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Law, Human Rights, and Women’s Health . David Barnard, PhD, JD University of Pittsburgh School of Medicine School of Law Center for Bioethics and Health Law. Overview. Introduction Brief overview of women’s health status in Ethiopia.

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Law human rights and women s health l.jpg

Law, Human Rights, and Women’s Health

David Barnard, PhD, JD

University of Pittsburgh

School of Medicine

School of Law

Center for Bioethics and Health Law


Overview l.jpg
Overview

  • Introduction

  • Brief overview of women’s health status in Ethiopia.

  • Ethiopia’s Federal Constitution and human rights commitments

  • Exploring the mismatch:

    • Gender inequality

    • Social determinants of health

    • Customary law and the relative imperviousness of custom to international norms

  • Two human rights narratives

  • An example from Botswana of interactions between narratives




  • Some major human rights treaties l.jpg
    Some Major Human Rights Treaties

    • Universal Declaration of Human Rights (1948)

    • Convention on the Prevention and Punishment of the Crime of Genocide (1951)

    • International Covenant on the Elimination of All Forms of Racial Discrimination (1969)

    • International Covenant on Civil and Political Rights (1976)

    • International Covenant on Economic, Social and Cultural Rights (1976)

    • Convention on the Elimination of All Forms of Discrimination Against Women (1981)

    • Convention on the Rights of the Child (1990)


    B women s inequality and its health consequences l.jpg

    B. Women’s Inequality and its Health Consequences

    The face of poverty in Africa is still a woman, the face of HIV/AIDS is still a woman. It is easier to change structure, but it is not easy to change patriarchy.

    --Micheline Ravololonarisoa, Chief, Africa Section, UNIFEM, July, 2006


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    Poverty and Patriarchy

    • Maternal Mortality

    • HIV/AIDS

    • Female Genital Cutting

    • Occupational Illness

    • (among others)


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    Do these narratives have anything to do with each other?

    What, if anything, should advocates for women’s health expect from the human rights regime as tools or resources for improvement in women’s health?




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    HDR 2007/08

    Life expectancy at birth, annual estimates (years), 2000-05

    • Ethiopia 51.8

    • Sierra Leone41.8

    • Iceland81.5

    • USA 77.4

      Adult literacy rate (% aged 15 and older), 1995-2005

    • Ethiopia 35.9

    • Italy 98.4

    • Sierra Leone34.8

    • USA 99

      GDP per capita (PPP US$), 2005

    • Ethiopia 1,055

    • Iceland 36,510

    • Sierra Leone806

    • USA 41,890


    Slide15 l.jpg

    Population living below $1 a day (%), 1990-2005

    • Ethiopia 23.0

    • Sierra Leone57.0

    • Republic of Korea<2

    • USA (no data)

      Population living below $2 a day (%), 1990-2005

    • Ethiopia 77.8

    • Chile 5.6

    • Nigeria 92.4

    • USA (no data)

      Population using an improved water source (%), 2004

    • Ethiopia 22

    • Iceland100

    • Sierra Leone57.0

    • USA 100


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    Population using improved sanitation (%), 2004,

    • Ethiopia 13

    • Iceland100

    • Sierra Leone39

    • USA 100

      Population undernourished (% of total population), 2002/04

    • Ethiopia 46

    • Iceland<2.5

    • Sierra Leone51

    • USA <2.5

      Physicians (per 100,000 people), 2000-04,

    • Ethiopia 3

    • Iceland362

    • Sierra Leone3

    • USA 256


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    Maternal mortality ratio, reported (per 100,000 live births), 1990-2004,

    • Ethiopia 870

    • Iceland4

    • Sierra Leone2,100

    • USA 11

      Births attended by skilled health personnel (%), 1997-2005

    • Ethiopia 6

    • Norway100

    • Niger 16

    • USA 99


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    Infant mortality rate (per 1,000 live births), births), 1990-2004,

    • Ethiopia 80

    • Iceland2

    • Sierra Leone165

    • USA 6


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    Female Genital Cutting births), 1990-2004,

    • In 1997/1998 the National Committee on Traditional Practices in Ethiopia (NCTPE) carried out a national baseline survey—72.7 % of the female population have undergone one of these procedures.

    • Regional statistics of the prevalence from the survey are: Afar Region—94.5%; Harare Region—81.2%; Amhara Region—81.1%; Oromia Region—79.6%; Addis Ababa City—70.2%; Somali Region—69.7%; Benseshangul Gumuz Region—52.9%; Tigray Region—48.1%; Southern Region—46.3%.

