so that his alternate could cast a vote against the bill, criticized his party’s position: “This is totally wrong and fails our historic responsibility to allow free conscience.”

Those opposed to decriminalizing abortion were just as passionate.  One Representative left the room in tears, saying that his wife had suffered two miscarriages.  Another swore he would bring this matter to a national referendum. Given that some 60% of the population in Uruguay supports the decriminalization of abortion, such a referendum would face an uphill battle.

Meanwhile, outside Parliament, demonstrators marched. Women, nude and covered in bright body paint, stood and chanted: “They put in their restrictions, but our bodies are on the line.”

The text approved by the House is quite different from the version Uruguay’s Senate had passed at the end of 2011. That bill had removed penalties for abortion up to the 12th week of pregnancy, without making women jump through any hoops. That was also the case for a bill passed by Congress in 2007, but later vetoed by then President Tabaré Vazquez. A Presidential veto is not expected this time.

Implementation of the new law will need to be closely followed to ensure that safe abortion is in fact accessible. Health regulations spelling out how and where abortion services will be provided are yet to be developed, and health providers will have to be trained to respect women’s decisions and provide them with quality care. Measures will have to be taken to ensure that conscientious objection claims do not prevent women from accessing services altogether, and to address cases where delays push a woman’s pregnancy past 12 weeks.

At this pivotal moment, IWHC stands in solidarity with the feminist activists who have tirelessly advocated for the decriminalization of abortion in Uruguay. For more than 12 years, IWHC has proudly stood by MYSU – Mujer y Salud en Uruguay – a team of committed and effective advocates for women’s rights and health who have been central to recent advances in women’s rights in Uruguay. MYSU has played an instrumental role in educating and mobilizing Uruguayan society, building political will, and influencing political negotiations in the Congress. They did not give up after the 2007 veto and will continue fighting for increased access to safe abortion services. In the words of MYSU’s Director Lilián Abracinskas, “We will continue to fight for women to be respected as citizens who have the right and the autonomy to decide.”

“And hey presto, I didn’t have to worry about getting pregnant!”

I was among the first generation of women in the 1960s to experience the miracle of the pill just at the age when I was wanting to start having sex. All I had to do was take a pill every day, I was told, and hey presto, I didn’t have to worry about getting pregnant if I didn’t want to, and it worked! But oh, if only it had all turned out to be that easy!  Like one in three women in the UK today, a country where contraceptive prevalence is almost as high as it can get, I needed an abortion several years later.  Again, I was lucky, the 1967 Abortion Act meant I was able to get a legal abortion. The lesson is simple – while contraception continues to be a miracle, because it helps people not to have children if and when they don’t want to, it is not enough on its own and it never has been.

Family planning has been out of the news for a long time, and suddenly it’s back. Welcome!! Bring out the red carpet, and I mean it!! Women and men need contraception  now as much as they have ever done, and young women and men who are beginning to explore their sexuality together need contraception and condoms more than anyone.  But there has been a lot of water under the bridge since family planning was promoted as the cure-all for the world’s ills in the 1960s when the pill came out, and everyone needs to study that history anew so that the same mistakes, of which there have been many, and the same narrow vision, are not repeated.

My generation of women’s health activists, along with a whole generation of researchers, service providers and policymakers who brought their knowledge together at the International Conference on Population and Development in 1994, got the world to recognise that the need for the means to control fertility, which is as old as history itself, was part of a much broader set of needs related to reproduction and sexuality, and that these were inextricably connected. These include: being able to have sex without fear of negative outcomes, being able to have sex if and only if we want to and only with whom we want to, being able to have the children we want, being able to get pregnant at all, being able not only to survive pregnancy but also still be in good health, being able to have a safe abortion without fear of death or condemnation when an unwanted pregnancy occurs, being able to protect ourselves from sexually transmitted diseases, and being able to get treatment for all the many causes of reproductive and sexual ill-health, which start with menstruation and menstrual problems, and continue into old age with things like breast and prostate cancer and uterine prolapse.

There is indeed a huge unmet need in today’s world, but the unmet need for contraception is only a fraction of the unmet need for sexual and reproductive health, and for sexual and reproductive rights. The results we should be working for encompass every aspect of the issues I have just named, and those in turn must be seen in the even wider context of the right to health, social justice and an end to poverty and violence – which were the real point of the Millennium Development Goals – not the measurable targets.

I will be blogging about these issues in the light of the FP Summit over the next few weeks at http://bererblog.wordpress.com – watch this space!

Marge Berer
Editor, Reproductive Health Matters