Women's health advocates have criticized the choice of contraceptives available for not meeting reproductive needs and for controlling women's fertility at the expense of women's health. There is a call for technology that is appropriate, safe, and under the user's control. Concern about contraceptive testing does not mean that all contraceptive methods should be criticized. Development and evaluation of contraceptive technologies involves conformity with drug regulatory and licensing groups. Scientific trials are used to evaluate a drug's performance, but a shortcoming of the method is the exclusion of vulnerable populations such as adolescent, anemic, pregnant or breast-feeding women. The assumptions for distribution after approval are healthy, well-informed clients, in clean, well-equipped settings, with adequate follow-up. However, the realities may be quite different. Providers may be poorly trained to serve users who are in poor health and/or illiterate, and who will be likely not to return for follow-up. Clinical trials are limited also by the time frame, which is usually five years and not long enough to ascertain long-term effects for cancer, for instance. Sample sizes may be too small to detect serious side effects. Acceptability trials also have limitations. Acceptability is defined by researchers and is sometimes not made explicit. The generally agreed upon criteria is the continued use of the method by the women in the trial, who do not represent the entire population of potential users of the method. Goals of users and researchers may be different. Prevention of pregnancy is the goal of researchers, while women may be selectively concerned with safety and acceptability. Researchers make value judgments about what is and what is not important to women. Menstrual disturbance is one measure that is frequently cited as more important to women than researchers, or for which cultural practices may be violated. Population growth limitation can be used as the entire justification for research; researchers do not report that women themselves desire longer acting contraceptive alternatives. Consideration is not given to client-provider relations, or to deficiencies in health infrastructure affecting provision. The potential for abuse or coercion is ignored by researchers.
The final statement made by DAWN to the 3rd final preparatory meeting for the United Nations Conference on Population and Development scheduled for September, 1994, in Cairo was given in full. DAWN's recommendations were briefly stated in 10 points. The women's group suggested that 1) structural adjustment assurances be made that investments in social programs would not be reduced; 2) equity and poverty adjustment and job creation be included in the development model; 3) population policy promote the well-being of people and reproductive rights of women; 4) comprehensive, high quality health services for women be provided responsibly by governments; 5) women's rights be recognized as human rights; 6) health services be reorganized to incorporate a wide range of services, including safe abortion; 7) safe, legal abortion be recognized as a necessary right; 8) gender and empowerment programs receive financial support; 9) accountability be required and women's groups' representation be included; and 10) resources be restructured to incorporate the aforementioned recommendations. The closing statement stressed the need to use a broad context and not to separate population issues from other issues of development. Women's issues are inseparably linked with women's rights, women's empowerment, and provision of comprehensive health services. Equity is a central development issue. The impact of development models on women must be considered. Development models and women's rights are both topics that need to be addressed concurrently at the conference. The Vatican's attempt to separate the issues and focus exclusively on women's rights only in religiously defined terms is blatantly political and an exercise of power domination of women. Many women's groups from a broad base of support have lobbied this forthcoming proceeding for a broader framework of women's rights within the document. Respect for women's issues will come from greater involvement of women in monitoring policies and implementation of programs.
Male dominated power systems in South Africa coupled with a culture of aggression and domination have not allowed for the mainstream emergence of qualities such as trust, compassion, and gentleness, frequently associated with female virtues. Rape under such circumstances is the assertion of male power, and, as expected, the numbers of rape cases and other forms of gender violence have increased. Under an apartheid system, where only the rape of white women was prosecuted, and gender and race issues could diffuse the black struggle, there were difficulties in mobilizing support to end violence against black women. There was social acceptance that rape of black women was part of life. Police statistics on the incidence of rape were notoriously unreliable, because only a small percentage of cases are reported to police, and many women would be ashamed to admit to marital abuse, including rape. In women's groups, it was reported that 1 out of every 4 women had been raped, and raped at early ages, such as 14 years of age. In impoverished communities, there is widespread poverty, injustice, prejudice, alcohol abuse, and other conditions impacting on women. The rapists may be school classmates, or street fighters, or political activists. The sexual initiation of women worldwide and in South Africa frequently is accompanied by coercion. Abduction and forced sex is considered legitimate for young men, who believe that mental health is deleteriously affected by lack of sex. Girls may even be abducted from the classroom, as a way of preventing women's power and control over assets and resources and diminishing the potential threat to gender power relations. School girls who become pregnant are often forced to leave school. Victims of rape may be excluded from family life and forced to seek prostitution as a means of support. Rape is reportedly experienced among older women with bottles, tins, or other devices which inflict injury. Only rape with penal penetration is an official offense. HIV infection is an increased risk for raped women, who are likely to suffer from bleeding. With an end to apartheid, it is up to the new government to enforce more equitable laws. Improvements are evident in Soweto at Baragwanath Hospital and in some police precincts, but the best protection is to teach nonviolence and respect for women.
(1994). Abortion, reproductive rights and maternal mortality. Gender & Development: Vol. 2, Population and Reproductive Rights, pp. 45-50.
Through the use of case studies from Kenya, Malaysia, Mexico, and Morocco, the influence of environmental degradation on women's livelihoods and fertility is broadly examined. The aim is to show how the environment impacts on women's childbearing decisions, and the consequences. The evidence appears to support the notion that environmental pressures on women will contribute to higher fertility, under conditions of gender division of labor, a very low social status for women, and women's limited educational opportunity. The Kenya experiences were among rural villages in various agro-ecological zones in Embu, on the slopes of Mt. Kenya, and involved coping strategies with poor soils and very little rainfall. The Malaysian research focused on river communities in the rain forests of Limbang River Basin in Sarawak and the logging industry and government regulation of tribal land use rights. In mountainous Tetouan and A1 Hoceimain, Moroccan populations struggle with poor social services and little rainfall. The study areas in Morocco and Kenya had very high population growth, but declining growth rates nationally. The study areas suffered from deforestation, declines in water quality and availability, and soil erosion and depletion. Family planning services would be welcome: 1) when women do not have to solely bear the responsibility for the additional work involved in environmentally degraded areas; and 2) when the value of children is not increased. Policy must recognize that where rigid gender division of labor is prominent, children are a crucial resource for women in the provision of household support. The Morocco case exemplified the extremes of men's refusal to ease women's workloads with time and labor saving technology. Family planning promotion in such situations must be accompanied by provision of alternative resources to address the adverse environmental impacts on women. Blaming women for environmental problems and family planning promotion will fail to gain credibility and the trust of women unless they are provided options.