      U.S. Department of State



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    Article 9 Commitments

    • 9(1) The Constitution is the supreme law of the land. Any law, customary practice or a decision of an organ of state or public official which contravenes this Constitution shall be of no effect.

    • 9(4) All international agreements ratified by Ethiopia are an integral part of the law of the land.


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    Article 13 Commitments

    • 13(2) The fundamental rights and freedoms specified in this Chapter shall be interpreted in a manner conforming to the principles of the Universal Declaration of Human Rights, International Covenants on Human Rights and international instruments adopted by Ethiopia.


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    Human Rights Instruments Adopted by Ethiopia Commitments

    • International Convention on the Elimination of All Forms of Racial Discrimination, 1976

    • International Convention on the Elimination of All Forms of Discrimination Against Women, 1981

    • Convention on the Rights of the Child, 1991

    • International Covenant on Civil and Political Rights, 1993

    • International Covenant on Economic, Social and Cultural Rights, 1993

    • Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, 1994

    • Africa Charter on Human and Peoples’ Rights, 1998


    Article 35 l.jpg
    Article 35 Commitments

    • 35(1) Women shall, in the enjoyment of rights and protections provided for by this Constitution, have equal rights with men.

    • 35(2) Women have equal rights with men in marriage as prescribed by this Constitution.


    Article 3525 l.jpg
    Article 35 Commitments

    • 35(4) The State shall enforce the right of women to eliminate the influences of harmful customs. Laws, customs and practices that oppress or cause bodily or mental harm to women are prohibited.

    • 35(9) To prevent harm arising from pregnancy and childbirth and in order to safeguard their health, women have the right of access to family planning education, information and capacity.


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    4. CommitmentsExploring the Mismatcha. Gender Inequality


    Slide27 l.jpg


    Slide28 l.jpg


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    • Net primary enrolment rate, female (%), 2005, Commitments59

    • Net primary enrolment rate (ratio of female rate to male rate), 2005, 0.92

    • Gross secondary enrolment ratio, female (%), 2005, 24

    • Gross secondary enrolment ratio (ratio of female ratio to male ratio), 2005, 0.65

    • Gross tertiary enrolment ratio, female (%), 2005, 1

    • Gross tertiary enrolment ratio (ratio of female ratio to male ratio), 2005, 0.32


    Slide31 l.jpg


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    4. Exploring the Mismatch Commitmentsb. Social determinants of health


    Slide35 l.jpg

    • The [first] example is that of a dead woman who had been given in marriage at 13 years of age. She lost her first pregnancy but was damaged due to obstructed labor resulting probably from disproportion between the baby’s head size and her birth structure. Three years following the repair of her damaged birth canal she again became pregnant. At seven months pregnancy she started bleeding after carrying a heavy jar of water from a distant source. She started labor the same day but did not make it to the hospital until three days later. By then the baby had no sign of life and she was in severe distress. She was delivered and the uterus was removed. On the 27th day of admission and medical care she passed away.


    Slide36 l.jpg

    • There is not a single cause for her death. Being young, married, doing heavy work during pregnancy, physical disproportion, no health services close by and no time to seek out the far away health service—all contributed. The gender-assigned job of fetching water does not relate to the sex-designated role of pregnancy. All jobs other than pregnancy, labour, delivery, and lactation could be shared, if it were not for society’s prescription of gender-segregated roles, of which the most burdensome and routine are assigned to women.

    Kidanemariam Adenech and Tamirat Azeb. “Gender Influence on Women’s Health: A Review of the Ethiopian Situation.” In: Tsehai Berhan-Selassie, ed. Gender Issues in Ethiopia. Institute of Ethopian Studies, Addis Ababa University, 1991. Proceedings of the First University Seminar on Gender Issues in Ethiopia, Addis Ababa, December, 1989


    Slide37 l.jpg

    • In 1990, over one-third of married women between 15 and 49 were married before the age of 15, while 41% married between the ages of 15 and 17. Mean age of marriage in rural areas is estimated at 15.2 years for girls and 21.5 years for boys. In the northwestern region of the country it was estimated in 1990 that at least half of the women married at the age of 14 or younger.

    -Center for Reproductive Rights


    Slide38 l.jpg

    Fertility rate, total (births per woman), 2000-05 were married before the age of 15, while 41% married between the ages of 15 and 17. Mean age of marriage in rural areas is estimated at 15.2 years for girls and 21.5 years for boys. In the northwestern region of the country it was estimated in 1990 that at least half of the women married at the age of 14 or younger.

