Harmony, Balance and Rights: Who Pays the Price?

Will future generations look back on these days and wonder what was wrong with us for not allowing all women the right to terminate an unwanted pregnancy? Even today, we wonder if those who criminalize abortion realize that most of the women who die from abortion are poor and are already suffering from a lack of access to many of their basic needs.

For the past two decades, some countries in Asia have also had to face the issue of sex determination followed by a selective abortion, most often of female fetuses. The subsequent debates, policy responses and rhetoric have focused on the abortion, whereas it is really about gender discrimination and women’s inferior positions within deeply patriarchal cultures. Governments want to correct the sex ratio using messages that reinforce the need to have enough women for the men to marry. Some of the proposals have included reducing the gestation limit for abortion, informing all pregnant women of the sex of the fetus and tracking those pregnant with a female fetus. There are also veiled threats of increasing violence towards women if the ratio drops. As though a 1:1 ratio is an assurance of safety!

Of course, the women who can afford it continue to have access to abortion for sex selection, either by paying prohibitively expensive fees for clandestine private services, or by traveling abroad to nearby countries where it is not against the law. However, due to the hostile environment created by governmental crackdowns, it is again the poorer women who are suffering. Doctors in the private sector are turning them away from abortion as well as sonography services.

While in the developing world we are struggling with this mismatch between the idea of sex selection and its reality, there is a new test called Harmony being used in Australia. It is a maternal blood test that can identify fetal cells and offer genetic diagnosis, including fetal sex determination. How long before this kind of test is available to those who can afford it in India and China, allowing people to circumvent any clinic and go for DIY?

The state can and does interfere with individual reproductive freedom in the developed world as well. In France, mothers with three children can take a year off work—and receive a monthly paycheck of up to $1,180 to stay home. Families are eligible for subsidized public transportation and holiday vouchers. With most of the family incentives being either financial or somehow linked to long-term security and benefits, it stands to reason that those who are likely to be incentivized are those who are not rich.

As civil society stakeholders, we need to address the fact that services—and, therefore, actionable choices—are increasingly available only to those who can afford them, while free services in the public sector are dwindling.

Neoliberal economic policies are policies carried out in the belief that a free market will look after itself. Unfortunately, one of the fallouts of these policies has been the gradual erosion of public-sector health services. As civil society stakeholders, we need to address the fact that services—and, therefore, actionable choices—are increasingly available only to those who can afford them, while free services in the public sector are dwindling.

In India, for example, less than one percent of the GDP is spent on healthcare, with the vast majority of health services in the free market requiring some kind of out-of-pocket expenditure. As a result, poor women continue to die in sterilization camps, in unsupervised childbirth and from unsafe abortions.

It’s worth noting that the outcome document for the United Nations Sustainable Development Goals (SDGs) seems to only recognize human rights and health as a means to greater economic growth, and not as an intrinsically valuable obligation of governments (or indeed, any nonstate actors). The document does mention the need to review and modify current models affecting the whole economy, which have been seen to perpetuate inequalities, especially gender inequalities.

While the UN’s SDGs have targets on addressing health and well-being, as well as gender and empowerment, one target is “to encourage and promote effective public-private and civil society partnerships.” As worded, this target could allow for multinational corporations to take a lead role, since the SDGs provide no mechanism for accountability about what can and cannot be given up by the public sector. Moving healthcare services into the hands of huge corporations would further reduce access to comprehensive and quality services for poor people and women.

Around the world, women’s reproductive healthcare tends to tell the same story, a bit like Dickens’ A Tale of Two Cities. Right now it is the best of times (medical abortion pills, telemedicine, safe self-use) and the worst of times (increasing attempts to control women’s bodies, more and more absurd laws, reductions in public-sector expenditure on women’s health services).

Consider this quote from a study conducted by Samyak, an NGO working on gender equality based in Pune, India, from a pending publication.

Who thinks about poor people like us? Everyone thinks about money. Those who can spend money can get treatment. I was feeling very helpless. Private Doctor said no for abortion because I was not having money and doctor in public hospital treated me very badly. He said people like you are responsible for increasing population. Don’t you have any work rather than sleeping (having sex), you do these things and then come to us to sort it out.

This story is from a 29-year-old woman who was married at age 16 and had four daughters and two sons. This was her seventh pregnancy. She concluded that “we poor people cannot do anything.”

To address the rights violations and social injustice faced by her and millions of other such women, it is imperative that our policies and programs do more than just make a token mention of women’s empowerment and gender equality. They need to actually be brave enough to transform the way we live as a society by challenging patriarchy. This can happen by shifting hegemonic discourse around women’s sexuality and by creating an environment in which cultural and religious norms can be revisited in order to create a society in which women can truly function and live as equals.