Guest post by Christina Wegs, Senior Advisor for Global Policy and Advocacy, CARE
December 10th was International Human Rights Day. This day commemorates the adoption of the Universal Declaration of Human Rights (UDHR) by the UN General Assembly in 1948, which affirmed the rights of all people, everywhere and all the time. The Declaration, as well as similar international treaties and agreements, confirm the centrality and importance of protecting and fulfilling sexual and reproductive rights (SRR). Embraced within the concept of SRR is the right to reproductive self-determination; the right to sexual and reproductive health (SRH) information, education, and services; the right to the highest attainable standard of health; and the right to equality and non-discrimination.
Despite international recognition of the importance of SRR, sixty years on and twenty years after the International Conference on Population and Development, women and girls in every part of the world continue to face considerable barriers to realizing their SRR. In many places, unmarried women and adolescents are denied access to reproductive health information and services, many women are not able to exercise full, free, and informed contraceptive choice, and women continue to die from preventable complications of pregnancy and childbirth. Pervasive gender inequality limits women’s decision-making autonomy and undermines their health and well-being throughout their lives. Finally, many women—especially poor and socially marginalized women—continue to experience systemic discrimination in health care, which not only results in poor quality of care and poor health outcomes, but also acts as a powerful disincentive to women seeking care.
While transforming inequitable gender roles and addressing deeply-rooted power inequities can be a slow and gradual process, CARE’s work with global partners indicates that critical shifts in gender norms and power dynamics can be achieved and in a relatively short time.
In India, Kenya, and Peru, CARE worked to challenge restrictive gender norms and empower women to claim their right to respectful, high-quality healthcare. We saw increases in women’s empowerment, as well as more equitable gender relations, more respectful relationships between women and health care providers, and improvements in the quality and utilization of SRH services.
In Uttar Pradesh, India from 2007-2009, women’s empowerment activities were integrated into antenatal and maternal care services. Women who participated in the project were significantly more likely to have the freedom to go out alone and to spend their own money, as well as to believe in their right to refuse unwanted sex. Couples were more likely to discuss sexuality and make household decisions together. The proportion of women using family planning rose from 7% to 35%, and the number of women delivering their babies with a trained provider more than doubled. These increases were much greater than those among women who only received standard health services.
From 2009-2013 in Siaya, a county in Western Kenya, CARE partnered with local leaders and community health care workers to catalyze community dialogue about gender and family planning. Ongoing dialogue created an environment that supported equitable communication and shared decision-making between women and men, including decisions about sexuality and family planning. Family planning increased significantly among both women and men (17.2% and 24.3%, respectively). Women who participated in CARE dialogues were significantly more likely to use a modern family planning method than women from a comparison group. Use of family planning was also associated with equitable gender beliefs, communication between spouses, women’s self-efficacy and women’s control over their own cash earnings.
In the Huancavelica, Piura, and Puno regions of Peru—areas with disproportionately high maternal mortality rates—many women are reluctant to use health care services because of ill-treatment by health care workers, including discrimination against indigenous women and refusal to provide free services to poor women who qualified for them. Since 2008, CARE has partnered with leaders from grassroots women’s groups who regularly monitor health services and work with regional health authorities to address rights violations and gaps in quality. In just the first year of the project, provider’s knowledge of women’s rights increased and improved service delivery protocols were adopted. Women’s reported satisfaction with services increased, and the number of facility-based births increased by 33%. This approach directly informed guidelines for citizen monitoring which were adopted as national policy by the Peruvian Ministry of Health in 2010.
Investing in strategies that challenge restrictive gender norms and inequitable power dynamics is as fundamental to sustainable change as investments in policies and health systems. Only when all women feel empowered to make decisions about their own health and lives—and to claim their equal rights to responsive, quality care—will we be able to realize the promise of SRR for all.
 Valdez, W. (2011). Evaluación Cuantitativa de la Vigilancia Ciudadana de la Calidad de los Servicios de Salud. CARE Peru.