Applause to the United Nations for releasing a joint action plan set on attacking Millennium Development Goal 5 -- reducing maternal mortality. It's one of the Millennium Development Goals the world is fast on track to miss. At the international Women Deliver conference last week, where the plan was released, the Countdown to 2015 initiative announced that only five out of 68 countries are on track to actually meet the goal. The UN plan is certainly well-timed. Unfortunately, it's missing the one element that will make it work.
Human rights. Medical causes of maternal death -- hemorrhage, sepsis, hypertension, unsafe abortion, HIV and AIDS--are inextricably linked to human rights. Each one of these instances can be prevented or treated by simply respecting women's human rights in health policies and delivery of services, and addressing systemic gender inequality. A human rights approach is critical to achieving the MDGs, and to the success of all global health policies.
At Women Deliver, the Center for Health and Gender Equity (CHANGE) organized a session, moderated by former President of Ireland Mary Robinson, "Delivering for Women at the Margins: Reaching the Hard to Reach." The panel focused on delivering health care to women who are the most marginalized -- sex workers, indigenous women, women living with HIV and AIDS and women who are incarcerated. We heard how the stigma and discrimination that these women face prevents them from accessing the health care they need to live healthy lives and raise healthy families.
Sylvia Mollet Sangaré, co-founder of DANAYA SO, a sex worker collective in Mali, described the fear many women sex workers face in accessing maternal and other health services due to the social stigma associated with sex work. DANAYO SO has responded to the negative--and sometimes abusive -- treatment sex workers experience from providers, and other clients, by bringing health workers to DANAYO SO to break these barriers. But still more needs to be done. Mollet made a plea for policies and service delivery that respect sex workers as women -- instead of focused on their profession.
When some talk about maternal illness and death, they tend to talk in sterile, medical terms, and focus on statistics and numbers. We need to be talking about women, all women, and what we need to do to reach them with the health care and information that is their human right. We need to be talking about women at the margins -- women living with HIV, indigenous women, women who are sex workers, women with disabilities, and incarcerated women -- and the stigma and discrimination that prevents them from accessing health care. In the U.S., we need to talk about the harmful U.S. foreign policies that prevent women from accessing the health care and information that is their human right.
For one, we need to talk about the anti-prostitution loyalty oath (APLO). Organizations receiving U.S. funds are required to sign a statement saying they oppose prostitution. Activities that would violate such a requirement have never been defined, creating confusion and self-censorship on the ground. Since its inception, the APLO has shown to decrease sex workers' access to condoms, HIV/AIDS education and occupational training, such as English classes. It strips women of their ability to protect themselves or their clients against HIV infection. By perpetuating stigma and discrimination against sex workers, it blocks their access to health care, including pre and postnatal care, and newborn and infant care. It ignores all the lessons learned from DANAYA SO and perpetuates policy based on ideology. As long as policies like the APLO exist, efforts to achieve the MDGs are handicapped.
At Women Deliver, we heard pleas from women living at the margins for health care services that treat women as women. For women incarcerated in the U.S., this means eliminating the practice of shackling women during labor and delivery. For women living with HIV, this means delivering services that do not treat women as "incubators for a negative child," but as human beings with a right to health. The U.S. has funded many so-called "successful" programs to prevent HIV infection in newborns. But are these programs successful if the woman's health and rights are not central to the program? We should judge success by what happens to the woman after giving birth to a negative child.
This is where the UN has the opportunity to step in with a human rights approach to the joint action plan. A human rights approach recognizes that we cannot achieve the MDGs as long as barriers of stigma and discrimination are pervasive. The leadership of the UN is critical on this matter to lead international donors, like the United States government, to recognize the critical need for such an approach and to follow suit.