Right wing policies threaten gender equality and health security

Shobha Shukla *

Young people call for all sexual and reproductive health services including safe abortion rights

Donald Trump’s presidency is likely to have far-reaching consequences for sexual and reproductive health, bodily autonomy and human rights worldwide. He has already withdrawn USA’s financial support to the UN health agency World Health Organization (WHO), and the US Centers for Disease Control and Prevention (CDC) will no longer share its invaluable expertise with the WHO.

Also all ongoing (as well as future) projects funded by US Agency for International Development (USAID) have been put on immediate hold. Many of these are lifesaving health programmes, including those directly related to sexual and reproductive health services.

All this is going to have high reaching negative impacts on global health, including access to sexual and reproductive health services. Under the regressive reimposition of the 'Global Gag Rule', organisations (outside the US) receiving any US funding cannot provide any services or information related to abortion, even with separate, non-US funding. This could result in fewer services for contraception, maternal health, and safe abortion and increase unintended pregnancies, unsafe abortions, and increased health risks putting millions of women around the world at risk, causing serious health complications and even deaths.

Young people are raising their voices against policies that are negatively impacting their sexual and reproductive health and rights and calling for youth friendly sexual and reproductive health services to be made available to all those in need.

“In Asia Pacific inequality, injustice and stigma continue to pose threats to the health and wellbeing of women and girls. They continue to face challenges in education and employment - going to school and getting a job, even access to decent facilities for menstrual hygiene. Many girls cannot go to school because they are not even able to menstruate with dignity,” rues Lady Nancy Lisondra, Youth and Advocacy Advisor at International Planned Parenthood Federation (IPPF), East and South-East Asia and Oceania Regional office.

Adolescent pregnancy is another issue that needs to be tackled. It poses health risks to adolescent mothers and also limits their access to education and economic opportunities. Every year, there are over 3.7 million births to adolescent girls aged 15-19 in the Asia Pacific region. Adolescent fertility rates are fairly high in South East Asia at 43 births per 1,000 girls.

Across South Asia, over 2.2 million adolescent girls become mothers every year and over 6,500 adolescent girls die giving birth every year, according to an analysis by UNICEF, WHO and UNFPA.

Early marriage is one of the factors that leads to adolescent pregnancy

As per UNICEF data India is home to the largest number of child brides in the world: 223 million child brides – a third of the global total. While it is illegal for girls under the age of 18 to marry in India, estimates suggest that at least 1.5 million girls under age 18 get married each year. Nearly 16% of all adolescent girls (aged 15–19) are currently married.

“Married adolescents tend to have less education, less household and economic power and less mobility. They lack knowledge and skills to negotiate situations that are detrimental to their health and well being- like deciding when to give birth, where to give birth, is there money to spare to give birth. It disempowers the young girls who get married and face adolescent pregnancy. Girls need to decide and have alternatives to an early marriage and pregnancy. We need to invest in girls”, adds Lisondra.

Maria Iqbal Shah, member of Y-PEER - Youth Peer Education Network Asia Pacific, shared the challenges that beset sexual and reproductive health in Pakistan. “There is little acceptance of sexual and reproductive health services in my country because of cultural and religious stigma and taboos. We are also struggling in services and resources regarding sexual and reproductive health due to floods and - like availability of contraceptives and menstrual products. Early child marriage is also prevalent that leads to early pregnancy which results in high maternal mortality and morbidity as well as affects the mental health of the young mother. It directly affects the education of the girls. Women, girls, LGBTQI+ community are facing gender-based violence, including domestic violence. Due to a patriarchal and male dominant society, honour-based violence or killing is very worrying too."

Challenges faced by young people living with HIV

"Many of the young people living with HIV in India are not aware of the available sexual and reproductive health services, especially in rural areas. Financial barriers also limit access to healthcare services as those living in rural areas are not able to afford to travel to the city to avail the services. There is also fear of disclosure in young people. They are reluctant to disclose their HIV status to healthcare providers due to fear of discrimination, breach of confidentiality and judgmental attitude of healthcare providers. This prevents them from getting essential services like condoms, contraception and pregnancy counseling as well as mental health support," says Pooja Mishra, National Coordinator, Youth Lead Voices and General Secretary, National Coalition of People Living with HIV in India (NCPI Plus).

She also cites limited or insufficient availability of youth-friendly spaces and services that are confidential, non-judgmental and culturally sensitive, especially in rural and remote areas, which deters young people living with HIV from seeking help.

Comprehensive sexuality education is no longer an option. It is a necessity.

A lot of young people still do not have enough access to age-appropriate and evidence-based comprehensive sexuality education to equip them with knowledge to make informed choices about their sexual and reproductive health.

Citing the example of Philippines, Gressa Mae G Pepito, Vice President of Family Planning Organization of the Philippines in Masbate, Philippines says, "Many young Filipinos are engaging in early and unprotected sex, multiple sexual partners, transactional sex and even coercive or violent encounters. These risky actions place them at greater danger for unintended pregnancies, sexually transmitted infections and emotional trauma. Lack of accurate and reliable information about sex is a significant barrier. Many youths rely on social media or peers for information, leading to widespread misinformation. Topics around sex are rarely discussed openly at home, making it even harder for our young people to receive correct knowledge. This gap enforces stigma and leaves them ill-equipped to make informed choices. All this has contributed to a rise in adolescent pregnancies and unplanned outcomes."

Philippines' Adolescent Pregnancy Prevention Bill could be a step in the right direction. It seeks to strengthen the roll out of comprehensive sexuality education as a key component of responsible parenthood and provide adolescent-friendly health services to address rising teenage pregnancies. However, the bill has faced significant challenges during its legislative journey (and is yet to be passed by the Senate).

Lady Nancy Lisondra, Maria Iqbal Shah, Pooja Mishra, and Gressa Mae G Pepito, were speaking as panelists of SHE & Rights (Sexual Health with Equity and Rights) initiative, which was hosted by National Coalition of People Living with HIV in India (NCPI Plus), Global Center for Health Diplomacy and Inclusion (CeHDI), International Planned Parenthood Federation (IPPF), Asian-Pacific Resource and Research Centre for Women (ARROW), Women's Global Network for Reproductive Rights (WGNRR), Asia Pacific Media Alliance for Health and Development (APCAT Media) and CNS.

Through education we can empower the young people to make informed decisions, advocate for their rights and protect their wellbeing. The alarming trend of adolescent pregnancy underscores the urgent need for comprehensive measures to address the factors contributing to early pregnancies, including limited access to reproductive health education and services.

Patriarchy and religious bigotry gives rise to harmful social norms that promote gender injustice and fuel many challenges related to the sexual and reproductive health of the youth, especially girls and women. Creating an enabling environment for providing education and employment to women and girls, promoting gender-transformative programming, providing age appropriate comprehensive sexuality education, ensuring accessible and youth-friendly sexual and reproductive health services, and empowering young people to make informed decisions can go a long way in improving their overall physical, mental and emotional wellbeing, and pave the way for a socially just and ecologically sustainable feminist world order.