Violence Against Women And Reproductive Health
Aisha Kolo Lawan
Violence against women has devastating health consequences on the victims and undermines women control over their own control over their own reproductive health. Most women undergoing violence are perpetrated by intimate partners also present with reproductive health risks and problems.
These can broadly be categorized into fatal outcomes and no fatal outcomes suffered as a result of violence. The fatal outcomes could be death as a result of homicide, suicide by the victim, maternal mortality and HIV/AIDS. The non-fatal outcomes include poor physical health as a result of injuries; poor mental health like depression, consequences related to reproductive health like unwanted pregnancies, unsafe abortions and sexually transmitted infections including HIV/AIDS.
The psychological consequences are even more long-term and devastating. The 2001 World Health Report identified gender-based violence as one of the factors contributing to the disproportionate rates of depression amongst women. It further points out that recurrent abuse can erode women’s resilience and places them at risk of other psychological problems such as post traumatic stress disorder, suicide, alcoholism and other substance abuse.
The right to access basic health care services and information is a basic health care services and information is a basic human right enshrined in several international conventions and Instruments like the convention on the elimination of all forms of violence against women (CEDAW), the universal declaration of Human Right, and the International Conference on Population and Development (ICPD).
Despite this, women in Nigeria do not have access to basic health care services and information due to lack of hospitals, inaccessible roads, dilapidated hospitals and lack of good hospital personnel. The situation is very pathetic more especially in Northern part of Nigeria and in the rural areas where they do not have the aforementioned facilities. The situation should be at least better in the urban areas but the government hospitals go on strike every now and then due to non-payment of salaries or good salaries, while the private hospitals are very expensive for an average Nigerian to patronize. Thus, it has a devastating consequence on the reproductive health of women because of the complex nature of our reproductive system.
The government should therefore provide basic health care facilities more especially to the rural areas of the country and at every reach of the country. It should also make sure that even if other workers are going on strike, doctors should be paid well so that they should not go on strike because ‘health is life’. The governance should be seriously committed on the issue of women’s reproductive health and other health related matters.
The government has signed the protocol on the African charter on human and peoples’ right on the right of women in Africa, but it still has not put an end to the problem of gender discrimination and inequality, as laws cannot be self-enforcing. The protocol when ratified and enters into force will need the intervention of all arms of government and the citizens of each African nation to give it interpretation, meaning and necessary relevance to address the issue for which it has been enacted.
The protocol to the African Charter on Women’s Right is one such instrument of promoting the right of women on the African continent, it provides a comprehensive and useful framework for safe guarding women’s sexual and reproductive health and rights while upholding the bodily integrity of duties relating to sexual and reproductive health and rights of women. Among the obligations it places on states are:
q Provision of adequate, affordable and accessible health services including information, education, and communication programmes to women especially those in the rural areas.
q Establish and strengthen existing pre-natal delivery and post-natal health and nutritional services for women during pregnancy and while breastfeeding.
The duty to respect, which entails that the government upholds a woman’s right to choice, information and control over her sexual autonomy and body integrity. It further prohibits states from interfering with the protection and promotion of reproductive health and rights.
It is also interesting to note that Article 14 has proved the most contentious in a number of countries yet it is one of the most liberating in terms of providing choice for women in matters a bodily integrity and autonomy. Women in Nigeria and the continent at large must not let the politics of control gain prominence over their rights to choice.
The protocol is a regional human rights instrument which seeks to combine values with international norms by promoting individual duties and collective rights in addition to internationally recognized individual right. It reflects the history, values traditions and development of Africa.
Once countries sign and ratify the protocol, they become duty-bound to uphold these rights. With glaring gaps that exist in legislative and policy frameworks in matters of reproductive health, it is necessary to continue building pressure for African governments that have not ratified the protocol to do so. Its passage will stimulate the enactment of national policies on violence, which are strategic tools for stimulating greater sensitivity that violence against women is a public health issue. It will also create the political space for dialogue between civil society and the state, while at the same time, committing governments to a discourse that encourages sanctions against violence.
Within the health sector systems violence against women remains highly invisible and there are glaring gaps within the health sector as well as the community level for dealing with violence against women. Most health workers/providers have consistently failed to recognize and consider violence against women on important part of their work. Some health workers, being products of a culture that condones violence against women, view it as a normal way of life and do not feel obligated to pay attention to women who present with signs and symptoms of abuse. They do not feel that caring for such women suffering from violence is part of their professional profile.
Across the nation, the health status of women remains precarious and in many instances, worsening, not only because of HIV/AIDS but also because of other STDs that exists in women health and the lack of accountability for our health. The rural areas more especially are locked out of health facilities across the nation.
The attitudes of health workers toward violence are also largely shaped by prevailing cultural norms. Owing to this disinterest, women living in violent situations also rarely reveal their situation to health workers because of the lack of concern towards the victims. Because of this, the victims are blamed rather than the aggressors, which pose a serious challenge to transforming the culture of silence and complicity of issues of violence against women. The situation is further compounded by lack of legislative and policy frameworks that require health programmes to integrate policies and national plans to address gender-based violence.
The establishment of health sector policies on addressing violence is a key step towards institutionalizing violence against women, programs and raising awareness amongst health providers on their role in addressing violence. Policy frameworks within the health sector systems are important as they create a mechanism for holding the health sector responsible in addressing violence against women.
Violence against women is directly related to power differences that exist between men and women and are directly related to the violence that men exercise against the opposite sex. In fact, violence between men is a mechanism used from childhood to establish a hierarchical order. Normalizing violence then renders men’s power over women or over other men invisible, or more precisely, this normalization hide power.
In these contemporary years, violence is now legally condemned and this achievement has given many invisible abuses legitimacy and standing as human rights violation. However, a culture of peace and human rights requires the creation of social and legal mechanisms that condemn and do not tolerate violence. It demands creative forms of resistance and of resolving domestic and international conflict, and ultimately requires that we ask ourselves if our daily acts, thoughts and emotions support the culture of peace and human rights.
The government is responsible for upholding women’s reproductive health and right yet, they consistently fail to do so. This has brought about the use of international normative frameworks as a strategy to build pressure on government to abide by universally acceptable standards of promoting women’s right to reproductive health.
When African heads of states met in Abuja 2001, they correctly declared HIV/AIDS, Tuberculosis (TB) and other related injections diseases (ORID) as a state of emergency. Recalling and reaffirming their commitment to all relevant decision, declarations and resolutions. In the area of health and development and on HIV/AIDS, particularly, the "Lome Declarations on HIV/AIDS in Africa." (July 2000) and the "Decisions on the adoption of the international partnership against HIV/AIDS." (Algiers 1999), they stated:
"We COMMIT OURSELVES to take all necessary measures to ensure that the needed resources are made available from all sources and that they are efficiently utilized. In addition, we PLEDGE to set a target of allocating at least 5% of our annual budget to the improvement of the health sector."
Now known as the "Abuja 15% commitment" this target was seen as a critical contribution to the fight against the HIV/AIDS and other diseases. Shockingly, despite this public commitment, four years on many countries continue to spend less than 10% of the revenue on health. Nigerian government must commit in this summit to increasing GDP allocation for health by three percent each year in order to reach the 2001 Abuja Summit commitments of 15%.
Women Rights activists must therefore not relent on their struggle to have government move beyond lip-service in securing serious commitments on issues of women’s reproductive health and rights at large.
Aisha Kolo Lawan
Faculty of Arts
Dept. of Mass Comm.
University of Maiduguri