Svenska Barnmorskeförbundets ordförande Ingela Wiklund deltog på XXI FIGO World Congress of Gynecology and Obstetrics i Vancouver.
Sexual and Reproductive Health and Rights – a matter of life and death
Ingela Wiklund International Confederation of Midwives
XXI FIGO World Congress of Gynecology and Obstetrics
Vancouver Canada 4-9 oktober 2015
Sexual and reproductive ill health is one of the most common health problems for women aged 15 to 44 in low income countries, where pregnancy, unsafe abortions, childbirth or harmful customs, such as female genital mutilation, can endanger the lives of women. Despite considerable efforts over the past 20 years, maternal mortality in the world is still very high, particularly in Sub-Saharan Africa and South Asia. Unequal power relation between men and women makes it difficult for women and girls to decide over their own bodies and negotiate safer sex. Women’s sexual and reproductive health is related to multiple human rights, including the right to life, the right to be free from torture, the right to health, the right to privacy, the right to education, and the prohibition of discrimination.
This means that women in all countries are entitled to reproductive health care services, goods and facilities that are: (a) available in adequate numbers; (b) accessible physically and economically; (c) accessible without discrimination; and (d) of good quality. Despite these obligations, violations of women’s sexual and reproductive health rights are frequent. These take many forms including denial of access to services that only women require, or poor quality services, subjecting women’s access to services to third party authorization, and performance of procedures related to women’s reproductive and sexual health without the woman’s consent, including forced sterilization, forced virginity examinations, and forced abortion. Women’s sexual and reproductive health rights are also at risk when they are subjected to female genital mutilation (FGM) and early marriage.
Violations of women’s sexual and reproductive health rights are often deeply engrained in societal values pertaining to women’s sexuality. Patriarchal concepts of women’s roles within the family mean that women are often valued based on their ability to reproduce. Early marriage and pregnancy, or repeated pregnancies spaced too closely together, often as the result of efforts to produce male offspring because of the preference for sons, has a devastating impact on women’s health with sometimes fatal consequences. Women are also often blamed for infertility, and being subjected various human rights violations as a result.
The role of the midwife and SRHC. In Sweden, where I come from, midwives have a unique level of autonomy in the Swedish health system, which includes prescribing contraception and administering medical abortions as well as care during pregnancy and birth. The introduction of trained midwives dramatically reduced maternal mortality in our country: During the time from 1861-1894 maternal mortality was reduced from 420/100 000 to 120/100 000 live births. Today we also work in over 250 youth clinics around the country. The midwifery profession and workforce have proven to have the power to save thousands of lives each year globally. High maternal and new-born mortality and morbidity, including devastating consequences such as stillbirth, need to be tackled urgently. In 2013 alone, an estimated 289,000 women died from complications related to pregnancy. Every year, nearly 3 million infants die in the first month of life and 2.6 million babies are stillborn.
The basic right to health and access to quality services for women and children is particularly important in crisis situations, including in conflict and post-conflict areas, and in regions affected by epidemics. Last year, the Lancet published a series of articles on how scaling up the skilled midwifery workforce could prevent close to two-thirds of maternal and newborn deaths. The series was accompanied by a major report by UNFPA, WHO and the International Confederation of Midwives, outlining the state of midwifery in 73 countries. Together, we represent a significant effort to highlight the importance of midwifery in saving lives and empowering women.
Midwives4all. Midwives do not only improve the chance of a safe pregnancy and delivery; we provide the full continuum of care throughout a woman’s life, and by doing so they play a key role in building sustainable societies. Yet, in many countries, this field of expertise is still not represented. It is time to recognize the midwifery profession as the life-saver and agent of change towards sexual and reproductive rights for all people that it is and can be.