    • Ethiopia 5.8

    • Iceland2.0

    • Niger7.4

    • USA 2.0

      Contraceptive prevalence rate (% of married women aged 15-49), 1997-2005,

    • Ethiopia 15

    • China 87

    • SierraLeone4

    • USA 76

      Condom use at last high-risk sex, women (% aged 15-24), 1999-2005,

    • Ethiopia 17

    • Niger7

    • Botswana75

    • USA (no data)


    Slide39 l.jpg
    4. Exploring the Mismatch were married before the age of 15, while 41% married between the ages of 15 and 17. Mean age of marriage in rural areas is estimated at 15.2 years for girls and 21.5 years for boys. In the northwestern region of the country it was estimated in 1990 that at least half of the women married at the age of 14 or younger.c. Customary law and the relative imperviousness of custom to international norms


    Article 34 l.jpg
    Article 34 were married before the age of 15, while 41% married between the ages of 15 and 17. Mean age of marriage in rural areas is estimated at 15.2 years for girls and 21.5 years for boys. In the northwestern region of the country it was estimated in 1990 that at least half of the women married at the age of 14 or younger.

    • 34(5) This Constitution shall not preclude the adjudication of disputes relating to personal and family laws in accordance with the religious or cultural laws, with the consent of the parties to the dispute. Particulars shall be determined by law.


    Slide41 l.jpg

    Proportion of respondents agreeing with statements on equality between sexes, and mean score of “positive” gender equality responses


    Slide43 l.jpg

    Chege, Jane et. Al. “Testing the equality between sexes, and mean score of “positive” gender equality responsesEffectiveness of Integrating Community-Based Approaches for Encouraging Abandonment of Female Genital Cutting into CARE’s Reproductive Health Programs in Ethiopia and Kenya”


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    5. Two Human Rights Narratives equality between sexes, and mean score of “positive” gender equality responses


    Slide45 l.jpg

    Do these narratives have anything to do with each other? equality between sexes, and mean score of “positive” gender equality responses

    What, if anything, should advocates for women’s health expect from the human rights regime as tools or resources for improvement in women’s health?


    Forms of action for promotion of human rights l.jpg
    Forms of Action for Promotion of Human Rights equality between sexes, and mean score of “positive” gender equality responses

    • Recognition

    • Agitation

    • Legislation

      Amartya Sen, “Elements of a Theory of Human Rights,” Philosophy & Public Affairs, 2004, 32(4): 315-356.



    The 1984 citizenship act l.jpg
    The 1984 Citizenship Act Narratives

    • A male Botswanan citizen who marries a non-citizen automatically passes Botswana citizenship to his children and may naturalize his wife

    • Female Botswanan citizens who marry non-citizens are prohibited from passing citizenship to their children or naturalization privileges to their spouses.


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    • 1991 High Court rules the gender differences in the Citizenship Act are unconstitutional in Attorney General v. Unity Dow

    • 1992 Court of Appeals upholds the High Court’s ruling

    • 1992-1994 Botswana government refuses to comply with the Court Decision

    • 1995 Parliament passes legislation to comply with the Dow decision.

    • 1996 Botswana ratifies Convention on the Elimination of All Forms of Discrimination Against Women


    The metlhaetsile centre in mochudi botswana l.jpg
    The Metlhaetsile Centre in Mochudi, Botswana Citizenship Act are unconstitutional in

    1991

    Informal dialogue and needs assessment by women participating in a local vocational training program (assisted by their teacher and a village-based attorney) identified topics and conducted workshops desired by village women.

    • Law and its effect on women and families

    • Employment issues (including sexual harassment)

    • Women in politics

    • Constitutional law

    • Women’s health (especially family planning and AIDS prevention)


    Slide57 l.jpg
    1992 Citizenship Act are unconstitutional in

    • Women’s Education and Information Center established in village center

    • Community-wide assembly convenes under leadership of Village Chief, with unanimous support for the continued activity of the Center.


    1992 1994 l.jpg
    1992-1994 Citizenship Act are unconstitutional in

    The Center is the base for continuing workshops, counseling, education for political mobilization, and advocacy.

    • Equal rights for women in marriage and divorce

    • Women’s health

    • Political participation

    • Law

    • Advocacy for compliance with Dow

    • Advocacy for ratification of CEDAW


    Slide59 l.jpg

    • Women’s subordination existing in societies of every degree of complexity is not something that can be changed by rearranging certain tasks and roles in the social system. The potential for change lies in changing social institutions at the same time as changing cultural assumptions through consciousness-raising and involvements of both men and women.

      --Almaz Eshet, in: Tsehai Berhan-Selassie, ed. Gender Issues in Ethiopia. Institute of Ethopian Studies, Addis Ababa University, 1991. Proceedings of the First University Seminar on Gender Issues in Ethiopia, Addis Ababa, December, 1989


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